testing the effect of nutrition and lifestyle ...• mori k, obara y, hirota m, azumi y, kinugasa s,...
TRANSCRIPT
Testing the Effect of Nutrition and Lifestyle Interventions to
Treat MS and Other Progressive Health Problems
Terry Wahls MD IFMCP
Clinical Professor of Medicine
University of Iowa
Disclosuresbull Grant Funding ndash
ndash National MS Society
bull Trademarks ndash Wahlstrade Diet Plans Wahls Protocolreg
bull Financial relationships with Penguin Random House Inc Integrative Medicine for Mental Health Institute for Health and Healing Suttler Pacific BioCeuticals NCURA MCG Health Inc Genova Diagnostics
bull Minding My Mitochondria
bull Wahls Protocol Wahls Protocol Cooking for Life
bull Equity interest ndash Dr Terry Wahls LLC
ndash The Wahls Institute PLC
ndash wwwterrywahlscom
Objectives- Review
bull The published research on dietary interventions for MS
bull The mechanisms by which dietary factors may contribute to potential worsening of MS related symptoms
bull The rationale for the structure of the dietary intervention in the Dietary Approaches to Treating MS Related Fatigue Trial NCT02914964
bull At present there are no dietary recommendations in the Evidence Analysis Library for treatment of neuroinflammation or neurodegeneration by the Academy of Nutrition and Dietetics
How many cups of vegetables did you eat in last 24 hours
In 2000 I Became A Patient
bull Left leg weakness
bull Prior history visual dimming
bull Lesions in spinal chord
bull Abnormal CSF
bull Diagnosis relapsing-remitting MS
2003
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Disclosuresbull Grant Funding ndash
ndash National MS Society
bull Trademarks ndash Wahlstrade Diet Plans Wahls Protocolreg
bull Financial relationships with Penguin Random House Inc Integrative Medicine for Mental Health Institute for Health and Healing Suttler Pacific BioCeuticals NCURA MCG Health Inc Genova Diagnostics
bull Minding My Mitochondria
bull Wahls Protocol Wahls Protocol Cooking for Life
bull Equity interest ndash Dr Terry Wahls LLC
ndash The Wahls Institute PLC
ndash wwwterrywahlscom
Objectives- Review
bull The published research on dietary interventions for MS
bull The mechanisms by which dietary factors may contribute to potential worsening of MS related symptoms
bull The rationale for the structure of the dietary intervention in the Dietary Approaches to Treating MS Related Fatigue Trial NCT02914964
bull At present there are no dietary recommendations in the Evidence Analysis Library for treatment of neuroinflammation or neurodegeneration by the Academy of Nutrition and Dietetics
How many cups of vegetables did you eat in last 24 hours
In 2000 I Became A Patient
bull Left leg weakness
bull Prior history visual dimming
bull Lesions in spinal chord
bull Abnormal CSF
bull Diagnosis relapsing-remitting MS
2003
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Objectives- Review
bull The published research on dietary interventions for MS
bull The mechanisms by which dietary factors may contribute to potential worsening of MS related symptoms
bull The rationale for the structure of the dietary intervention in the Dietary Approaches to Treating MS Related Fatigue Trial NCT02914964
bull At present there are no dietary recommendations in the Evidence Analysis Library for treatment of neuroinflammation or neurodegeneration by the Academy of Nutrition and Dietetics
How many cups of vegetables did you eat in last 24 hours
In 2000 I Became A Patient
bull Left leg weakness
bull Prior history visual dimming
bull Lesions in spinal chord
bull Abnormal CSF
bull Diagnosis relapsing-remitting MS
2003
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
bull At present there are no dietary recommendations in the Evidence Analysis Library for treatment of neuroinflammation or neurodegeneration by the Academy of Nutrition and Dietetics
How many cups of vegetables did you eat in last 24 hours
In 2000 I Became A Patient
bull Left leg weakness
bull Prior history visual dimming
bull Lesions in spinal chord
bull Abnormal CSF
bull Diagnosis relapsing-remitting MS
2003
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
How many cups of vegetables did you eat in last 24 hours
In 2000 I Became A Patient
bull Left leg weakness
bull Prior history visual dimming
bull Lesions in spinal chord
bull Abnormal CSF
bull Diagnosis relapsing-remitting MS
2003
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
In 2000 I Became A Patient
bull Left leg weakness
bull Prior history visual dimming
bull Lesions in spinal chord
bull Abnormal CSF
bull Diagnosis relapsing-remitting MS
2003
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
2003
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
copyright 2010 Terry Wahls all rights reserved
2007
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Institute For Functional Medicine
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
11
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
copyright 2010 Terry Wahls all rights reserved
2008
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
The Swank Diet
bull N=144 followed 50 years
bull lt 15 grams saturated fat vs gt 20 grams
bull Greatest benefit earlier in the disease course
bull More likely to remain ambulatory
Review of MS patient survival on a Swank low saturated fat dietNutrition 2003 Feb19(2)161-2 ReviewEffect of low saturated fat diet in early and late cases of multiple sclerosisLancet 1990 Jul 7336(8706)37-9Multiple sclerosis twenty years on low fat dietArch Neurol 1970 Nov23(5)460-74
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial
bull This was a randomized-controlled assessor-blinded one-year long study
bull N=61
bull No change in EDSS MRI
bull Trend towards reduced FSS (fatigue)
Low-fat plant-based diet in multiple sclerosis A randomized controlled trial Mult Scler Relat Disord 2016 Sep980-90
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Mediterranean diet adherence and risk of multiple sclerosis ndash Case control study
bull N=70 RRMS 140 controls Interviews re diet
bull Reduced risk of MS
ndash Fruits (OR=028 95 CI 012-063 p-value 0002)
ndash Vegetables (OR=023 95 CI 010-053 p-value 0001)
Mediterranean diet adherence and risk of multiple sclerosis a case-control study Asia Pac J Clin Nutr 201625(2)377-84
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Mediterranean Diet bull High olive oil
bull High vegetable polyphenol
bull Whole grains
bull Low red meat
Potential for diet to prevent and remediate cognitive deficits in neurological disordersNutr Rev 2018 Mar 176(3)204-217The Role of Diet in Multiple Sclerosis Mechanistic Connections and Current EvidenceCurr Nutr Rep 2018 Aug 16Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory DiseasesEndocr Metab Immune Disord Drug Targets 201818(1)36-50
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
bull The following slides represent the rationale for the dietary intervention we are studying in the Dietary Approaches to Treating MS Related Fatigue
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
bull This protocol is not validated nor does it currently meet the current evidence based guideline criteria as set forth by the American Academy of Neurology or the Academy of Nutrition and Dietetics
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Dairy amp MSCasein Gluten amp Schizophrenia
bull Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0836) across 27 countries and 29 populations
bull IgG to Casein and gluten were significantly uarrin recent onset and non-recent onset schizophrenia compared to controls (ple000001-0004)
1 Correlation between milk and dairy product consumption and multiple sclerosis prevalence a worldwide
study Neuroepidemiology 199211(4-6)304-12
2 Severance EG Alaedini A Yang S Halling M Gressitt KL Stallings CR Origoni AE Vaughan C
Khushalani S Leweke FM Dickerson FB Yolken RH Gastrointestinal inflammation and associated
immune activation in schizophrenia Schizophr Res2012 Jun138(1)48-53
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Gluten and Casein and Opioids
bull Gluten can be degraded into several morphine-like substances named gluten exorphins
bull Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 and exerts its influence on nervous digestive and immune functions via the opioid receptor
1 The opioid effects of gluten exorphins asymptomatic celiac disease J Health PopulNutr 2015 Nov 243324
2 Opioid receptor ligands derived from food proteins Curr Pharm Des 20039(16)1331-44
3 β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis Peptides 2014 Dec62144-9
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Nutrition in Parkinsons Disease
Seidl SE Santiago JA Bilyk H Potashkin JA The emerging role of nutrition in Parkinsons disease Front Aging Neurosci 2014 Mar 7636 doi 103389fnagi201400036 eCollection 2014
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Gluten sensitivity is an abnormal immune response to gluten in genetically susceptible individuals and may manifest solely with neurological dysfunction 90 of gluten sensitive individuals have no GI symptoms
Lancet Neurol 2010 Mar9(3)318-30 Hadjivassiliou M
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivity can be seen in these four patients (AndashD) A and C show diffuse white matter changes whereas B and D show more f
Marios Hadjivassiliou David S Sanders Richard A Gruumlnewald Nicola Woodroofe Sabrina Boscolo Daniel Aeschl
Gluten sensitivity from gut to brain
The Lancet Neurology Volume 9 Issue 3 2010 318 - 330
httpdxdoiorg101016S1474-4422(09)70290-X
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
MS and Gluten References 1 Gluten antibodies in patients with multiple sclerosis Hum Nutr Appl
Nutr 1984 Apr38(2)142-32 Multiple sclerosis and gluten sensitivity Clin Neurol Neurosurg 2007
Oct109(8)651-33 Prevalence of celiac disease in multiple sclerosis BMC Neurol 2011 Mar
711314 Celiac disease with neurologic manifestations in children Rev Med Chir
Soc Med Nat Iasi 2013 Jan-Mar117(1)88-945 Celiac disease with cerebral and peripheral nerve involvement
mimicking multiple sclerosis J Med Life 2014 Sep 157(3)440-4 Epub2014 Sep 25
6 A case of multiple sclerosis and celiac disease Case Rep NeurolMed 20132013576921
7 Gluten-related disorders gluten ataxia Dig Dis 201533(2)264-88 Transglutaminase-6 is an autoantigen in progressive multiple sclerosis and
is upregulated in reactive astrocytes Mult Scler 2016 Dec 11352458516684022
9 The progression of coeliac disease its neurological and psychiatric implications Nutr Res Rev 2017 Jun30(1)25-35
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Risks of Eggs
bull Prosndash Grass fed - DHA choline biotin lutein Vitamins A D K2 and
B3 B6 B9 B12
bull Cons ndash Eggs are most common food allergen in IBD gt70ndash 60 allergy patients have IgG Ab to eggsndash 13 seasonal allergies have IgG Ab to eggs ndash Wheat milk eggs are common food triggers to Eosinophilic
Esophagitis
References next slide
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
References Risks of Eggs bull Wang G Ren J Li G et al The utility of food antigen test in the diagnosis of Crohnrsquos disease
and remission maintenance after exclusive enteral nutrition Clin Res Hepatol Gastroenterol 201842(2)145-152 doi101016jclinre201709002
bull Shakoor Z AlFaifi A AlAmro B AlTawil LN AlOhaly RY Prevalence of IgG-mediated food intolerance among patients with allergic symptoms Ann Saudi Med 2016 Nov-Dec36(6)386-390
bull Dhanapala P De Silva C Doran T Suphioglu C Cracking the egg An insight into egg hypersensitivity Mol Immunol 2015 Aug66(2)375-83 doi 101016jmolimm201504016
bull Pang KA Pang KP Pang EB Tan YN Chan YH Siow JK Food allergy and allergic rhinitis in 435 asian patients - A descriptive review Med J Malaysia 2017 Aug72(4)215-220
bull Philpott H Nandurkar S Royce SG Thien F Gibson PR Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis A comprehensive prospective study using five modalities Aliment Pharmacol Ther 2016 Aug44(3)223-33 doi 101111apt13676
bull Cai C Shen J Zhao D et al Serological Investigation of Food Specific Immunoglobulin G Antibodies in Patients with Inflammatory Bowel Diseases Boone DL ed PLoS ONE 20149(11)e112154 doi101371journalpone0112154
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Lectins
bull ldquoBy eliminating dietary elements particularly lectins which adversely influence both enterocyte and lymphocyte structure and function it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RArdquo
Cordain L Toohey L Smith MJ Hickey MS Modulation of immune function by dietary lectins in rheumatoid arthritis British Journal of Nutrition 200083(03)207-217
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
bull Lectins are proteins found in plants and animals that bind sugars (hemagglutinins)
bull They can bind the glycoproteins on the intestinal lining leading to barrier damage
bull Lectins are found in most foods but are especially high in grains (esp wheat) dairy legumes and nightshade vegetables
bull Most traditional methods cooking these foods such as soaking ferment-ing amp cooking will decrease the lectin content
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Nutrient Triage
bull Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage
ndash Zn Mg biotin Vitamin K D A
ndash Lipoic Acid Acetyl carnitine
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triageProc Natl Acad Sci U S A 2006 Nov 21103(47)17589-94
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
What to Eat
Fruit and vegetable consumption and mortality from all causes cardiovascular disease and cancer systematic review and dose-response meta-analysis of prospective cohort studies
16 studies - 833234 participants
BMJ 2014 349 g4490
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
BMJ 2014 349 g4490
Risk of all cause mortality associated with servingsday of fruit and vegetables
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Dose-response relation between fruit and vegetable consumption and risk of all cause mortality
BMJ 2014 349 g4490
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Myelin
ndash Omega 3 Fatty Acids
ndash Thiamine (B1)
ndash Folate (B9)
ndash Cobolamin (B12)
ndash Minerals
Key Micronutrients
Bourre JM Effects of nutrients (in food) on the structure and function of the nervous
system update on dietary requirements for brain Part 1 micronutrients
Part 2 Macronutriients
J Nutr Health Aging 200610(5)377-85
Bowman Nutrient biomarker patterns cognitive function and MRI measures of
brain aging Neurology 2012 Jan 2478(4)241-9 Bowman
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Sulfur Rich Foods
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Why Brassica and Allium
bull Improve detoxification
bull Increase glutathione production
bull Increase GABA production
bull Enhance Neuroprotection
bull Improve endothelial function
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Brassica and Allium References
1 Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimers Disease Med Cell Longev20152015781938
2 Learning and memory promoting effects of crude garlic extract Indian J Exp Biol2013 Dec51(12)1094-100
3 Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract Arch Physiol Biochem2015 Feb121(1)19-25
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Why Emphasize Mushrooms
bull Increase nerve growth factors (NGF)
bull Hericium erinaceus (Yamabushitake or Lionrsquos Mane) stimulate the production of NGF (in vitro)
bull Activate natural killer cells
bull Prime innate and adaptive immunity
bull Mori K Obara Y Hirota M Azumi Y Kinugasa S Inatomi S Nakahata N Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human
astrocytoma cells Biol Pharm Bull 2008 Sep31(9)1727-32
bull Lee DH Kim HW Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway Int J Med Mushrooms 201416(1)1-16
bull Akramiene D Kondrotas A Didziapetriene J Kevelaitis E Effects of beta-glucans on the immune system Medicina (Kaunas)200743(8)597-606
bull Lai PL Naidu MSabaratnam VWong K DaviP Kuppusamy UR Abdullah N Malek SN Neurotrophic properties of the Lions mane medicinal mushroom
Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms201315(6)539-54
bull Phan CW David P Naidu M Wong KH Sabaratnam V Therapeutic potential of culinary-medicinal mushrooms for the management of
neurodegenerative diseases diversity metabolite and mechanism Crit Rev Biotechnol201535(3)355-68
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Why Greens
bull Vitamin K1 metabolized to K2-mk7 in gut
bull K2 important in hellip
ndash Myelin production
ndash Calcium influx into bones and teeth
bull Carotenoids magnesium
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Greens References
1 Age- and brain region-specific effects of dietary vitamin K on myelin sulfatides Nutr Biochem2010 Nov21(11)1083-8
2 Vitamin K and sphingolipid metabolism evidence to date Nutr Rev2005 Apr63(4)111-21
3 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 1 micronutrients J Nutr Health Aging 2006 Sep-Oct10(5)377-85
4 Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system update on dietary requirements for brain Part 2 macronutrients J Nutr Health Aging 2006 Sep-Oct10(5)386-99
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Why deeply pigmented
bull Pigments (especially bluepurpleblack) are associated with improved cognitive performance and neuroprotection
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Blueberries and Mild Cognitive Impairment (MCI)
bull N = 47 with MCI 68 yo + Blueberry powder vs placebo 16 weeks equivalent of 1 cup berries
bull There was improvement in cognitive performance and brain function compared with placebo
bull N=94 62 to 80 yo with memory complaints bull Fish oil + blueberries vs fish oil + placebo 24 weeksbull The blueberry-supplemented participants had a better sense of
well-being fewer memory mistakes and were less inefficient
Krikorian R Shidler MD Nash TA Kalt W Vinqvist-Tymchuk MR Shukitt-Hale B Joseph JA Blueberry supplementation
improves memory in older adults J Agric Food Chem2010 Apr 1458(7)3996-4000
Funding for the studies was provided by the US Highbush Blueberry Council the National Institute on Aging
and Wild Blueberries of North America Dr Krikorian has disclosed no relevant financial relationships
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Pigment amp Blueberry References1 Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health
Scientifica (Cairo)201620163109254
2 Berry antioxidants small fruits providing large benefits J Sci Food Agric2014 Mar 3094(5)825-33
3 Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia Recent Pat Food Nutr Ag 2013 Aug5(2)128-43
4 The impact of fruit flavonoids on memory and cognition Br J Nutr2010 Oct104 Suppl 3S40-7 d
5 Grape juice berries and walnuts affect brain aging and behavior J Nutr 2009 Sep139(9)1813S-7S
6 Fruit polyphenolics and brain aging nutritional interventions targeting age-related neuronal and behavioral deficits Ann N Y Acad Sci2002 Apr959128-32
7 Reversing the deleterious effects of aging on neuronal communication and behavior beneficial properties of fruit polyphenolic compounds Am J ClinNutr2005 Jan81(1 Suppl)313S-316S
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Why Organ Meat
bull Pre-industrial - 30 of all meat consumed was organ meat
bull Excellent source of ubiquinone minerals essential fatty acids fat and water soluble vitamins
ndash Retinol Vitamin A
ndash Vitamin K2-mk4
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
β-carotene Is Not Retinol (Vitamin A)
bull β-Carotene is converted to vitamin A in the intestine by the enzyme β-carotene-1515-monoxygenase (BCMO1) to support vision reproduction immune function and cell differentiation
bull Considerable variability in BCMO1 exists and can effect individual vitamin A status
Lobo GP Amengual J Baus D Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX J Biol
Chem2013 Mar 29288(13)9017-27
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Leung WC Hessel S Meacuteplan C Flint J Oberhauser V Tourniaire F Hesketh JE von Lintig J Lietz G Two common
single nucleotide polymorphisms in the gene encoding beta-carotene 1515-monoxygenase alter beta-carotene
metabolism in female volunteers FASEB J 2009 Apr23(4)1041-53 doi 101096fj08-121962 Epub 2008 Dec 22
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Figure 1 The two routes by which diet can influence our health (A)
the metabolism of our cells and (B) the population of our gut
microbiota
Paolo Riccio and Rocco Rossano ASN Neuro
201571759091414568185
Copyright copy by SAGE Publications Inc or the American Society for Neurochemistry unless
otherwise noted Manuscript content on this site is licensed under Creative Commons Licenses
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Total number of microbiome-related publications in PubMed by year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
year 199719981999200020012002200320042005200620072008200920102011201220132014201520162017
Articles
Articles
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Gut Brain Immune Axis
bull Gut microbiota influence the brain and immune system balance
bull Diet influences the microbiome strongly
bull Exercise sleep stress level also important
bull Changes in the colon mucosa every early in the disease process
1 Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology J Immunol Res 20172017790482
2 The multiple sclerosis microbiome Ann Transl Med 2017 Feb5(3)533 Microbiota-gut-brain axis and the central nervous system Exp Mol Med 2017 May 2649(5)e3394 Microbiota-gut-brain axis and the central nervous system Oncotarget 2017 May 105 Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med 2017 May 49(5) e3406 Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol Neuroimmunol
Neuroinflamm 2017 Jun 144(4)e362
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Life Begins in the Ocean
54
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Life Timeline Billions of Years
Going back in time Billions of years bull 45 Water bull 40 Simple life bull 30 Photosynthesis bull 25 Oxygen crisis bull 15 Mitochondria Multi-cellularbull 05 (500 Million) Land plants animals bull 02 (200 Million) Mammals bull 000025 (250 Thousand) Humansbull 000001 (10 Thousand) grains and legumes
55
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Our Human Ecosystem Began In The Ocean
copy Dr Terry Wahls LLC All Rights Reserved 56
By Tiago Fioreze -httpscommonswikimediaorgwindexphpcurid=6111892
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
bull We have co-evolved with the organisms that were in the ocean
bull Microbes divide every 20 minutes (1 billion years)
ndash Billions of generations
bull Humans every 25 years (250000 years)
ndash 10000 generations
57
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Guts Populated by Ocean Microbiome
bull Co-operative mutualistic relationship
bull We are all supra-organisms ndash as dependent on the microbes as our cells are upon our mitochondria to function
copy Dr Terry Wahls LLC All Rights Reserved 58
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager- Hunter 500000 BC Main Cause of death -Infection trauma Mean age 30s
45 mortality before age 15
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Population and Development Review33(2007)321-65 Kaplan
Forager-Hunter 2007Traditional diet no medical careMain cause of deathInfection trauma
Often live into 60s and 80s
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Forager-Hunter to Farmer -10000 BC uarr fertility infection darrheight
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Industrial Revolution 1800suarr sugar white flour darr breast feeding
uarr obesity heart disease diabetes
Investig Genet 4 (2013)10 Sajantila Am J Prev Med 37
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Sugar intake per capita in the United Kingdom from 1700 to 1978 (30 31 ) and in the United
States from 1975 to 2000 (32 diams) is compared with obesity rates in the United States in non-
Hispanic white men aged 60ndash69 y (17 bull)
Johnson R J et al Am J Clin Nutr 200786899-906
copy2007 by American Society for Nutrition
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copyright copy 2016 Dr Terry Wahls All rights reserved
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation
Clin Ther 2015 May 137(5)984-95
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
8 Studies 250 Patient Fecal Samples
van den Hoogen WJ1 Laman JD2 t Hart BA23Modulation of Multiple Sclerosis and Its Animal Model Experimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol 2017 8 1081
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Fiber Grams Day bull Westernized society 15 grams
bull Target - 30 grams
bull Study Diet 50 grams
bull Hunter Gatherer 100 to 150 grams
bull Feed your bacterial friends more fiber
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Kombucha Mature by Mgarten at the English language Wikipedia Licensed under CC BY-SA 30 via Commons
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
More Vegetables
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Favorable Nutrient Profiles
bull Fermented food
ndash Microbiome
bull Seaweed
ndash Iodine alginates
bull Nutritional yeast
ndash B vitamins minerals
bull Algae
ndash Carotenoids detoxification
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
BristolStoolChart by Cabot Health Bristol Stool Chart - httpcdnintechopencompdfs-wm46082pdf Licensed under CC BY-SA 30 via Commons -httpscommonswikimediaorgwikiFileBristolStoolChartpngmediaFileBristolStoolChartpng
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Human Feces by User Cacetudo on enwikipedia - Own work Licensed under CC BY-SA 25 via Commons -httpscommonswikimediaorgwikiFileHuman_FecesjpgmediaFileHuman_Fecesjpg
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Modified Paleolithic Diet
Home Exercise Program
+
Neuromuscular Electrical Stimulation
Vitamins amp Nutritional supplements
Stress Management
Multimodal Intervention
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Study Diet
Food Instruction Servings
Green leafy vegetables Recommended3 cups cooked6 cups
raw=3srvg
Sulfur-rich vegetables Recommended3 cups raw or cooked=
3srvg
Intensely colored fruits or
vegetablesRecommended
3 cups raw or cooked =3
srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded
Eggs Excluded
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Stop processed foods gluten dairy eggs
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Nutritional Adequacy (RDA) US Diet Vs Study Diet
0 100 200 300 400 500 600 700 800 900
Riboflavin
Thiamin
Vitamin B12
Vitamin B6
Niacin
Vitamin C
Vitamin A
Iron
Folate
Zinc
Magnesium
Vitamin E
Calcium
Vitamin D
US Diet
Wahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Methyl B12 Methyl Folate Vitamin D Fish Oil
httpvitaminreviewsitecomwp-contentuploads201304natural-Vitaminsjpg
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Stretching Exercises
Gastro-soleus
Hamstring
Quadriceps
Erector spinae
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Electrical Stimulation of Muscles
Builds Muscle Mass
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
20 individuals (18 SPMS 2 PPMS)
Age 517 (+ 64) years
Baseline EDSS 62 (+1)
Fatigue Severity Scale Score 55 (+ 12)
Subject Demographics
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Average daily servings of the study diet recommended (vegetablesfruits) and excluded (glutendairyeggs) foods
p lt 001 difference from baseline to 12 months
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Side effect ndash Overweight and obese subjects lost weight and got to a healthy weight
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
-200 0 200 400 600 800 1000 1200
Retinol
Vitamin B9 (folic acid)
Vitamin K
Alpha Carotene
Iodine
Docosahexaenoic Fatty Acid (DHA)
Percent Change in Intake
Significant Changes in Micronutrient Intake
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
plt00005
plt 005
Multimodal intervention improves quality of life
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Mood and Cognition
90
In the setting of progressive MSImproved thinking ability and
reduced anxiety and reduced depression
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Average scores on the mood measuresat each study visit
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Average scores on the DKEFS and WAIS subscales at each study visit
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Associations Between Adherence and Outcomes P values
Variables 0 to 12 months
Mood BDA BDI
Cognition Verbalreasoning
Fatigue
Vegetables fruits 00001 lt00001 lt00001
Gluten dairy egg free
0001 0005 lt00001
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Relapsing Remitting MS
94
In the setting of relapsing-remitting MS Reduction of fatigue and improved motor function
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Herorsquos Journey
bull Struggle adversary facing individual society
bull Hero leaves to learn some key point to overcoming the struggle adversary
bull Returns to engage in the struggle
bull Religious mythical stories across time and space
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Alzheimerrsquos Disease
99
Reversal of early and moderate dementia usingfunctional medicine approach
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Bredesen et al J Alzheimers Dis Parkinsonism 2018 85 DOI 1041722161-04601000450
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Subject 3- Baseline and 12 Month Walk
SPMS TUG-127 secFSS-56
SPMS TUG-418 secFSS-44
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Subject 17- Baseline and 3 Month Walk
PPMSTUG-21 secFSS-67
PPMSTUG- 153 sec with one cane
176 sec without cane FSS-49
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Subject 11- Baseline and 3 Month Walk
SPMS TUG-149 secFSS-53
SPMS TUG- 86 secFSS-14
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Subject 11- 6 months
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
How many cups of vegetables did you eat in last 24 hours
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls
Copies of papers
wwwterrywahlscompapers
One page summary
wwwterrywahlscomdiet
bull Instagram
ndash drterrywahls
bull Facebook
ndash Terry Wahls MD
bull Twitter
ndash TerryWahls