The Wahls Protocol for Treating Chronic Conditions

The Wahls Diet 101

Diet is where it all begins. It is the one most influential element about your environment that you can control, and it is therefore your most powerful tool in healing your MS or other autoimmune or chronic disease. I didn’t come to this realization right away; in fact, developing the Wahls Diet plan as it exists today has been a multistep process. Now it is refined to a great extent, and customizable, because you can choose which stage or level is right for you:

• Wahls Diet: The most basic level kick-starts your system by infusing it with intense nutrition and removing dietary elements that could be contributing to your decline.
• Wahls Paleo: The next level, and the level where many people choose to stay, provides more structure to further eliminate dietary elements that can compromise gut health.
• Wahls Paleo Plus: This most challenging level is also the most therapeutic for those with autoimmune conditions and is particularly beneficial for anyone with neurological or psychological issues, whatever the underlying disease state, as well as for those with a history of cancer.

While each dietary plan has very specific components, there are some underlying principles that are relevant to any and all dietary aspects of the Wahls Protocol. First and foremost, it is designed to maximize the vitamins, minerals, antioxidants, and essential fats that your brain and mitochondria need to thrive, based on what I’ve learned from functional medicine, my own review of the medical research, and an emulation of the diet that humans ate as hunter-gatherers. I believe it is important for you to understand why this is not only a healthful way of eating but much closer to the diet your DNA expects, so let’s look at some of the background on which the Wahls Protocol dietary plans are based.

One of the basic principles behind the Wahls Diet is the Paleolithic or hunter-gatherer diet. Paleo-style diets seek to replicate the original human diet as closely as possible, considering the changes in the environment since Paleolithic times...

You may be wondering whether you even need the Wahls Diet at this point. Can’t you just do one of the other Paleo-type diets? There are a lot of versions of the original human diet currently available in books right now: the Paleo Diet, the Primal Diet, the Caveman Power Diet, etc. They all have some similarities and some differences, but Dr. Cordain began the movement with his original book, The Paleo Diet, based upon medical anthropologic studies of people who lived more than 10,000 years ago and people who are still living as subsistence hunter-gatherers. The movement was largely popularized by Robb Wolf, co-author of The Paleo Solution: The Original Human Diet, as well as by Mark Sisson, the author of The Primal Blueprint: Reprogram Your Genes for Effortless Weight Loss, Vibrant Health, and Boundless Energy.

I am a big fan of the Paleolithic-style diet, but I also want you to understand that the Wahls Diet is not just another Paleo diet. It provides more structure and guidance to help you maximize your nutrition, which is critical for those with any chronic disease. You need a more aggressive plan to restore your health. This was an important crux of my research as I developed the Wahls Diet. Although I was on the Paleo Diet for a long time (as originally detailed by Dr. Loren Cordain), it was not enough to heal me. Many people do well on this diet—or well enough—especially if they are already healthy. For someone with health challenges, however, you will benefit from more structure than the usual Paleo or primal or hunter-gatherer diets provide because you need to do more than just stop eating foods that may harm you. You also need to know how to maximize your nutrition for your cells and mitochondria.

The main differences between the Wahls Diet plans and other Paleo-type plans are:

• Nutrient density: All levels of the Wahls Diet plans are rigorously and meticulously nutrient-dense. You will get a specific structure to follow to ensure maximum but not toxic vitamin, mineral, and antioxidant levels. I don’t leave anything to chance, assuming you will eat enough fruits and vegetables or enough protein and/or healthy fat. You need a very specific nutrient load. Your body has been missing it. It is medicine for you.
• A high level of fat: The Paleo Diet recommends lean meats, but the Wahls Paleo Diet, and especially the Wahls Paleo Plus Diet, ramps up healthy fat intake in a brain-beneficial way (in the form of specific kinds of fats, like those in oily wild fish, coconut oil, and avocados). The brain is 60 to 70 percent fat. We need healthy fats to make the myelin insulation for the wiring in your brain so you won’t be skimping on the healthy fats.
• Emphasis on local: I recommend expanding your palate and the food on your plate to include as many native/local/seasonal foods as possible. To me, this is the essence of eating Paleo—getting as close to how your Paleolithic forebears ate, living right where you live now. Locally grown foods tend to be more nutritious because you are likely to consume them shortly after harvest. The longer food is stored, the more vitamin and antioxidant levels break down. Food out of season, shipped from across the globe, has far fewer nutrients. Also, native, wild foods grow in the soil and under the conditions most natural for them, so they are likely to be healthier plants. Healthier wild soils lead to healthier plants that are more nutritious. They have built-in protections against native insects and have a much higher level of protective antioxidants and vitamins. I encourage my veteran patients to hunt, learn to forage for wild foods, and add gardens and edible plants to their yards. The food obtained and the time spent being out in nature are both quite healing.
• No gluten, no dairy, no eggs, few if any legumes: Some Paleo-style diet plans allow dairy (preferably raw organic), encourage egg consumption, and even permit some legumes. (Note that legumes and gluten-free grains are necessary if you are eating Paleo-style and are a vegetarian.) I do not recommend these food items on the Wahls Diet. Gluten is completely out, but so are dairy and eggs. While legumes do contain some antinutrients, I’ll show you how to reduce those antinutrients in the Wahls Paleo chapter if you need to eat legumes.

Level One: The Wahls Diet

This is the most basic diet required in the Wahls Protocol. It involves just three primary elements:

Nine cups of fruits and vegetables every day

Nine cups of fruits and vegetables every day, broken down as follows:

• Three cups tightly packed raw or cooked leafy greens, like kale, collards, chard, Asian greens, and lettuces (the darker, the better)
• Three cups deeply colored vegetables and fruits, such as berries, tomatoes, beets, carrots, and winter squash
• Three cups sulfur-rich vegetables, including broccoli, cabbage, asparagus, Brussels sprouts, turnips, radishes, onions, and garlic.

I recognize that 9 cups sounds like a lot, and there are two reasons for this. One, in order to get enough concentrated nutrition, you need to eat a lot of vegetables. Two, sufficient vegetable and fruit intake will fill you up so that you won’t feel as much of a need to eat grains, sugar, and dairy. I want you to fill up mostly on vegetables, and this means learning to eat a lot of them. I also understand that for some people—especially those who don’t often eat a lot of fruits and vegetables or who suffer from a delicate digestive system—such a leap in fiber consumption can be uncomfortable. Later on I’ll give you more specific information about how to transition to eating 9 cups comfortably. You don’t have to do it all at once.

Gluten-Free/Dairy-Free

The 9 cups puts nutrients into your body that you were missing, but this next step is about taking out what may be causing reactivity in your body, and that requires removing gluten and dairy from your diet. Unlike the first step, where it’s okay to ease in, I recommend you go cold turkey on this one. Stop eating gluten and dairy today. It could be the most important thing you ever do for yourself.

People with autoimmune disease are more likely to have a leaky gut, and if you have a leaky gut, gluten and dairy are particularly damaging. When the intestine has holes in it, incompletely digested wheat (gluten) and/or milk (casein) proteins can get into the bloodstream. These undigested particles are too large to be in the bloodstream. If you are genetically vulnerable to having your immune cells be activated by gluten and/or casein, this will cause even more issues. Twenty to 30 percent of those with European ancestry have the DQ2 or DQ8 genes, which put them at risk for developing gluten sensitivity. In these people, gluten and casein proteins in the bloodstream can trigger an inappropriate immune response. This can lead to a hyperreactive immune system that can then become supersensitive to other foods that weren’t bothersome before, such as tree nuts, citrus, strawberries, or other vegetables and fruits.

How your body will react to a leaky gut is individual. You may not have the genetic predisposition to get into trouble or your responses may still be relatively mild. Others may have more dramatic reactions, including severe allergy or gastrointestinal symptoms that can eventually lead to more severe problems. If you have MS or another autoimmune disease, however, the likelihood that you will respond drastically to leaky gut is high.

I ask you to give up these two things with the full awareness that this is extremely difficult. The reason why gluten and dairy foods are considered “comfort foods” (think macaroni and cheese, cupcakes, and cheeseburgers) is because they actually have an opiate-like addictive effect in the body. Giving them up can actually feel a bit like withdrawal. Once you get over the initial shock of removing gluten and dairy, however, you will start to feel better rapidly.

Organic, Grass-Fed, Wild-Caught

High-quality protein is the third crucial element on the Wahls Diet. While you can be a vegetarian or even a vegan at this first level—and I’ll explain how —I don’t recommend it. The highest-quality protein sources for humans are organic, grass-fed meat, wild-caught meat (like game meat), and fish, and I strongly recommend that you eat them. Choose organic whenever you can, but don’t go without high-quality protein.

Wahls Paleo

Wahls Paleo is similar to the Wahls Diet. If you are in the throes of severe autoimmune disease or have other types of neurological or psychological problems or other chronic medical problems, I recommend starting here, or moving here as soon as you have adjusted to the Wahls Diet.

Wahls Paleo includes everything the Wahls Diet includes, with these added components:

Reduce all non-gluten grains (presumably you are completely gluten-free by now), legumes, and potatoes to just two servings per week.

It’s preferable to eliminate grains and legumes entirely, but allowing two servings a week gives you more flexibility to be social with friends and family. That is what we have done in the second wave of our study. These servings are not required but they are allowed, should you feel the need. Even gluten-free whole grains, legumes like black beans and lentils, and potatoes contribute to increased carbohydrate load. You also get more lectins and phytates, which are antinutrients, in these foods. I encourage you to have more nonstarchy vegetables than gluten-free grains and to eat more vegetables than fruit. In addition, you can eat more meat as you further reduce the carbohydrates.

Add seaweed or algae and organ meats to your diet

A lot of people balk at the notion of eating seaweed and organ meats. My patients who are suspicious of vegetables in the first place have a particularly hard time with seaweed and algae, and former vegetarians often have a really hard time with the concept of eating organ meats. Adding these two foods to your diet, however, is a potent healing step. Seaweed adds critical minerals, and organ meats add coenzyme Q, both of which supply valuable nutrients for your mitochondria that can be difficult to get from more common foods.

Add fermented foods, soaked seeds and nuts, and more raw foods.

Enzyme-rich foods are an essential part of traditional diets, but much of our modern food is bereft of enzymes because of processing and cooking.14 The best sources for enzymes are:

• Raw fruits and vegetables
• Fermented foods like lacto-fermented sauerkraut, pickles, kimchi, and kombucha tea
• Soaked and sprouted nuts and seeds (Soak nuts and seeds in water for six to twenty-four hours before consuming; I’ll tell you more about how to do this in chapter 9.)
• Raw animal protein such as sushi, steak tartare, and ceviche.

Wahls Paleo Plus

This is the most extreme and most intense level. This is the diet I follow because I find that I do best on it, and I recommend it for my patients who aren’t seeing enough progress at the Wahls Paleo level. This is an extremely low-carb, high-fat diet, similar to ketogenic diets already being used in a medical setting to treat epilepsy. It adds the following elements to the rules of the Wahls Diet and Wahls Paleo:

Eat more fat!

I want you to add at least 5 tablespoons of coconut oil or 3/4 can (or more) of full-fat coconut milk. (You may also use unheated olive oil or ghee to get some of your fat calories.)

Reduce the daily 9 cups of fruits and vegetables to 6 to 9 cups, depending on your gender and size (or even 4 to 6 cups for very petite women)

Fruit is limited to 1 cup per day with a preference for berries. All dried fruits are excluded, as are canned fruits and commercial fruit juices

Eliminate all grains, legumes, and potatoes

That includes nongluten grains like rice and quinoa. It also includes rice milk (use coconut milk instead) and all forms of soy, including organic and fermented. This may seem difficult, but once you get in the habit of not even considering grains on the menu, it won’t seem so hard.

Limit starchy vegetables, like cooked beets or winter squash, to a maximum of twice per week, always with at least 1 tablespoon of fat and some protein to lower their glycemic index.

If you want more starchy vegetables, you may eat them raw, but also with at least 1 tablespoon of fat.

Reduce your meat intake back to 6 to 12 ounces

This diet sounds crazy to a lot of people, and I understand why. How can you possibly eat that much fat for health? That little fruit? No grains or potatoes at all? I have very good reasons for prescribing this diet, and as I mentioned, it is the diet I follow myself, with great results. I believe you will be more likely to get behind the diet if you understand how it evolved.

Once again I have laid out the comparison of the average diet compared to my program, this time the Wahls Paleo Plus. What is noteworthy is that Wahls Paleo Plus is still much more nutrient-dense than the standard American diet, even though I have increased the fat consumption so drastically. Most ketogenic diets (I’ll define this term momentarily) require the addition of vitamins and other supplements because the nutrient density becomes so poor due to the severe restriction on carbohydrates. Wahls Paleo Plus is much more balanced than the traditional ketogenic diets in use because it has a somewhat higher carbohydrate intake from nonstarchy vegetables.

Wahls Paleo Plus is a modified version of what doctors call a ketogenic diet. In a ketogenic diet, fat is high and carbohydrates are low, so that the body begins to burn fat as fuel instead of sugar from carbohydrates. This has traditionally been a diet prescribed for people with certain health issues like seizure disorders, but in my research I have found it to be of extreme benefit to people with other types of brain problems, not just seizures, in the modified form you will find in this [section].

Ketogenic diets are nothing new, but they continue to evolve. In order for you to accept the unconventional dietary characteristics of Wahls Paleo Plus, I want you to understand what a ketogenic diet is and why it is so good for your brain, especially if you have an autoimmune disease with neurological symptoms. Let’s first look at what a ketogenic diet is.

The Ketogenic Diets and MCTs (Medium-Chain Triglycerides)

In the simplest terms, ketosis means you are burning fat, rather than sugar, as your primary fuel source. Specifically, when your body is in a state of nutritional ketosis, the liver begins producing ketone bodies—acetoacetate, acetone, and beta-hydroxybutyrate. The brain cannot burn long-chain fats because long-chain fats can’t cross the blood-brain barrier. Instead, the brain uses for fuel what can cross the blood-brain barrier: ketone bodies. Thus, your liver will burn fat and produce these small molecules known as ketone bodies as a by-product of burning the fat. These then proceed to cross the blood-brain barrier to be burned as fuel in your brain cells’ mitochondria. The longer you are in nutritional ketosis, the more enzymes for burning the ketones will be upregulated—that is, increased—making it increasingly easy for your body to utilize the ketones.

You may have heard that ketosis is dangerous, and there are forms of ketosis that can be damaging to you, but nutritional ketosis is not harmful. In fact, it is healing, and has long been a mechanism for human survival. In human history, depending on environment and season, fat was often an easier fuel source to find than carbohydrates. In winter, the food supply declined and our metabolism switched to burning fat because simple carbohydrates were less available as food. Our bodies are very good at burning fat, but our cells do not choose to burn fat when they have an easy supply of simple sugars. The splitting of the sugar molecule (glycolysis) occurs outside of the mitochondria in the cell cytoplasm. That is what yeast and bacteria do, and it is called fermentation. When oxygen first appeared, it was toxic, killing off 90 percent of the bacterial species. But some tiny bacteria were able to use oxygen as the bacteria burned sugar. Those small oxygen-using, sugar-burning bacteria were engulfed by larger bacteria and made the larger bacteria much more efficient. These tiny bacteria were the precursors to the modern-day mitochondria living in each of our cells. That made us far more efficient at extracting energy from our food than the fermentation process that occurs in yeasts and bacteria. It is because of mitochondria that those ancient bacteria were able to evolve into multicellular organisms!

When starchy foods became plentiful with the advent of agriculture, and even more so with industrialization and modernization, however, humans didn’t go into ketosis as often. Modern industrialized societies have diets packed with carbohydrates year-round. We burn sugar for fuel, but that isn’t ideal, especially if you have a problem with your brain. Sugary, starchy diets promote inflammation. We have lost touch with the benefits of the metabolic state of ketosis, and we have paid the price.

However, ketogenic diets haven’t disappeared. In 1911, a clinical study showed that water diets, also called fasting, benefited treatments for epilepsy. Although scientists didn’t fully understand why, the reason was that in a state of fasting, no simple sugars are coming in, so the body switches into nutritional ketosis, burning fat stores. In 1921, Dr. R. M. Wilder at the Mayo Clinic developed a diet that would allow patients to eat some food but have the same benefits as they would enjoy from fasting. This diet was very high in fat, included some protein, and almost zero carbohydrates. He reported success with his epilepsy patients. Dr. M. G. Peterman, also at Mayo, described the first ketogenic diet that was used with success with children suffering from epilepsy.

Some of this research fell out of favor when Dilantin, the first effective anticonvulsant drug, became available in 1938. (Anticonvulsants continue to be a popular treatment for epilepsy, even though these drugs are not effective for up to 30 percent of individuals with seizures.) But scientists continued to explore the notion that a diet that promoted fat burning instead of sugar burning could improve seizure disorders. In 1971, it was discovered that consuming medium-chain triglyceride (MCT) oil, extracted from coconut oil and palm kernel oil, generated more ketones per calorie than other fats. Because a ketogenic diet depends on the manufacture of a certain level of ketones, this meant that diets using MCT oil as the sole fat source could include carbohydrates at a slightly higher level than was used in the 1920s and still generate ketones. That discovery made it possible to modify the original ketogenic diet into what became known as an MCT ketogenic diet, which was much easier to follow because it allowed a wider variety of food. Wahls Paleo Plus is actually a modified MCT ketogenic diet, because it relies heavily on coconut oil and full-fat coconut milk.

The public interest in ketogenic diets increased when, in 1994, two-year-old Charlie Abrahams, son of Hollywood director and writer Jim Abrahams, became seizure-free on a ketogenic diet after previously having uncontrolled seizures. This led to the development of the Charlie Foundation to promote the diet and fund research. In 2011, there were more than seventy-five centers that used a ketogenic diet to treat refractory epilepsy. Additionally, physicians are now studying whether ketogenic diets can treat a much wider array of health problems: Parkinson’s disease, dementia, Lou Gehrig’s disease, chronic migraine, autism, stroke, and psychiatric diseases. There is also exciting research indicating that ketogenic diets are an excellent way to fight an active, even advanced cancer.

My own research, as well as self-experimentation, has centered on an exploration of how a diet rich in MCT fats and low in carbohydrates might impact multiple sclerosis and other neurological conditions. This is how Wahls Paleo Plus evolved. This diet, if followed strictly, will put you into a mild state of nutritional ketosis, but it contains more carbohydrates than the traditional ketogenic diets because of the importance of including a rich supply of nonstarchy vegetables for nutrient density. Vegetables contain carbohydrates, but these and a small amount of berries (a relatively low-carb fruit) are the only carbohydrate sources. To me, this is the best of both worlds: The diet has the benefits of ketosis and high fat for brain health and low carbohydrates to reduce inflammation and stabilize blood sugar, but is also nutrient-dense beyond other ketogenic diets. To some, Wahls Paleo Plus may seem extreme, but I want you to understand that it is far less extreme than standard ketogenic diets that require supplementation because they are so nutrient-poor. Wahls Paleo Plus is designed to be workable in the real world. It’s challenging, but it’s certainly not impossible. I do it, and so do many other Wahls Warriors, with great results.

The Wahls Diet Progression

1. Add More Fat, Especially Coconut Oil and Full-Fat Coconut Milk
2. Cut Back to 6 Cups (or Even 4) of Vegetables and Fruit
3. Eliminate All Grains, Legumes, and Potatoes
4. Limit Starchy Vegetables to Two Servings per Week
5. Reduce Protein
6. Limit Fruit to One Serving per Day, Preferably Berries
7. Eat Just Twice a Day and Fast Every Night for at Least Twelve Hours

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