The Wahls Protocol and HD
The Wahls Protocol is a diet program designed to mediate symptoms of Multiple Sclerosis (MS), an autoimmune disease that acts by removing the protective coverings that surround neurons. Terry Wahls introduced this diet around 2011, with the claim that it helped her go from using a wheelchair to walking and biking.1 Since its release, the diet protocol has gained popularity within the MS community, with Wahls publishing books, doing a Ted Talk, and selling lifestyle products on her website. Although the diet is targeted toward the MS community, it could be of interest to the HD community because both diseases target the brain.
What is the Wahls Protocol?
The Wahls Protocol is a modified Paleolithic (Paleo) diet, in which people can only eat types of food that hunter-gatherers used to eat in the Paleolithic era over 12,000 years ago. Wahls altered this diet to better suit MS, placing special importance in foods with anti-inflammatory properties and vitamin K. These modifications were chosen to combat brain inflammation, increased autoimmune activity, and digestive issues that are characteristic of MS.2
Main components and claimed benefits:
High consumption of sulfur rich and leafy green vegetables.
- Dark green leafy vegetables, such as arugula and kale, contain carotenoids and vitamin K. Wahls et. al. claim that these nutrients support immune function, neuron health, and calcium absorption.
- Vegetables like cabbage and mushrooms are rich in sulfur, which is said to prevent brain inflammation and brain degeneration, and help with immune function.
Meat and fish recommended.
- Meat and fish are typical components of a Paleo Diet, and are recommended due to protein content, but not for any MS-specific nutritional benefits.
Organ meats encouraged.
- Organ meats, such as liver and kidneys, are a rich source of vitamins A, B, and D, phosphorus, zinc, selenium, copper and manganese, which provide nutrition that are absent in other parts of the diet. Typically, individuals do not consume sufficient daily amounts of these vitamins.
- Liver is a source of retinol, which helps with bone growth and immune function.
Avoid grains and dairy.
- Grains are excluded due to their lectin content, which can cause digestive problems and increase autoimmune activity. This has been shown to break down brain cells in MS.
- Dairy can also trigger intestinal issues or inflammation, and may be associated with higher MS prevalence.
- Seaweed is a source of carotenoids (benefits listed in 1.a.) and antioxidants, which reduce inflammation and have general health benefits due to rich mineral composition.
Nutritional yeast encouraged.
- Nutritional yeast is a source of Vitamin B and can be a cheese substitute.
Fermented foods encouraged.
- This includes teas and pickled vegetables, which have favorable impacts on the gut microbiome and may help with digestion.
Potential Impacts on HD
One aspect of the Paleo Diet and the Wahls Protocol that may impact HD involves elimination of grains. Grains are a major source of gluten, which has been linked to the protein aggregates that characterize HD, although evidence is limited. This potential connection between HD and gluten may be one of the reasons individuals with HD have considered the Wahls Protocol. For more information about gluten and HD, click here.
Additionally, a recent study by Wasser et. al. has linked HD to gut dysbiosis, an imbalance of healthy bacteria in the gut. In this study, HD patients had less diversity of their gut bacteria and had different gut enzymes, which are needed to digest food.3 These microorganisms are important, not only because they affect the quality of digestion and nutrient absorption, but because a connection exists between gut bacteria and brain function. However, more research is needed to connect gut dysbiosis to HD specifically. This relates to the Wahls Protocol because many foods that impair digestion–such as wheat and dairy–are eliminated, and foods that promote digestion–such as fermented foods–are encouraged. These aspects of the diet could potentially help mediate the digestive issues that HD patients face, and a better-functioning gut may also improve brain function.
While some components of the Wahls Protocol focus on supporting the digestive system, other elements, such as sulfur rich vegetables and seaweed, are catered toward reducing brain inflammation. With respect to HD, there is limited evidence of a relationship between brain inflammation and HD symptoms. In 2016, Rocha et al. reviewed existing evidence about HD and brain inflammation, and suggested that there is an association.4 However, it remains unclear whether brain inflammation contributes to HD symptoms, or if inflammation is a result of HD symptoms. Because there is a lack of substantiated information, it is unclear whether the anti-inflammatory foods recommended in the Wahls Protocol would help with HD.
Wahls Protocol Validity
Although the Wahls Protocol is widely known among the MS community, there is limited evidence that proves its validity. While the story about founder Terry Wahls becoming a long distance biker after being wheelchair-ridden for years is quite remarkable, most of the evidence that supports the diet’s claims is in the form of success stories. There are a few published articles that examine the scientific nutritional mechanisms behind the Wahls Protocol, but none of them prove real, observed improvements for MS patients who adhere to the protocol. Additionally, all of these articles have been co-written by Terry Wahls, which may present a conflict of interest because she developed the protocol and sells diet products on her website. As for clinical studies, Wahls began a trial that began in 2016 and was supposed to end in January 2020, but results have yet to be published. All in all, there is a lack of evidence that proves a cause-and-effect relationship between specific foods and their claimed physical effects on the body.
Aside from the story about founder Terry Wahls, another piece of anecdotal evidence comes from Dawn Hovey. Hovey participated in a pilot study for the protocol, and apparently experienced results early on. After a month of adhering to the protocol, doing physical activity, and receiving electrical stimulation, Hovey went from using her wheelchair to walking without a cane. She also decreased the medication she took for MS-related fatigue.5While this sounds promising, it is unclear whether the improvements came from the diet or the other lifestyle changes she made, and this isn’t sufficient evidence to prove that the regime will work for others.
Concerns for any Diet Protocol
Before trying any restrictive diet regime, it is important to discuss the topic with a physician and/or nutritionist. While following individual elements of the protocol might not hurt (unless you’re allergic to them) and may even be beneficial, this diet in particular restricts all sources of wheat, dairy, and some fruits, among other things. These food groups normally are a source of energy, protein, and essential nutrients, so strictly adhering to the Wahls Protocol may not only be difficult in a practical sense, but might also cause some harmful nutritional deficiencies. Because of the restrictive nature of the Wahls Protocol and lack of studies connecting it to physical benefits, it is not yet clear whether it could be useful to the MS community it was made for, let alone the HD community.
- Lava, N. (2019). What Is the Wahls Protocol Diet and Does It Work for MS?. WebMD. [↩]
- Wahls T, Chenard C, Snetselaar L. (2019). Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic. Nutrients, 11(2): 352. [↩]
- Wasser C, Mercieca E, et al. (2020) Gut dysbiosis in Huntington’s disease: associations among gut microbiota, cognitive performance and clinical outcomes. Brain Communications. [↩]
- Rocha N, Ribeiro F, et al. (2016). Neuroimmunology of Huntington’s Disease: Revisiting Evidence from Human Studies. Mediators of Inflammation. 8653132 [↩]
- Landau M. (2017) For Dawn, the Wahls Protocol Yields Significant Benefits. Everyday Health. [↩]