 Welcome to Ancestral Health Today, evolutionary insights into modern health. Welcome to Ancestral Health Today, a podcast providing evolutionary insights into modern health. I'm Todd Becker and we're talking today with Terry Walls. Terry is a professor of clinical medicine at the University of Iowa and through her own experience and her recovery from multiple sclerosis. She's developed a dietary framework for recovery from MS. It's called the Walls Protocol. She summarized it in this great book here and on her website which we'll have links for later on. And I first saw Terry give a very inspirational talk in 2012 at the Ancestral Health Symposium at Harvard and since then she's given TED talks, she's lectured around the world and she's refined her protocol. We just now been tested in several clinical trials in the diets based generally on paleo principles, functional medicine concepts supported by research that Terry's done and it can be customized to some extent individual needs and it's helped individuals with a variety of autoimmune conditions, not just MS. So thanks for joining us on Ancestral Health Today, Terry. Thanks for having me, Todd. Great. I'd like to start out with your personal experience and I understand that besides being a medical doctor and professor you were an accomplished runner, cross cruncher skier, you climbed mountains and you did taekwondo and then somehow at some point you realized something was going on. Can you talk about how you first realized that you might have multiple sclerosis? Yeah, it was 23 years ago. I walked here with my wife Jackie a half mile from home. My left leg grows weak, dragging it out of the home. I see the neurologist who says this could be bad or really, really bad. And I think about the fact I've already had 20 years of worsening electrical face pains that start here coming down to my jaw. And Todd actually prayed for a fatal diagnosis because I don't want to be disabled. Three weeks later, I hear multiple sclerosis. I find the best MS center of the country, take the newest drugs. And three years later, I hear tilt recline wheelchair. I take a reclining wheelchair, right? You are totally recline because it's totally core muscles are weak. I have severe fatigue. And I treat my disease aggressively. So I move on to mydozantro, which is the form of chemotherapy. That does not help. Then I move on to Tysabri, the new biologic drug that was just out. That does not help. Then I'm switched to cells up. And that's when I'm like, you know, it's very clear. This is really going to be terrible. I clearly on track become bedridden by my illness. And I decide to start reading the basic science. At first I'm looking for more drug studies. Then I start looking for supplement studies. And I decide that mitochondria are what drives disability. Now I should back up a little bit. I've been a vegetarian for 20 years. And my neurologist had mentioned the work of Lauren Cordang. And so two years into my diagnosis, after a lot of prayer and meditation, I went back to eating meat. And so that was a really big deal. So Lauren Cordang, who wrote about the paleo diet. So you started out sort of on a paleo path. On a paleo path, I continued to decline. So there's no grain, no legumes, no dairy. I'm still getting worse. But I'm like, well, who knows how long it's going to take to recover. At least I'm doing something. That's when I start reading the basic science. I decide mitochondria are the driver. And I create a supplement cocktail for my mitochondria. And it slows the speed of my decline. And I'm very, very grateful. What puts you on to the track of mitochondria? So you were doing paleo, and something led you to mitochondria. What was it about mitochondria that made the connection with MS? Well, when I was reading the animal studies, I was looking for studies with shrinking brains, shrinking spinal cord. So ALS, Huntington's, Alzheimer's, cognitive decline, dementias, and progressive MS. And mitochondrial dysfunction was a constant across all those diseases. So I thought, no one was talking a lot about mitochondria for MS yet. But I thought it would make sense to me that mitochondria were key. And at least that was something that I could target. So I slowly add in more supplements that are useful for my mitochondria. I can tell. It's actually sort of interesting. After six months of doing my mitochondrial cocktail, I got disgusted, like, okay, I'm really not that much better. And I quit. And 36 hours later, I could not get out of bed. I just really could not function. And 72 hours later, my wife comes in and says, you know, honey, why don't you take the supplements again? So I'm like, okay, so I took them. And that's where I could get back up and go to work. And I thought, wow, that's really interesting. So two weeks later, I did the same thing. What supplements are we talking about that you were taking? So at that time, it was creatine, carnitine, lipoic acid, coenzyme Q, and B vitamins. And it was super interesting in that next day, I'm back to my usual level of fatigue. I could get up and go to work. And now I'm still not so inclined wheelchair. But I thought, wow, that's really interesting. So two weeks later, I stopped everything. And at 36 hours, I can't get out of bed. I'm exhausted. I even more exhausted than usual. It's hard to function. I wait by 72 hours. Then I take my supplements again. And next morning, I can go to work. And so I think, hey, I've written stuff that my neurologist is not telling you. And I'm very excited. I'm much more into scanning the literature. I'm a member of the institutional review board. So I'm reviewing research every month. And I tell the review committee that please send me all of the human brain related studies. So I was getting more and more comfortable reading the research. And over the next couple of years, you know, I'm still declining, declining, declining, I'll be a little more slowly. In the summer of 07, my chief of staff tells me he's going to sign me to the traumatic brain injury clinic up to start in January, about six months. And he describes the job, I won't have residents in the clinic. I'll be a part of a multidisciplinary team. And I'll have to examine that. That's myself and write the notes. So you were working all this time as a doctor? I have that cognitive decline. So, you know, the residents would see the patients and I would staff and they would discuss the cases and I would staff them. And I would review studies for the IRB for clinical trials. So I'm still working. I'm beginning to have a little brain fog. And I think this was my chief of staff job's way of saying, Terry, I don't think you can do your job. We're going to put you on a job that you can't do. So you'll have to take medical retirement. But, you know, I think now in retrospect, I think God was whispering in his ear to put me in that job. Because two weeks later, I reviewed a study with electrical stimulation of muscles. And that was used for people who had been paralyzed so they were able to walk again. And so I wondered, you know, could that help me get a quick search? There's only 212 papers taking that long to read all those abstracts. And they're just a handful with cerebral palsy and stroke. Nothing in MS. But I convinced my physical therapist to let me have a test session. And we added it to my physical therapy. Then at that same time, I discovered the Institute for Functional Medicine. And they had a course on neuroprotection. So it was all about the mitochondria. So I was super excited. I had a longer list of supplements, which I added. And then I had this really big ah-ha tab. And now in retrospect, I laugh at myself that it took me this long to have this ah-ha. What if I redesigned my paleo diet based on the slowness of supplements I was taking? And I said, like, where are these nutrients in the food supply? Really key point because you were doing a paleo diet and you were taking handfuls of supplements. And the question is, could you get everything from food, right? Do you have to take tons of supplements? And then I was also recognizing that our food is much more complicated than the supplements. That, you know, there's tens of thousands of compounds in the food that we eat that we've not even named or described that, you know, our bodies somehow use to nourish us. So I thought, well, you know, I'd probably get other really good things for me if I ate a diet that concentrated on these. And there was like, you know, there are now 17 nutrients that we track. But you know, when I asked my dietitian colleagues where these nutrients were in the food supply, they said, well, I don't know. And then went to the library. There were really good resources there. So I went back to the internet. And Linus Pauling Institute for micro nutrients was super helpful. So I reorganized my paleo diet that now just as important as what to avoid is what to stress. So the story gets pretty dramatic. Now, in 2007, you know, in December, I'm being a brain fog, I have trigeminal neuralgia, my level of pain is really extremely difficult. I have weak torso muscles, so I couldn't sit up like I am now. I was in a zero gravity chair with my knees higher than my nose. I could take just a couple of steps. If I sat in a regular chair like this, I can only do so for about 10 minutes. If I sat longer than that, I was just completely exhausted. And that, by the way, Todd, is the definition of being bedridden. It's good that I did not know that at the time. So I start this new week in December 26. And then in January, I go to the Schmeid Branger Clinic. In the first two weeks, I'm just in my total client wheelchair, watching my partners do the exams. And then the third week of January, it's time for me to start examining the veterans and writing the notes for them. And that first day I come home and, you know, it's not too bad. I was sort of surprised. And at the end of the week, you know, I tell Jackie, you know, that's not too bad. I think I can do this. And I also say that I want to sit in a regular chair for supper, because I feel like, you know, I am stronger. And so we get the regular chair and I have supper sitting at the chairs upright, normally. Very exciting. When I see my physiotherapist, my physiotherapist says, Terry, you're definitely stronger in the advances of exercises. So I'm doing 10 minutes of mad exercises twice a day with my electrical stimulation muscles. And we keep advancing them. And in February, maybe you could just fill us in on you're talking about electrical stimulation. That was something you had started. Yeah. So electrical stimulation tends is something that people use to help over sensory nerves to help with pain. It's a slightly different frequency. If you put it over motor nerves and muscles, you can get more muscles to contract. And this is very helpful for people who are paralyzed, so the muscles are still doing work. And we're blocking the harm of inactivity. But there's still never going to walk. And then for me, I would volitionally contract the muscle and doubt the current that I get electrically driven contraction as well. So I get a bigger workout and I could tolerate the workout when I had electrical augmentation. My physiotherapist said, Terry, I can definitely grow bigger muscles. What I do not know is if your brain can talk to the bigger muscles that we grow, it's possible I may be making dead weight on your legs, and we may be making it harder for you to walk. So you want to be sure I understood that. Yeah, I could be making circumstances worse for myself. The other thing that was super interesting, Todd, was every time I did the electrical stimulation, which, by the way, was quite painful because I, you know, being a former athlete, like if I got out of the way, nothing on the table, like, you know, I figured more would be better. And so I would doubt the current and I'd be sweating from the intensity of the current. It did really good things for my mood and my metaclarity. And so the rectal stimulation. And so at the end of January, my physiotherapist says you're definitely stronger. He's advancing my exercises. I believe at the end of February, I decided to mail a letter. So people see me walking in the hallway now with walking sticks, but for the first time in four years, you know, which stuns everyone. And then in March, I'm walking with one walking stick and then with by the end of March, no walking sticks. And in April, I am talking with my wife, Jackie, that I'd like to try riding my bike, which I've not done in six years. It just says, well, you know, things keep going well, maybe we can do that in the fall. Well, on Mother's Day, we have to have an emergency family meeting because I really want to try riding my bike. And so Jackie tells my son, Zach, who's six foot five and he's 16. Zach, you jog alongside in the left. She tells Debbie, my 13 year old daughter, you jog alongside on the right. And that she'll follow. So we all get in a position. She gives the all clear. And I push off and I bike around the block. That's amazing. Now that big 16 year old boy, he's crying. The 13 year old girl, she's crying. Jackie's crying. And when I relive that moment, I cry even now, because you see Todd, when you have progressive MS or a progressive neurologic disorder, one of the things you do is you let go of the future. You learn to accept each day as it unfolds. And so even though I've been walking around the block, I didn't know what it even meant because I'd let go of the future. But when I, when I biked around the block, I realized that the current understanding of progressive neurologic disorders, including progressive MS, is incomplete. And who knows how much recovery might be possible. And so this is, this is an incredible story. I mean, it's emotional. It's so remarkable to have that kind of recovery from being flat on your back. And then you're walking with sticks. And then you can ride a bike. I mean, that's transformational. And then so I keep biking a little bit further. In October, Jackie signed us up for the courage ride, which was 18.5 miles. And y'all, and when I crossed that finish line, we're all crying again. But I biked 18.5 miles. And I can bike for hours. I went up to, I can jog in the neighborhood, not fast, but I can jog. So no, I'm not normal. I'm not going to be athletic in the way that I once was athletic. But, you know, I have a very rich and amazing life. And it certainly transformed how I think about disease and health. It will transform the way I practice medicine. And it will transform the type of research that I do time. And it certainly made it my mission that I want everyone with multiple sclerosis and a systemic autoimmune condition to be told, yes, we may have FDA approved drugs that we can offer you. But just as important is addressing your diet and lifestyle. And we're making headway on that. It's incredible. I just want to rewind to where we are. So you did the paleo diet. You looked at supplementation. You did the research and added nutrients that could help with mitochondria. And you even expanded what you ate to make sure you're getting the right things. And you did the electrical stimulation. Were you taking any, still taking any disease modifying drugs at this time? Or had you just continued that? Interesting. So at that time, I was taking cell sept, which is a drug given to people with transplants. It does suppress your immune system. And I've had three relapses in the whole disease course. When I walked into my neurologist office in April of 2008 and told him what I'd done, showed him my Eastern device. And we talked about whether or not I could be tapered off my disease modifying drug treatment. He said, yeah, let's do that because it really didn't help you. And you're old enough that the risk of harm over the age of 50 begins to be increased. So he tapered the cell sept over two weeks and then stopped it. And I've not been on any disease modifying drug treatment since then. And I still see my neurologist twice a year. I still get periodic MRIs. And I'm old enough that you would not expect me to have any relapses because people would have any relapses and no enhancing lesions. Generally straight around age 45 to 50. And certainly by 55, it'd be very, very, very hard to have a relapse. But what they have is this progressive decline, worsening disability, worsening brain volume loss and cognitive decline. And of course, the exact opposite has happened. I'm getting stronger and stronger. You know, I am getting older. So I'm probably having some age-related brain volume loss. But you know, I'm doing research writing papers, teaching collisions around the globe. So I'm doing really very well. You've turned the corner and more so. So incredible story. And I want to build on that. But I want to come in back to your key insight, which I think seemed to really move things in a new direction. And that was your focus on mitochondria. And you know, there's been a lot of theorizing and there's studies about what's the cause of MS. Some people look at viral infections like Epstein-Barr. There's a lot of association there. There was this theory of cerebral venous insufficiency, which may be a piece, but didn't really play out. So what's your view of what's the cause? And does it all come back to mitochondria? Is there one cause? Are there many causes? What causes MS? So there's a sequence of things that need to happen. First, you have to have genetic vulnerability right now identified about 300 genes that increase the risk for having MS. And each gene might increase the risk about 1%, 2%. There are just a couple of genes that increase the risk about 10%. The vast majority is just a tiny, tiny increase. Then step two is having an infection. And there are 16 different microbes that increase the risk for having MS or another autoimmune disease. And Epstein-Barr is one of them. So is the coronavirus. So is strep staff, Lyme disease. And again, there are 16 microbes that have been identified. So step one, step two, step three is developing a leaky gut. And step four is all those other environmental factors, diet, physical activity, sleep, stress, social connectedness, being lonely, toxin exposure, your overall gut health, the microbiome, the microbes you have in your gut, on your skin, in your mouth, on your genitals, in your vagina. All those factors will either let the disease be very mild or very severe and aggressive. So the list you just gave sounds like a list that could apply to other many autoimmune diseases, maybe all of them. Many, many autoimmune diseases. And so this approach would absolutely work. And clinically, we see this approach working very well for things like rheumatoid arthritis, inflammatory bowel disease, systemic lupus, Hashimoto's, Graves disease, psoriasis, any of those autoimmune skin disorders. You know, there are 80 plus systemic autoimmune diseases in using this framework would be very helpful. Now, see, it's not a matter of I'm going to do diet, lifestyle, functional medicine, ancestral principles, or I'm going to do a conventional medicine, disease, modified drug treatments. You can do both. You can decide that, you know, my systemic autoimmune disease is not too bad. It's fairly mild, just got diagnosed. I don't have any significant disabilities. I'm going to lean into the functional medicine, ancestral health principles, and see if that will be enough. But a close follow-up, and so if it's not, then I can add the DMTs. Or you may decide that, you know what, I want to treat my disease very aggressively, because I don't want to be disabled. So I'm going to do both. I'll do the disease, modified drug treatments immediately, and I'll do diet and lifestyle immediately. But certainly everyone should be doing both, should be doing diet and lifestyle. Yeah. So the pattern you described, you said is not just MS, it's arthritis, lupus, it's the same pattern, but so that's the commonality. Then what makes the different autoimmune diseases different? What makes them distinctive? Well, so the concept called molecular mimicry. So the amino acid sequence, in my case, I'm sensitive to gluten, dairy, and eggs. And we know that dairy proteins and gluten proteins have amino acid sequences in those food proteins that also have some amino acid sequences that are similar to brain structures. And so when I developed a food-sensitive reaction, an immune reaction, to those food proteins, it also reacted to proteins in my brain, which leads to my having autoimmunity. And again, depending on your genetics and the food sensitivity that you develop and the infections that you've had, if there are similar amino acid sequence to the microbes, to some of your brain structures, or lung structures, or skin structures, when you go after those microbes, you accidentally go after your body as well. Okay. So that's why Epstein Bar, which has a particular motif, might cross-react with something that's going after the myelin protein. So they do these, this is the molecular mimicry, and that's different for each autoimmune condition. And it's different for each person. And remember, we're all a little bit different. Our amino acid sequences in our structures are a little bit different. Yeah. And so the concept of molecular mimicry is the food proteins and the proteins in the structures of the viruses and the bacteria. And by the way, we never completely eliminate the virus or the bacteria. And well, I have enough gray here that when I went to medical school, I was taught that your brain and your bones and your blood and your urine was sterile. Now that we have the technology that we can look for the DNA and the RNA in all of those spaces, it's shocking. My brain is not sterile, you know, nor is my blood or my bones or my urine. My immune cells keep you mostly in check, so I stay healthy and vigorous. But as I get older, my immune cells are gradually less and less competent. And that contributes to why we have more infection, we may have more cancer. And probably why we have more cognitive decline, because the microbes in my brain create more mischief. Now, I think the way that we accelerate aging is the standard American diet, high in sugar, high in carbs, continuous eating, no hormetic stresses. That leads to accelerated aging of the brain, accelerated aging of our immune cells, accelerated aging of our mitochondria, accelerated aging of the whole organism. But the good news is we can reverse that and certainly slow it and we can use them. So some of the things you're saying we hear a lot about in the ancestral community in terms of eliminating some of the potential allergens or infections that can initiate this inflammatory process. So that's the avoidance part. But in your protocol, maybe we can start to get into the diet, you're actually adding nutrients and you're adding things that you say overcome some of the weakness or strain on the mitochondria and build the mitochondria. How does that work? How does diet help restore your mitochondria? It's super interesting. I had gone paleo, no grain, no dairy, and still no lagoons and still declined. The magic happened and had all these supplements decline more slowly, still decline. When I went back and said, okay, where are these foods, where are these ingredients of the food supply? Man, that's when the magic happened in surprisingly rapid space. And I'm eating huge amounts of green leafy vegetables. For the first four years, if I didn't get my extraordinary amount of green leafy vegetables in about 36 hours, I could tell my cognition was not as clear, my energy was not as good. Super interesting. And I was feeling well that I could travel to do lectures, like the one that you saw at Harvard. So I travel with cabbage, I travel with green drinks because I see a huge amount of non-starchy vegetables. Now I'm a little more ketogenic. I have more resilience because I'm further into my recovery. And so I still eat a lot of green leafy vegetables, but if I don't get my three cups of greens every day, I can go to a scientific conference and I'm not having cognitive problems. I could not have done that in the first three years. You mentioned green leafy vegetables in your protocol. I think you have three different categories at least of vegetables. Can you talk about that? Yeah. So we'll talk about the ads. When I use this concept in my clinic, I stress with my vets that we do the ads first because it's easier to add than subtract. So the goal is nine cups of vegetables. And I'd say like, is that per month or per week? So no, no, that's per day. Three cups of green leafy vegetables, three cups of sulfur rich in the cabbage, onion and mushroom family, and that in three cups of deeply colored like carrots, beets, berries. The green leafy are a great source of calcium magnesium, vitamin K, and your gut bacteria will metabolize into a more active form of vitamin K that we need. And we know the animal models, vitamin K is very helpful for myelin and for brain stem cells. And was that why I was so sensitive to green leafy in the beginning? Perhaps the green leafies are also vital for retina health, eye health, and for cognition. The cabbage family, onion family, great sources of sulfur, very, very good for brain neurotransmitters, mushrooms, again, very good for brain neurotransmitters, and good for brain nerve growth factors. And we know in multiple studies that the more mushrooms you eat, the lower the rates of anxiety, depression, and cognitive decline. Deep colors, particularly blue, purple, black, very good again for cognition. And the lower cause, lower rates of all cause mortality, cancer, heart disease, diabetes, and obesity. So a lot of reasons to have those colors. Yeah, I think that that's, yeah, that's really helpful to have those three different categories, because they are all performing different functions, right? You really want to have some of each, the green leafies, the sulfur rich and the colors, right? And you want to have sufficient meat. A simple way to think about that is meat or fish, two palm-sized servings of meat or fish every day. And then you have your vegetables, as what is the other stuff that you eat. If you're a guy, or a tall lady, I'm six-foot tall, you should be able to get your nine cups in. If you're petite, then it's going to be proportionately less. It's not that you have to force yourself to eat food beyond your appetite. I don't want people to be hungry, but I want them to eat foods that are good for them. So first, we get them to eat all their vegetables, make sure they have enough meat, and that's it, then eat what you want. And what they discovered is, well, if they had all those vegetables in their meat, they weren't really hungry after that, and that was the goal. Now, people who are very petite, particularly my four-foot-ten ladies, they're having more like four to six cups of vegetables. So Teri, what specifically are we looking for in meat and fish? How is this helping? Well, for my vegetarian friends, their diets are low in branched chain amino acids, and that leaves them vulnerable to not having a protein in their diet, leaves them vulnerable to having sarcopenia, loss of muscle mass, and that will make insulin resistance metabolic syndrome much more likely. And so I'm wanting them to have meat for the complete protein. I'm wanting them to have plenty of carnitine. And if they're having liver, they're going to get coenzyme Q. They're going to get minerals, zinc, magnesium, copper that's readily and easily absorbed. And if you're getting minerals from plant sources, it's not quite as readily absorbed. The one nutrient that's not very plentiful in meat is vitamin C. And if you cook your meat, you tend to destroy all the vitamin C. And then I'm not going to be very enthusiastic about raw meat because of the risk of bacterial infection in parasites from raw meat. Our traditional societies, if you look at the, you know it, and the societies that are basically more carnivore have very little carbohydrate intake, those societies had a lot of fermented meat and a lot of raw meat. And that's not what, yeah, yeah. That's not what people are doing here in the U.S. I am certainly not what I feel comfortable recommending. Yeah. So within the communities that we, we both circulate, the ancestral community, people who are looking at paleolithic nutrition as inspiration, there's a lot of emphasis on grass fed meat, wild caught fish, and the, and there's reasons for this, right? And there's an emphasis on liver and bone breath, but there's some people who may have an aversion to some of these foods, the cost or availability may be limited. What do you say? Can you adapt this to people who either have financial limitations or some aversion to the tastes? Actually, Todd, that is a really good point. In my traumatic ranger clinic and in the therapy class, so when I got the VA, we often had people who were not working, who were disabled by their illness. They were shopping at small rural grocery stores in Iowa, so there's some food deserts. And so we in fact taught them how to do some beans and rice and some vegetarian meals. And we taught them that at least here in the Midwest, many communities have controlled hunts to deal with the overabundance of deer. So you could get venison for free. And many folks had friends and colleagues who were hunters and fishermen, so they could access meat and fish that way. We had classes on foraging and gardening to make it more affordable. We also talked about how the biggest problem is 40% of the food in the United States is thrown away. That's shocking. 40% of the food that we buy, either the groceries because we never get around to cooking it or we cook it and there's leftovers and we get around to eating them. And in the restaurants, foods are thrown away. So planning, learning how to cook, learning how to plan for leftovers so that you have a meal and you learn how to plan for leftovers and eat the leftovers. One, it saves time in terms of I only cook like three times a week because it takes time to cook. So I cook and I plan for leftovers. And a lot of our folks don't know how to plan. They don't know how to shop. They don't know how to plan for efficient cooking strategies so they can batch cook and not have to cook every day three times a day. And that makes doing the law's protocol much more affordable. That makes aid for health much more affordable in terms of the time burden and the cost burden. It sounds like you've done some education on this. Can you say a little bit more? Oh yeah. So in our clinics, we would have skills classes once a week. We have some cooking classes, meditation classes, movement classes. They teach people these skills because people aren't necessarily learning how to meal, plan, grocery shop, plan their menus. They aren't necessarily learning how to incorporate exercise into their daily routine. And we also had skills classes on how you grow your motivation because acquiring any new health behavior habit requires some effort. Just as extinguishing a habit that you want to stop requires some effort adding a new habit that you want to utilize requires some effort. So we're very upfront. We acknowledge that and then we have at our most popular skills classes were those about how we grow our internal motivation. And following on what you're just saying about the clinics and the information, is this available on your website and your book for people who want to learn some of these things? Yeah, we have a bunch of programs to give people more support for adapting the principles that we've been discussing. We have a lovely online course, the autoimmune and adventure master course, which by the way, we did a randomized controlled trials testing. Does access to the autoimmune and adventure master course need to reduce fatigue, improve quality of life? In fact, it did. We had we randomized people to either get immediate access or wait 12 weeks and then they got access. We followed everyone for 24 weeks. We had a masked statistician who did all the analyses and reached the conclusion. So that paper was just published. So I'm very excited. There are a bunch of courses out there, but I'm like the only one that does any research to show that the stuff that I say works actually works. So our online course works. The autoimmune and adventure master course, it's been shown to reduce fatigue, improve quality of life. Then the diets that we study was level one, level two. Again, I have been shown to reduce fatigue, improve quality of life, improve walking function and hand function. In several studies now, we have a ketogenic diet study that the study is too small for me to be able to say whether or not that was helpful. We have a larger ketogenic diet study and that we'll know at the end of 2026. We'll have all of our data. We'll be analyzing it and probably presenting it to hopefully in scientific variants in 2027. So Todd, you'll have to have me come back and then I can tell you all about that study. That's great. And now we're getting into, I think, one of the topics that's really interesting here, and that is your work on clinical trials, because your personal story is amazing. It's an end of one and you can probably work with a small group of people in clinics. But if you really want to transform medicine, if somebody's going to the neurologist and say, I heard about this great WALS protocol diet, the practitioners have to believe in it and their standard is to look at randomized control trials. And you've done a lot in that in the 10 years since I've heard you. Can you describe, first of all, give us an overview of what are the clinical trials you've done and then what is what are you about to do? Control trial is what you need to do. So you have the intervention compared to control group. Then you see, does the intervention, is it helpful? And we look at fatigue and quality of life as the primary outcomes. And then secondary outcomes have to do with walking hand, vision function, cognitive function. We've done seven trials. We're in our eighth clinical trial right now. In our earlier trials, some variation of the WALS diet has led to reduced fatigue, improved quality of life, and improvement in a variety of clinical functions that we measure walking and hand function. We are presently, and then I should say Todd, so we have a network meta-analysis, 12 studies looking at eight diets, a modified paleo, Mediterranean, low fat, ketogenic, anti-inflammation, fasting pattern, calorie restriction, and usual diet. There were 608 individuals in those 12 studies. And what we saw is for reducing fatigue, the paleo diet, Mediterranean diet, low fat diet, those three were helpful. Paleo diet being about 50% more effective than either Mediterranean or low fat. And then for improving quality of life for physical health and mental health quality of life, it was the paleo diet and the Mediterranean diet. And the paleo diet was twice as effective as the Mediterranean diet. And that was in neurology, the highest impact journal that is out there. And this is a recent, recently published study, right? The neurology study? Recent published, it was published about six months ago, six months earlier. And this is the one that compares the different diets? It compares different diets. And because it's a network meta-analysis, they're able to rank where they're most effective to least effective. And the journal had an editorial with a published that said, you know, we now have good evidence that diet really matters. And that people with MS should all be told that diet really matters. They should be referred to a nutrition professional who can help them improve their diet. They should eat more vegetables, less sugar, less processed food. And if one of these diet plans speaks to them, whether it's the Mediterranean, paleo diet, low fat diet, or even a ketogenic diet, or fast or intermittent fasting, they should be encouraged to improve their diet. So the, the walls protocol was one of those diets. Where did it come out, particularly as it, what was its main strength over the other diets? It was, it was the most effective. It was 50% more effective than either Mediterranean or low fat. It was twice as effective as the Mediterranean diet. And the modified period diet was the studies that we did basically that we're looking at level two of the walls protocol. Just to back up a little bit, this was how many people over how long a period of time, it sounds like a pretty big studies. So that is a, what they do is they combine all of the studies. So they combined to 12 studies. You had to have a diet intervention that lasts at least four weeks. And you need to have a randomized. So some of the studies were controlled with a control arm, and some were what we call parallel arms where they're combining compared to or more arms. And these were all MS patients? Were they primary progressive? MS confirmed by at least the McDonald's criteria of 2010 or 2006 or 2017. So neurology confirmed MS diagnosis. And was it relapsing remitting? There's a progressive MS? It could be relapsing remitting or it could be progressive MS. Wow. Well, this would be great reference to show to your neurologist if you're, if you're wanting to get to help there, right? And Todd, I will make sure you have a copy of both the network blood analysis link for that and a link for the company editorial that said, we now have good evidence that that matters and that everyone should be getting referral to nutrition profession. So we'll get you those. We can put it in our, in our show notes as a reference. I think that would be very helpful. Terry is a guide. Thank you. So maybe, I guess I just want to go back a little bit because it's amazing that you've done this many clinical trials. Was it hard in the beginning? Did you have a lot of resistance? Was it, was it hard to get funding for this? Because this, you don't get funding for these trials very easily if you're not selling a drug. So what's really helpful is that my chair of medicine at the university is a rheumatologist. So he understood that, you know, secondary progressive MS is a progressive disorder. He was thrilled to see me walk in. He hadn't seen me walking in four years. And he, in that first meeting in 2008, he said, Terry, I want you to write a case report because a single case report can change everything. It can change the direction of medicine. And so I like, on myself said, yes, work with your treating, neurologist, a physical therapist, but get that written up. So we wrote, I wrote it up and then he said, write a little case series, because by then we had a few, my physical therapist had a little case series going. So we wrote that up. And then he said, as I'm doing all this, write up the protocol is the next you're going to do at what's called a safety and feasibility study. And I said, well, you know, Dr. Rotham, that's not the kind of research that I do. I will get you the mentors. This is your assignment. This is what I need you to do, because what has happened is so important. We need to see can other people do what you did. And if they do what you did, what happens to them? So you got me the mentors. We took about a year to get the protocol written up, submitted. And with the changes that my, the committee that we use research required, it's going to have to raise about $100,000. And I thought, okay, well, this is going to be not going to happen. But I was able to convince the MP company to give me access to the electrical stimulation devices and the supplies for 20 people. And a group in Canada direct MS charity gave me $50,000 to cover the supplement costs and some testing costs that I need to do. And we're able to do the study. So the IRB said, do 10, give us the safety port and then you can do the next 10. And I found a PhD student who wanted to do this as her thesis dissertation project. So that was helpful. We did the first 10. We were ready to publish those findings. It took me two years to find a journal that would publish those findings. But, you know, and I was, I would present the findings at a scientific meeting in 2011. And it was not, so we had the manuscript ready in 2011. It wasn't until 2014 that was as able to get it published. But after we got the first one published, and by then we had the second 10 through. So we had our manuscript with 20 people in it. And we got that published in 2015. And then we were able to start, you know, our third clinical trial and our fourth clinical trial. And I went back to the group in Canada, they gave us some funding to do some more. By this time a small randomized controlled trial. So we got those going. And my book came out. In mind you, I have been banned as a speaker by the MSS side because they thought my message was dangerous. I had been giving a lecture to the medical school about what's like to have to be diagnosed with a progressive neurologic disorder and become progressively more disabled. And it was a very, very popular lecture, it was one of the highest rated lectures in the medical school curriculum. But when I was able to talk not about progressive disability, but about the fact that I became disabled, but you know what, I now bike and I could, you know, there's remarkable recovery. Then my talk became controversial. And I was pulled from the medical school curriculum. And all that happened in 2009. So I just kept going where I was invited. So I came out and spoke with the ancestral health symposium. And talking at regional conferences where I was invited. And then national conferences where I was invited. And we're submitting our research in our posters and our manuscripts. And we are, our work is slowly being cited by other folks. Then my book, I'd get the TED Talk in 2011 that goes viral, which probably annoys a lot of neurology, because that people are coming and saying, well, what about that doc in, you know, in Iowa? And then my book comes out in 2014 and is a bestseller, huge bestseller. And the MS society monitors social media. So they see that their constituents are now talking about the walls protocol, diet, meditation, exercise, self-care. And they decide they have to have a wellness conference. And they want to bring their scientists and patient advocates to talk about the gaps in the research. And they track me down and invite me and say, well, I'll come, but you have to unbanned me and I need that in writing. And they did. They unbanned me. It took them a couple hours. They got me unbanned. I rearranged my schedule. So I went and helped them understand that, yes, if we're going to make diet research and lifestyle research a priority, they have to have a different way, a different set of experts review the studies because this is a very different science than drug discovery study. They need people who do diet research. They need people who do exercise research and who do mindfulness research to review the proposals. So where is the MS society on this now? I think you've given talks there. Are they embracing this? They embrace it. So in 2016, they gave me a million dollars, or not me personally, the University of Iowa was awarded a million dollars to study a low-fat diet compared to the modified palliative diet. So basically the swank versus the walls diet. And that study showed that compared to the observation period, both swank and walls reduced fatigue, improved quality of life, and that walls was about 50% more effective than swank. But both were good. So if the swank diet speaks to you more than the walls diet, by all means do the swank diet because you'll be helped. If the walls diet speaks more, then do the walls diet. I think it's admirable that even though you're advocating the walls diet, you're not an absolutist and you make room for the fact that some people may want more keto, some a little bit more vegetarian or Mediterranean, and there's some, it's a framework, right? It's not a rigid, rigid in, you know, it just look at it again from an ancestral health perspective. If we accept that we can't we're originated in Africa, we migrate up to Europe, have a war, a hundred thousand year war within Neanderthals, assimilate them, and, you know, go into Asia, Australia, North South America, we eat a wide variety of foods, you know, from a wide variety of ecosystems. Clearly, there's not going to be one diet that is the only diet that works for us. And if we look at the, where we have people who have societies that people thrive to a hundred, there are a wide variety of dietary patterns where people can thrive to 100. There's never going to be one correct diet. There are many helpful diets. There's one terrible diet, and that's a diet high in added sugar and processed foods. So whatever progress you could make away from that terrible diet towards one of these better diets, that is, you know, I'm happy to endorse that. And I also tell my tribe that if you are finding someone who says there's only one diet, that is the indication that that process too much hoover, and they are incorrect. There will be just one diet. There are many diets that are helpful. Some diets may be more helpful for you than others. And it may be for my genes and for my microbiome, there's one or two diets that are most helpful for me. And there are three or four diets that are somewhat helpful. And there's one diet, the standard, what size diet, that is really terrible. Yeah. Well, listen, I think it's great that you went from there's a lot of skepticism and even being banned to being accepted, embraced, and now even getting an article published in a top journal like Neurology, which is top of the line, top tier. So you've definitely climbed that hill. And I guess I'd like to end by talking about where you're going next. You're recruiting for another clinical trial. Do you want to say something about that? Yeah. So we have a new trial, the efficacy of diet on quality of life and multiple sclerosis. People with relapsed humidity MS age 18 to 70, you'll must be willing to be randomized to the modified paleo diet, which is basically the wall's diet, or a time restricted, although ketogenic diet or usual diet. So that if you're eating, let's say you're a Mediterranean diet person, you have to be willing to be randomized and that you'll go keto or paleo. But if you're usually get to stay on your Mediterranean, if you're already on the wall's diet, you're like, okay, I want to be in this. And if you're randomized to the keto diet, you're like, okay, I'll go keto. But if you're in the usual care arm, you get to keep eating your wall's diet the way you want. Key is that you have to be willing to be randomized. Our primary measure of interest is can we reduce your fatigue, improve your quality of life. And then we'll also look at your mood. And we'll look at some functions, walking function, hand function, vision function, working memory. And then the thing that I'm really excited about time is because it's a two year study, we are looking at brain volume changes over two years. All of us who have MS as a group, our brains are shrinking at about 1% per year, or more, which is why we are at higher rates of frailty, needing assisted living, needing nursing home care. But we, it's my hypothesis. And this is because clinically, I see very consistently that people's mental clarity improve their mood improves their cognition and memory improve as they implement either one of these diets. So I actually am very hopeful that I can get people back to healthy rates of brain volume loss. And because I'm giving tips to the control group on how they can, you know, eat more of these radical things known as vegetables, and less processed foods, that I expect all three groups will improve. And I think it's quite possible that all three groups will get to healthy rates of brain volume loss. Or at least, yeah, it's very exciting. I think that will be the most interesting part of the study because the DMTs do a great job of turning off relapses. They do a great job of reducing the new enhancing lesions. They do not stop fatigue, anxiety, depression, or brain volume loss. And so if we're able to do, you know, have an impact on fatigue, anxiety, memory, and brain volume loss, that is huge. I love how it's combining the subjective, the functional, and even the biometric, you know, measures of brain volume loss. So you're actually going to be doing scans and quantifying brain atrophy. Are no contrast. So we have a little stronger magnet. There's no contrast. We get that baseline, get that at 24 months. And if your medical team gives you a little adamant or a mild relaxant so you can stay calm, because some people find it very anxiety-producing to be in a scanner, it's fine for you to take your usual relaxing medication before going into the scan. Where are you in the recruitment process? Do you still have openings for people to apply? We are approved to enroll 156. So that means basically I have about 50 to go. And I anticipate recruiting through the end of this year and probably into the first couple months of January. I'm hopeful, Todd, you can help me get another 50. I would love to do that. Can you say again, what are the criteria you have to meet? So you need to be between age 18 and 70, have relapsing, remitting, multiple sclerosis. If you're willing to come to Iowa at month zero, month three, month 24, you can live in Canada, the United States or Mexico. We do have several people from Canada. I think we have one person from Mexico. And you have to be willing to be randomized. This is great. So I think you've given us the information. If people want to learn more about this study, you go to terrewalls.com.com. Say that one more time. And we'll be sure to put that up. It's very exciting. So I guess in the final minutes, can you say anything else about what's next for Terry Walls? What's next in terms of projects? If you haven't been following me on Instagram, I think everyone should follow me on Instagram because then you can see what I'm eating and doing. That is lots and lots of fun. And if you go to terrewalls.com, be sure to sign up for my emails because there you get to see once a week I send out a research roundup where I discuss a couple of interesting papers that I've seen. And the things that I tend to discuss are studies that talk about things that are under our control. And that's diet, meditation, mindfulness, exercise. So what is the research showing in terms of how things under our control can influence disease progress? And again, I'll remind everyone, this is not just multiple sclerosis. This is anti systemic autoimmune disease. And it's probably also true for people with a neurologic problem, Parkinson's and cognitive decline. It's been super helpful for those people as well. Do you think it could help people with ME-CFS and COVID? So people with chronic fatigue syndrome, yes. For those folks, in general, we have them start and they take a much more gradual transition from their current diet and lifestyle into the walls protocol. So for them, we have them work on gradually adding the good stuff as they gradually remove the sugar and processed foods. In ideally, Todd, what you can do is find a practitioner with whom you can work who could help personalize all this and watch as you make these stepwise contributions or stepwise changes. Great. Well, this has been fantastic to talk with you today, Terry. You've had a long trajectory of starting from personal experience, expanding outward, doing clinical trials, writing books, helping so many people. It's a high interest to those of us in the ancestral health community. We hope to maybe have you speak at one of our future conferences too if you're up for it. Yes, I would love to do that. I would love to come back. It would be so much fun. All right. Well, thanks for talking with us today. Thank you. Thanks for joining us on this episode of Ancestral Health Today. We hope you enjoyed our discussion on how evolutionary insights can inform modern health practices. 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