Multiple sclerosis (MS) is an autoimmune condition affecting more than 2.5 million people worldwide and between 400,000 and 800,000 Americans. It is the No. 1 cause of early departure from the workforce and one of the leading causes of disability.
Patients — and their families — fear becoming disabled: needing first a cane, then a walker, then a wheelchair or even becoming bedridden by MS. They are also concerned about developing MS-related dementia. Billions of dollars are spent every year on developing treatments, and today there are several options for patients to consider. In order to understand these options, we must first understand what MS is and why we think it develops. Then I’ll discuss two approaches to treating it.
MS is most commonly diagnosed after 10 to 20 years of poorly explained symptoms of fatigue, balance problems, pain or vision problems. This is the nature of an autoimmune disease: the body’s immune system begins to attack and damage a normally functioning part of itself, hence the name autoimmune. In the case of MS, the body attacks the myelin — the fatty insulation on the wiring between cells in the brain or spinal cord.
Why this happens in the first place is not well understood. The current thinking is that an infection that occurred sometime earlier, typically in childhood, was not properly cleared from the brain. Then something or many “somethings” in the environment — though precisely what these are is not known — reactivates the immune system.
Now the immune cells are unable to recognize myelin as part of the body and attack it as though it were a foreign invader. The slow, steady destruction of myelin begins. At first, episodes of worsening, or relapses, occur, followed by periods of improvement or remission. This phase, known as relapsing-remitting, may go on for several years. But within 10 to 15 years, the majority of those with relapsing-remitting MS convert to the progressive phase of the disease. In that phase, the patient experiences a steady accumulation of disability, first requiring a cane, then a walker, then a wheelchair. In this stage, once functions are lost, they cannot be regained and are considered gone forever.
The goal of MS treatment is to prevent or at least delay the onset of disability. A study that tracks the disease over time and how long it takes to convert to the progressive phase would last at least 5 to 10 years. It would cost a lot of money and take a long time to develop any drugs based on that study. In an effort to develop drugs more quickly, scientists began to look for other ways to track and measure the disease.
It would be ideal to use some kind of biomarkers that could be followed, so scientists turned to the MRI, which they could examine for changes, specifically the number of active MS lesions. If there were fewer brain lesions and fewer attacks of MS symptoms, then less disability would accrue.
To block attacks, the logical strategy would be to find a way to stymie the immune cells that do the attacking. Therefore, the focus is on developing drugs that can stop the immune cell attack on the myelin and thus halt damage.
Current drugs on the market block some aspect of the immune cell function so that a fewer number of relapses, or attacks of MS-related symptoms, occur each year. The first generation of these drugs was interferon-based and could decrease the probability of attacks by about a third. When they were first released, these drugs cost about $700 a month, which meant that many patients could not afford them. Then companies began to add prescription coverage for medications to health insurance plans. More people were able to afford these expensive, disease-modifying drugs.
As the understanding of immune cell biochemistry improved, it became possible to design drugs to block a very specific part of the immune system. This new class of drugs are called biologics and are much more effective at turning off the inflammation: they can reduce the rate of new attacks and new lesions by 60 percent or more.
The cost of these new drugs soared to $4,000 or $5,000 a month. Market forces soon caused the cost of the old, interferon-based medications to double and then triple. This means substantial costs of care for the multiple sclerosis patient and substantial profit for the drug companies providing these medications. Thus, a multibillion dollar pharmaceutical industry surrounding the treatment of MS is born.
But as Professor Dr. George Ebers, a leading MS researcher in Europe notes in this lecture, neither the number of active lesions or number of acute relapses predict how quickly someone will need a walker, wheelchair, or become bedridden due to MS. He states that we need many years of research to know whether the disease-modifying drugs really do prevent the conversion to progressive MS and lengthen the time without MS-related disability. Those studies do not exist because they would need to last 10 years.
The conventional approach to treating MS is simple—prescribe these potent and expensive ($2,000 to $5,000 per month) medications that block immune response. Sadly, few physicians ever talk to their patients about what they can do themselves to prevent disability. However, there is another approach to addressing MS and other autoimmune disease: teaching patients how to create more health in their lives by using diet and lifestyle changes that are health promoting.
The functional medicine approach to treating autoimmune disease aims to get to the root cause of why immune cells began to attack the self. The functional medicine practitioner treats the human ecosystem rather than focusing only on immune suppression. Functional medicine practitioners look at a patient comprehensively; checking his nutritional status, physical activity level, gut health, food and/or mold sensitivities, hormone balance, toxin exposure history, infection history, the mix of bacteria, yeasts and parasites living in the gut and on the skin, sleep quality, stress level, and social and family support.
Each of these factors is closely examined to see if it might be promoting disease. If it is potentially contributing to the person’s poor health, the patient and practitioner work together to modify this factor, lessening its contribution to a disease state. Functional medicine practitioners use diet and lifestyle changes as an integral part of their treatment plan to create a healthier human ecosystem, which results in disease stabilization and often a steady regression of symptoms.
I am a clinical professor of medicine at the University of Iowa and I conduct clinical research. I am also a patient with MS. When I was first diagnosed, I saw the best doctors at the best MS center that I could find, the Cleveland Clinic. I took the latest drugs, including the new biologic drugs, but continued to decline. I needed a cane, then a wheelchair. Eventually my trunk muscles were so weak that it was difficult to sit in a chair for more than 10 minutes.
That was when I discovered the Institute for Functional Medicine and took their course, Neuroprotection: A Functional Medicine Approach to Common and Uncommon Neurological Syndromes. I used what I learned from my research and from the Institute for Functional Medicine to create a dietary and lifestyle program that changed everything. Within 6 months of this new program, what I now call The Wahls Protocol, I was able to walk throughout the hospital without a cane, my fatigue was gone, and my brain fog dissipated. And within 12 months I was able to bicycle again, even completing an 18-mile bicycle tour with my family.
This changed me not only as a person but also as a physician. I see disease and health in an entirely new way, practice medicine differently, and conduct cutting-edge clinical research. I now study the use of diet and lifestyle interventions to treat multiple sclerosis, including progressive MS. My research team has been able to show that others can adopt and sustain the protocol with minimal side effects and a dramatic reduction in fatigue. We have published our first paper, the second has been accepted, and more are on the way.
In addition to research, I am also committed to teaching the public about dietary and lifestyle changes they can make to improve their health, increase their energy, stabilize mood, improve motor function, and reduce pain.
We use this approach of examining and improving the entire human ecosystem to treat all complex autoimmune conditions, mental health problems, and medical problems in the Therapeutic Lifestyle Clinic at the University of Iowa, often with tremendous success at restoring health and regressing disability. If you would like to learn more about my work, visit www.terrywahls.com. If you are ready to begin the diet and lifestyle changes I study in my clinical trials, pick up my new book, The Wahls Protocol: A Radical New Way To Treat All Chronic Autoimmune Conditions Using Paleo Principles.
