Multiple Sclerosis

The stress and pressure of medical school may have been what triggered my first symptoms in 1980, years before I had any idea what they were. I would eventually call them “zingers”—intense stabs of facial pain. They lasted just a moment and would come randomly, sometimes in waves, the episodes building over a week or two and then gradually fading over the next several. They were most likely to happen during my busiest and most brutal hospital rotations, with shifts lasting thirty-six hours and allowing for little sleep. Over the years they became steadily worse, like electrical pain that felt like a 10,000-volt cattle prod sticking me in the face.

[...]

This was my first symptom, but it was not likely the moment when multiple sclerosis began its relentless march through my central nervous system. For at least a decade before then, probably two, my brain and spinal cord had been under siege from friendly fire—my own immune system attacking the myelin that insulated my nerves. I couldn’t feel it at first. I couldn’t feel it for years. Nevertheless, it was happening.

[...]

Many people who are ultimately diagnosed with multiple sclerosis go through a similar experience. Symptoms develop slowly over years, and diagnosis may take additional years once physical problems manifest and become obvious.

I spent the next few weeks going through test after test, dreading each result. Some tests involved flashing lights and buzzers. Others involved more electricity and more pain. There were more blood tests. I said little and feared much. Everything came back negative, but there was clearly something wrong with me.

Finally, we were down to the last test: a spinal tap. If there were oligoclonal-band proteins (an indicator of excessive amounts of antibodies) present in the spinal fluid, then the diagnosis would be multiple sclerosis. But if this test was also negative, then I likely had what they call “idiopathic degeneration of the spinal cord” (meaning they don’t know the cause). In the long list of potential diseases I had faced, this seemed like the best option. I was hopeful.

When I got up the next morning, I knew that the results should be in my chart. I could get into the clinic medical records from my home computer through remote access. I brought up my medical record on the screen and went to the laboratory section. Positive. I stood up. I paced. Two hours later, I logged onto the system and checked again. Five times I looked up my results, hoping they would somehow change. They never did.

It was official: I had multiple sclerosis.

Wahls MD Terry and Eve Adamson: The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, 2014

Multiple Sclerosis

MS was first described by French physician Jean-Martin Charcot back in 1868, and although we’ve known about this condition for more than a hundred years, there is still a lot we don’t understand about how the disease gets started, how it progresses, and why. Although the majority of people with multiple sclerosis are diagnosed initially with relapsing-remitting multiple sclerosis, in which periods of disability come and go, within fifteen years of diagnosis, 80 percent will transition to the more severe form of the disease, secondary progressive multiple sclerosis, in which disability becomes permanent and inevitable in spite of therapy.

There are several theories about why someone develops multiple sclerosis, but MS is generally thought to be related to some genetic vulnerability that interacts with many unknown environmental factors. Numerous studies have shown that it is the interaction of multiple genes and the environment that determine whether someone will develop MS. There have been nearly a hundred genes identified that slightly increase the odds for getting MS. Yet no study has definitively identified precisely which problem is the cause of MS, or why the problem develops in the first place.

When the disease is triggered, immune cells begin attacking and damaging myelin and other parts of the brain, leading to shrinking brain and problems with balance, vision, and/or muscle strength. Over the years, as symptoms accrue, doctors are finally able to diagnosis these symptoms as multiple sclerosis.

The highest rates of MS are found in Europe, Canada, the United States, and southern Australia. Epidemiologic evidence suggests that people who develop this disease probably acquired an infection before the age of 15 that, because of a genetic vulnerability, was not completely cleared from the body. If the person who suffered from the infection is also exposed to particular environmental factors (whatever they might be) and is genetically vulnerable (in some way not clearly understood), the immune system will commence destruction to the brain and spinal cord. In other words:

Genetic vulnerabilities + Environmental triggers = Onset of MS

That appears to be the formula, and the more genes you have that put you at risk, the smaller the dose of environmental triggers you will require to develop the symptoms that will be ultimately diagnosed as multiple sclerosis. The disease may not rear its ugly head or show on the surface for decades, but inside the body the process of silent damage has already begun its inexorable march.

As the immune cells attack the myelin, which wraps around the wiring connecting cells in the brain and in the spinal cord, the transmission of information down the long arms of the nerve cells slows. As the damage to the myelin progresses, the nerve cells can become so damaged that they can no longer transmit information at all. When that happens, the loss becomes permanent.

Types of MS

According to current diagnostic criteria, there are now four subtypes of MS, categorized by the way in which the disease presents and progresses.

Most people—80 percent—will be initially diagnosed with relapsing-remitting multiple sclerosis, or RRMS. This form of the disease involves acute episodes of worsening symptoms, called relapses, which are followed by gradual improvements as the brain and spinal cord add sodium channels to the nerve cells, allowing them to transmit information again, albeit more slowly than before. In addition to the relapses, which have obvious symptoms, the person with RRMS will often develop silent lesions (lesions that have no apparent symptoms), which can be seen on MRI scans of the brain.

The majority of people diagnosed with RRMS will convert to a different form, called secondary progressive MS (SPMS), within twenty years of initial diagnosis. When that happens, the person often stops having acute relapses and remissions. Instead, there is a gradual worsening of the MS-related symptoms and increasing disability. There is only decline. (This is what happened to me.)

Approximately 10 to 15 percent of MS patients are initially diagnosed with another form called primary-progressive MS (PPMS). They never have acute worsening and remissions. They experience only a gradual decline from the beginning.

Another 5 to 10 percent will have progressive-relapsing MS (PRMS) and experience steady decline, with occasional superimposed attacks of worsening MS symptoms but without experiencing periods of improvement.

Conventional Treatment for MS

Because multiple sclerosis is an autoimmune disease, the mainstay of treatment is suppression of the immune cells with progressively more potent drugs.

Even if we take as truth the notion that genetic vulnerability plus environmental triggers equals MS, scientists are still seeking to understand the exact nature of the genetic vulnerabilities and why they are not all the same in every person with MS. There are some theories that currently influence treatment.

One theory is that multiple sclerosis is actually a vascular disease. Dr. Paolo Zamboni has described chronic cerebrospinal venous insufficiency (CCSVI) in the setting of multiple sclerosis and as the cause of MS. CCSVI is the narrowing of the veins that drain the brain. The consequence is that the backing up of pressure in the veins leads to an excess deposit of iron in the tissues, increasing inflammation and oxidative stress, thereby contributing to the development of MS symptoms.

Although the typical conventional treatment for MS often involves immune-suppressing drugs, Zamboni reports that doing angioplasty to open the blockages has been associated with an acute reduction of MS-related symptoms. He further reports success treating fatigue with angioplasty—that is, using a balloon or stent to open up the narrowed blood vessel in an outpatient procedure. This is certainly interesting and, on the surface, sounds promising. A simple surgical procedure to correct MS? It almost sounds like a miracle. For some, dramatic improvement is immediately noticeable following angioplasty. Some subjects find that the reduction in symptoms is relatively short-lived, however, necessitating multiple angioplasties to reopen the blood vessels. Furthermore, there has been controversy about whether CCSVI is present at an increased rate in those with MS over those without MS. Some scientists have found no significant increase in CCSVI in MS patients.

This is just one of several conventional approaches that prescribe surgery or pharmaceuticals to relieve MS symptoms. They do not address the initial cause of the dysfunction, so they cannot ever actually cure it. If MS is related to CCSVI, what caused the veins to narrow in the first place? Once again, conventional medicine stops short at symptom relief—and when it comes to MS, symptom relief is notoriously ineffective.

The Functional Medicine Approach to Treating MS

Conventional medicine has divided MS into four types, but even within the four types, the way MS presents is widely variable because the damage can occur anywhere in the brain and spinal cord. If the damage occurs to the nerves that carry information from the sensory organs, then abnormal sensations will result. The person may have poor vision, poor balance, or problems with pain. If the damage occurs to the nerves that are going between the brain and the muscles, then problems with weakness and/or poor coordination will result, which often impedes mobility. Because the damage is often spotty, people can develop a uniquely abnormal pattern of walking, standing, or using their hands.

These are all characteristics of what we call multiple sclerosis, but here is the interesting part: When we look at the level of our cells, autoimmune conditions share six common characteristics, regardless of the specific diagnosis:

Functional medicine looks at MS less as a specific disease and more as a system-wide malfunction that shares a commonality with a broad range of chronic diseases. This turns treatment on its head, because defining the problem and therefore the “solution” is no longer about which drugs relieve specific symptoms and much more about correcting mitochondrial strain, immune cell irritability, toxin load in the body, stress hormone balance, and infections. Accomplish that, and you’ve helped a host of diseases and unexplained chronic symptoms and yet-to-be-diagnosed problems, no matter what you call them. You will reduce the severity of symptoms for many kinds of autoimmune diseases, not just MS. You’ll also reduce symptoms of many other chronic diseases, like mood disorders, obesity, high blood pressure, and heart disease. You do that by fixing the cells, which can then fix the body.

Functional medicine’s prescription—and my preference as both a physician and a patient—is to use intensive lifestyle management to allow blood vessels to begin healing and reopen any blockages there may be throughout their vessels—whether or not this is a particular “cause” of multiple sclerosis. (I believe it is more likely just another symptom of immune cells attacking the body inappropriately—in this case, the blood vessels.)

Life is a series of self-correcting chemical reactions. Therefore, once you have optimized your cell chemistry, the body will often begin to heal itself in remarkable ways, even when scientists don’t understand the exact nature of what was wrong in the first place. Yes, functional medicine seeks to find an underlying cause, but it is less focused on naming and categorizing because this can result in a narrowed view of what is really going on.

Diet

Dr. Embry’s website was full of scientific references, which I began to read one by one. [...] After a lot of intensive reading, I determined that Dr. Embry was not a charlatan and that maybe he was on to something. What if diet could have a major impact on MS? After years of leaving my health in the hands of doctors while continuing to decline, this idea fascinated me. I could control what I ate. It seemed too easy and too good to be true. I had to know more.

Dr. Embry’s website was the first place I heard about Dr. Loren Cordain. Dr. Cordain linked changes in the human diet to the development of chronic disease in Western society. He had published a number of articles and had also recently published a book for the public called The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat, which was much easier reading than the technical scientific papers. I began to absorb information more quickly: molecular mimicry, leaky gut, lectins, immune modulation (I’ll talk about all these things later in this book). I began to see where Dr. Embry and Dr. Cordain were going with their theories. I began to consider that what we eat has a major, rather than a minor, influence on how our bodies work.

I was particularly interested in the idea that excessive carbohydrates and sugars in our modern diet lead to excess insulin and inflammation. The evidence that the original human diet could possibly improve my MS was compelling, but switching to this kind of diet would be a major change for me. I had been a vegetarian since my college days and I loved my beans and rice. I loved making bread. Could I really cut out grain, dairy, and legumes, the current staples of my diet?

Wahls MD Terry and Eve Adamson: The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, 2014

Vitamins and Supplements

Getting into that wheelchair triggered something. I realized that conventional medicine was not likely to stop what was happening to me. I still hoped that the Paleo Diet would make a difference, but I hadn’t seen much of a change thus far. I decided to go back to reading the medical literature. I wanted to know if there was something more, some other avenue, something the doctors had overlooked. [...]

At first, I began to read all about the latest clinical drug trials going on, but then I realized that those all involved medications that I’d be unable to get. This kind of knowledge would only be theoretical. So I started to think outside the box. I knew how science worked—I knew that studies on mice and rats are always the source of tomorrow’s treatments, but that it’s typically years, often decades, before anything becomes a matter for a clinical trial, let alone a standard of care. This was the cutting edge of the cutting edge, so I began to look there. I wanted to know what the brightest minds were thinking and how they envisioned the future of diseases like mine.

Each night I would spend a few minutes searching www.pubmed.gov for articles about the mouse model for MS. I knew that brains afflicted with MS shrink over time, so I also began reading about the animal models of other conditions with shrinking brains. I researched Parkinson’s disease, Alzheimer’s dementia, Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS), and Huntington’s disease. I discovered that, in all four of those conditions, the mitochondria—small subunits within cells that manage the energy supply for that cell—stop working well and lead to early death of brain cells, causing shrinking of the brain. More searching led me to articles in which mouse brains and their mitochondria had been protected using vitamins and supplements like coenzyme Q, carnitine, and creatine.

I didn’t have anything to lose, so I decided to take action. I translated those mouse-size doses into human-size ones, then made an appointment with my primary-care doctor. She looked over my list and decided the supplements were likely safe. She entered each one into my medication list, one by one, to check for potential adverse interactions with my medication list. There were none. I was excited about starting my new, experimental vitamin-and-supplement routine. I began to take them and was disappointed when nothing happened. After a couple of months I stopped taking them, and a few days later I couldn’t get out of bed. When I resumed the supplements, I could get up again. They were helping after all!

Wahls MD Terry and Eve Adamson: The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, 2014

Electrical Stimulation

Next, I discovered electrical therapy. I got the idea by reviewing a research protocol that used electrical stimulation of muscles to treat people who’d become paralyzed due to an acute spinal injury. The purpose of this therapy, known as e-stim, in the research was to maintain bone health and quality of life for these patients. Reviewing that research protocol made me wonder if the electrical stimulation might slow down my disability. I talked to a physical therapist who used this technology, and he warned me that it was painful and exhausting for the athletes who did it. He wasn’t sure if it would help me, but he was willing to give it a test session.

During my first session, the therapist had me lie on my belly and applied the electrodes to my left paraspinous back muscles. I lifted my left leg off the table and held it there as he dialed up the electrical current. If felt like bugs racing across my skin. He kept dialing up the current. The bugs raced faster. It became more and more electrical, and then painful. After a minute my therapist asked if he could turn up the current again. This is the typical procedure because the brain releases endorphins and nerve growth factors that make the e-stim more comfortable, so after a few minutes patients can typically tolerate a higher dose of electricity. When that was done, we did my quadriceps muscles on my left leg, where I suffered particular weakness. After it was over, I had completed thirty minutes of “exercise” that was more rigorous than what I had been able to do in years. I began a regular regimen of e-stim therapy.

Functional Medicine

Every night, after everyone else was sleeping, I searched the Internet, looking for more information that might help me. One night I stumbled onto the web page for the Institute for Functional Medicine and was immediately intrigued. Its goal was to provide clinicians like myself with a better way to care for people with complex chronic disease by looking at how the interaction between genetics, diet, hormone balance, toxin exposures, infections, and psychological factors contribute to the development of disease or the improvement of one’s health and vitality.

This was exactly what I had been searching for since I’d hit the wheelchair. The institute had textbooks, conferences, and continuing education courses for physicians and other health care professionals. One course captured my attention immediately: Neuroprotection: A Functional Medicine Approach for Common and Uncommon Neurologic Syndromes. I ordered it and began studying, night after night. Although it was difficult at first, that functional medicine course taught me that I could improve the condition of my mitochondria and my brain cells. It gave me an entirely new way of thinking about brain health and how it relates to whole-body health. Although it wasn’t the way I was trained, it made sense to me. It was all logical and scientifically supported, so it resonated with me as a doctor, but it also fit into the context of my experience as an MS patient.

I also understood that it was likely that I had a genetic vulnerability, or several, that had increased the likelihood that I’d develop multiple sclerosis. I finally had a much deeper understanding of the significance to the brain of leaky gut, food allergies, toxins, mitochondria that were not providing enough energy for the cell, neurotransmitter problems, and the impact of having inefficient enzymes for the metabolism of B vitamins and sulfur. Based on what I now knew, I had a much longer list of vitamins, minerals, amino acids, antioxidants, and essential fatty acids that I understood were helpful for mitochondria and brain cells. I finally understood why my brain was on fire, under attack by my immune cells, and I also had some ideas about what I could do to cool the fires of inflammation that were raging there. My worldview was changing. I immediately began to plan and implement lifestyle changes that went far beyond anything I’d been doing before. The seeds for the Wahls Protocol, although not yet named, were sown.

The Wahls Protocol

But how would I do it? I had a long list of nutrients, but was I really going to take huge fistfuls of pills every day? And would that even work? The Paleo Diet suggested that food was the best source, but many functional medicine concepts relied on supplements. Our Paleolithic ancestors didn’t take supplements, obviously. The Paleo Diet had taught me to eliminate certain foods but didn’t necessarily tell me how to get the precise nutrients I now knew I needed. Functional medicine helped me to determine what nutrients I needed with their list of advised vitamins and supplements to take but didn’t necessarily tell me how to get them.

If I could get those same nutrients I was taking in pill form from the food I was eating, I reasoned, those nutrients might be more effective than the synthetic versions of the nutrients I was taking. In addition, I might also pick up many additional compounds—maybe thousands of compounds—that had yet to be named, that contributed synergistically to the effectiveness of a particular vitamin or supplement because they existed along with the nutrients in the original package. (Most vitamins in nature are actually a family of related compounds that are all biologically active in our cells.) I realized that I needed an eating plan specifically designed to maximize my mitochondrial and brain function—an eating plan that went beyond anything I’d already encountered. It would incorporate Paleo principles, functional medicine concepts, and my own research. Maybe that would jump-start the changes in my body I desperately wanted to see and feel.

I stared at my new list of the nutrients functional medicine suggested I needed for better brain health and wondered: Which foods contain these nutrients? I had no idea. I showed my list of nutrients to my registered dietitian friends, but they didn’t know where to find those things in the food supply, either. Next I went to the health science library. I couldn’t find any answers there, and so I went back to the Internet and began searching once again. With more work, I finally developed a long list of new foodstuffs to add to my diet that seemed to match up nutritionally. I began to add these to every meal.

That’s when things really began to change in my brain and body.

Food is the core component of the Wahls Protocol, and cellular as well as brain-targeted nutrition can determine what happens to your health for the rest of your life. It is not the entirety of the Wahls Protocol, however, and it is not the only thing I changed in my life in order to drastically reverse my symptoms. Many other factors led to my continuing recovery. These include targeted toxin reduction, electrical stimulation of muscles, a regular and appropriate exercise program, a few key supplements, and a commitment to a targeted program of stress reduction.