A Nutritionist’s Approach to Functional Medicine
Dr. Terry Wahls Introduces 2020 Wahls Protocol Seminar Speaker Natasha Azrak
In this interview, Dr. Wahls and Natasha Azrak discuss how to get the most benefit from a functional medicine intervention without expensive testing or supplements. Natasha Azrak is the first and only nutritionist certified by the Institute for Functional Medicine in Canada and the only French-speaking in the world. She is also a Wahls Protocol® Health Professional.
She’s recognized for her passion and curiosity, which is demonstrated by the number and diversity of trainings she has undertaken. She has a true passion for science and is always up-to-date with the latest natural health research. She was in charge of selecting 300 scientific studies for Dr. Brouillard’s bestselling francophone book La santé repensée (Rethinking Health). She also collaborated on his second bestselling book on pain, writing the nutrition chapter.
Throughout the years, Natasha’s expertise has been shared in the media, including many magazines and blogs, through nutrition capsules at Global News, and in the French documentary Les Persévérants on RDI. She’s been a consultant and keynote speaker at conferences for companies like L’Oréal, Vichy, Pfizer, the National Bank, and other major companies in Quebec.
Her rigor for science made her the best candidate to teach preventative nutrition at the University of Montreal and allow the movement of natural health to get into universities, teaching to health practitioners, including doctors.
Visit her clinic website, https://cliniquevi.com/
Natasha will be giving her talk “Having a Hard Time Tolerating 3 Cups of Sulfur Per Day? Causes, Treatment Approaches & An MS Case Study” at The Wahls Protocol Seminar and Retreat in 2020. Learn more at terrywahls.com/seminar
Read The Transcript Here:
So Natasha, I’ll let you sort of run our interview and our discussion. I know you have a lot of passion in regards to the critical role of diets in all of our healing journeys.
Yes, and I think that’s something that we’ve talked in the past. I think that the reason why The Wahls Protocol works so well it’s because it focuses on food a lot, and I think in functional medicine, sometimes we can … It can seem like it’s about testing or supplements, but I think the basics are so foundational, not just nutrition but the lifestyle as well. But nutrition has such an important part to it, and I think because my background was in nutrition, going through the dietetics program, I think taking all of my patients hand by hand and showing them how to make these food habits that are so essential for real impact in their life, which are usually the hardest because it’s easy to take a supplement, but it’s not easy to find the time to go grocery shopping, change your habits there of what you buy and then cook and then test different recipes and then figure out how your taste buds like different foods.
So I think this is one of the most crucial parts and why your protocol and then how functional medicine can have better results. It’s really when you take care of the basics and then go by layers.
I’m thinking that your tribe may not know of my story, so perhaps I should retell my story to get a little context of we got connected.
So I’m a conventional internal medicine doc here at the University of Iowa in the United States, and I was very skeptical of special diets, complementary alternative medicine, and then I got diagnosed with multiple sclerosis. I developed weakness in my left leg. I’d had years of trigeminal neuralgia that have been slowly getting worse. I treated my disease aggressively, seeing the best people, taking the newest drugs, but I went relentlessly downhill. Within three years, I needed a reclined wheelchair. Within seven years, I was unable to sit up. I was beginning to have brain fog. My trigeminal neuralgia was more and more severe and more difficult to turn off, but I’d been reading the basic science, ancestral health principles, functional medicine and integrating all three, I created a diet and lifestyle program that was designed specifically for my brain and to my amazement, it got me out of that wheelchair.
It radically changed how I thought about disease and health. It would change the way I practice medicine, and it would ultimately change the research that I do. Within a year of this new way of eating, I’d gone from being unable to sit up to be able to do an 18.5-mile bike ride with my family. So it was really quite transformative. And then, I started teaching the public; I got banned by the MS Society for creating false hope. So I spoke at community college and other meetings and had my YouTube talk that went viral, then I had my book. And I have the French copy here for Natasha.
[inaudible 00:04:00] in Canada.
Yes, and so that led to the MS society changing their mind, creating a wellness conference, and making dietary intervention studies a research priority. And in fact, they gave us over $1 million to study the Wahl’s diet and preach the Swank Diet, so. We made big progress
And I have to say these studies are so good that they’re helping … I think it was the ADA or the Dietetics Association in the U.S. that really … It’s very hard to do good science on the trip mission because it’s hard to manage all of the co-founding factors and to make sure that it’s the diet changes that we can measure. And then sometimes you can teach a diet to someone in one session, but it doesn’t mean that they’re going to apply it. So having good research and then showing the results because it is a lifestyle change and it’s not necessarily the easiest thing. So your research is really helping out a lot.
And one of the things that I’ve learned through my research and through the therapeutic lifestyle clinic that I ran at the VA for years is the critical need to expand the behavior change model. And so we’ve created a much more detailed behavior change model that goes through how to inspire hope, how to help people understand why they want to do this work, then how they can create an environment that either sabotage them or makes it easier to succeed and how to have these conversations with friends and family. And so we’ve created a much more detailed step by step by step process for the patients, for their families, and for practitioners who want to implement these concepts.
I totally agree. I do. We were discussing this, and the first thing we had said was that nutrition is so important. But the second thing is the support around these lifestyle changes. Exactly what you said, the step by step approach. That’s something that I found was very necessary for people to just know what’s their next step and then see the big picture as well. So educational.
So I know that with our patients, they do have all of the theory in videos that they can rewatch, and that really helps them a lot. It’s normal for people to forget 10% of what they heard the day before. So it can be normal to lose motivation if you don’t really know why and if you’re not insanely talking about it constantly. So the information, the education that you can look at again and again, but also the community. So with Facebook groups now, it can be even easier to just have people that are going through the same things. And I know that with our patients, we have videos where we answer everybody’s questions two times per month. And that helps a lot in just maintaining the focus and the hope and then seeing everybody interact. So it’s really the focus on the lifestyle and then also the support. The step-by-step support where the community is super important as well.
Man, I so agree that sense of community, that peer to peer conversation, and inspiration, telling the story of how to make this successful and possible is very, very helpful.
Yeah. We’re always listening to the opposite. We hear the opposite. So it’s hard to keep focused and put in all this effort that you’re not sure that it’s going to work for yourself. So when you have inspiration and then peer to peer motivation can help out a lot. And then one thing that I’ll … The conference I’m going to give at your seminar this summer will be also about one part, that’s where … You know in The Wahls Protocol how there’s three cups of sulfur per day that needs to be consumed at that point. Sometimes this can be a hard factor for some people that can have a complication digestive wise with the small intestinal bacterial overgrowth. So sometimes this part when they have that overgrowth in their small intestine, and I’ll explain what it is in a couple of minutes, but sometimes when they have this compensation, it can really affect their motivation because they can feel like they’re doing all of the portions but when you have this overgrowth … So technically for people who don’t know what SIBO is, so small intestinal bacterial overgrowth.
What it is you’re supposed to have all of the good bacteria and the bad ones if you do have any in the colon, the large intestine. And then, when you have so many, they can overgrowth and then move into the small intestine where in your digestive system, your small intestine is supposed to absorb your foods. It’s not supposed to ferment at that place. So when you have these fermentable foods that are very good for health, that arrive in the small intestine to be absorbed if there are bacteria there, they can ferment it and so typically the symptoms are that people feel good in the morning and then as soon as they start eating, they started bloating and bloating and bloating, and some of my patients can really feel like they look three to six months pregnant. So that can feel very discouraging-
Well, discouraging, yeah
Yeah, exactly and also because there’s so much fermentation, sometimes it can come with very smelly gas or bad breath sometimes as well. Even if you have good oral hygiene. So sometimes it can feel like you’re doing the right things and you are, but you have this little complication that needs to be taken care of and if it doesn’t resolve through food. So that’s exactly what I’ll be talking about at the seminar.
Oh. Awesome. I’m so glad you’re coming.
It’s a pleasure to me to be there and honestly an honor to be at the seminar.
So another something that I want to point out to folks is we’re one of the few people that do these dietary intervention studies. We have dieticians on our team. In addition to training people to do the study diet and then keep them motivated to do all this stuff, we take very detailed records of what people actually eat. So did they implement the diet that we asked them to? Because that’s important to know when you’re trying to sort out, did the diet work or not? You have to know what did they actually eat. And then we’re able to do an analysis of the dietary path. Did they follow the diet? Was it nutritionally adequate or sound? Did we have any glaring problems? Because one of the things many dieticians feel whenever they see a diet that excludes whole food groups, like, “Oh my God, that diet, that’s a fad diet. It can’t be good for you.”
If you’re excluding the whole food groups like the paleo diet does and my diet does. So we had to answer that scientifically. We’ve conducted a detailed nutritional analysis using weighed food records, using recipes and menus, using the nutrition data software. And then we roll all that up. It took me about a year to get all of that stuff done by the way. And we’ve published it in Nutrients, and I think Natasha you saw those papers come by.
Yes. And I love them. I was so happy to see them because it’s true. It can be done correctly.
And, so the key thing is we took the time and expense to do that analysis, and we reported out those results. So we compared the Wahls elimination diet, which is the most restrictive, the most difficult of our various diets to the standard American diet, vastly superior. And then, when you compare it to the dietary guidelines recommendation, my healthy plate, it was still superior. We had less added sugar; we had more fiber, we had more vitamins, more minerals. It was low in vitamin D. No problem there because we make vitamin D from our skin. So that’s not a big deal. It was relatively low in calcium. And so I certainly want to acknowledge that. And there’s a debate. Does that mean people should take supplemental calcium or not? And that’s an unknown. We don’t have an answer for that. The hazard of taking extra calcium is that you have more kidney stones.
And on the other side, what I’ve seen in my experience is that sometimes for the body to … So vitamin D will help calcium be absorbed, but vitamin K2 is very important as well for the calcium to get into our bones and not necessarily into our arteries or calcify anywhere else. And the vitamin K2 is usually produced by the good bacteria in our digestive system. So what I’ve seen is that if you can make sure that you can supplement vitamin D3 with the K2 or make sure that you have probiotics and prebiotics in your food intake to make sure that you produced this vitamin K2 naturally to make sure that you use the calcium correctly. I think that’s an important factor that isn’t being talked about enough.
It’s not being talked nearly enough about that. And another precursor for the vitamin K2 is plenty of vitamin K1 or the greens, and for the vitamin D to work well, you need vitamin A, vitamin K2, which we’ve mentioned, and magnesium. So again, more reasons to have plenty of greens and have origami for once a week. And this is part of why I feel so strongly that it’s food. It’s all about the magic of the food that we’re eating. It’s not-
And the synergy that we can have in food. Sometimes we can take a supplement with calcium, but if you’re lacking any of the other nutrients, it doesn’t have the same synergy. So food is so important because we still don’t know all of the synergies that happen from our food. And so I agree with you completely. It’s really-
Yeah, I talk to my patients, and I explain that all of our nutrients have a U shaped curve. If it’s too low, you’re in trouble, and you have diseases of deficiency, and then there’s a broad area where you have good health and then the smaller area we have optimal health, then you go back to good health, and if it gets too high, you can become toxic. And so even water, even water, has a U shaped curve. So if it’s too low, we die of dehydration. If it’s too high, we get water intoxicated, and we could have strokes and serious brain damage as a result of water intoxication. People were like, “Oh my God! Even water.” Said, “Yes, even water.” So when we get things from food, we’re much more likely to be in that broad area of good health and optimal health.
When we take supplements, and sometimes I use supplements and sometimes I absolutely recommend them to my patients, but now I have to watch them to sort out when they’re getting over replaced, I have to take them off the supplement. Sometimes I can do that by monitoring the symptoms, the physical exam, sometimes we have to do blood work, but I really don’t like to have people take supplements without working closely with their physician and their nutritionist to guide them, so they keep in the … They call it optimal health range. Otherwise, you can overdo it, folks.
Exactly, and you were talking earlier about the research you’re doing where you’re not only … It’s not like it’s an observational study where people are trying to remember what they ate in the past. It’s really like they’re writing down what they’re eating so that you can really make sure that what you’re measuring is what-
What actually happened.
What actually happened. And I also think on the other side that it’s a great way to do it because you can actually show that it is doable. You will have a percentage of compliance or not. So this will also be a very good indicator to see if this is doable or not. Because I think a lot of people in the health domain, a lot of practitioners can feel like, yes, it could help, but people don’t even eat enough vegetables. So let’s just start with that. So sometime the practitioners because of their experience, they can feel like it’s too much work and they don’t want to overwhelm their patients, but it’s not for us to decide, it’s really for us to give the right information and then have the person see what they can do.
What I’ve started doing lately is … Yeah and we did this at our clinic, at the VA people come in with a standard American diet and we tell about the functional medicine, my recovery story, and they’ll all start it. And then we’d invite them like, “Okay, if they’re ready to be all in, they could come to our group classes, and they could do the Wahls diet.” If they weren’t ready to do that, they could work with the dietician, and they’d start with the Mediterranean diet, more vegetables, more legumes, and then when they were ready, they wanted to go gluten-free, dairy-free and come join the group. They could do that. So you can sort of see it as a sort of four-step program. Step one is just more vegetables just to improve the quality of your diet. You can do a more Mediterranean kind of diet. When you’re ready to really take it.
See what would happen if I went all in, if I went gluten-free, dairy-free, ramped up the vegetables, it really did label one of the Wahls diet. You might be quite surprised that there’s another big job in how well are you doing. And then yeah, you could decide, “Well, that wasn’t so hard. Well, I’ll do the next level.” And now we’re adding in origami. We’re adding in fermented foods. You’re exploring seaweeds, and people are like, “Wow! Wow!” And they’re experiencing that health transformation. And I have some folks who are ready to go all-in from day one, but we also honor the folks who need a more incremental approach.
Yeah. It really depends. Not everybody is at the same point, and it’s important to really give the different options. I think that’s an important-
Yes. Yeah. I think people need to have that autonomy to decide at what pace they’re ready to come at. And some folks are like, “This is not the right time in my life. I have too many other things going on. I just can’t do this at this time.” And we’re like, “Okay, that’s fine. Come back when you are.”
Which is completely okay because if this is just going to stress the person and give them a bad experience, it might not be the right time because stress is one of the most damaging thing that you can do or that you can go through. So it’s important to have that listening. And then sometimes you need to rearrange a few things in your life, pre-prioritize these things, and sometimes it can take some time. But it’s all about the journey about what’s happening, yeah.
Well, and I’m excited to tell you the Natasha that we’ve updated The Wahls Protocol® and so we have the new book coming out and let me sort of highlight what’s new and exciting. So we spent more time on understanding behavior change, helping people get deeper into touch with why they want to go on this journey and all those incremental steps. We have a lot more on oxalates and histamines FODMAPs; how to identify is that an issue for you, and what changes to make to address those? And then if you’re on the ketogenic diet, I’ve talked more about that.
I really have narrowed who I want in ketosis longterm. I’m much more interested in people doing ketosis intermittently and then coming in ketosis and then out of ketosis and how to do that either with coconut milk or with olive oil and how to do ketosis using fasting, time-restricted feeding, intermittent fasting, product fast, and the benefits for that. I’ve talked about Stem cells, who should think about Stem cells, what are the approved indications, what are the experimental indications right now, and what we can do to boost our own Stem cells right now without having to, go off to a Stem cell center. So that’s exciting. We talk about neuro rehab and the progresses we made with neuro rehab, the additional research on E-stim, and some other rehabilitation strategies. So people are on top of that. And then, finally, we’re talking more about resilience, emotional resilience, and metabolic resilience. How to improve your insulin sensitivity, how to improve your hormonal functioning, and the various things that we can do to improve both our emotional resilience and our metabolic resilience. That’s about a third new material. So it’s going to be-
Right. Writing the book was amazing. And now it’s just like whole lot of-
Yap, it’s fabulous.
It covers everything you need to know. And that’s what’s nice about a revision is that it’s like sometimes people don’t really know what … They can read a book and then feel like it’s really so good. And then once you publish it and then you’ll get the experience and then the feedback and then everything just gets-
Well, there’s been a lot of progress on the science, a lot of progress on understanding the microbiome, epigenetics, my ideas, which were so radical on that are much more embraced and accepted. And so I wanted people to know the research progress and the understanding that we have now on the mechanisms of why The Wahls Protocol is so helpful.
Yes. No, it’s really well. I love the parts that you’ve added because they are important parts, and then sometimes they just help you out. Especially the first part with the behavior change and I think is important because it can do the mental work of preparation and self-acceptance as well. So that’s really good to start with that. That was a really good addition. All of them. I’m really happy, and I’m excited to see it and read it.
Oh, it is so exciting. It is just such a wonderful addition.
Yes. Let me see here. I know we had talked about at the seminar who would benefit from learning more about that conference or not? I think … Yeah.
The people who come to the seminar, we have a lot of patients with autoimmune diseases, multiple sclerosis. We also have more people coming with brain [inaudible 00:25:32] stuff, mental health issues, anxiety, depression. We’ve had folks with Parkinson’s, headaches following chronic concussions. So all of those people come … People come back year after year after year, and we have practitioners that come as well. So they can watch me train the public. Then we have another day with the practitioners going through case-based learning. And so it’s fun. Oh, it’s fun. We sing, we dance, we laugh, and we eat amazing food.
And the food is amazing. I have to say; I was really impressed about the food. I’ve been to a lot of conferences, and the food was really good, and it’s really great to have a good example, like multiple days of example of foods and how they taste good. And it’s great to see how everybody is so happy, and they really have enough. It’s not like when you’re traveling, and let’s say you are on a different diet than what’s available. You always have to prepare so much, but for this seminar, you don’t. Everything is already prepared for you. So that’s really like pampering.
Yes, yes. Then we have a time period to meet new friends, reconnect with old friends. And we have a lot of sessions where you practice the skills that we just went over. So this is about skill development. So you’re comfortable and competent that you have the ability to actually do these new skills, new ways of thinking about your purpose in life, your meaning in life, why you want to do this work, how to talk about these food choices with your waitstaff, with your family members. You’ll have chances to practice new ways of moving. We’ll do some bagel training, so we’ll be doing that. And again, you’ll sing and dance. Don’t worry; you don’t have to sing in tune. We never expect that. So that’s pretty fun.
Yes. Looking forward to it.
Yes, so, Natasha, I’m so glad to have a chance to chat with you and your audience. Thinking about one, a couple of things to that your audience could do right now. Think deeply about what you want your health for, because when you make a big change in diet, it’s hard to think about giving up today’s pleasures for tomorrow’s benefit. It is so helpful if we know what we want our health for, what is my mission? What is my purpose? That can be very motivating. And then if your primary care doc is not excited that you want to eat more vegetables, add a meditative practice, and move more. I would get a new primary care doc and find a practice that is excited about those things because we do exist.
Most primary care physicians are trained to be fired up about eating vegetables, to be fired up about adding a meditative practice, and to be fired up about having your patients want to exercise more. And if for some reason you happen to find a practitioner that is not, I would go look for someone else. Here in the U. S., there are practitioners that are getting more training in functional medicine with the Institute for Functional Medicine, [inaudible 00:29:17] forum group. Also, there’s a integrative fellowship group with Andy Weil. So any kind of those three certification boards, those practitioners would be well equipped to help you in this healing journey.
Mm-hmm (affirmative). Yeah, I think it’s getting because there is more education. I’m also teaching at the University of Montreal, of course, for health practitioners. So there is the math now, which is a very … I’m feeling very optimistic about that there is this need for it, and so I think a lot more practitioners are going to be aware and have access to this information. And with all the research that you’re doing and publishing, it just helps out because it’s true that sometimes when we’re practitioners, we just want the best for our patients.
And sometimes we’ve seen patients try things and then get their hopes up and not get to a result that they want. But sometimes it just didn’t have the good support or the good method. So sometimes it can feel like things don’t actually work. So we do need research like yours that actually can show what does and how to do it and what was then and what exactly are the results. So I think that’s super important. That’s going to help out not only in North America but also in all the countries because it’s important. And then just seeing that there’s more funding for research that’s well done is a really great motivation.
Here in the U. S. there’s been a little more interest in culinary medicine, and so some of the medical schools are now having cooking classes for the physicians and teaching physicians cooking culinary medicine and how to have a position practice get cooking classes as part of their practice because if we want people to begin to implement these radical things. Eating vegetables, cooking at home, so many folks never learned how to cook. Didn’t learn how to make a menu, didn’t learn how to make a shopping list, didn’t learn how to plan meals so they could make a meal plan for leftovers, and major all this in a busy life. And so I actually I’m very excited that more and more medical schools are including cooking in the curriculum and including culinary medicine as a potential area of emphasis. So great things are happening.
It’s really wonderful, wonderful things are happening. It’s thanks to you and the public that is creating the increased awareness that food is so critical, that learning how to cook at home is so critical. That learning how to make a shopping list, to make this really operational in our daily life and our family lives is a very important skill, and I tell the positions that I’m training that, “Are you asking your patients if they’re cooking at home? Now, do they know how to cook? Do they need to have a cooking class? Do we need to help them get more comfortable with planning their meals?” Exciting stuff. So excited. Okay. Well, Natasha, this has been great. I so look forward to seeing you this summer.
It would be wonderful, and hopefully that we’ll see some of your folks from your tribe come with you as well. We would love to have more folks. We have always every year, many people coming down from Canada, and we have people coming from Europe. I don’t know that I’ve had anyone from Africa yet, but we’ve had folks from Europe, Asia, Australia, South America, and, of course, a lot of folks from Canada and Mexico as well, so.
And Asia is far, so.
Yeah Australia and Asia, that’s a lot of struggle.
It’s true. It’s true. I had seen somebody from Australia last time.
But if it’s changing your life in a positive way, people find it to be extraordinary, then it’s fun. It’s just really a wonderful time.
It is. A wonderful event and it’s not only very educated but very fun, delicious and also you can just meet people that are alike, so that helps out with the support as well.
All right, well, thank you very much, Natasha.
Thank you, Doctor Wahls.