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Testing the Effect of Nutrition and LifestyleInterventions toTreat MS and Other Progressive Health ProblemsTerry Wahls, MD, IFMCPClinical Professor of MedicineUniversity of Iowa

Disclosures Grant Funding –– National MS Society Trademarks – Wahls Diet Plans, Wahls Protocol Financial relationships with Penguin Random House Inc.;Integrative Medicine for Mental Health; Institute forHealth and Healing; Suttler Pacific, BioCeuticals; NCURA;MCG Health Inc.; Genova Diagnostics Minding My Mitochondria Wahls Protocol, Wahls Protocol Cooking for Life Equity interest– Dr. Terry Wahls LLC– The Wahls Institute PLC– www.terrywahls.com

Objectives- Review The published research on dietaryinterventions for MS The mechanisms by which dietary factors maycontribute to potential worsening of MSrelated symptoms. The rationale for the structure of the dietaryintervention in the Dietary Approaches toTreating MS Related Fatigue TrialNCT02914964.

At present there are no dietaryrecommendations in the Evidence AnalysisLibrary for treatment of neuroinflammation orneurodegeneration by the Academy ofNutrition and Dietetics.

How many cups of vegetables did you eat in last 24 hours?

In 2000 I Became A Patient Left leg weaknessPrior history visual dimmingLesions in spinal chordAbnormal CSFDiagnosis relapsing-remitting MS

2003

Institute For Functional Medicine

Figure 1. The two routes by which diet can influence our health: (A)the metabolism of our cells and (B) the population of our gutmicrobiota.Paolo Riccio, and Rocco Rossano ASN Neuro2015;7:1759091414568185Copyright by SAGE Publications Inc, or the American Society for Neurochemistry, unlessotherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses.

The Swank Diet N 144 followed 50 years 15 grams saturated fat vs. 20 gramsGreatest benefit earlier in the disease courseMore likely to remain ambulatoryReview of MS patient survival on a Swank low saturated fat diet.Nutrition. 2003 Feb;19(2):161-2. Review.Effect of low saturated fat diet in early and late cases of multiple sclerosis.Lancet. 1990 Jul 7;336(8706):37-9.Multiple sclerosis: twenty years on low fat diet.Arch Neurol. 1970 Nov;23(5):460-74.

Low-fat, plant-based diet in multiplesclerosis: A randomized controlled trial This was a randomized-controlled, assessorblinded, one-year long study N 61 No change in EDSS, MRI Trend towards reduced FSS (fatigue)Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trialMult Scler Relat Disord. 2016 Sep;9:80-90.

Mediterranean diet adherence and riskof multiple sclerosis – Case control study N 70 RRMS 140 controls Interviews re dietReduced risk of MS– Fruits (OR 0.28, 95% CI: 0.12-0.63, p-value: 0.002)– Vegetables (OR 0.23, 95% CI: 0.10-0.53, p-value: 0.001)Mediterranean diet adherence and risk of multiple sclerosis: a case-controlstudy. Asia Pac J Clin Nutr. 2016;25(2):377-84.

Mediterranean DietHigh olive oilHigh vegetable/ polyphenolWhole grainsLow red meatPotential for diet to prevent and remediate cognitive deficits in neurological disorders.Nutr Rev. 2018 Mar 1;76(3):204-217.The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence.Curr Nutr Rep. 2018 Aug 16.Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols: Which Role in thePrevention and Treatment of Immune-Mediated Inflammatory Diseases?Endocr Metab Immune Disord Drug Targets. 2018;18(1):36-50.

The following slides represent the rationalefor the dietary intervention we are studying inthe Dietary Approaches to Treating MSRelated Fatigue

This protocol is not validated nor does itcurrently meet the current evidence basedguideline criteria as set forth by the AmericanAcademy of Neurology or the Academy ofNutrition and Dietetics

Dairy & MSCasein, Gluten & Schizophrenia Liquid cow milk (not cheese) and MS prevalence washighly correlated (rho 0.836) across 27 countriesand 29 populations. IgG to Casein and gluten were significantly in recent onset and non-recent onset schizophreniacompared to controls (p 0.00001-0.004) .1. Correlation between milk and dairy product consumption and multiple sclerosis prevalence: a worldwidestudy. Neuroepidemiology. 1992;11(4-6):304-12.2. Severance EG, Alaedini A, Yang S, Halling M, Gressitt KL, Stallings CR, Origoni AE, Vaughan C,Khushalani S, Leweke FM, Dickerson FB, Yolken RH. Gastrointestinal inflammation and associatedimmune activation in schizophrenia Schizophr Res.2012 Jun;138(1):48-53.

Gluten and Casein and Opioids Gluten can be degraded into several morphinelike substances, named gluten exorphins. Milk proteins are particularly strong allergens andare additional source of bioactive peptidesincluding β-casomorphin-7 and exerts itsinfluence on nervous, digestive, and immunefunctions via the opioid receptor1. The opioid effects of gluten exorphins: asymptomatic celiac disease. J Health PopulNutr. 2015 Nov 24;33:24.2. Opioid receptor ligands derived from food proteins. Curr Pharm Des. 2003;9(16):133144.3. β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expressionin children with atopic dermatitis. Peptides. 2014 Dec;62:144-9.

Nutrition in Parkinson's DiseaseSeidl SE, Santiago JA, Bilyk H, Potashkin JA. The emerging role of nutrition in Parkinson's disease. Front Aging Neurosci. 2014 Mar 7;6:36. doi: 10.3389/fnagi.2014.00036. eCollection 2014.

Gluten sensitivity is an abnormal immune response to gluten in genetically susceptibleindividuals and may manifest solely with neurological dysfunction. 90% of glutensensitive individuals have no GI symptoms.Lancet Neurol. 2010 Mar;9(3):318-30 Hadjivassiliou M

Figure 2 MRI in four patients with gluten encephalopathy The extent and variability of white matter abnormalities caused by gluten sensitivitycan be seen in these four patients (A–D). A and C show diffuse white matter changes, whereas B and D show more f.Marios Hadjivassiliou , David S Sanders , Richard A Grünewald , Nicola Woodroofe , Sabrina Boscolo , Daniel Aeschl.Gluten sensitivity: from gut to brainThe Lancet Neurology Volume 9, Issue 3 2010 318 - 330http://dx.doi.org/10.1016/S1474-4422(09)70290-X

MS and Gluten References1.2.3.4.5.6.7.8.9.Gluten antibodies in patients with multiple sclerosis. Hum Nutr ApplNutr. 1984 Apr;38(2):142-3.Multiple sclerosis and gluten sensitivity. Clin Neurol Neurosurg. 2007Oct;109(8):651-3.Prevalence of celiac disease in multiple sclerosis. BMC Neurol. 2011 Mar7;11:31.Celiac disease with neurologic manifestations in children. Rev Med ChirSoc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94.Celiac disease with cerebral and peripheral nerve involvementmimicking multiple sclerosis. J Med Life. 2014 Sep 15;7(3):440-4. Epub2014 Sep 25.A case of multiple sclerosis and celiac disease. Case Rep NeurolMed. 2013;2013:576921.Gluten-related disorders: gluten ataxia. Dig Dis. 2015;33(2):264-8.Transglutaminase-6 is an autoantigen in progressive multiple sclerosis andis upregulated in reactive astrocytes. Mult Scler. 2016 Dec1:1352458516684022.The progression of coeliac disease: its neurological and psychiatricimplications. Nutr Res Rev. 2017 Jun;30(1):25-35.

Risks of Eggs Pros– Grass fed - DHA, choline, biotin, lutein, Vitamins A, D, K2, andB3, B6, B9, B12 Cons––––References next slideEggs are most common food allergen in IBD 70%60% allergy patients have IgG Ab to eggs13% seasonal allergies have IgG Ab to eggsWheat, milk, eggs are common food triggers to EosinophilicEsophagitis

References: Risks of Eggs Wang G, Ren J, Li G, et al. The utility of food antigen test in the diagnosis of Crohn’s diseaseand remission maintenance after exclusive enteral nutrition. Clin Res Hepatol Gastroenterol.2018;42(2):145-152. doi:10.1016/j.clinre.2017.09.002Shakoor Z, AlFaifi A, AlAmro B, AlTawil LN, AlOhaly RY. Prevalence of IgG-mediated foodintolerance among patients with allergic symptoms. Ann Saudi Med. 2016 NovDec;36(6):386-390.Dhanapala P, De Silva C, Doran T, Suphioglu C. Cracking the egg: An insight into egghypersensitivity. Mol Immunol. 2015 Aug;66(2):375-83. doi: 10.1016/j.molimm.2015.04.016.Pang KA, Pang KP, Pang EB, Tan YN, Chan YH, Siow JK. Food allergy and allergic rhinitis in 435asian patients - A descriptive review. Med J Malaysia. 2017 Aug;72(4):215-220.Philpott H, Nandurkar S, Royce SG, Thien F, Gibson PR. Allergy tests do not predict foodtriggers in adult patients with eosinophilic oesophagitis. A comprehensive prospective studyusing five modalities. Aliment Pharmacol Ther. 2016 Aug;44(3):223-33. doi:10.1111/apt.13676.Cai C, Shen J, Zhao D, et al. Serological Investigation of Food Specific Immunoglobulin GAntibodies in Patients with Inflammatory Bowel Diseases. Boone DL, ed. PLoS ONE.2014;9(11):e112154. doi:10.1371/journal.pone.0112154.

Lectins “By eliminating dietary elements, particularlylectins, which adversely influence bothenterocyte and lymphocyte structure andfunction, it is proposed that the peripheralantigenic stimulus (both pathogenic anddietary) will be reduced and thereby result ina diminution of disease symptoms in certainpatients with RA.”Cordain L, Toohey L, Smith MJ, Hickey MS. Modulation of immune function by dietary lectins inrheumatoid arthritis. British Journal of Nutrition. 2000;83(03):207-217.

Lectins are proteins found in plants and animals thatbind sugars (hemagglutinins) They can bind the glycoproteins on the intestinal liningleading to barrier damage Lectins are found in most foods but are especially highin grains (esp wheat), dairy, legumes, and nightshadevegetables Most traditional methods cooking these foodssuch as soaking, fermenting & cooking will decreasethe lectin content.

Nutrient Triage Low micronutrient intake may accelerate thedegenerative diseases of aging throughallocation of scarce micronutrients by triage.– Zn, Mg, biotin, Vitamin K, D, A– Lipoic Acid, Acetyl carnitineLow micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarcemicronutrients by triage.Proc Natl Acad Sci U S A. 2006 Nov 21;103(47):17589-94.

What to Eat?Fruit and vegetable consumptionand mortality from all causes, cardiovasculardisease, and cancer: systematic review anddose-response meta-analysis of prospectivecohort studies.16 studies - 833,234 participantsBMJ. 2014; 349: g4490

Risk of all cause mortality associated withservings/day of fruit and vegetables.BMJ. 2014; 349: g4490

Dose-response relation between fruit and vegetableconsumption and risk of all cause mortalityBMJ. 2014; 349: g4490.

Myelin–––––Omega 3 Fatty AcidsThiamine (B1)Folate (B9)Cobolamin (B12)MineralsKey MicronutrientsBourre JM. Effects of nutrients (in food) onthe structure and function of the nervoussystem: update on dietary requirements forbrain. Part 1: micronutrients.Part 2 MacronutriientsJ Nutr Health Aging 2006;10(5):377-85.Bowman Nutrient biomarker patterns,cognitive function, and MRI measures ofbrain aging. Neurology. 2012 Jan24;78(4):241-9. Bowman

Sulfur Rich Foods

Why Brassica and Allium? Improve detoxificationIncrease glutathione productionIncrease GABA productionEnhance NeuroprotectionImprove endothelial function

Brassica and Allium References1. Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice ina Cellular Model of Alzheimer's Disease. Med CellLongev.2015;2015:7819382. Learning and memory promoting effects of crude garlic extract.Indian J Exp Biol.2013 Dec;51(12):1094-100.3. Enhancement of the neuroprotective activity of Hericiumerinaceus mycelium co-cultivated with Allium sativum extract.Arch Physiol Biochem.2015 Feb;121(1):19-25.

Why Emphasize Mushrooms? Increase nerve growth factors (NGF) Hericium erinaceus (Yamabushitake or Lion’sMane) stimulate the production of NGF (invitro) Activate natural killer cells Prime innate and adaptive immunity Mori K, Obara Y, Hirota M, Azumi Y, Kinugasa S, Inatomi S, Nakahata N. Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 humanastrocytoma cells. Biol Pharm Bull. 2008 Sep;31(9):1727-32. Lee DH, Kim HW. Innate immunity induced by fungal β-glucans via dectin-1 signaling pathway. Int J Med Mushrooms. 2014;16(1):1-16. Akramiene D, Kondrotas A, Didziapetriene J, Kevelaitis E Effects of beta-glucans on the immune system. Medicina (Kaunas).2007;43(8):597-606. Lai PL, Naidu M,Sabaratnam V,Wong K, DaviP, Kuppusamy UR, Abdullah N, Malek SN. Neurotrophic properties of the Lion's mane medicinal mushroom,Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms.2013;15(6):539-54. Phan CW, David P, Naidu M, Wong KH, Sabaratnam V. Therapeutic potential of culinary-medicinal mushrooms for the management ofneurodegenerative diseases: diversity, metabolite, and mechanism. Crit Rev Biotechnol.2015;35(3):355-68.

Why Greens? Vitamin K1 metabolized to K2-mk7 in gut K2 important in .– Myelin production– Calcium influx into bones and teeth Carotenoids, magnesium

Greens References1.2.3.4.Age- and brain region-specific effects of dietary vitamin K on myelinsulfatides. Nutr Biochem.2010 Nov;21(11):1083-8.Vitamin K and sphingolipid metabolism: evidence to date. Nutr Rev.2005Apr;63(4):111-21.Bourre JM. Effects of nutrients (in food) on the structure and function ofthe nervous system: update on dietary requirements for brain. Part 1:micronutrients. J Nutr Health Aging. 2006 Sep-Oct;10(5):377-85.Bourre JM. Effects of nutrients (in food) on the structure and function ofthe nervous system: update on dietary requirements for brain. Part 2 :macronutrients. J Nutr Health Aging. 2006 Sep-Oct;10(5):386-99.

Why deeply pigmented? Pigments (especially blue/purple/black) areassociated with improved cognitiveperformance and neuroprotection

Blueberries andMild Cognitive Impairment (MCI) N 47 with MCI, 68 y/o , Blueberry powder vs. placebo, 16 weeks,equivalent of 1 cup berries "There was improvement in cognitive performance and brainfunction compared with placebo" N 94 62 to 80 y/o with memory complaints Fish oil blueberries vs. fish oil placebo, 24 weeks The blueberry-supplemented participants had a better sense ofwell-being, fewer memory mistakes and were less inefficient.Krikorian R, Shidler MD, Nash TA, Kalt W, Vinqvist-Tymchuk MR, Shukitt-Hale B, Joseph JA. Blueberry supplementationimproves memory in older adults. J Agric Food Chem.2010 Apr 14;58(7):3996-4000.Funding for the studies was provided by the US Highbush Blueberry Council, the National Institute on Aging,and Wild Blueberries of North America. Dr. Krikorian has disclosed no relevant financial relationships.

Pigment & Blueberry References1. Medicinal Effect of Nutraceutical Fruits for the Cognition and Brain Health.Scientifica (Cairo).2016;2016:3109254.2. Berry antioxidants: small fruits providing large benefits. J Sci Food Agric.2014 Mar30;94(5):825-333. Dietary and plant polyphenols exert neuroprotective effects and improvecognitive function in cerebral ischemia. Recent Pat Food Nutr Ag. 2013Aug;5(2):128-43.4. The impact of fruit flavonoids on memory and cognition. Br J Nutr.2010 Oct;104Suppl 3:S40-7. d5. Grape juice, berries, and walnuts affect brain aging and behavior. J Nutr. 2009Sep;139(9):1813S-7S.6. Fruit polyphenolics and brain aging: nutritional interventions targeting age-relatedneuronal and behavioral deficits. Ann N Y Acad Sci.2002 Apr;959:128-32.7. Reversing the deleterious effects of aging on neuronal communication andbehavior: beneficial properties of fruit polyphenolic compounds. Am J ClinNutr.2005 Jan;81(1 Suppl):313S-316S.

Why Organ Meat Pre-industrial - 30% of all meat consumed wasorgan meat Excellent source of ubiquinone, minerals,essential fatty acids, fat and water solublevitamins– Retinol, Vitamin A– Vitamin K2-mk4

β-carotene Is Not Retinol (Vitamin A) β-Carotene is converted to vitamin A in theintestine by the enzyme β-carotene-15,15'monoxygenase (BCMO1) to support vision,reproduction, immune function, and celldifferentiation. Considerable variability in BCMO1 exists andcan effect individual vitamin A statusLobo GP Amengual J, Baus D, Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX. J BiolChem.2013 Mar 29;288(13):9017-27.

Leung WC, Hessel S, Méplan C, Flint J, Oberhauser V, Tourniaire F, Hesketh JE, von Lintig J, Lietz G. Two commonsingle nucleotide polymorphisms in the gene encoding beta-carotene 15,15'-monoxygenase alter beta-carotenemetabolism in female volunteers. FASEB J. 2009 Apr;23(4):1041-53. doi: 10.1096/fj.08-121962. Epub 2008 Dec 22.

Total number of microbiome-relatedpublications in PubMed by 0000year 0920102011201220132014201520162017Articles

Gut Brain Immune Axis Gut microbiota influence the brain andimmune system balance Diet influences the microbiome strongly Exercise, sleep, stress level also important Changes in the colon mucosa every early inthe disease process1. Does the Gut Microbiota Influence Immunity and Inflammation in Multiple Sclerosis Pathophysiology? J Immunol Res.2017;2017:7904822. The multiple sclerosis microbiome? Ann Transl Med. 2017 Feb;5(3):53.3. Microbiota-gut-brain axis and the central nervous system. Exp Mol Med. 2017 May 26;49(5):e3394. Microbiota-gut-brain axis and the central nervous system. Oncotarget. 2017 May 105. Microbiota in T-cell homeostasis and inflammatory diseases Exp Mol Med. 2017 May; 49(5): e340.6. Mucosal biopsy shows immunologic changes of the colon in patients with early MS Neurol NeuroimmunolNeuroinflamm. 2017 Jun 14;4(4):e362.

Life Begins in the OceanBy Tiago Fioreze https://commons.wikimedia.org/w/index.php?curid 611189254

Life Timeline Billions of YearsGoing back in time Billions of years 4.5 Water 4.0 Simple life 3.0 Photosynthesis 2.5 Oxygen crisis 1.5 Mitochondria Multi-cellular 0.5 (500 Million) Land plants/ animals 0.2(200 Million) Mammals 0.00025 (250 Thousand) Humans 0.00001 (10 Thousand) grains and legumes55

We have co-evolved with the organisms thatwere in the ocean Microbes divide every 20 minutes (1 billionyears)– Billions of generations Humans every 25 years (250,000 years)– 10,000 generations57

Guts Populated byOcean Microbiome Co-operative mutualistic relationship We are all supra-organisms – as dependent onthe microbes as our cells are upon ourmitochondria to function Dr. Terry Wahls LLC, All Rights Reserved.58

Forager- Hunter 500,000 BCMain Cause of death-Infection, traumaMean age 30s45% mortality before age 15Population and Development Review33(2007):321-65. KaplanCopyright 2016 Dr. Terry Wahls.All rights reserved.

Forager-Hunter 2007Traditional diet, no medical careMain cause of deathInfection, traumaOften live into 60s and 80sPopulation and Development Review33(2007):321-65. KaplanCopyright 2016 Dr. Terry Wahls.All rights reserved.

Sugar intake per capita in the United Kingdom from 1700 to 1978 (30, 31; ) and in the UnitedStates from 1975 to 2000 (32; ) is compared with obesity rates in the United States in nonHispanic white men aged 60–69 y (17; ).Johnson R J et al. Am J Clin Nutr 2007;86:899-906 2007 by American Society for NutritionCopyright 2016 Dr. Terry Wahls.All rights reserved.

Gut-Microbiota-Brain Axis and Its Effect on NeuropsychiatricDisorders With Suspected Immune Dysregulation.Clin Ther. 2015 May 1;37(5):984-95.

8 Studies 250 Patient Fecal Samplesvan den Hoogen WJ1, Laman JD2, 't Hart BA2,3.Modulation of Multiple Sclerosis and Its Animal ModelExperimental Autoimmune Encephalomyelitis by Food and Gut Microbiota Front Immunol. 2017; 8: 1081.

Fiber Grams / Day Westernized society 15 gramsTarget - 30 gramsStudy Diet 50 gramsHunter Gatherer 100 to 150 gramsFeed your bacterial friends more fiber

"Kombucha Mature" by Mgarten at the English language Wikipedia. Licensed under CC BY-SA 3.0 via Commons

More Vegetables

Favorable Nutrient Profiles Fermented food– Microbiome Seaweed– Iodine, alginates Nutritional yeast– B vitamins/ minerals Algae– Carotenoids/ detoxification

"BristolStoolChart" by Cabot Health, Bristol Stool Chart - http://cdn.intechopen.com/pdfs-wm/46082.pdf. Licensed under CC BY-SA 3.0 via Commons olChart.png#/media/File:BristolStoolChart.png

"Human Feces" by User Cacetudo on en.wikipedia - Own work. Licensed under CC BY-SA 2.5 via Commons https://commons.wikimedia.org/wiki/File:Human Feces.jpg#/media/File:Human Feces.jpg

Modified Paleolithic DietHome Exercise Program Neuromuscular s & NutritionalsupplementsStress Management

Study DietFoodInstructionGreen leafy vegetablesRecommended*Sulfur-rich vegetablesRecommended*Intensely colored fruits orvegetablesOmega-3 oilsAnimal aining grainDairyExcludedExcludedEggsExcludedServings3 cups cooked/6 cupsraw 3srvg3 cups raw or cooked 3srvg3 cups raw or cooked 3srvg2 tablespoons4 ounces or more

Stop processed foods, gluten, dairy, eggs

Nutritional Adequacy (%RDA)US Diet Vs. Study DietVitamin DCalciumVitamin EMagnesiumZincFolateIronUS DietVitamin AWahls*Vitamin CNiacinVitamin B6Vitamin 800%900%

Methyl B12, Methyl Folate, Vitamin D, Fish /2013/04/natural-Vitamins.jpg

Stretching ExercisesGastro-soleusHamstringQuadricepsErector spinae

Electrical Stimulation of MusclesBuilds Muscle Mass

Subject Demographics 20 individuals (18 SPMS, 2 PPMS) Age: 51.7 ( 6.4) years Baseline EDSS: 6.2 ( 1) Fatigue Severity Scale Score: 5.5 ( 1.2)

Average daily servings of the study diet recommended(vegetables/fruits) and excluded (gluten/dairy/eggs) foodsp 0.01 difference from baseline to 12 months

Side effect – Overweight and obese subjects lostweight and got to a healthy weight

Significant Changes inMicronutrient IntakeDocosahexaenoic Fatty Acid (DHA)IodineAlpha CaroteneVitamin KVitamin B9 (folic acid)Retinol-2000200 400 600 800 1000 1200Percent Change in Intake

Multimodal intervention improves quality of life**p 0.0005*p 0.05

Mood and CognitionIn the setting of progressive MSImproved thinking ability andreduced anxiety and reduced depression90

Average scores on the mood measuresat each study visit

Average scores on the DKEFS and WAIS subscalesat each study visit.

Associations BetweenAdherence and Outcomes P valuesVariables 0 to 12monthsMoodBDA/ BDICognitionVerbalreasoningFatigueVegetables/ fruits0.0001 0.0001 0.0001Gluten, dairy, eggfree0.0010.005 0.0001

Relapsing Remitting MSIn the setting of relapsing-remitting MSReduction of fatigue and improved motor function94

Hero’s Journey Struggle/ adversary facing individual/ society Hero leaves to learn some key point toovercoming the struggle/ adversary Returns to engage in the struggle Religious, mythical stories across time andspace

Alzheimer’s DiseaseReversal of early and moderate dementia usingfunctional medicine approach99

Bredesen et al., J Alzheimers Dis Parkinsonism 2018, 8:5 DOI: 10.4172/2161-0460.1000450

Subject 3- Baseline and 12 Month WalkSPMS TUG-127 sec.FSS-5.6SPMS TUG-41.8 sec.FSS-4.4

Subject 17- Baseline and 3 Month WalkPPMSTUG-21 sec.FSS-6.7PPMSTUG- 15.3 sec. with one cane17.6 sec. without caneFSS-4.9

Subject 11- Baseline and 3 Month WalkSPMS TUG-14.9 sec.FSS-5.3SPMS TUG- 8.6 sec.FSS-1.4

Subject 11- 6 months

How many cups of vegetables did you eat in last 24 hours?

Copies of paperswww.terrywahls.com/papersOne page summarywww.terrywahls.com/diet Instagram– drterrywahls Facebook– Terry Wahls MD Twitter– @TerryWahls

Wahls Protocol, Wahls Protocol Cooking for Life Equity interest – Dr. Terry Wahls LLC – The Wahls Institute PLC – www.terrywahls.com. Objectives- Review The published research on dietary intervent