[This article discusses health improvements based, at least in part, on a ketogenic diet. Professor Loren Cordain and many others, including The Paleo Diet editorial review board, don’t recommend or endorse long-term ketogenic dieting for the general public. They do acknowledge that it can be effective if used short-term or as a therapeutic measure for multiple sclerosis, Alzheimer’s, and other diseases.]
The title of Dr. Terry Wahls’ book, The Wahls Protocol: A radical new way to treat all chronic autoimmune conditions using Paleo principles,  highlights issues vital to retirees or anyone facing autoimmune conditions. But it also modestly avoids the book’s central revelation: Wahls’ own personal experience dramatically improving severe multiple sclerosis symptoms.
An avid martial artist and cyclist when first diagnosed with MS, Wahls became progressively debilitated despite the best conventional medical care—including drugs and chemotherapy. Within seven years she was wheelchair-bound, only able to walk short distances using two canes.
A firmly committed conventional physician herself, she realized she needed to look beyond Western medicine and began her own research. This resulted in a carefully crafted, rigorous diet-and-lifestyle intervention that improved her health so dramatically she could walk without canes or assistance at four months and ride a bicycle (for the first time in 10 years) at five months. She remains fully active today, devoted to both widening awareness of health problems caused by the standard Western diet and to clinical research on replicating her personal results.
“How did I not know any of this?” (from The Wahls Protocol, p. 5)
Many hours on Google and PubMed eventually led Wahls to the Paleolithic or Ancestral diet, which became integral to her own protocol and recovery. She credits Professor Loren Cordain as a strong early influence in her research, including his book The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat.  Wahls gradually abandoned her conventional Western (vegetarian) diet, and designed from scratch, by trial and error, an intensively micro- and phytonutrient-rich whole-food regimen. Her goal was not just to remove western staples like processed foods, grains, and legumes, but to add optimal levels of all vitamins and minerals needed to promote brain health—using food, not supplements.
The balance of macronutrients—heavy on vegetables, some fruit and healthy fats—that appears to have improved Wahls’ MS symptoms result in “mild ketosis.” Her protocol also includes regular exercise, toxin reduction, e-stim, whole body vibration, and decreasing stress. Some supplements may be used, but the bulk of nutrients are derived from whole foods. Her well-known TED talk  concisely introduces her protocol—and describes her remarkable personal resurgence. It is just as timely today as it was when it was recorded in 2011. It has been viewed (as of this writing) over 3 million times.
Many conditions, one etiology
Wahls views most chronic health issues, and specifically autoimmune conditions like MS, as essentially the same disease :
“The primary driver of disease is biochemical dysfunction/accelerated aging due to mitochondrial dysfunction and cell membrane dysfunction. Fix those two things—cells begin to repair organs, organs function well, aging slows and often reverses, and the need for pharmacologic interventions decline and we need to steadily reduce and often eliminate prescription drugs…” 
In an email interview, Wahls reports success using her protocol “across a large swath of disease states across multiple specialties,” both helping patients and causing previously skeptical colleagues to reconsider her approach.  She emphasizes cellular nutrition, multiplying and strengthening mitochondria (the “engines” or energy-producing substructures in each cell) and the importance of treating the whole person to restore optimal biochemical processes.
Wahls, who added functional medicine to her own medical practice during her MS research, also notes that the basic whole-food, whole-person protocol can be at least as effective as a costly test- and supplement-intensive functional approaches. As many patients find, good functional practitioners are scarce—and typically not covered by health insurance. Extended functional treatment may cost thousands of dollars, including exotic lab work, versus a modest increase in the household food budget, with some funds earmarked for stress-reduction, natural detox and exercise.
Despite the success of her protocol, Wahls cautions that medical supervision is still important, especially for MS and other autoimmune patients taking medication. Each individual responds differently. Wahls recommends monitoring the protocol based on standard indicators including lipid profile, homocysteine, insulin and A1C levels. If adjustments are necessary, they typical involve changes in ratios of various vegetables, targeted supplements, or possibly the amount of dietary fat consumed.
Paleo vs. Keto in the protocol
The Wahls Protocol offers three versions or levels of the diet, all of which are built on six to nine cups of vegetables (and some fruit) each day. Wahls recognizes the initial difficulty of eliminating classic Western diet stressors, like sugar, grains, potatoes and dairy. These are first de-emphasized, then restricted, and finally eliminated in the third level, called “Wahls Paleo Plus.” This level targets “mild” ketosis and is credited by Wahls for reversing her MS symptoms.
Wahls includes exercise, e-stim, detox, and stress reduction in all levels.
“Wahls Paleo Plus” is unusually nutrient-dense compared to other ketogenic plans, and includes at least six cups of greens, sulfur-rich and colorful vegetables, along with coconut milk, seaweed, organ meats, and grass-fed or other carefully sourced protein. Ketosis should be consistent (but may be intermittent.)
Wahls observes, however, that no modern (or ancestral) hunter-gatherer populations maintain a year-round ketogenic diet, and that it may not be practical or even desirable, as we’ve pointed out on this website, to stay in ketosis indefinitely. She has come to favor cycling through periodic fasting (or a fasting-mimicking diet), other caloric restriction, and matching a ketogenic diet to the winter season of an individual’s ethnic background. 
This fosters therapeutic ketosis for a generous stretch of time each year, takes advantage of occasional controlled fasting to promote autophagy and detoxification, and allows “three-seasons” use of the less restrictive ancestral food choices in “Wahls Paleo” (the second level of the protocol.)
“Wahls Paleo” study results
Wahls estimates  that most of her patients choose the second level of the diet or “Wahls Paleo.” It follows many common Paleo guidelines, with the nine cups of vegetables as a foundation. No gluten-bearing food is permitted, and starches like legumes, brown rice, or potatoes are severely limited (two servings per week at most.)
Anecdotal evidence of patient success in her books (and on the internet) is strong, but Wahls has gone beyond word of mouth. Her intervention, typically at the “Wahls Paleo” level , has shown improvement or reversal of MS symptoms in multiple studies.
One study, first published in 2019 in PloS One, tracked changes in lipid profiles and the associated improvements in fatigue scoring. The intervention (diet plus e-stim, exercise, and stress-reduction) measurably reduced fatigue, a primary symptom of progressive MS, over 12 months. 
The same intervention was shown to improve gait and balance, primarily in mild-to-moderate progressive MS patients in a 2017 study first published in Degenerative Neurological and Neuromuscular Disease.  Wahls shared a related YouTube video showing some very marked improvements. [5,9]
Another important 2017 study, which first appeared in The Journal of the American College of Nutrition, showed that progressive MS patient scores for mood, cognitive and executive function, and anxiety were measurably improved by the Wahls intervention . The authors noted, in particular, that the Paleolithic dietary component specifically improved mood and cognition more directly than the exercise or stress management. Fatigue, anxiety, and depression scores increased more gradually, but showed significant improvement after several months.
Finally, a 2019 study first published in Nutrients compared “Wahls Paleo” to a standard American “healthy diet.” Conventional nutritional bias is carefully balanced against Wahls’ recommendations and concluded that nutrient density was comparable in both diets (specifically that the Wahls diet is “safe” to follow.) 
Dr. Wahls’ work has important implications for treatment of all autoimmune conditions. Her success in reversing symptoms of a long-standing, progressive debilitating disease like MS, deserves much wider recognition.
- Wahls, Terry, M. D., and Eve Adamson. The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles. Reprint edition, Avery, 2014. (hereafter “Wahls”)
- Cordain, Loren. The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. Revised edition, John Wiley & Sons, 2010.
- Wahls, Terry. YouTube. 30 Nov. 2011, https://www.youtube.com/watch?v=KLjgBLwH3Wc.
- Wahls P. 47
- Wahls, Terry, M.D., email to the author, 9/3/2019
- Wahls P. 149
- Fellows Maxwell, Kelly, et al. “Lipid Profile Is Associated with Decreased Fatigue in Individuals with Progressive Multiple Sclerosis Following a Diet-Based Intervention: Results from a Pilot Study.” PloS One, vol. 14, no. 6, 2019, p. e0218075. PubMed, doi:10.1371/journal.pone.0218075.
- Bisht, Babita, et al. “Effects of a Multimodal Intervention on Gait and Balance of Subjects with Progressive Multiple Sclerosis: A Prospective Longitudinal Pilot Study.” Degenerative Neurological and Neuromuscular Disease, vol. 7, 2017, pp. 79–93. PubMed, doi:10.2147/DNND.S128872.
- Bisht, Babita et al. YouTube. 26 Nov. 2017, https://www.youtube.com/watch?v=tsOMPBS277Q.
- Lee, Jennifer E., et al. “A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.” Journal of the American College of Nutrition, vol. 36, no. 3, Apr. 2017, pp. 150–68. PubMed, doi:10.1080/07315724.2016.1255160.
- Chenard, Catherine A., et al. “Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern.” Nutrients, vol. 11, no. 3, Mar. 2019. PubMed, doi:10.3390/nu11030537.