Health & Wellness

The Diet Debate: McDougall Diet and Wahls Protocol

By MSF Staff
Two very different diets are stirring debate in the MS community. The Wahls Protocol eliminates starches and includes certain meats, while the McDougall Diet focuses on starches and eliminates meat. What does the research say about these two diets and their effect on MS? What do you need to know? 

MSFocus Radio hosted the leading proponents of these MS diets, Dr. Terry Wahls and Dr. John McDougall, in separate interviews. In these interview excerpts, you'll find out what these diets are and what evidence there is for their use in MS. For the full interviews click On Demand Audio

The Wahls Protocol
Avoids: Wheat, grains, legumes, dairy
Emphasizes: Leafy greens, sulfur-rich vegetables, colorful fruits and vegetables, organ meats and fish 

The Background

MSF: Our guest today is Dr. Terry Wahls, assistant chief of staff at Iowa City VA Healthcare, clinical professor of medicine at the University of Iowa, and author of the new book The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine.
Can you let our listeners know a little bit about where you were before you began this protocol?
Dr. Wahls: [In] 2000, I was diagnosed with multiple sclerosis on the basis of optic neuritis, a new problem with my left leg… I had abnormal lesions in my spinal cord and abnormal spinal fluid. I knew that a third of people within 10 years would have difficulty walking – needing a cane, walker, or wheelchair – and one half would be unable to work. So I sought out the best MS center that I could find – and that was the Cleveland Clinic – saw the best people, took the newest drugs, and still, within three years, my disease transitioned to secondary-progressive. So in that phase, the disease is progressive and there are no more spontaneous remissions. My doctors told me functions, once lost, were gone forever. So I took chemotherapy, got the tilt-recline wheelchair, I even took that ‘miracle drug’ Tysabri, but continued to decline. From 2000 to 2007, I was at the point where my belly and back muscles were so weak that I couldn’t sit in a regular chair anymore. I had to be in a zero-gravity chair that allowed me to recline fully at work. I could walk short distances using two walking sticks. I had severe fatigue, was exhausted by ten in the morning, and I was just starting to have problems with brain fog.
In 2002, my neurology doctors at Cleveland Clinic introduced me to the work of Loren Cordain and the Paleo diet. After 20 years of being a vegetarian, I made the very big decision to go back to eating meat. I removed grains, legumes, wheat, and dairy from my diet. In 2002, I still continued to decline. When I hit the wheelchair in 2004, I started reading the science and animal studies about MS and other diseases that also had shrinking brains and spinal cords like MS. I added some vitamins and supplements as I found studies that were used in mice that protected those mouse brains. I found that slowed my decline – if I missed my vitamins one day, I felt much worse.
So the vitamins were clearly helpful, but they did not lead to the recovery. In the summer of 2007, I discovered the Institute of Functional Medicine and took their course, Neuro-protection: A Functional Medicine Approach to Common and Uncommon Neurologic Syndromes. I had a much deeper understanding of things that I could do to protect my brain, a much longer list of vitamins and supplements that I am now taking. Later that fall, I had the insight that I should take this list of nutrients that I was taking in pill form and figure out where they are in food. That, of course, meant more research.
The Diet
MSFocus: Can you give us a brief description of what your protocol is?
Dr. Wahls: Ultimately, this new way of eating still based on Paleo principles, but now organized to maximize these nutrients that were important to the brain. In fact, I now track 36 different vitamins, minerals, essential fats, and antioxidants to make sure the diet has been specifically designed to provide those things, and that is what I now call the Wahls Diet. We’re basically adding more leafy green vegetables; sulfur-rich vegetables like cabbage, mushroom, onion family; deeply pigmented foods like carrots, beets, berries; grass fed meats; wild fish; and seaweed. As people progress in the diet, we help them transition from their current way of eating to a more nutrient-dense, more low-glycemic way of eating that is better for one’s brain health.
MSFocus: So it sounds like it’s more than a Paleo diet – you’re using the Paleo principles, but you’re adding additional nutrients.
Dr. Wahls: Yes, I want to make it clear to people. I went Paleo in 2002 and declined for five more years. Paleo was not enough to heal me, and while it may be enough to heal people who are not so ill, many require a more intense approach that’s more specially-designed to lower inflammation and maximize nutrients to support detoxification.
MSFocus: I understand that your protocol contains more than just diet, though. Can you tell us a little bit about that and particularly about neuromuscular electrical stimulation?
Dr. Wahls: Another thing I discovered that summer was electrical stimulation of muscles – I did that by reviewing the study by Rick Shields. He used it to maintain the bone and muscle health of people who have had a spinal cord injury. The participants liked the intervention so much they didn’t want to stop, so he’s asking to extend the study. I thought that was very interesting and therefore decided to get that for myself, and so I approached my physical therapist. (He) told me, “It is not approved for MS. This is used for athletes to help them recover from their injuries – the athletes find it exhausting and painful. You have a lot of pain and fatigue. We could probably grow muscle in your leg, but I’m not sure that your brain can talk to the muscles that we grow.” After a long talk, he agreed to let me have a test session. He was right; it hurt a lot. But at the end, I felt the best I’d felt in years. So we began a course of training in the clinic that lasted several weeks. Then, he decided that I could tolerate it and that I could safely operate a home health device, so I began training at home. I talk about this in detail in my book – how to find someone that will help get you a test session, some of the approved indications and challenges in getting access to this, how to approach your health care provider and physical therapist to get test sessions.
The Research
MSFocus: I understand you’ve been conducting research on your protocol. What’s the status with that now, and what kind of trends are you seeing?
Dr. Wahls: I had my recovery in 2008. In 2009, I started writing up the protocol and the grants, and we did secure funding. So in 2010, we had the funding to test 20 people using my diet, targeted vitamins, mediation, and exercise – so everything that I did. This was such a radical new concept that the institutional review board that reviews the research said, “Okay, I’ll tell you what: you can take 10 people. Give us a safety report, and if everything is safe, no one is harmed, and the trends are in a favorable direction, we will let you do the second ten.” So we did that and published the results on the first 10. It showed that people could implement the study diet. The biggest side effect was that if you were overweight, you lost weight and got back to a healthy weight without being hungry. And the fatigue… with a severity scale score from seven to one – one equaling no fatigue and seven being total fatigue  – that improved by 2.38 points on a baseline of 5.70 to 3.32 at 12 months. This is the largest reduction of fatigue reported. By contrast, if you use exercise to treat fatigue you can see an improvement of about .5. The drug studies have been variable showing no benefit to showing modest benefit at the .6 - .75 range. So an improvement of 2.38 really is clinically meaningful. Very, very exciting. And it was quite remarkable that even in this very small sample size the T value is .0008, and that is just a demonstration of how large the effect size is. Now we have more studies going on that are looking at the exercise alone, another that is looking at the diet alone, and another that is looking at diet – comparing the original Wahls diet with the ketogenic version of the Wahls diet and usual care. We are writing grants all the time. I just sent a grant off to the MS Society. We are hopeful because our preliminary data now is so exciting that we’ll have greater success with getting funding for a much larger study.
Find out More 
The Website:
The Book: The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine 
Common Ground: Both diets have been proven to have a positive effect on MS fatigue. They eliminate dairy, encourage eating a variety of colorful vegetables and fruits, and avoid processed foods. 
The McDougall Diet
Avoids: Meats, dairy, oils, processed foods
Emphasizes: Rice, grains, corn, beans, colorful fruits and vegetables 

MSFocus: Today’s guest is Dr. John McDougall, nationally renowned expert on health and diet, creator of the McDougall Diet, and co-author of a recent study on the effects of that diet on MS.
Let’s start from the beginning. What led to your interest in diet as a form of healthcare?
Dr. McDougall: I have a long history – I’ve been at this for a while, almost 40 years – and my interest really grew out of frustration. Medicine does some wonderful things when it comes to a thing called “acute problems.” These are things like lacerations, broken bones, infections. These are things that when modern medicine gets involved, you can describe it as nothing short of a miracle. [But] when it comes to chronic disease, doctors come in with their pills and surgery, and just… the difference they make in a positive way is really hard to see sometimes. I was frustrated, and I wanted to do a lot to help people – that was my goal, as it is with every other doctor – and when I applied my skills as a young doctor, I didn’t see those kinds of benefits. I took it as a personal failure until I realized that the problem is that you can’t deal with chronic disease by just adding a bunch of pills and potions.
But there is a way to deal with chronic disease; that is to stop it at the source. The injury that is producing the illness – we have to stop that. For example, you see a cigarette smoker and they’re coughing. [They] have a chronic cough and mucus production. The way you stop that is you stop the repeated injury of 20 or 30 cigarettes a day. If someone is falling down drunk, and they have liver damage as a result of drinking too much, you don’t give them vitamins or pills to solve the problem; you stop the daily consumption. When people are suffering from ‘food poisoning’ – now, let’s get this term on the table now – ‘food poisoning’ is what causes the majority of illness that people suffer from in most Western countries, and one of those diseases is called multiple sclerosis.
MSFocus: And what led you to the conclusion that a vegetarian diet was going to have a positive impact?
Dr. McDougall: Well, it’s a little premature to call it vegetarian, but you could. I mean, I could be accused of teaching a vegetarian or vegan diet, and I guess that could be fair, but it would be a little off-point. What I teach is a diet based on starches. Starches are a category of food that are vegetable in matter but also have a lot of calories. When I say starch, you should think beans, corn, sweet potatoes, and rice. Those are the kind of foods that I teach people to eat, and yes, they are vegetable foods, and along with those, you eat non-starchy green, red, purple, and yellow vegetables – such as kale, broccoli, and cauliflower – and some fruits. The most important thing that I teach is that the diet should be mostly from starches, grain, tubers, and legumes – those kinds of foods. Those are the foods that people have been eating for ten, fifteen, twenty thousand years. All major civilizations have consumed those foods.
From just what I learned in high school, I should have figured out that the diet of human beings was a diet of starch. When I look at the Mayan and the Aztecs and how they’re the people of the corn, and – what I learned from the people in South America –the Incas, they were potato eaters. In the Far East, you’re looking at people that are rice eaters, and the Middle East, that is the bread basket of the world.
The Diet
MSFocus: With your own diet protocol, can you tell us what you specifically recommend?
Dr. McDougall: I’ve been doing this for over 35 years, and I’ve taken care of over ten thousand patients, and we’ve published results in scientific literature about changing people’s diets. People who come to see me are typical Americans. In fact, if you go out on the street right now or walk out of your office and look around, you will see the people that I take care of. Eighty percent of the people in our country are overweight, and most are sick because they’re suffering from ‘food poisoning.’ What I do is I take people – your friends, your relatives, your coworkers, and by the way, your children – I take these people who are sick from ‘food poisoning’ – they are being poisoned by red meat, poultry, fish, eggs, cheese, and milk – and I take them off those foods.
[But] you can’t just walk up to people and say, “Hey, you’re not going to eat hamburgers or pepperoni pizza anymore.” They think to themselves, “I’m going to starve to death.” What you have to do is, in place of that calorie source from meat, dairy, and junk food, you have to replace it with something else. You say, “Okay, you’re going to eat a starch-based diet … what you have to eat is oatmeal for breakfast, hash browns, pancakes, or waffles. For lunch, you can have bean soup, pea soup, or lentil soup. For dinner, you can have bean burritos, veggies over rice, or pasta with marinara sauce.” We have over three thousand recipes published in books and on our website that my wife has put together.
[The standard diet] is ‘food poisoning.’ It would be the same as feeding someone lead – you take it away, and your body will eliminate the toxin, and the body will heal and get well. That’s what you do. You’ve heard this before. You’ve heard this – that eating bacon, butter, and brie will make you sick, and if you stop eating these things you will get well.
MSFocus: So with this diet protocol that you recommend, is it different for people with MS or do you recommend the same diet for all?
Dr. McDougall: It’s the same diet for humans. Multiple sclerosis is another disease of ‘food poisoning.’ Many manifestations occur when you get yourself poisoned with arsenic or lead. Many manifestations occur in the body, but you wouldn’t call them separate diseases from separate things; they’re all due to those poisons. Likewise, you get an infection from, let’s say bacteria like tuberculosis, for example, you can get brain tumors, spine tumors, lung infection, and so on. You don’t say that they are all different diseases – you say it’s from the tuberculosis. It’s the same thing with ‘food poisoning.’ ‘Food poisoning’ damages the arteries, bowels, the skin, and the nervous system, and sets us up for diseases that are all secondary to malnutrition – malnutrition from over-nutrition of animal foods and oils and an under-nutrition of starch. The result is because of this ‘food poisoning’ people get multiple sclerosis.
This is a disease that occurs only with the Western diet. Back before 1980, there were almost no cases of multiple sclerosis in China. [In] post-WWII Japan, virtually no multiple sclerosis. These are diseases that only came out when those countries switched to the Western diet.
The Research
MSFocus: The recent study that you did with Oregon Health and Science University, can you tell us how that study was structured and what the results were?
Dr. McDougall: I set up a research foundation – the McDougall Research and Education Foundation, which was a private 501(c)(3) foundation – several years back and raised money. Not a lot of money in terms of what research costs, but I raised the money and went to the Oregon Health and Science University in 2008, and asked them if they had any interest in work based upon the work of (pioneering MS diet researcher) Dr. Roy Swank. […] They wanted to, so we started in 2009. Do you know it took ethics board – the IRB (institutional review board) – at Oregon Health and Science University almost a year to determine that feeding patients rice, corn, and potatoes was safe? It took them almost a year to determine that treating a patient with diet was okay to do, was safe. Yet the same board will approve drugs that cost fifty-five hundred dollars a year and have horrible side effects and questionable benefits.
We started the study with only a limited amount of money, so I was only able to enroll a small amount of people – 60 people total – which we had to divide into two groups. So 30 went into the diet therapy group, and 30 went to the control group. We started in 2009 and finished the study in 2013. We  evaluated the two groups with MRI scans and clinical measures, and we gathered data, and it showed some really remarkable things in the short period of time.
First of all, we showed that it was safe, and second of all, we showed that it improved the general health of these people. We got between about a 10- to 20-pound weight loss that was permanent. People don’t think that patients will follow a healthy diet, so we studied to see if people would follow the diet, and what we found was that the average fat intake compared to the control group… the control group was 40 percent fat intake in the year. The average fat intake dropped to 15 percent of the calories and was maintained over a year. So people permanently changed their diet and dramatically. The estimate is 80 percent of the people followed the diet all of the time for the year. In other words, 10- to 20-pound permanent weight loss, about a 20-point drop in cholesterol, and similar drops in the lipids in the patients permanently over a year. The other thing that it showed that was quite dramatic – and I think that this would be important info for MS patients and their doctors – was the change in fatigue. The NMSS says that 80 percent of MS patients suffer from fatigue. What we showed was a dramatic drop in fatigue almost overnight, and it lasted through the year.
What we didn’t show was changes in disability or changes in MRI scans. There are several reasons for this. One is that this was a short study – it was only a year – and two, we only had a limited number of people, so we were limited in what we could do. What we did, in my mind, was kind of amazing. We opened the door for diet treatment for MS. We showed benefits that you have to accept: permanent changes in people’s diets, dramatic improvement in overall health, dramatic drop in fatigue. We showed those things. We can help MS patients have a better life. 
Find out More
The Website:
The Book: The Starch Solution: Eat the Foods You Love, Regain Your Health, and Lose the Weight for Good