Whither the Wahls protocol?

Published 1.15.2016
I first learned of Terry Wahls in her famous TEDx talk, which the TED people seem to have decided does not meet their standards, so there's a big red warning box on it at the beginning. I think the objections boil down to: this is anecdotal, she had no scientific evidence for her claims. In the video, she basically tells her tale of how she reversed the effects of multiple sclerosis (MS) using a "Paleo" diet. If you don't want to watch the video, you can read this, which might be her earliest reporting of her personal results. And of course, she's written a book, The Wahls Protocol.

Reading the paper on her experience made me wonder if her protocol was ever actually proved in a trial. The studies are ongoing, so there is only preliminary results. As her protocol attacks multiple variables at once, and so the skeptics will never accept the results anyway. I listened to Wahls presentation at the 2013 "Evolution in Medicine Summit." Overall, unfortunately, that summit was mostly "woo on parade." I also read through her responses she gave at a Reddit "Ask me anything (AMA)." Loathe as I am to link to Reddit, she didn't duck some very tough questions.
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And it does sound like she is having adherence problems. No treatment works if patients can’t adhere to it. Wahls does not take people in her trials off their medications, just like Esselstyn's heart intervention does not. To do so would be unethical. However, that means that skeptics will always assert that it was the drug, not the diet that made the difference. That might change if she can get the subjects off the drugs. I don’t even know if Wahls herself is drug free at this point. She does seem to have passed through the “honeymoon” period and is still mobile. The honeymoon period in a treatment (as I understand the term) is similar to the placebo effect. In other words, a major change is made, and a patient feels better— just due to having made a change and having expectations that the change will have a positive effect. However, such benefits don’t typically last for very long— and for the record, drug treatments, at in in MS, also experience honeymoon periods too. I should link to where I read this, but it was a comment at a skeptic blog a couple years ago, and I have neither the time nor the inclination to search for it. Here is one MS sufferer’s account of the honeymoon.

Do people overstate what she’s done? Yes. (And to be fair, the linked snarky post is mostly complaining the claims made in an article written about her, rather than claims she's actually made.) Does she benefit from that, yes. But in the end her basic message is to eat a diet high in the micronutrients that are important for the brain, which hardly seems outlandish. She also uses electric stimulation of muscles and doesn't try to hide that fact. In short, she’s a physician trying to treat people with every tool she has INCLUDING pharmaceuticals. The “enlightened” disdain for her efforts makes no sense to me.

Frankly, most of her efforts fall into the “won’t do harm” category. That doesn’t mean her protocol will heal or reverse MS, but at least it won’t do any harm to those who choose to follow it. Seriously people. She wants MS sufferers to eat more vegetables. How is this a horrible thing? Her advice for the dairy and gluten restriction are meant (she claims) to eliminate potential sensitivities. Neither dairy nor gluten is an essential nutrient, you can live a long happy life without either. Many, many people are lactose intolerant. That’s simply a fact. The gluten sensitivity thing is on shakier ground, but in the AMA, she said that after a 3 month complete elimination, dairy and gluten (and anything else) could be added back if there was no change in condition. However, if you fill your plate with 3 cups of vegetables at each meal, there’s going to be less room for other items. In that sense, it’s a bit like the Volumetrics Diet.

Of course, her seeming embrace of “complementary or integrative” medicine will automatically disqualify her in the eyes of some. I agree it would be better to get published in better quality journals, but the state of the work isn’t there yet. The first paper published from her research was published in the in the Journal of alternative & complimentary Medicine, and the full text is online for free. The point of the study was to see if people would adhere to the protocol. Fatigue symptoms improved in people who followed the protocol.

Should she have remained silent rather than sharing her experience? No, I don't think so. She’s found a potentially interesting effect that deserves further study. But as with all lifestyle shifts, a double blind study isn’t going to be feasible. If that’s your criteria for credibility, then you preclude even the possibility that lifestyle shifts could make the difference.

For the record, I am no fan of the "Paleo" diet, as it is overly restrictive and the result of a faulty understanding of the evidence relating to paleolithic humans.

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