Dietary Approaches to Treating Multiple Sclerosis-Related Fatigue (Part 1)

good morning everybody good morning everybody watching on uh livestream welcome we're at the celia scott weatherhead center for functional medicine it's our first grand rounds in our new center so welcome and we're privileged today to have an extraordinary physician and thinker and leader in functional medicine dr terry walls who was formerly at the va who was running the therapeutic lifestyle clinic for ms patients with great success and is involved in doing clinical research showing how diet and lifestyle can actually reverse or greatly improve multiple sclerosis which is heretofore something we've never seen without medication and she was actually an ms patient with progressive ms and was in a wheelchair for four years could not sit up could barely feed herself could barely function and discovered functional medicine and diet changes and was able to apply these to herself and now is walking functioning riding her bike and actually actively growing her career and building a new center called the walls institute which will further progress her research she's the author of the walls protocol which is how i beat progressive ms with paleo principles and functional medicine so i'm really pleased to welcome her and and her own story is quite extraordinary here in a minute but she discovered that many of her symptoms and her ms was due to a trigger which was a lifelong load of toxins starting with chemicals and paints like mercury academy and lead in her undergraduate degree in fine arts and in medical school with formaldehyde in many of her hobbies and growing up on a farm in iowa highly exposed to atrazine and other toxic pesticides all of which accumulated to lead to her ms so with that i welcome dr terry walls thank you for joining us today thank you okay so let me get my clicker here uh and you see that i'm sitting it's not because of the ms it's because i've had the happy privilege of getting spinal stenosis along the journey as well so standing for a long time gets to be a problem so we'll just go ahead and do the sitting so here are the objectives i'm going to go past though so then say i did take the time to write out some very nice objectives for you my disclosures i have grant funding direct ms charity i now also have funding from the national ms society and had in-kind funding from djo pinnacle life tz press for our first study copyrights to a couple of books uh trademarked the walls diet plans the walls protocol and a couple of companies that i've owned and now also the wallace institute so let me go back uh to my story in 2000 i became a patient and at that time i developed a weakness in my left leg i saw my physician who went through my chart and saw that 13 years earlier i complained of dimness in my left eye when i was out rollerblading on a hot day getting ready for my uh brickabinder which is the 55 ski kilometer race in northern wisconsin i had a big workup at that time including mris of my brain and my spinal cord and they saw lesions at the high cervical cord c1c2 and i got a spinal tap and showed abnormal spinal fluid and so a diagnosis of relapsing remitting ms was made and they suggested that i get a second opinion and as luck would have it recommended the cleveland clinic uh and so i'll come back here i came to the cleveland clinic to get the confirmatory diagnosis of relapsing remitting ms now at that time i knew that having ms sort of a big deal it's a progressive illness and when you think of the the downstream cost of having ms it's a very big deal because the vast majority of folks will ultimately convert into a secondary progressive ms and the cost is very high both to society and the individual now this is from a study done in poland uh and it was uh published in uh 2013. the cost was forty thousand to seventy two thousand dollars a year for drug costs alone uh and that on top of that there's an annual mri uh physical therapy occupational therapy office visits and as i said within 10 years of diagnose one half will convert to secondary progressive one one-half will be unable to work due to severe fatigue and one-third are going to have problems with gait disability and this is a big impact on the family because you're going to have lost income from the person who has the ms diagnosis you'll have um and ms is the leading cause of disability here in the us of in terms of leaving the workforce early it's a caregiving cost for from strangers for the person has become progressively more disabled and there is the caregiving cost from the family members who have lost income as they have to provide cares to that individual with ms you're much more likely to have early and sustained nursing home care and then there is the ms related pain which before the onset of gabapentin and lyrica was very very difficult to treat in fact ms was the leading cause or the leading diagnosis for all those people who were requesting assisted suicide with dr kuvorkin and i have a great deal of empathy for that because ms pain was a big part of my ms diagnosis so as i mentioned earlier i was referred to the cleveland clinic and i got my care here for the first three years seeing dr stone over at the mellon center and despite taking the newest drugs still within three years of diagnosis my disease had converted and i had secondary progressive ms and was started on mitosantrone and i had a lot of weakness in my torso muscles it was getting more and more difficult to set up and i was having more and more difficulty with fatigue now since 2003 i did the north narcoms north american research committee on ms quality of life survey and i've just taken a couple of questions out of that which was rate your ms symptoms were they better somewhat better no different somewhat worse worse or dramatically worse so every six months i'd say my symptoms were worse and my fatigue when i first completed the survey was mild but i think this my first year here is 2005. i it's moderate it becomes severe at its total which means the fatigue was impacting every aspect of my life so by the summer of 2007 so june i am so weak in the torso i cannot sit up in a regular chair so i couldn't sit uh i couldn't sit in the chairs that you're sitting here now i had a zero gravity chair like this uh one at home one in my office another in the clinical area where i saw patients with residents and when i ate i was in that zero gravity chair somewhat more upright but i was still had to recline far back and of course my family's pretty nervous about how well i can protect my airway i'm also at this time losing my keys losing my phone i that summer i'd lost my phone three times i'd lost my smart keys twice and my chief of staff in july had called me in to say we're going to assign you to the traumatic brain injury clinic come the middle of january you'll be seeing patients with the fiscal medicine rehab doc and the psychiatrist and you won't have residence now at home to tell my wife about this she knew that and i knew that was a job i couldn't physically do and so this was really the va and the university's way of saying you know what we've redesigned your job for you for quite a few years now but it's time we're done uh and we're going to force your hand to have to take medical disability i was depressed it was not a good time and so i'm going to give you a quick timeline of my illness um uh during medical school uh in the 1980s i began to have these electrical twinges of discomfort at first and i could tell that it's more likely to have this trouble when i was being yelled at by my attendings if i had been sleep deprived and the episodes of discomfort would last a couple of days and then they would fade away and they'd come on sort of randomly and i could also tell over time the intensity and the frequency of these episodes uh so they'd be a bit more frequent uh and a bit more intense uh in 1987 i'd completed my residency i was in uh private practice up at the marshfield clinic and of course you know there's some stress with all of that uh i am out rollerblading after work because i uh at that time in my life i was doing uh marathons long distance bike rides i did the brickabrider which is a 55 kilometer ski race uh every winter and so i was training on a lovely hot august day and i had a 10 miles a roller ski five miles out and i realized i couldn't see out of my left eye so i took off my skis and i walked back by the time i got back i could see again had a big workup and they really weren't sure what it was they said just don't ski in really hot weather okay and if i did i couldn't see out of my left eye so i backed off in my training and the episodes of my face pain continue to get a little bit worse a little bit more difficult i finally did see uh back to neurologists was treated with gabapentin probably not with tegritol developed a drug rash i had to stop that and there was no drug therapy i just sort of tought it out eventually i went back to see neurology i went to pain clinic and got pain injections and then we started on gabapentin which i used episodically uh but these would become more frequent more severe and then in 2000 i developed some weakness in my left leg and that's when i uh was diagnosed and started on copaxone now here at the cleveland clinic dr stone mentioned the work of ashton embry and a group called direct ms charity and through them i discovered lauren curdain and the paleo diet so after 20 years of being a vegetarian which really annoyed my parents who were farmers i went back to eating meat but continued to decline now i should tell you i gave up all grain all legumes all dairy so it was a big change i stayed with being a palet paleo eater because i was like i'm doing something and i realized that you know it might take a long time to see any benefits but i was continuing to decline in the following year i'd need the tilt recline wheelchair uh 2003 i get the wheelchair i started novantrone 2004 i'm like i got to start reading the the science i'm reading and i begin reading about various vitamins and supplements i decide that mitochondria are the big driver in what's causing brain atrophy what's causing progressive ms and so i'm beginning to read and search what are the the vitamins nutrients and supplements i can use to support my mitochondria so i'm adding creatine carnitine uh coincident q b vitamins and after a few i think it was about six months i thought i'm wasting my money i'm wasting my money i quit taking uh the vitamins and i can't get out of bed and uh you know i three days later jackie comes in and says you know honey i think you ought to take these again i take them and i can get up and go to work and that was really exciting and it makes me really curious so a couple of weeks later i try it again i stop all my vitamins and i'm exhausted i cannot go to work the next day so this is just wonderfully exciting news very exhilarating it really motivates me to continue to read the science and do this little self-experimentation so i'm adding stuff testing ideas and what i have done is i've taken what had been a very fast decline and i've slowed it i've made it more gradual and i'm very grateful but i i am still declining um so i've taken tyzabi uh for several cycles that gets pulled from the market i get switched over to celcept another form of immune suppressants which by the way gives you oral ulcers leaves your skin sort of gray you don't feel very good but because i don't want to become demented and bedridden by my illness i'm happy to take that selcept and the summer of 2007 i discover uh because i'm on the institutional review board reviewing paper uh reviewing studies a study by dr rich shields that is using electrical stimulation of muscles in the setting of new acute traumatic injury to the spinal cord and he's doing that to maintain muscle strength in one leg and letting the other leg become weak and he's asking to extend that study for another two years and i think hmm could this help me out with ms so i do a pubmed search there's 212 articles it doesn't take that long to read 212 abstracts most of them are are not relevant there are a few papers with stroke injuries that occurred five years earlier where people have been helped and a few papers with cerebral palsy nothing with ms so i then start searching for e-stem devices and i'm ready to order my own my wife says no no no you're gonna call a physical therapist you'll see a physical therapist so i see my physical therapist who tells me that e-stem is not approved for ms we have some continued conversation and he says well we could do this we could do the stem you could maybe grow more muscles for your legs but i don't know for sure that your brain could talk to those muscles we could be making additional two to five pound weights on your legs that you can't use and making walking even more difficult but with some more debate he agrees to let me have a test session he also says it's probably going to hurt you have a lot of issues with neuropathic pain but we he agrees to let me try this and he is right it hurts it hurts like hell um but we do 20 minutes session to my pure spinus on my back on the left on the right then we do my quads so i've now have done 24 minute workout and by the way at that point i could only do about a 10 minute workout on the mat if i did 12 minutes i was too exhausted and could not work so i just dramatically increased my workout time tolerated it and i felt great at the end of the workout not during at the end uh and so dave told me this was probably release of the endorphins he agreed that i could have sessions and so i came into clinic three times a week for the next two weeks uh and trained tolerated well and he uh then decided that i could begin training at home he arranged for me to get a home device and i began doing e-stem to my belly and my back while i did my 10-minute workout i'm going to back you up a little bit because during the same time where i was discovering the e-stem i discovered this organization called the institute for functional medicine they had a course on neuro protection which i ordered and i took and so it's a lovely notebook of cases uh and audio sync synced powerpoints with lectures that talked a lot about mitochondria so i was really fired up and i had a much longer list of vitamins and supplements that i now added so i was now up to 20 things and so i was doing the e-stem i had this longer list of vitamins and supplements and there was no dramatic difference and i was doing all of this because i knew that that progressive ms does not recover that i was doing all this in attempt to try and slow my decline even further and to be able to walk the small amount of walking i could do for a few more months uh and then in december you know in november december i'm like you know i should take this list of nutrients and get them from my food and so i'm re redesigning my food but like where do i get these 28 nutrients in the food supply so i go to my dietitian friends they don't really know i go to the college of medicine health science library they can't really help me out but the university of google does and so by the end of december i've got this new food groups that i should be stressing i'm still following the paleo diet but i redesigned my diet into what will ultimately become the walls protocol and we'll get to that and that is when the magic begins so um in my chair of medicine who had seen this decline in this amazing recovery um said this is so important you need to write a case report up and gives you assignment of getting a case report so this is my treating neurologist uh treating physical therapist and dr shields who was doing the e-stim so he wrote this up and then he called me back aft and we got that in he said now what i need to have you do is write a little research protocol we're going to have you test this in other people with progressive ms so this is a visual image of what it looks like uh 12 months in 2007 can't sit up i'm using a toy client wheelchair 12 months out of the diet and i did the diet exercise easter and i went back to doing a daily meditation 12 months later i'm able to do a 20-mile bike ride with my family so of course that really changes how i think about disease and health and it would change how i practice medicine and so that really shifted my focus uh it actually now turns out to be marvelous i'm at the traumatic brain injury clinic because i'm really focused on teaching these folks that yes there's a whole lot that you can do if we focus on diet and lifestyle to restore the function of your brain and we talk to our patients a lot about mitochondria talk about brain talk about neural restoration talk about neuro regeneration and this comes down to thinking if we look at diet diets going to impact i think through through two main avenues of approach one is its impact on human cells that is us and the other is the impact on our microbiota that is the bacterial and yeast and parasites uh single cellular organisms that live within us so i'm again it's going to give you some just a few references i could go on for uh weeks about all of this but this is just some of the known literature on casein the protein and dairy and gluten uh one of the proteins in grain in ms and schizophrenia so liquid cow milk but not cheese is associated with higher rates of ms across i think 27 countries and 29 different populations and antibodies to casein and gluten were more prevalent in recent onset and uh long-term diagnosis of schizophrenia um and there's also another paper which i i did not include in here that makes the same observation uh casein and gluten increase the risk of parkinson's now let's get so the foods i excluded casein and so dairy products and gluten grain products now mind you i've been paleo for quite a while that that was not enough so excluding that had not been enough to recover me it was not until i reorganized my diet so what did i add in i paid a lot more attention to what i needed to add to make sure i was maximizing nutrition for my brain and my mitochondria first group i'm zeroing in on are sofa rich foods in a very specific way the cabbage family onion family and mushroom family and here's why so mushrooms mushrooms increase nerve growth factors and these are in some lab studies lions main mushrooms they also activate natural killer cells and they will prime innate and adaptive immunity so it does great thing for immune cell function and does great thing for nerve cell uh factor and bdnf brassica which is the cabbage family and onions improve your detoxification enzymes increase intracellular glutathione production will increase gamma-aminobutyric acid production your neural inhibitors for the brain so it's increasing your neuroprotection it improves endothelial function particularly the onion garlic family so again excellent stuff for our brain and this will improve our ability to process eliminate all of those toxins that mark told you that i'd had likely stored in my fat and contributing to my decline leafy greens why why was i so keen on leafy greens so greens are a great source of vitamin k1 which in your gut your bacteria will metabolize to k2 mk7 and you'll reabsorb that in your ilium now k2 is really important in the production of myelin and k2 is also important in the efflux of calcium from your endothelial walls and your heart valves where if you have a lot of vitamin d you'll deposit calcium into the endothelium in the heart valves if you have a lot of k2 you'll take it out of the endothelium out of the heart valves and into your teeth and your bones and you'll make more myelin plus if you have a lot of greens you're going to have a lot of carotenoids and magnesium colored foods in a particularly blue black are really good for you but you want all of the colors and pigments are a great marker for the polyphenols the antioxidants that are great for resuscitating again your mitochondria and quenching those free out free radicals but in addition blue purple black are associated with improved outcomes for uh in terms of cognitive decline in neural protection here's a couple of papers that looked at blueberry powder versus placebo and people had early dementia or mild to moderate cognitive decline and there was improved performance in the placebo group versus the control group and the amount one cup of fresh blueberries or frozen blueberries so pretty easy to achieve from a dietary standpoint so the target it i'll say i had probably considerably more than this so it's three cups of greens three cups of deeply pigmented three cups of the sulfur rich category so i'm a tall lady about six foot tall in my va clinic mostly men it's pretty easy for them to get to nine cups and realistically i was probably having 12 to 15 cups of vegetables every day lots and lots of vegetables which i did not do when i was a paleo eater it was more meat some vegetables um i was also much more appreciative of oregon meat now when i grew up on the farm we had delivered onions every friday and by god you ate it or you got a second serving and my my parents you know we were pretty tough farmers and you followed the rules now pre-industrially oregon meat was what you ate because you didn't waste any of the animal and a third of the animal when it's slaughtered would be classified as organ meat uh it's an excellent source uh the organ meat is a great source of uberconon or coenzyme q minerals essential fatty essential fatty acids uh fat stable vitamins and water soluble vitamins k2 there the bacteria when you eat greens we'll make it into k2mk7 and you will store it in your liver as k2mk4 so liver is a good source of vitamin k2 it's also a good source of pre-made vitamin a or retinol the vitamin a in greens and vegetables and orange vegetables is beta-carotene which you will have to convert into retinol and if you have a chronic disease it's more likely that your enzymes at converting it are less effective so this is just a little chart that lets you know that organ meat is a superfood i'm sort of illustrating that 100 grams of kale versus turkey versus liver versus heart is a superior source of minerals and here is superior source of the fat soluble and the water soluble vitamins so um grass-fed meat organ meat wild fish at this point i was like if it wasn't organic i wasn't going to eat it and if it wasn't organic personal care product i wasn't going to use it and i really had liver now twice a week intermittent fasting calorie restriction dietary restriction the longer the more time we spend without consuming calories the better for mitochondria and so i would intermittently go at least 16 hours and occasionally 24 hours and occasionally three days without eating food intentionally to lengthen that time for a mitochondria without food increases the number and increases the efficiency of the mitochondria i think it also by the way increases nerve growth factors so let's talk a little bit about the other thing that food does it feeds my microbiota so there's emerging evidence that the microbiome is has a role in ms this is a study from japan that looked at 20 patients with ms and i think 40 controls and they saw that there was a depletion of clostridius species that is involved in the regulatory th17 cells so if you have ms is part of this due to altered microbiota small steady suggestive but certainly supports my theory that the microbiome is a major player in ms this is a another paper again that looked at the microbiota in people with ms people who don't have ms and they look to add the disease severity and they're able to predict who has ms who does not have ms and were they having a flare of their symptoms so this is just a look at how well we are feeding our microbiome the average american westernized diet 15 grams of fiber a day the us government target is 30 grams a day if you follow the walls diet we've analyzed this and we see that you using recipes and a week's worth of menus and in our study it can get up to 80 grams if you analyze hunter-gatherer societies they're eating 100 150 grams a day how much should you feed your microbiota a lot more than you are now i think it's a pretty uh fair answer so we're very fond of fermented foods so we teach people how to make kombucha we teach them how to make fermented cabbage kimchi fermented pickles fermented beets fermented carrots we talk a lot about poop you want a poop you want to poop every day if you're not pooping a snake every day you need more fiber and we so we talk about chia pudding flax seed puddings resistant starch plantain flour uh green banana flower if you're pooping diarrhea soft pudding stools you need to back off and you may need to eliminate the raw foods and have only cooked foods until that resolves so in our clinical trial uh these are the interventions that we use and i'll tell you it was actually quite an ordeal to get approved um we had to go it was it was a challenge that now the part of the reason we're able to get approved is that i was a member of the institutional review board the irb had seen my decline and then my recovery i and so they were very interested in approving the study but gave us the restriction that you need to do what you did and mimic that as closely as you can and so this is what i did the modified paleo diet um targeted vitamins and supplements i would had gone back to a mantra based meditation so we taught our subjects how to do that and we taught them how to do a simple self massage we gave them a home exercise program that targeted the muscles of walking and we taught them how to do e stem the study diet nine cups of vegetables was the target and if you were petite we understood that you you couldn't get your nine cups in so we didn't want people to overeat or over consume and we excluded gluten dairy we also excluded eggs because that's the third most common and because i had to exclude eggs because of my own food sensitivity we had to mimic what i did to make the diet more tolerable we let people have two gluten-free starches per week so that's two small pieces of gluten-free bread per week or a half cup of rice twice in a week so mostly vegetables and meat we talked about the importance of stopping sugar processed foods gluten dairy and eggs and the targeted vitamins were methyl b12 methylfolate vitamin d with the target of getting the vitamin d between 50 and 100 nanograms uh in fish oil we taught them a mantra based meditation we taught them how to do self massage we taught them a stretching exercise program for the gastrocs the quads the hamstrings in the back the erector spinaes and we gave them an exercise program targeting those same muscle groups in order to be in the study they had to tolerate e-stem not everyone did because the stem hurts and for some people it's too activating for the neuropathic pain and they just couldn't do it and so they couldn't be in the study the other thing they had to do to be in the study they had to do a two-week run-in where we gave them food logs and they had to follow the diet a hundred percent for seven days straight if they couldn't do that they could not be in the study and so uh we we had a 25 of our folks could not make it through that two-week uh run-in period we did become much more uh clear in what our expectations were uh and so we got so that we we had much greater success at people being able to enroll and make it through that run-in study the other thing that we had to do is we had to show that for safety we had to enroll we had money to do 20 we were able to enroll 10 and show that people could implement it was safe and so we got the 10 folks in and then uh showed that safety data then we're able to enroll the next 10. so we have 20 data that we're going to show here people were between kane and walker and the average age was 51 and their fatigue score was quite severe at 5.5 the score goes from 1 no fatigue 7 total fatigue in every aspect of your life our biggest side effect was if you were overweight you lost weight without being hungry a few people had skin burns who had to uh reinstruct them on how to properly do the e-stem we radically changed what they ate like most americans ate a lot of grain and few vegetables my public health folks say if they can get someone to increase their intake of vegetables by one serving a day at the end of 12 months that's a home run we had this dramatic change from 1.5 to i think almost eight servings a day and that is a stunning level of success with a change in diet this is the change in quality of life the green in blue bars improved quality of life improved energy levels the red bars is the decline in fatigue severity scale score uh 2.38 and the p value .0005 now mind you when you have only 20 no one expects you to have statistical significance so again very gratifying that we did so well here the the factors associated with greater success if you have less disability shorter disease duration and you're able to do more of the stuff that we asked it's no surprise if the family did the diet with you you're much more successful if you did the diet and everyone else ate the same old way it was a big struggle and the more exercise you could do the better the impact on the gait or maybe you are getting better so you can do more exercise it's hard to know um we have a study that we're doing now thank you dietary approaches to ms fatigue we're recruiting you have to be within 500 miles of iowa the ms diet study at uiowa healthcare.uiowa.edu i did this for the va for three years we saw people with a wide variety of diseases we did this with group classes we had the teaching kitchens i taught people in the group how to do a timeline a matrix and then we had the dietitians in a group teach them how to cook and make this food same kind of diet we had very basic primary care labs that we that we monitored and very very basic lab supplement interventions that we use and we had remarkable uh improvements in biometric outcomes and remarkable improvements across many disease states this is the best part we're going to show you some of the changes from our study and this is secretary of progressive ms it takes her 120 go ahead and start the video please it takes 127 seconds to get up walk eight feet turn around and come down we're so concerned about her ability to walk we chase her with a chair if you watch her feet you see that she has difficulty picking her toes up and her toes are going to get stuck on the floor as she walks go ahead and start the other video so did you start the other video yeah so what you see is uh 12 months later she can arise in the chair much more easily she can uh walk she can swing her leg forward she can pick up her toes uh dorsal flex much more effectively she's now able to uh do little walks in the neighborhood she's far more independent she's able to climb stairs now for the first time she thinks in about six years which means she can visit friends and extended family and can get out of the house next in her fatigue by the way has gone from what 5.6 down to 4.4 so big impact on fatigue uh oh i move it sorry okay so this lady has primary progressive ms go ahead and start the slide here um and fatigue is her biggest issue so her fatigue score is 6.7 she uses uh two and the two walking sticks and go ahead start the next slide and in three months she's able to walk without the canes her fatigue is markedly reduced again primary progressive ms there's no known treatments no fda approved treatments people just go downhill either very very rapidly or somewhat more slowly and i guess i go next and you can start this one this lady was working part-time fatigue is a major issue for her she uses a cane for short distances and a walker for long distances her son is living with her she's decided that she cannot live independently so when he finishes her his graduate degree she's going to go move into assisted living but start now after three months she can do this now that gate looks normal to me my physical therapy friends tell me that they can tell it's still not quite normal and fatigue has dropped from 5.3 to 1.4 really quite quite quite remarkable oh it timed up and go so it's uh you sit in the chair you stand up walk eight feet turned around come back and sit down on the chair so it's time from the time you up go and come back and then here she is and she can now jump and then she can also do this this other activity and i really like that so we're going to watch it twice so at the end of uh three years this lady who when she enrolled with us struggled to drive 15 minutes her granddaughter had been born and lives four hours away so she's able to now drive to go see her granddaughter four hours away without any problem and her son has moved six hours away and she can drive to see her son without any problem uh she never really got into drugging so she doesn't jog she does do pilates does do weight training and certainly feels like she's gotten her life back so uh the key thing i want i want all of you to take from this message today is this interventions that we use work across multiple disease states the modifiable lifestyle factors that was my toolkit i had very basic primary care testing in my va clinic we had very very basic uh supplement interventions my toolkit was diet and lifestyle with the expectation if you're going to work with me you have to commit to doing the diet and lifestyle recommendations a hundred percent for a hundred days um and we had favorable impact across many disease states on fatigue mood and cognition the best steps get rid of the sugar get rid of processed foods and eat vegetables lots of them lots lots of them and i think this is my last slide and so we'll stop here and take questions thank you dr wallace and uh we appreciate that i'm gonna just start with the first question because i think it's something you missed in your story that's critical which is how you deliver the program in a way that is inexpensive scalable and effective yeah so what i'm going to talk about is what we did when i was back at the va so we have a group classes so the first class is an introductory class where i tell my story describe the tenets of functional medicine and the intervention so gluten-free dairy-free living nine cups of vegetables uh and that that's step number one then we'll talk about meditation exercise in addition and give people the option to say like up that's too hard i'll just stay with primary care or i am ready to do this 100 and they'll come work with me in the group classes or i want to uh ease into this so we call that the glo go slow they'll go work with a dietician individually the go is come to the group class if they come to the group class their next visit is a far visit two hours with me where we do a timeline and a matrix and i teach it to a group usually about eight folks and they're doing and i teach them how to do their timeline how to do their matrix and review their modifiable lifestyle factors uh what to do with their diet stress reduction exercise social networks and then i identify for them what are their highest leverage points and what were likely the environmental factors that led to their organ system dysfunction then i hand that group off to our dietitians who run a cooking class and we give them cooked greens we give them a green smoothie and help them reimagine their relationship to food then so that takes four hours then they come in every six to eight weeks uh for uh what i think of as like a aa model uh sort of a a two-hour session that is run with me in the dietitian we have a 15 to 20 minute educational component often talking about labs then we count up how many people we have in the room which might be eight to fifteen we divide up the time and so everybody gets to check in say like hi i'm terry walls progressive ms my original msq 150 today it's 22. i follow gluten-free dairy-free 100 my big struggle is when my grandkids come i get them treats and ate the whole bag before they get there and then i'm terrible so help me figure out what to do when my grandkids come and everybody gives them some feedback then they go on to the next person and we go around the whole group and then i try to have like a five to ten minute closing at the end um what really seems to help is that peer-to-peer coaching about how you deal with family that doesn't want to buy in or grandkids whatever the challenge is those and you can come see us for a year then you graduate and then you're done the other thing you can see us forever is the skills class in the skills class people come in again we have a 15 15-minute q a session and then we teach skills and the skills might range from what i call the resilience factors what is your life mission what is your purpose the meaning of your illness to movement tai chi yoga strength training to cooking more cooking classes and to my surprise the most popular class was the resilience effect is the resilience factor classes having to do with life's purpose and life's meaning terry i think that what's extraordinary here is that there is no one-on-one visits with a physician there's an opportunity for one-on-one visits with a dietitian but this is done in a group model over time with profound results it totally transforms both the content and the delivery of health care which i think is very instructive for us as a way to deal with the burden of chronic disease so i think you pioneered not only the content of how to treat disease but also the delivery model you know it would also tell everyone that i i did this when the va was very resistant to functional medicine functional medicine was not a word i could use so we called the therapy lifestyle clinic i did it with no functional medicine testing we only did things that we could just order through primary care clinics so homocysteine b12 folate vitamin d levels lipids a1cs and i had to agree uh the only uh uh things that i could use were uh b12 plain b12 not the methyl version plain plain b12 a b complex and fish oil i could let people go by on their own if they wanted methyl folate muscle b12 anesthetic cysteine and algae so very very basic tremendous tremendous and it's it's really testament to the power of food as medicine so any other questions there's an online question here terry that asks if you are have worked with any other kinds of e-stem such as cold laser or frequency specific microcurrent so i've worked with cold laser myself i have i'm aware of frequency specific i have not worked with it myself i've also worked individually with beamer post electromagnetic fields myself and i found that to be helpful but did not use that in our clinical trials any other questions you touched on this a little bit you touched on a little bit um when you said you know the grandkids were coming over and you ate all the treats before they got there how long do people take to recover after they've kind of fallen off the wagon as it were okay so let me touch a little bit so we've had people have dramatic results lupus ra scleroderma myasthenia uh and then humans being what we are after six months feel like you know i i could indulge uh and a few people get by with occasional indulgence and don't get into trouble but you'll also find some people have an occasional indulgence get a dramatic flare of their disease and then it may take many weeks to get the disease quiet and they may have to take pulse cellular or some other disease modifying therapy so i do a much more explicit uh recommendation that if you get response and you stop the program you're stopping disease modifying treatment and you should expect a disease flare and you know and myself i want to make it very clear that if i accidentally get exposed to gluten in 24 to 72 hours i'll get a flare of my face pain that is horrific that will be so horrific i cannot you know you'll see me jolting i won't be able to talk i may not be able to walk i'll need high-dose prednisone and i may need high-dose soluble to stop it so i now carry pregnazone with me so if i get my first twinge of pain i'll be in my pregnancy uh taper orally so i can hopefully not need that solubility it's an incredible statement that food is a disease modifying drug absolutely it's a very powerful disease modifying drug and if you stop expect your disease to flare dr wells um the the the the connection with the microbiome seems incredibly interesting and just very recently coming up and also for other types of diets that have been i'd say somewhat successful or have provided a lot of comfort to people with this like the one by dr jelenek i believe yes um i i just wonder if uh for for for patients that are all over you know the internet learning about both these approaches if you um have some connections with him that you would both explore how micro the microbiome is modified through these different approaches this is a great uh question uh so i i do have the uh opportunity that we've had donors from all all over the globe donate to the walls research lab and so in the study or comparing the walls diet and the swank diet we're freezing uh microbiome we're freezing blood for so we'll be able to do an analysis of the changes in the microbiome uh and we'll see what happens if you follow what looks like the gelatic diet or you follow the walls diet or you're just doing uh usual care so we'll have that we'll also have we're freezing dna and rna so we'll be able to change monitor gene expression as well so yes these are great questions and we will be able to answer them one last quick question yeah so just to clarify your um gluten intolerance or sensitivity i maybe i missed it um you are not a true celiac by definition i don't have diarrhea no no no no classic mistake in our amongst our colleagues is often it's only gi related so i just wanted to kind of emphasize the fact that you have extreme outward symptoms by exposing yourself to gluten correct i have extreme neurologic symptoms you know so i have perfect pain and in addition i will get other neurologic symptoms so my most recent exposure that resulted in the face pain also had weakness of my right hand that took weeks to recover um you know it is interesting uh when i was working with the ms society to do uh this uh the trial that we're doing the swank versus the wall side there was a a request to have a crossover and we discussed whether that many people thought i should do a crossover design and you know that there'd be a lot of reason to do that they'd be very nice but there's this problem ethically i can't possibly do that because if one of my hypotheses is that there's going to be a subset of folks who have severe symptoms if they eat gluten and then i cross them over you know i'm going to intentionally create harm and i just said nope i can't do that design so terry there's some other questions online as well we've got about uh 250 people who've been watching this live thank you so much for watching um through ifm and i'll be re-broadcast over the next 24 hours but they asked about um what do you do with vegan patients or vegetarian patients so um and my paleo friends gave me a really hard time for being so sympathetic to vegans and vegetarians but you know i was one for quite a while so i am quite sympathetic for them we do have uh my first level diet i have people use gluten-free grains and of course gluten-free legumes soak them for at least six hours they that uh sprouting process uh modifies the lectins and i that talk lectins is another big problem lectins are the compounds that plants use to poison animals so we don't eat eat the plants and they're mostly target insects but for people who are genetically susceptible eating the seeds can make you ill therefore those who have a chronic disease were somewhat more likely to have sensitivity to those lectins that's one of the reasons to avoid seeds and legumes if you do eat seeds and legumes soaking them for at least six hours uh greatly reduces the inflammatory impact of those lectins you mean grain you don't mean pumpkin seeds or no i mean seeds so in in people who are sensitive uh even pumpkin seeds sunflower seeds nuts and seeds may be a problem i don't take nuts and seeds away from most people in our diet in the my clinical trial we do for 12 weeks in the clinical trial uh we'll have them either avoid the nuts and seeds or soak them for six hours and then we reintroduce after 12 weeks any other questions i mean i i have a question you didn't mention fat you implied well i love fat but you know since yeah your nerves are made of fat and you're getting fat so how do you address fat we want people to eat lots of fat uh and i talk about the ratio omega-6 omega-3 ideally about three to four omega-6 to every omega-3 60 of our cell membrane is either saturated fat or cholesterol so i don't view cholesterol as a problem i don't view saturated fat as a problem i think oils olive oil in any liquid oil that is liquid at room temperature should be eaten cold and not heated because when you heat it you damage some of the antioxidant components and you increase the possibility of oxidizing that fat so we do want people to eat fat i there's just so much information i i did leave the fat out but yes we stress fat in the diet which is the big difference from the genetic diet it's very big so so uh in their diet for fidelity we stress at least four servings of grain every day uh and less than 15 grams of saturated fat in my diet we stress all the vegetables in at least 20 grams of saturated fat every day so we want to be sure that there's plenty of spread between the two diets thank you thank you thank you dr walls this has been really an extraordinary conversation and you really done pioneering work i think the thing that i want to just emphasize is that most people think that functional medicine is about testing about supplements and you've been able to do this in a poor population with little resources without extensive testing or extensive supplementation using the power of food as medicine and they don't have to eat organic food and you know and i say don't worry about it not being organic don't worry about whether it's grass-fed or not you do have to cook at home you do have to eat vegetables powerful thank you so much for your time dr wells and your work thank you you

Channel: Cleveland Clinic

Views: 20,178

Keywords: professional development, grand rounds cleveland clinic, cleveland clinic grand rounds, functional medicine grand rounds, mark hyman md, functional medicine, grand rounds for doctors, functional medicine mark hyman, mark hyman md youtube, terry wahls md, terry wahls protocol, terry wahls, multiple sclerosis story, terry wahls story, treating ms related, treating ms related fatigue, multiple sclerosis, multiple sclerosis related fatigue

Id: FGjIO4JTb4I

Length: 59min 22sec (3562 seconds)

Published: Mon Dec 28 2020