The Wahls Protocol

By Dr. Terry Wahls

     Dr. Terry Wahls is an American physician who has managed through diet and other alternative methods to recover from SPMS that had led to her being confined to a reclining wheelchair at one point. After several years of trial and error and ultimately developing the plan that worked for her, Wahls is back to an active life and is engaged in researching and accompanying patients in her method. 

     Wahls’ protocol is a modified version of the Paleolithic diet, also based on clean eating, elimination of potentially inflammatory/antigenic foods (gluten, casein, and lectins), and high intake of healing foods1. For her enhancement, Dr. Wahls has identified and focused on 36 nutrients (vitamins, minerals, essential fats, and antioxidants) important for brain health. This translates to an emphasis on nutrient-dense foods like leafy green vegetables; sulfur-rich vegetables like cabbage, mushrooms, and the onion family; deeply pigmented foods like carrots, beets, and berries; grass fed meats; wild fish; and seaweed. Further, the protocol guides people to ultimately transition to a particularly low-glycemic – almost ketogenic – way of eating that may provide an advantage to the brain, enhanced by intermittent fasting.

     Dr. Wahls recommends combining diet with other modalities relevant to MS, including supplements, stretching, strengthening exercises, electrical stimulation of muscles, meditation, and massage. The supplements she recommends include vitamins A, B12, C, D, and K2, alpha-and R-lipoic acid, curcumin, eicosapentaenoic acid (EPA), fiber, melatonin, n-acetyl cysteine, phosphatidyl choline, zinc, and maitake, reishi, and shiitake mushroom extracts.

     Not one to just practice and preach, Dr. Wahls has conducted several clinical studies applying her protocol in MS patients. The first was a small single-group trial in SPMS patients, showing promise with a significant improvement in fatigue2. Next was a randomized controlled trial on the diet portion alone in RRMS patients, also resulting in improved fatigue, as well as increased mental and physical quality of life, exercise capacity, and hand and leg function3. In a single group study in both PPMS and SPMS patients, the multiple modality approach resulted in improved mood and cognitive symptoms4, as well as improved walking performance and balance in those with mild-to-moderate impairment5. A later randomized controlled study in the same population compared Wahl’s diet to a keto plan, finding the former to yield superior clinical outcomes6. The most recent randomized parallel-arm clinical trial in RRMS patients compared the Wahls and Swank diets, finding that both were associated with clinically meaningful within-group reductions in fatigue and improvements in quality of life7,8.

     The Wahls Protocol is divided into three different stages in order of progression, to ease the user into the ultimate plan.

Stage 1

  • Add 9 cups of vegetables and fruits every day:

    • Three cups of bitter green leafy vegetables;

    • Three cups of vegetables and fruits with bold colors like carrots and beets, berries, pumpkins and tomatoes

    • Three cups of sulfur-rich vegetables and similar plant foods from the cruciferous family e.g., cabbage and kale, allium family, e.g., onions and garlic, and mushroom family

  • Eliminate gluten, dairy, and eggs completely

  • Add good quality proteins, specifically pastured meats and fish

Stage 2: Wahls’ Paleo

To the changes in Stage 1, add the following:

  • Eliminate all grains and pseudo grains (such as quinoa), legumes, and potatoes. You can consume a small portion of them twice a week, in order to get used to giving them up. 

  • Eat more non-starchy vegetables and less fruits, with the aim of reducing the amount of carbohydrates.

  • Add seaweed and pastured organ meats to obtain essential minerals and enzymes. 

  • Add fermented foods and sprouted nuts and seeds, and eat more raw foods, vegetables, fruits, and fish to get probiotics and more essential enzymes

Stage 3: Wahls’ Paleo Plus

To the changes in Stages 1 and 2, add the following:

  • Reduce the amount of carbohydrates and increase the amount of fats, similarly to a ketogenic diet.

  • Completely eliminate grains, pseudo grains, legumes, and white potatoes.

  • Lower the vegetable and fruit amount from nine cups to six cups in a similar ratio.

  • Reduce tubers and starchy and root vegetables such as beet, sweet potato, and carrots to once a week, and focus on vegetables that grow above ground. 

  • Reduce most fruits (other than berries) to once a day.

  • Add coconut and coconut products, avocado, olives and olive oil, and animal fat generously. 

  • Concentrate the meals into two or three a day. 

  • Leave a fasting window of 12-16 hours a day, with the aim of expanding the time when the body is not busy with digestion and absorption and can cope with the excretion of toxins and healing of damaged cells.

 

References

1. Wahls T, Scott MO, Alshare Z, et al. Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perceived fatigue in persons with relapsing-remitting multiple sclerosis: study protocol for a randomized controlled trial. Trials. Jun 4 2018;19(1):309. doi:10.1186/s13063-018-2680-x

2. Bisht B, Darling WG, Grossmann RE, et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. May 2014;20(5):347-55. doi:10.1089/acm.2013.0188

3. Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18. doi:10.2147/DNND.S116949

4. Lee JE, Bisht B, Hall MJ, et al. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. J Am Coll Nutr. Mar-Apr 2017;36(3):150-168. doi:10.1080/07315724.2016.1255160

5. Bisht B, Darling WG, White EC, et al. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis. 2017;7:79-93. doi:10.2147/DNND.S128872

6. Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma beta-Hydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study. J Am Coll Nutr. Jan 2021;40(1):13-25. doi:10.1080/07315724.2020.1734988

7. Wahls TL, Titcomb TJ, Bisht B, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. Jul-Sep 2021;7(3):20552173211035399. doi:10.1177/20552173211035399

8. Wahls TL, Chenard CA, Snetselaar LG. Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic. Nutrients. Feb 7 2019;11(2)doi:10.3390/nu11020352

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