Dr. Terry Wahls and the Wahls Protocol

Terry L. Wahls, MD, MBA, is an American internal-medicine physician and clinical professor of medicine at the University of Iowa Carver College of Medicine, and for many years a physician at the Iowa City Veterans Affairs (VA) health system. She has secondary progressive multiple sclerosis (MS). Starting in December 2007 she followed a program of her own design — a nutrient-dense, modified Paleolithic diet combined with neuromuscular electrical stimulation, exercise and stress reduction — that she later named the Wahls Protocol and credits with her return from a tilt-recline wheelchair to walking and cycling. Her research group at the University of Iowa has since tested the diet in single-arm pilot studies and randomized trials.

This hub gathers the seven deep-dive articles on her work: her life and career, the diet levels and food rules, her book on mitochondria and brain nutrients, the multimodal pilot studies in progressive multiple sclerosis, the randomized diet trials, the exercise, electrical-stimulation and stress-reduction parts of the program, and her books and legacy. Below the article cards are a short account of who she is, her approach on one page, a dated timeline and her most central papers. Everything here is reported as she and her research team state it, attributed to them.

Deep-Dive Articles

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Terry Wahls: Life and Career

From a northeast Iowa farm and a fine-arts degree to her 1982 medical degree, Marshfield Clinic, the Iowa City VA and the University of Iowa — and her own course with multiple sclerosis as she has published it.

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The Wahls Protocol Diet Levels and Food Rules

The Wahls Diet, Wahls Paleo, Wahls Paleo Plus and the Wahls Elimination version: nine cups of vegetables and fruit in three groups, organ meat, seaweed, nutritional yeast and fermented foods, and the reasons she gives for each exclusion.

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Minding My Mitochondria: Nutrients for the Brain

Her 2010 book and 2011 TEDx talk on the nutrients she says mitochondria and myelin depend on, her study of brain micronutrients, and research on mitochondria in progressive multiple sclerosis.

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Wahls Multimodal Pilot Studies in Progressive Multiple Sclerosis

The single-arm study that combined diet, supplements, electrical stimulation, exercise, meditation and massage, and its published results on fatigue, gait, mood, cognition and blood markers.

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Wahls Diet Randomized Trials in Multiple Sclerosis

The 2017 randomized pilot, the Paleolithic-versus-ketogenic study, the WAVES trial comparing the Wahls Elimination and Swank diets, and the reviews that pooled diet trials in multiple sclerosis.

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Exercise, Electrical Stimulation and Stress Reduction in the Wahls Protocol

Neuromuscular electrical stimulation, her 2010 case series, the home stretching and strengthening program, and the meditation and self-massage used in her trials.

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Terry Wahls: Books and Legacy

Minding My Mitochondria, The Wahls Protocol and its cookbook, the Wahls Behavior Change Model, her co-edited journal issue on diet and multiple sclerosis, and the research field that has grown around it.

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Who Terry Wahls Is

Wahls describes herself as a fifth-generation Iowan who grew up on a farm in northeast Iowa. She earned a Bachelor of Fine Arts in painting at Drake University in 1976 and her medical degree at the University of Iowa College of Medicine in 1982. She trained first in obstetrics and gynecology at Barnes Hospital, Washington University, St. Louis, then in internal medicine at University of Iowa Hospitals & Clinics. She chose internal medicine, she told an interviewer, because “It allowed me to have ongoing relationships with my patients, which I find very satisfying.”

In the early 1990s she was a general internist at Marshfield Clinic in Wisconsin, and in 2001 she completed an MBA at the University of St. Thomas in Minnesota. She has been on the University of Iowa faculty since 2000 and worked at the Iowa City VA, later as director of its Extended Care and Rehabilitation Service Line. Before turning to multiple sclerosis research she published health-services and patient-safety studies at the VA on missed test results, delayed responses to elevated prostate-specific antigen (PSA) values and barriers to earlier colorectal-cancer diagnosis.

She was diagnosed with relapsing-remitting multiple sclerosis in 2000. “By 2003, I had transitioned to secondary progressive multiple sclerosis,” she writes; she underwent chemotherapy to try to slow the disease and used a tilt-recline wheelchair for four years. “In December 2007, I began the Wahls Protocol®,” she writes, and “Within a year, I was able to walk through the hospital without a cane and even complete an 18-mile bicycle tour.” Today she teaches internal-medicine residents in their primary-care clinics and runs clinical trials on diet and lifestyle in MS.

Her Approach on One Page

Wahls built her diet in 2008 on the tenets of the Paleolithic diet and her own review of the literature. As her research team describes it, the Wahls diet “was designed to reduce oxidative stress and excitotoxicity, nourish the mitochondria, prevent nutrient deficiencies, minimize food allergies and reduce toxic load, feed the microbiome, activate anti-inflammatory genes and increase nerve growth factors.” Grains and dairy, the same paper says, “were excluded because of the potential for undesirable immune effects.”

The central rule is volume and variety of plants: nine or more cups of vegetables and fruit a day, split among leafy greens, sulfur-rich vegetables (the cabbage and onion families and mushrooms) and deeply coloured produce. Her plan adds organ meat, seaweed and algae, nutritional yeast and fermented foods — her list includes sauerkraut, kimchi, kefir, natto, miso and tempeh. In 2015 she developed the Wahls Elimination version, which also removes gluten-free grains, legumes, eggs, nightshades and all cow, goat, mare and soy dairy products, reflecting what her team calls “the theoretical benefits of a low lectin diet.” The book series describes a ketogenic level, Wahls Paleo Plus, as well.

Wahls holds that food is only one part of the program. In her own recovery and her first trials she combined the diet with neuromuscular electrical stimulation of the trunk and leg muscles, a home stretching and strengthening program, and stress management through meditation and self-massage. In her 2022 review of dietary approaches she writes that no dietary pattern “has been proven to be effective for reducing the number of relapses or enhancing lesions,” while several pilot studies — including those of the Swank, McDougall, Wahls, gluten-free, Mediterranean and fasting approaches — show reduced MS-related symptoms. Her papers repeatedly state that larger randomized controlled trials are needed.

Timeline at a Glance

Key Research Papers

  1. Reese D, Shivapour ET, Wahls TL, Dudley-Javoroski SD, Shields R. Neuromuscular electrical stimulation and dietary interventions to reduce oxidative stress in a secondary progressive multiple sclerosis patient leads to marked gains in function: a case report. Cases J. 2009;2:7601. — PubMed PMID: 19918474
  2. Wahls TL, Reese D, Kaplan D, Darling WG. Rehabilitation with neuromuscular electrical stimulation leads to functional gains in ambulation in patients with secondary progressive and primary progressive multiple sclerosis: a case series report. J Altern Complement Med. 2010;16(12):1343-9. — PubMed PMID: 21138391
  3. Wahls TL. The seventy percent solution. J Gen Intern Med. 2011;26(10):1215-6. — PubMed PMID: 21253878
  4. Bisht B, Darling WG, Grossmann RE, Shivapour ET, Lutgendorf SK, Snetselaar LG, et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. 2014;20(5):347-55. — PubMed PMID: 24476345
  5. Bisht B, Darling WG, Shivapour ET, Lutgendorf SK, Snetselaar LG, Chenard CA, et al. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2015;5:19-35. — PubMed PMID: 30728736
  6. Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18. — PubMed PMID: 30050374
  7. Wahls TL, Chenard CA, Snetselaar LG. Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic. Nutrients. 2019;11(2):352. — PubMed PMID: 30736445
  8. Chenard CA, Rubenstein LM, Snetselaar LG, Wahls TL. Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern. Nutrients. 2019;11(3):537. — PubMed PMID: 30832289
  9. Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma β-Hydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study. J Am Coll Nutr. 2021;40(1):13-25. — PubMed PMID: 32213121
  10. Wahls TL, Titcomb TJ, Bisht B, Eyck PT, Rubenstein LM, Carr LJ, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021;7(3):20552173211035399. — PubMed PMID: 34377527
  11. Wahls TL. Dietary Approaches to Treating Multiple Sclerosis-Related Symptoms. Phys Med Rehabil Clin N Am. 2022;33(3):605-620. — PubMed PMID: 35989054
  12. Elliott-Wherry AN, Lee JE, Pearlman AM, Wahls TL. The Wahls Behavior Change Model for Complex Chronic Diseases: A Clinician’s Guide. Degener Neurol Neuromuscul Dis. 2022;12:111-125. — PubMed PMID: 36110247

PubMed Topic Searches

  1. Wahls TL and multiple sclerosis
  2. Wahls TL and the modified Paleolithic diet
  3. Wahls TL and the Swank diet comparison
  4. Wahls TL and neuromuscular electrical stimulation

Further Reading

Connections