Episode 136

Dr. Terry Wahls is back for a third time to talk functional medicine, ketosis, and implementing the Wahls Protocol™.

Who is Terry Wahls, M.D.?

In case you missed her earlier episodes (Episode 15 and Episode 27), Dr. Wahls is a clinical professor of medicine at the University of Iowa and is also a patient with secondary progressive multiple sclerosis.

That diagnosis confined her to a wheelchair, prompting her research into functional medicine and the Paleo diet.  The research and subsequent experimentation paid off, as within a year she was out of the wheelchair and completing an 18-mile bicycle ride.  She wrote a book, Minding My Mitochondria, about her experience recovering from MS.

The Wahls Protocol

Based on her experience and research, Dr. Wahls developed the Wahls Protocol™, a diet to treat chronic autoimmune conditions.

At its core, the Wahls Protocol™ is focused on consuming high levels of the most brain-healthy vitamins, minerals, antioxidants, and essential fatty acids from food (as opposed to supplements).  The Protocol focuses on tons of veggies (nine cups a day for men; six for women), wild or grass-fed meat (including organ meat), fermented foods, and seaweed.  On the blacklist:  sugar, dairy, and gluten.  As Dr. Wahls puts it, it’s “Paleo Plus.”

Of course, the diet can be personalized for food sensitivity issues (nitrates, tree nuts, etc.)

One tip:  to save money, you’re going to have to cook your own food.  That doesn’t mean slaving away in the kitchen though.  Dr. Wahls has a repertoire of quick weeknight dinners (like soups and stews) that take no longer than 30 minutes from cutting board to plate.

Potential Pitfalls

Dr. Wahls admits her diet can be “pretty tough” to stick to religiously.  Unfortunately, even “cheating” as little as 20% of the time can derail benefits, since that 20% of your diet will probably include inflammatory foods.

What’s the key to success?  Recognizing what your social triggers are for eating inflammatory foods (almost everyone will struggle with having a piece of birthday cake set down in front of them) and then purging your environment of those triggers.

So many of our food habits are automatic and influenced by other people.  Counteract this by getting friends and family onboard with supporting your diet when you’re together and figuring out different ways of socializing.  For example, go for a hike instead of meeting up for drinks and bar snacks.

The Benefits of the Protocol

In Dr. Wahls’ clinical trials, she’s seen significant benefits to mood, cognition, and fatigue across a variety of conditions.  So, what conditions does the Wahls Protocol™ benefit?  It’s almost easier to list what it does not benefit…  but here’s a partial list:

  • Multiple sclerosis
  • Parkinson’s disease
  • Lupus
  • Rheumatoid arthritis
  • Depression
  • PTSD
  • Moderate traumatic brain injuries
  • Fibromyalgia
  • Diabetes

A New Take on Ketosis

Dr. Wahls has plenty of experience with ketosis — she once spent 18 months (!) in ketosis.  But she’s come to a new, seasonal-based understanding.

Distant ancestors who lived in regions with distinct summer and winter seasons would not have been in a state of ketosis all year.  Even arctic dwellers aren’t in year-round ketosis.  Instead, during the warm summer months, people would have eaten a non-ketogenic diet high in sugary fruits and vegetables.  As the weather turned cold, their diet would have increased in fat and decreased in carbs, leading to ketosis during the winter months.

Based on this idea, Dr. Wahls now allows herself berries from her garden during the summer months (yum!), while following a stricter, true ketogenic diet in the winter.

Further Reading

Episode Highlights

0:32Our third episode with Dr. Terry Wahls
1:45This Week in Neuroscience: Exercise Releases Brain-Healthy Protein
5:06The audience interaction section
7:15The Wahls Protocol
11:47Trials being conducted using the Wahls Protocol
15:29Different "levels" of dieting and social triggers
18:31Acute symptoms and "dwindlers"
19:50Seasonal ketosis
23:53Where does fatigue come from?
26:23Adjustments in the Protocol for people with traumatic brain injury
29:16Eating properly at a low cost
31:17Dr. Wahls' seminar in August 2016 and call for MS patients looking to get involved in a Wahls Protocol study
33:02Ruthless Listener-Retention Gimmick: Greater Busyness Is Associated with Better Cognition

PS:  For more delicious and nutritious news, don’t miss our weekly Brain Breakfast emails.

Episode Transcript hideshow

— This Week in Neuroscience --

Jesse: Okay, so if you listen to this show with any regularity, you know—and probably even if you don’t, you already know—that exercise is not just good for your body, it is good for your brain.  We’ve talked before about how exercise increases the secretion of something called BDNF—that’s Brain-derived Neurotrophic Factor—which makes your brain more likely to create new neurons, new synapses, either and both of which are instrumental in learning and memory.  And there’s more than just that going on.  Increased blood flow, lots of good things about exercise.  But a recent study by the NIH, the National Institute of Health, has identified one more likely helper chemical that is responsible for some of exercise’s positive effects on the brain.  Trying to get a sense of why physical exercise has the effects that it does on the brain, scientists started with cell cultures of muscle cells, so skeletal muscle as it’s called, and they stimulated these cultures with a chemical called AICAR, and this chemical mimics the effects of exercise on those muscle cells.  So basically they made these cells think that they’d just exercised to see what chemicals they would spit out as a result.  Once they had a laundry list of those chemicals, they could do further studies and cross reference with earlier research to see which of those might be known to have effects on the brain. 

At the front of the pack in the chemicals that were identified by this experiment is something called cathepsin B.  Cathepsin B is a small enzyme that is primarily known for its role in the degradation of peptides and proteins inside cells.  So now that scientists had the reason to look at cathepsin B more closely, they took some mice, they got some of them on exercise regimens, they had the other mice sit around, they verified that, yeah, this isn’t just something that happens in a petri dish with cell cultures, but we actually see this in real mice.  When the mice exercise on a repeated basis, they start generating higher levels of cathepsin B, which starts in the skeletal muscles but winds up also circulating in the bloodstream.  Then they took another batch of mice, they did genetic knockouts on them so they could not generate any of their own cathepsin B even if they did exercise.  So these mice, they exercised, their blood levels of cathepsin B were unaltered—I’m not sure if that’s actually a level of zero or some sort of physiological baseline.  But unlike normal mice, these mice, when they were exercising, they no longer produced new neurons in the dentate gyrus, which is a part of the brain associated with the formation of memories.  They also just didn’t get better at the tasks they were given; they weren’t any better at navigating the maze the way that they normally would be. 

So this theory seemed to be holding up pretty well, that cathepsin B is a major part of what makes exercise neurologically beneficial.  Finally, not satisfied with cell cultures, not satisfied with mice, they wanted to see if similar things might happen in humans.  And so, a study was conducted, this was conducted in Germany on 40 healthy young adults between the ages of 19 and 34, both men and women in this group.  And sure enough, the study showed a significant increase in cathepsin B levels within the blood after regular fitness training, and they also showed that the increases in cathepsin B levels matched well with the ability of participants to remember and accurately draw a bunch of complex lines and geometric shapes, one of the tests that’s commonly used to assess a person’s visual memory. 

Now, an interesting wrinkle in all of this is that previously cathepsin B had been linked in other studies to a wide array of diseases, from cancer to epilepsy.  However, it’s also believed to have an alleviating Effect in the development of Alzheimer's disease.  So, a lot of interesting correlations with this compound, some of them positive, some of them negative.  But in the case of exercise leading to the secretion of more cathepsin B, higher levels in the bloodstream, crossing the blood-brain barrier and encouraging the development of new learning and memory, that seems to be a causative arrow, not mere correlation.  One more piece of evidence on the many benefits of getting regular exercise, if that’s not something you’re doing already. 

— Main Interview --

Jesse: So the last time we spoke with Dr. Terry Wahls on this show was actually a really long time ago.  She was the guest back in episodes #15 and then #27, so over a hundred episodes ago now at this point, which is blowing my mind a little bit because I didn’t really think it was quite that long.  But the last time we talked, she had just published her book or was maybe in the process of about to go live with it, called The Wahls Protocol.  If you do not remember either of those episodes or are not familiar with Dr. Wahls’ story, she’s got a really well-known TED Talk, a couple of million views, talking about her story.  She has multiple sclerosis, and when it first started to really make its presence felt in her life, it really kind of took her out of action over the course of a few years, made her unable to work, unable to really do much of anything. 

Major physical symptoms, lack of mental clarity and sharpness, she kind of realized she was on a very steep downslope.  But being a doctor and not being willing to take no for an answer, she went into a deep study on what the actual root of her condition was and what she might be able to do to alleviate some of her symptoms.  Came up with a working hypothesis that, at its root, what she had was a problem with the health of her mitochondria, and by really, really changing her diet around, cutting things out, adding things in, and switching to what amounts to a modified style of a paleo diet, she was able to really, really roll back her symptoms and revitalize her life, the upshot of all this for everybody else being that now this protocol exists that has been helpful not just to her but to a lot of other people as well. 

Before we talk, she rattled off a list of a lot of the different conditions that she’s been able to see positive benefits to from people who’ve taken up this diet and made it their own, and it’s a long list, some things which we think of as strictly physiological, others which at face value look like they’re neurological conditions.  But on that list was Parkinson’s, idiopathic neuropathy, polyneuropathy, small fiber neuropathy, diabetic retinopathy, lupus, fibromyalgia, rheumatoid arthritis, scleroderma, connective tissue disease, Hashimoto’s thyroiditis, depression, bipolar disorder, PTSD, obsessive-compulsive disorder, anxiety, moderate traumatic brain injury, obesity, diabetes type 1 and 2, high blood pressure and severe cardiomyopathy…

--

Dr. Wahls: I have secondary progressive MS, diagnosed.  Some of the best people took numerous drugs and had a rapid downhill decline, needing a tilt & recline wheelchair.  Started experimenting on myself, would eventually discover Institute of Functional Medicine and the paleo diet world.  I would ultimately create a protocol that restored my health.  So, I went from a tilt & recline wheelchair to riding my bike 20 miles after one year of this new intensive protocol.  That, of course, changed everything—how I understood disease, how I understood health; it would change my clinical practice, it would change the research that I do.  And I have since totally, due to the focus of my clinical work and my research work, I would do a TED talk, I would write a book, The Wahls Protocol, that details my story, that’s gone on to become a bestseller.  And we keep doing more research studies and I have more grants under review, and my lab is growing, and good things are happening. 

Jesse: From the people that have bought and read the book, do you know how many of those people are actually taking the diet and going off and running with it, actually making it their diet? 

Dr. Wahls: You know, I could say that, you know, we’ve had two and a half million people watch the TED talk, and I’m sure we’ve had hundreds of thousands, if not millions, of people talking to their doctors about, "Well, what about this diet?  What if I eat all these vegetables?"  We have well over a hundred thousand books that have sold.  How many of those are actually able to implement and sustain the protocol, I’m not sure.  I have followers on Facebook that are always talking about the dietary interventions, and we get success story after success story with a wide variety of disease types.  Now, certainly not everyone is helped, and I do hear from people who are like, "Well, you know, I’ve been doing the protocol, I’m not helped," and it’s a little hard for me to know how completely they’re able to follow the protocol.  Certainly when I engage in conversation with these folks, often I find that, "Well, I’m doing the protocol like 80%," and they don’t realize that 80% is not doing the protocol because you’re still eating a lot of inflammatory foods that can create a lot of trouble…

Jesse: Yeah, if your diet is 20% skittles and cheese puffs, that can still be a problem. 

Dr. Wahls: And then, of course, there’s the other factors, that the diet may have to be personalized for your unique food sensitivity issues.  It might be that you have problems with kale, and there are some people that have food sensitivities to kale.  There might be other food sensitivities that are troublesome for you; nightshades or tree nuts.  So, the diet may have to be personalized.  And then, there are other factors—your microbiome, status of your stress hormones, and your other hormonal balance, toxin load, physical activity, how you’re activating your brain.  So, there’s more that I talk about in the book and more that I do chronically to personalize the protocol to that person’s unique environmental factors and their unique genetics. 

Jesse: The last time that you and I spoke, you were in the midst or I think you might’ve just recently finished an actual trial with a decent-sized number of people using the protocol in a supervised environment.  Can you talk now about the results of that controlled-environment study? 

Dr. Wahls: Well, the original study of 20 people that we followed for three years, we’ve gotten a couple papers published, another paper that’s under review, hopefully we’ll get that soon accepted, because when we do, the videos that we have before and after for all of our study subjects will be available for the public to look at.  And that will be very, very exciting when I have that, because then people can judge for themselves that some people had dramatic improvement, some had modest improvement, and a few did continue to decline.  But you don’t have to be a statistician to be able to tell that if it took you two and a half minutes to walk 45 feet and it drops to 45 seconds, that something pretty dramatic happened to have that kind of change.  So, that will be exciting. 

We have a cognition and mood paper, we’ve analyzed that data and that’s getting ready to be sent off for review.  And while I can’t give you the specifics, I can tell you when you have progressive MS, we don’t expect cognition to improve; we often see that anxiety gets worse, depression gets worse, and again, we saw some very nice, very positive, very exciting findings that we’ll be looking forward to reporting there.  Now, we have another paper that’s under review, enrolled people with relapsing-remitting MS, and there were either weightless control or they got trained on the Wahls Protocol Diet and coached over the phone, we gave them food logs.  Small study, just 20, but again, statistically significant, favorable results were observed in a wide variety of motor measures and quality of life measures and fatigue measures. 

Jesse: And that 20-person trial, that was a three-year trial? 

Dr. Wahls: My first 20-person trial was three years.  So we’ve published several papers, we have more under review, and we’re analyzing the MRI data from that paper as well.  I don’t really know what conclusions we’ll draw from that; we’re just now pulling up the MRIs and getting that stuff looked at.  It’s pretty cool that we have that MRI data, and that was only in eight of our subjects.  MRI is really expensive, so after we had our first 10 that we enrolled, we went back to our funder and said, "We have these exciting results.  How about funding some MRIs?"  So they gave us funding to do MRIs; we were able to have eight pre and post, so that’s what we’re analyzing. 

Jesse: You kind of have to pick your battles when it comes to funding limitations. 

Dr. Wahls: Yeah.  It’s a small enough group that I don’t expect we’ll have statistical significance when it’s that small, but it’ll be very interesting to see what the trends are so when we’re funding for more studies in the future, we can identify how many MRIs we’d have to get to reach statistical significance and how large that study would have to be. 

Jesse: In the course of doing these studies, have there been any real-world results that have been surprising to you, that have sort of gone counter to your intuitions? 

Dr. Wahls: There’s certainly some things that I’ve learned when I think about this in my clinics.  So, the VA asked me to create a functional medicine clinic where I could do this stuff and quit being in my primary care and traumatic brain injury clinics.  So, we’ve been running those now for about three years, and I’ve gone to primary care, especially medicine, and gone to health doctors, talking about our work and telling them that they could come watch and participate, we’re happy to see anyone who has any kind of health challenge who’s open to using diet and lifestyle, who’s willing to commit to being gluten-free, dairy-free, and eating more vegetables.  So, they come and we give them an introductory lecture, and I’ll do it in big groups, so 50 to 100 at a time, tell them my story, the functional medicine, all the principles… And then if they want to come work with us, they have to gluten-free, dairy-free, lots of vegetables, and then we put them through a functional medicine assessment and work on diet and lifestyle. 

Jesse: In your book, you talk about three levels of adherence, that there’s Wahls Level 1, Wahls Paleo, and Wahls Paleo Plus.  I’m wondering which of those levels is followed in the studies. 

Dr. Wahls: In our studies, we put people—and I’ve done several studies now… The first study is really sort of a hybrid between level 1 and level 2.  We made it an easier diet for the public.  The study is really much closer to a level 2 diet.  I made the intentional decision to make a level 1 diet that would work for vegetarians and would be more of a transition diet, because the study diet I ask people to do is really pretty tough.  In my clinic, I’m sort of halfway between level 1 and level 2.  I let people know that, yes, you can have a gluten-free/starch one-a-day if you want, six ounces of meat or more, and the goal is nine cups of vegetables, or six if you’re a female or a really petite guy.  And we talk about seaweed, we talk about organ meats.  I don’t push that as hard when people begin because, you know, if I tell them to give up sugar and gluten and dairy, eat all these vegetables… What I find is that I’m spending a lot more time talking about addiction and controlling the environment.  In our skills classes, we do a lot of cooking classes, talking about growing food, making fermented foods.  And now more recently, we’ve been having more skills classes with our psychologist, talking about motivation, our meaning in life, resilience, and how you control your eating environment with family and friends.  So, what I have more and more respect for is that the reason people fail is not from lack of knowledge about what the diet is supposed to look like, it has much more to do with how do they manage the addictive nature of food and controlling their environment. 

Jesse: Yeah, social triggers can be really difficult, especially if family members and close friends are not having anywhere near as healthy of a lifestyle. 

Dr. Wahls: We talk a lot about if excluded foods are in your environment, before you know it, they’ll be in your mouth and you’re chewing them because so many of our habits are automatic.  You get hungry, you’re out there, rummaging around, and this delicious food got into your mouth… Because when we’re hungry, we eat food that looks good.  So, to be successful, it means having to figure out how you’re going to purge your environment, which can mean then how do we have these uncomfortable conversations with friends and family that, "I’m addicted to that food that’s harmful and I can’t be around it." 

Jesse: And actually having people take you seriously.  If it’s something they eat, they’re like, "Well, how can you be addicted to fill-in-the-blank food?" if it seems totally normal to them. 

Dr. Wahls: "A bite’s not going to hurt you," and, "My friendship isn’t that valuable to you that you can’t manage this?"  I spend a lot of time talking about our friends, our social support.  We tend to eat what our friends eat, and so that may mean that you have to figure out a different way of socializing particularly early on in order to be successful, and have your family commit to an all-in with you and, "We will all eat this diet with you when we’re together."  If you’re not together and they want to go out and have gluten pasta with a lot of cheese on it and it doesn’t bother you, as long as they don’t come home and talk about it, that’s okay. 

Jesse: Have you found that the adherence has been easier for people that have more physiological difficulties, more problems that they’re trying to overcome, because that way their family is not acting like they’re just being weird? 

Dr. Wahls: In my clinics, I would say it looks like about 75% of the people discover that if I take the gluten and dairy out and I have a cheat meal, I’m going to have noticeable symptoms of something usually within three days.  Pain, congestion, fatigue, brain fog, something that’s really uncomfortable, and I’ll feel like, "No, I really don’t want to do that."  Twenty-five percent don’t have any symptoms that they can really identify, but they have what I call "the dwindles."  They just gradually get feeling not as well, so after two weeks or so, there’s more fatigue, more mood change, more pain.  But because it came on so gradually, it’s not as obvious.  So for the "dwindler," it’s much, much harder.  For the person who has the acute symptoms, the closer it is to when you ate the wrong food, the easier it is for you to say, "Well, that was not worth it." 

Jesse: Yeah, the hand on a hot stove.  It’s real easy to break yourself from that habit because the feedback is immediate. 

Dr. Wahls: So we just spend a lot more time talking about what you really want is to have some sort of adverse reaction that you can latch on to pretty quickly.  If you don’t have that adverse reaction, it’s far more difficult to stay completely compliant. 

Jesse: Now that you’ve seen a number of people that have stuck with the protocol for a long time, have there been tweaks, adjustments to the underlying protocol itself that you’ve wanted to make? 

Dr. Wahls: Yeah, let’s talk about ketosis.  So, I was pretty deep into ketosis for 18 months, felt great, and I would certainly say that I could tell, in terms of my mental clarity, if I was in ketosis or not. 

Jesse: Were you doing the blood measurements? 

Dr. Wahls: On my finger, yeah.  I would prick my finger, and I was doing it twice a day, and then I fell to doing it once a day, and then I’d do it a couple times a week.  And then I’d gotten so I could sort of tell cognitively, okay, I feel like I’m slipping out of ketosis, and could check my ketones, like, "Yeah, I was."  And then, it’s sort of interesting, after being in ketosis for about a year, I couldn’t appreciate the cognitive difference anymore.  I thought, okay, well that’s pretty interesting.  And then after 18 months, I started reading more that even arctic dwellers are not in ketosis year-round, that even they get to have summer and would get to have more carbs during the summer and then go back into their high-fat diet the other 10 months out of the year.  So, I began to think that most of us are from an ethnic region where there was winter and then there was summer, and plus I have a garden, I have a lot of fresh berries.  I thought, you know, I want to go back to eating my berries during the summer and I’ll do ketosis during the winter, and I’ll enjoy my garden produce.  I still eat a very low glycemic diet. 

I’m beginning to think that, acutely, a year of a ketogenic diet might be a very good thing for people who have cancer risk or neurodegeneration.  And then, depending on your clinical circumstances, seasonal ketosis may be better.  We’re really all at the cutting edge of research, we don’t really know.  But my thought process is I’m just trying to emulate what my ancestors in northern Europe would have done, say, 30,000 years ago, which is we would have had winter in ketosis, then I would have had summer, and then I’d be eating a low glycemic index diet with high quality fats, but I still would have had enough carbs, I probably would have been out of ketosis.  And then fall comes, and once snow came, probably November through March, likely I would have been back in ketosis. 

Jesse: That’s really interesting what you just mentioned there, because it kind of raises the question: for people that don’t come from an ethnic background of being at a far northern or far southern latitude, somebody that’s living more at an equatorial belt and they never probably would have had a period of the year when there wasn’t sugary fruits and vegetables available, do you think that a ketogenic diet maybe doesn’t make as much sense for people of those ethnic backgrounds? 

Dr. Wahls: It’s a very interesting question.  I do not know.  I know that historically, or from a bad chemical process, our mitochondria can burn fat, sugar, or amino acid, which are protein, so that if we would have been stressed by war or famine, which can still happen even in equatorial regions, we would have survived.  So, I think we probably certainly could survive and they could likely do okay in ketosis, but I don’t think any region would expect to go on for years and years and years, because that society would have died off.  But it may have gone on for several months.  For those of us who live far from the equator and experience winter, our ancestors certainly would have expected to be in ketosis for many months every year.  And there’s plenty of reason for us physiologically to know when you’re in ketosis, it helps you create more nerve-growth factors, so it’s great for your brain; it helps your cells make more mitochondria, so it’s great for the efficiency of your cells; and it markedly reduces the risk of cancer cells.  So, lots of reason that ketosis is really a helpful thing, and if you’re worried about early Alzheimer’s or you’re thinking, "Man, I’m not quite as mentally sharp," that’s a good reason to have some intermittent fasting.  Even if it’s a three-day fast with every season, so you have some religious fasting or holiday fasting, that is great for us.  So, it doesn’t have to be a three-month fast.  A three-day fast can be very beneficial. 

Jesse: Yeah, it seems like the idea of hormesis and every now and then just a system shock in one direction or another can be really helpful to the body and the brain in a lot of ways. 

Dr. Wahls: Absolutely. 

Jesse: In the published study that you have, I believe that fatigue was the main variable that you were measuring. 

Dr. Wahls: Correct. 

Jesse: Why was fatigue chosen as sort of the primary thing that you were tracking? 

Dr. Wahls: Well, fatigue is the most disabling problem for people with relapsing-remitting MS.  It was the first symptom of mine that just really disappeared.  Cognition also markedly improved.  There is robust research on fatigue using the scale that we had, the fatigue severity scale, and so we chose that.  I really had no idea whether or not I could be hopeful that people experienced the kind of remarkable change in gait that I experienced.  So, it seemed like it was the safest variable to have as my primary outcome variable.  Then we had a whole slew of secondary outcome variables which had to do with quality of life measures that you do on self-reported surveys, and motor variables that had to do with hand coordination and walking speed and balance. 

Jesse: For fatigue, I was just wondering, how much of fatigue is physiological loss of strength vs.  the lack of motivation of feeling like you can’t do it?  It kind of seems like it’s a combination of both.  I’m thinking of when I had a heavy fever, I probably could lift a 50-pound weight if I really put my muscle behind it, but you just feel mentally that you’re not motivated to. 

Dr. Wahls: Fabulous question.  What is the source of fatigue?  We have a lot of discussion, for people who have MS and other autoimmune conditions and chronic health problems, what is that source of fatigue?  The answer is, scientists, we don’t really know.  We think there’s a central or brain component, and then there’s a component that has to do with your muscles.  So, you could stimulate my muscles using electrical stimulation and fatigue out the muscle to the point where, yeah, my muscle can’t do anything more because we’ve completely shut it down.  And you can measure brain activation and show that people with fatigue have more difficulty activating their brain independent of activating a muscle.  So, people with MS and autoimmune conditions have clearly a central component to our fatigue in addition to the muscular component.  And then, of course, people wonder if there is a depressive and a mood component, so that’s a reason why many of us who do fatigue studies, we ordinarily always also do a bunch of measures for mood and cognition so we can make sure that we’re not just measuring the effect of depression. 

Jesse: Part of the work that you do I know is with patients that have head traumatic brain injury.  Can you tell us about how you might adjust your protocols and recommendations with that in particular?  And for people that, let’s say you’re a BMX bike rider or you’re driving on a race car track and you think that you might have a concussion in your future, is there anything you can do to lay the groundwork…? 

Dr. Wahls: These are great questions.  The answer is yes on all of that stuff.  So, traumatic brain injuries are a very big deal to the military, who do a lot of research in that.  I worked in the traumatic brain injury clinic six years, where we took care of these vets.  There’s some very interesting work that, when you have an acute traumatic brain injury, we set off an inflammatory cascade on the brain, which if you don’t get quelched, can feed forward and become aggressively more damaging to the brain, leading to problems with memory, with pain, with mood, and psychiatric changes.  So, getting someone who’s had a concussion a lot of antioxidants, intensive intensive, nutrition, can be very helpful at preventing the feedforward damage and speeding their recovery.  So, that’s lesson #1: nutrition, absolutely vital. 

Lesson #2 is omega-3 fats are really important in that initial repair, rebuilding the myelin and repairing the damage.  Now, if the person has not been on fish oil at all, they’re probably strongly tilted too many omega-6s, not enough omega-3s.  So, there’s a researcher that gave some individuals extraordinary amounts of fish oil twice a day, like 30ccs twice a day, gradually tapering down to 5 grams a day, and reported marked improvement in recovery.  If you’re already on fish oil, then they would measure your omega-3/omega-6 fatty acid ratio in your cell membrane and titrate what amount of omega-3s you need to get that rapidly corrected.  So in my clinics, I would have people take 4 grams a day and clean up their diet, and they’d see a big, big difference.  The VA in the military recommended that soldiers take 2-4 grams a day prophylactically.  And that’d be my advice to everyone, is that you’ve got to take some fish oil, ideally get your omega-3, omega-6 fatty acid ratios in your red blood cells monitored so you don’t overshoot or undershoot, that you have those ratios in like a 3 to 1, so 3 omega-6 to 1 omega-3 would be the ideal range.  The downside of taking supplements is that we can skew the ratios of our nutrients when we take things via supplement.  If instead you eat grass-fed meats, wild fish, lots of vegetables, some nuts and seeds, plenty of organ meat, you’re going to be well-nourished.  As long as you’re getting your nutrients from food, there’s far less risk of getting the ratios wrong and accidentally overshooting. 

Jesse: Is that true even now that a lot of our plant food and animal food sources are themselves being raised in fairly unnatural environments? 

Dr. Wahls: So, it’s absolutely true that you want to get your food to be as high quality as possible.  So, if you can get wild food, wild game, grass-fed meat, animals raised outside, growing vegetables in your backyard organically or from your own small acreage organically, absolutely that is the best.  Having said all of that, because I work at the VA and many, many of my veteran patients don’t have much money, I’m very mindful that I need to help work with them.  We’re trying to make this as doable as we can for them.  They need to do the best they can.  It doesn’t have to be organic; eat more vegetables, eat meat.  If you can’t, don’t waste your money on gluten-free products, because they’re expensive.  Instead, get vegetables or potatoes, or yams, dried mushrooms, dried onions, dried herbs.  That’ll go a long way.  A lot of my folks are very opening to gardening, to foraging for wild food.  And I tell them the thing you do have to do is you have to cook.  If you don’t cook your own food, you can’t afford this.  Getting high-quality food that someone else makes for you is going to be far more expensive.  So we have cooking classes and we cook with them, showing them how to make tasty food that is not expensive to make and doesn’t take a lot of time.  People who are chronically ill, you have to make things simpler.  We don’t have the luxury of a lot of time that we can spend cooking, because we’re already chronically tired. 

Jesse: Yeah, there’s a lot of great meals that somebody can make with relatively few ingredients—shockingly few, sometimes. 

Dr. Wahls: Shockingly few.  Soups, stews; if you have a blender, smoothies.  My feeling is that if it takes more than 20 minutes from the time I start to the time I’m sitting down to eat, I’m not making that meal during the week.  I might do it on the weekend, but during the week, because I work all day, I get home, I’m usually the chef, my daughter will set the table and I’ll make the meal, and I expect to be eating within half an hour, preferably within 20 minutes. 

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Jesse: So, a big thank you to Dr. Wahls for taking the time for that interview.  A couple of things to mention there.  It is the first week of July as I record this.  In August of this year, 2016, Dr. Wahls, she’s done this a few times before but there’s a twist now, she’s going to be holding a seminar in Cedar Rapids, Iowa, for people that really want to go hands-on for a few days about the Wahls Protocol and how to live and eat by this diet.  Three days of that seminar are pretty much for anybody, open to the public.  There’s a fourth day specifically for healthcare providers, medical professionals that might want to get certified to actually teach this diet to other folks.  So unlike when she’s done this before, there will be a test at the end.  Not everybody will pass, there will be an officious-looking proctor, that kind of thing.  But if you are a healthcare professional and you want to get certified as somebody who really, really knows what they’re talking about when it comes to the Wahls Protocol Diet, that is worth checking into.  We’ll put a link to that, it’s coming up in just about a month.  But if you’ve been looking for an excuse to spend part of your summer in Cedar Rapids, Iowa, now you’ve got one. 

Also, Dr. Wahls does have another study coming up that she’s actually looking for participants in.  This is a study specifically for people with relapsing-remitting MS, multiple sclerosis.  So, needless to say, this won’t be everybody, but if you are somebody like that or you know somebody that is, you might want to let them know that this is going on.  I will revert right back to the tape of Dr. Wahls here so she can tell you herself. 

Dr. Wahls: We’re enrolling people in another relapsing-remitting MS study.  We’ll be comparing a low saturated fat diet, the Swank Diet, which was really the first diet that’s been advocated for MS, there’s a long history with that, to the Wahls Paleo Diet.  And we’ll be monitoring the microbiome changes in the two diets, so that’ll be very fun, having people poop in a little box for us and we’ll be measuring that.  And we’ll, again, be measuring fatigue and a whole host of measures related to thinking, mood, as well. 

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— Ruthless Listener-Retention Gimmick --

Jesse: So I’ve got some good news for you if you think that you’re sometimes just too darn busy for your own good: that might be kind of an oxymoron when it comes to your brain.  Researchers from a couple of different schools actually, this was the University of Texas at Dallas and the University of Alabama at Tuscaloosa teaming up and looking at information derived by the Dallas Lifespan Brain Study, from which they had over 300 older adults.  These were adults ages 50 to 89, and they did a correlational study to look at how busy those adults were, which is just like it sounds like—they’re self-reported assessments of how much stuff they had to do in a day, how many things they were trying to jam in, how busy their to-do list was, places they had to go, people they had to make phone calls to, whatever it is, just how much life they had—and how this correlated with their performance on a bunch of cognitive evaluations, a big, big battery measuring everything from short-term memory to behavioral inhibition to forming memories amidst distraction, lots and lots of different things.  There have been a lot of studies showing that things like social engagement are really positively correlated with good cognitive outcomes for older people, and their hypothesis behind this study was that how busy a person is might be a pretty good proxy for how socially engaged they are.  There probably is a strong correlation between those two ideas.  Especially if you’re past the point of retirement, what do you have to be busy with other than social stuff? 

First, one funny thing reading this study is that we don’t have a better word than "busyness" in the English language for this, because I can only assume "business," like, "He’s a businessman," is some sort of bastardization of the original terms "busyness."  But at this point, when we talk about business, we’re talking about the wheels of commerce and stuff like that.  It’s become a word unto itself and there isn’t a noun to describe the state of being busy other than spelling busyness with a "y," which I kept blinking at as I read this study. 

But anyway, good news here, or at least I take this to be good news if you’re a busy person.  This is a correlational study, so they don’t have proof positive that any of this is causative, but in everything they looked at as far as cognitive measures, there was a positive correlation between how busy a person reported themselves as being and their cognitive performance.  The busier, the better, quite literally.  The size of the impact and the level of statistical significance wavered a bit from one cognitive outcome to the next, with the strongest correlations being in episodic memory.  Now, one of the assumptions that the researchers were looking into was that keeping one’s self busy might be a good protective thing as a person ages.  And that may be true; nothing that they found disputes that.  But one thing that seems like was a bit of a surprise to them was that they found that the correlational match between how busy a person was and their cognitive performance did not vary with age.  Now again, this study had people from the ages of 50 to 89, so a pretty wide range there, and just 50 to almost 90, you know there’s a lot of difference that happens in that time.  But what they didn’t see was any difference in the level of impact that a person’s busyness seems to make, or at least seems to be involved with on a person’s cognition. 

Now unfortunately, they weren’t doing this study on younger people, that we could see if that trend remains true back to 17-years-old or something like that.  But based on this almost 40-year swath of people, there’s no reason to think that the same doesn’t hold true for younger people as well.  Is it a cognitively good idea to keep a really busy schedule?  This is a correlational study, so they can’t say the answer is definitively yes, but I guess the alternative hypothesis would be that people who are cognitively high performers just pack their schedules with more stuff because they’re able to better handle it.  And that seems possible, too.  I mean, there’s probably a bit of both.  But that latter hypothesis seems to ignore both human laziness, the fact that some people who are high performers might choose not to pack their schedules just because they don’t want to.  And in most aspects of life, we tend to get better when we push ourselves.  So if you push yourself to be able to handle a busy schedule, that might be reasonably anticipated to improve your ability to actually contend with that schedule.  So, interesting finding.  This might be a nice little stress-reducer to think about this: the next time you feel completely overwhelmed, you may be able to take a little solace that maybe, at the very least, you’re giving yourself a great cognitive workout. 


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Written by Hannah Sabih
Hannah believes there's nothing 8 hours of sleep and some kale can't cure (yes, she's from California). She's an avid runner, reader, and traveler, who brings you the latest and greatest in neuroscience via our social media channels.