Wednesday, March 19, 2014

The Wahls Protocol – Paleo Magic or Faulty Logic?

Terry Wahls, author of The Wahls Protocol, asks "Could Vegetarianism Increase Your Risk Of Autoimmune Disease?"
In this article Wahls suggests that she developed multiple sclerosis because she adopted a 'vegetarian' diet in her teen years after reading Frances Moore Lappe's Diet for a Small Planet. 

Wahls writes:

"I eventually chose medical school instead of vet school. As a student, I lived on beans and rice, whole-grain bread, eggs and cheese, vegetables and fruit. At the time, the medical profession promoted a low-fat, low-cholesterol diet. I disagreed with this on an intuitive level. I ate eggs and cheese in addition to my beans and rice, believing I needed the fat and protein for my high-energy lifestyle. Through med school, my internship, and various relationships, I remained a vegetarian."

This tells us that her 'vegetarian' diet included plenty of animal protein, saturated fats, and cholesterol, and that she mistakenly believed that fat and protein are the best sources of energy for a physically and mentally active young adult.  Cheese and eggs are the richest dietary sources of saturated fats and cholesterol, respectively.  Dairy fat has the highest proportion of saturated fats (~54%) and 100 g whole egg supplies 372 mg cholesterol, whereas 100 g of grass-fed beef supplies only 62 mg, i.e. the eggs have on a weight basis 6 times the cholesterol of the beef.  One egg also provides ~5 g saturated fat.

Saturated fat consumption increases the risk of developing multiple sclerosis, and MS patients have higher nerve membrane levels of shorter-chain SFAs than controls. 1, 2  

The 2013 Atlas of MS, page 8, shows that MS primarily afflicts people in affluent nations eating animal-rich diets.  Nations that consume large amounts of dairy products – U.S.A., Canada, Scandinavian nations – have the highest prevalence.  The regions with high intakes of grains and legumes but lower intakes of land animal flesh, dairy products and eggs – Africa and Asia – have a low prevalence.  Anyone claiming that grains and legumes cause MS needs to explain why the nations with the highest intakes of grains and legumes have the lowest prevalence of the disease.

Based on this ecological data indicating that the prevalence of MS is many times greater in regions consuming diets high rather than low in saturated fat, in the 1950s Roy Swank developed a low-fat diet protocol for MS.  Over the course of 34 years of treatment, Swank reported:

"Minimally disabled patients who followed diet recommendations deteriorated little if at all, and only 5% failed to survive the 34 yr of the study, whereas 80% who failed to follow diet recommendations did not survive the study period."3
Of important interest, the Swank diet allows unlimited intake of whole grains and legumes, including wheat and soy. 4 Swank proposed an explanation for the role of saturated fats in MS:
“During digestion all fats are first reduced to small globules of fat and then to chylomicra in the blood. These chylomicra collect in the small arteries from which feeding capillaries arise. After a large fatty meal, the chylomicra are crowed together and form aggregates.  When formed from unsaturated fats (oils), aggregates are relatively small and loosely held together.  The aggregates are small enough to enter and pass through the capillaries and nourish the tissue.  Conversely, saturated fat aggregates are much larger and tightly bound together. They may or may not enter the capillaries and, due to their size, may get lodged in the capillaries or very slowly pass through.  The rigidity of the aggregates makes them less easy to deform by the shear forces than the softer aggregates formed from the lower molecular weigh droplets from vegetable oils.  As a result the tissues to be nourished by the large aggregates fail to receive adequate nourishment and may starve or function poorly.
"Multiple scattered lesion or malfunction will result in all tissues and organs of the body due to the temporary blockage of the feeding capillaries and subsequent poor nourishment.  We suggest this is a cause of MS when these lesions occur in the central nervous system.  The damage due to the obstruction of feeding capillaries and starvation of scattered tissue may be a contributing factor in aging and the deterioration of other organs resulting in disease such as diabetes and heart disease. All the surviving patient in the [Swank low-fat diet MS] study on low saturated fat show youthful facial condition, demonstrating the efficient microcirculation in the subcutaneous tissue.” 5
Dairy and eggs are also among the eight foods that account for 90 percent of food allergy reactions in the United States. 6  Cow milk and chicken egg proteins are among the most allergenic proteins consumed by humans. 

MS risk is increased by diets rich in animal products, and reduced by plant-based diets.   7  Cow milk consumption has a strong worldwide correlation with MS incidence.  8, 9

In contrast, some research suggests that some peptides present in at least one cereal grain (rice) may be in part responsible for the low prevalence of MS in Asian rice-eating populations. 10

 Wahls reports adopting a dairy- and egg-free diet to treat her MS. 

"I began experimenting on myself, and one of my first discoveries was the work of Dr. Ashton Embry, who had connected diet to multiple sclerosis. Nobody had ever suggested to me that there could be any connection between multiple sclerosis and diet (the mainstream medical literature continues to deny the connection).

"Dr. Embry’s son had multiple sclerosis, and he wrote that a diet without grains or dairy products that included meat could have a dramatic effect on MS progression. I decided it was worth a try. At first, the thought of eating meat was nauseating to me, both physically and morally. I wanted desperately to heal, and I was willing to try just about anything, but by this time I had been a vegetarian over 15 years."

She also writes "I would refine it further, not only eliminating foods that were causing problems for me (grains, legumes, dairy, and eggs)..." 

From this experience, Wahls concludes that avoiding meat caused her to get MS, and that eating meat cured her and is essential to human nutrition:

"I once was a vegetarian because of my conscience, but now, as a doctor, I can no longer in good conscience recommend it.

She seems oblivious to the significance of removing dairy and eggs, the richest dietary sources of cholesterol and saturated fats, from her diet.  As quoted above, she says that she disagreed with the recommendations for a low-fat, low-cholesterol diet "on an intuitive level."  Yet removing these high-fat, high-cholesterol foods from her diet improved her condition.  How good was her intution?  And should a medical doctor rely on "intuition" when there is data to be had? 

Sorry to say, I am surprised and dismayed that someone with such weak reasoning skills can have graduated from medical school.   This woman grew up on a farm, "milking the cows" daily, eating eggs, dairy products, and the flesh of chickens, cows, and pigs, until her teen years, then persisted for 15 years eating "eggs and cheese" for fat, protein, and "energy" as a part of her "vegetarian" diet and she thinks that eating grains and beans caused her MS and eating meat cured it?  Does she recognize that eggs and cheese are not plant foods?  Does she not realize that her diet was rich in saturated fats, cholesterol, and animal products all along?  Does she rely on her "intuition" to determine the cause of MS, even when it conflicts with the data?  Does she even care about the data?

She writes:

"I eventually developed the Wahls Diet, which focuses on vegetables and fruits: 9 cups every day, divided into 3 cups of leafy greens, 3 cups of brightly colored fruits and vegetables, and 3 cups of sulfur-rich vegetables, as well as a regimen of organ meats and sea vegetables"

The patients in the Swank study achieve the same results or better than hers.  Based on the data we have about MS, and the proven success of the Swank protocol for MS (low saturated fat plant-based diet) her improvement was caused by avoiding dairy and eggs, not by adding meat or avoiding grains and legumes. The common factors are reduction of dairy and egg products, and increase of vegetables and fruits, not consumption of organ meats, which are not emphasized on the Swank diet, but are relatively low in fat.  For example, beef liver supplies only 1.5 g fat and 0.5 g saturated fat per ounce, compared to cheddar cheese's 9.4 g total fat and 6 g saturated fat per ounce; the cheese has 6 times as much total fat and 12 times as much saturated fat.  By removing cheese and eggs from her diet and substituting beef liver or other organ meats, she sustains a very significant reduction in total and saturated fat intake. There is no paleo diet magic here.  Her protocol is lower in fat and saturated fat than the diet that she ate for years before her MS diagnosis, including her "vegetarian" diet.  Further, vegetables and fruits supply many anti-inflammatory compounds including dietary salicylic acid, which improves blood circulation. 

Finally, to answer her posed question: Yes, a "vegetarian" diet could very well increase your risk of autoimmune disease, because a "vegetarian" diet can include plenty of animal protein, fat, and saturated fat from dairy products and eggs.  But a whole foods plant-based diet does not include dairy, eggs, or any other animal matter as staple foods.  Dr. Wahls came to some right conclusions – avoid dairy and eggs, eat more vegetables – and some wrong conclusions – eat more organ meats – by some faulty logic.  She believes in a false dilemma, that we must choose between eating ethically, or suffering MS or other autoimmune diseases.  The evidence I have cited indicates that she could have both her ethics and her health by choosing a whole foods plant-based diet.