Ever since getting out of a wheelchair and back on my bike¹, I have been talking to my patients with various autoimmune conditions about using diet and lifestyle as part of their treatment and wellness plan.  We have conducted four clinical trials of diet and lifestyle in MS patients, all of which have demonstrated the benefits of the Wahls™ modified Paleolithic diet for reducing fatigue and improving quality of life ^2-8. We just completed the Dietary Approaches to Treating Multiple Sclerosis Related Fatigue Study and have published the study protocol9Multiple Sclerosis Journal – Experimental, Translational, Clinical.⁸

To control for the potential conflict of interest, I had no access to study participants and no access to the study data.  The people who conducted the study assessments were masked to diet assignment and person who conducted the statistical analysis was also masked to diet assignment.  We wanted to measure the effect of the study diets on fatigue, quality of life and walking endurance. People came in for the first study visit and had all the assessments completed. They went home and ate their usual diet and returned 12 weeks later to repeat all assessments.  Then we randomly selected patients to begin either the Swank Diet, a diet low in saturated fat, or the Wahls elimination diet, which is a modified Paleolithic diet.

The key elements of the Wahls diet are the consumption of 6-9 cups of non-starchy vegetables and berries, and exclusion of gluten, dairy, and eggs. The key element of the Swank diet is limiting saturated fat to less than 15 grams per day. Learn more about the specifics of the Wahls diethereand the Swank diet here.

We repeated all measurements after participants had been on their assigned diet at 12 and 24 weeks. Change in Fatigue Severity Scale Score at 12 weeks was the primary outcome. Secondary outcomes were change in Modified Fatigue Impact Scale scores, MS Quality of Life Physical Health and Mental Health subscales, and the 6 Minute Walk Test.  Fatigue, quality of life, and walking endurance were largely stable during the observation phase, when participants were eating their usual diets. After 12 weeks on one of the two study diets, both groups experienced reduced fatigue severity and improved quality of life; however, walking endurance did not change. In terms of fatigue, the Swank and Walks diets were not significantly different at 12 weeks.

However, when analyzing the secondary outcomes, the Wahls diet group had a significantly better quality of life than the Swank group. After 24 weeks, improvements continued in both groups, but those on the Wahls diet now had significantly greater reduction in fatigue in the more sensitive measure of fatigue, the Modified Fatigue Impact Scale, and significantly greater improvements in quality of life. The key observation is that both diets were associated with reduced fatigue, improved quality of life and walking endurance, with the Wahls diet having significantly greater improvements than the Swank group for several measures. These outcomes are detailed in the graphs below.

These findings are consistent with our previous studies. In previous studies we have found that study participants who adopt the Wahls™ diet plans experience reduced fatigue and improved quality of life ^3,5-8,10, improved cognition6, improved motor function ^4,5 and improved cholesterol levels ¹¹.

These principles are good for overall health and reducing the severity of other health problems that people may have. In my clinical practice at the Iowa City Veteran Affairs Medical Center, I utilized the same concepts, a modified paleolithic diet, targeted supplements, stress reduction and regular exercise.  We went to the pain clinic, primary care clinics, and mental health clinics, offering to take care of their most difficult cases.  We added diet and lifestyle medicine to the veteran’s care and had the veterans continue to work with their other treating physicians for their prescriptions for their chronic health problems.  For these veterans, pain, fatigue, brain fog, and low mood were common symptoms.  Many had autoimmune problems, including multiple sclerosis, and other chronic problems like obesity, insulin resistance, pre-diabetes, diabetes, heart disease, anxiety, depression and prior traumatic brain injury.  We taught how to use diet and lifestyle as part of their wellness plan to create more healthy behaviors in their lives.  Consistently, we observed pain reduce, energy improve, moods improve, blood pressures, blood sugars and blood cholesterol improve. Although I have since retired from the VA, the lifestyle clinic that I founded has continued and grown in size.

For those who are concerned about the safety of the Wahls or Swank diet, we have analyzed both diets ^{12, 13} using menus and recipes. We have also analyzed the diets of people in our clinical trials and following the Wahls™ diet ¹⁴. Consistently, the Wahls™ diet is superior to the standard American diet.

The research continues to build that if you have MS or other autoimmune condition, your diet impacts your energy and quality of life. In the near future, we plan to conduct larger studies with controls (people who follow their regular diet), following people for longer periods and obtaining biomarkers to investigate disease activity and mechanisms impacted by diet.

Currently, we have several active clinical studies for people with MS and two more that will begin soon. If you are interested in participating in our clinical trials, visit the Wahls Lab website here.

Get support for improving your diet and self-care routine.

The research is very clear. Multiple studies have found the Wahls™ diet is associated with better energy, higher quality of life, and fewer symptoms overall. If your medical team doesn’t believe diet and self-care should be part of your treatment plan to manage your autoimmune condition, you can still make dietary and lifestyle changes that will improve your health. Pick up my book,The Wahls Protocol,inspiration and guidance, and sign up for The Autoimmune Master Course, which breaks the lessons down into 10 to 20-minute bite-sized chunks.

We have had thousands request more support and guidance for improving their diet and their self-care routine because they can’t get help from their medical team. To address that need, we’ve created The Autoimmune Master Course, which includes five online modules with many lessons within each module. Topics include the inner game and mental strength, food and nutrition, movement and exercise, supplements, non-food and non-exercise self-care routines that promote health, and how to work with your primary care team to monitor and support improving your diet and self-care routine.

Also, I periodically offer 7 weeks of weekly group support calls to answer questions and deepen your understanding of what is possible. The Autoimmune Master Course is a wonderful resource if you are looking for inspiration, guidance, and support as you work to do all that you can to improve your health. This course has helped countless people with multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, low mood, chronic pain, chronic fatigue, and brain fog use diet and lifestyle choices to begin getting their lives back. We would love to support your work towards reclaiming your health and see you in our next term!

Here are a few other media outlets that have picked up the story of this exciting new research:

The Best Diet For Multiple Sclerosis, According To A Researcher (mindbodygreen.com)

Swank and Wahls Diets Help with MS Fatigue, Quality of Life, Trial Finds (multiplesclerosisnewstoday.com)

Two Diets Reduced Fatigue and Improved Quality of Life in Society-Funded Clinical Trial –With FAQs | National Multiple Sclerosis Society (nationalmssociety.org)

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.
2. Bisht B, Darling WG, Grossmann RE, et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. 2014;20(5):347-355.
3. Bisht B, Darling WG, Shivapour ET, 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.
4. Bisht B, Darling WG, White EC, et al. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis. 2017;7:79-93.
5. 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.
6. Lee JE, Bisht B, Hall MJ, et al. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. J Am Coll Nutr. 2017;36(3):150-168.
7. Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma beta-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.
8. Wahls TL, Titcomb TJ, Bisht B, 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.
9. Wahls T, Scott MO, Alshare Z, et al. Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perceived fatigue in persons with relapsing-remitting multiple sclerosis: study protocol for a randomized controlled trial. Trials. 2018;19(1):309.
10. Wahls T, Rubenstein L, Hall M, Snetselaar L. Assessment of dietary adequacy for important brain micronutrients in patients presenting to a traumatic brain injury clinic for evaluation. Nutr Neurosci. 2014;17(6):252-259.