May 01 2014

Can Diet Cure MS?

I always find it fascinating to read an opinion piece that, from my perspective, is entirely wrong. In general I like to confront views that differ from my own; it is a great opportunity to probe and understand your own position better. I also find it fascinating to dissect the process that could lead someone to a demonstrably wrong position. Are they just misinformed, is their logic flawed, or are they overwhelmed by bias and ideology?

Usually it is the result of all three of these things in a self-reinforcing echochamber, an ideologically pleasing narrative propped up by confirmation bias.

A number of people have sent me links to this opinion piece, and other articles about Dr. Terry Wahls, who claims to have cured her own multiple sclerosis (MS) with diet alone. She advocates a paleo-style diet to cure whatever ails you. The evidence for this claim – zippo.

The article in the Daily Beast, however, finds the story an indictment of the entire medical system. The author, Daniela Drake, is an internist, but by judging from her other articles she seems to have a clear “alternative” ideology. She writes:

But with a focus on managing—not curing—chronic disease, many thoughtful physicians know that chronically ill patients don’t get better—they get medicated.

This is cookie-cutter alternative medicine propaganda. The focus of medicine is always to discover any treatable underlying cause, and then to treat such causes. If there is a bacterial infection, then we give antibiotics. If there is an anatomical problem, it may be fixable surgically. If there is a toxic exposure, we eliminate the exposure to the toxin and help the body rid itself of what it was already exposed to. If there is a nutritional insufficiency or deficiency, we supplement.

Many diseases, however, do not lend themselves to a cure. This is not because doctors don’t look for curable causes or aren’t “focused” on a cure – it’s because we don’t currently have the knowledge or technology to effect a cure. This is not a criticism, it is the reality of the current state of our medical knowledge.

Alternative practitioners, however, make it seem like it is a flaw in the system, suggesting that they have the answer. This is pure nonsense.

This alternative meme also denigrates chronic management of illness. Right now we cannot cure type I diabetics, but we can manage their lack of insulin to improve their quality of life, functionality, and survival.

I cannot cure migraines. No one can. But I can manage them effectively. I first review with patients lifestyle changes, including dietary changes, sleep hygiene, exercise, and avoidance of triggers. Occasionally this is enough, but usually (at least in my headache specialty clinic) it isn’t. I also check for nutrient levels that can affect migraines, and supplement as necessary. I rule out underlying causes that can be treated or cured (about 2% will have a secondary cause). For those who need it, I then develop a plan for medical management to both prevent migraines and stop them when they occur.

Compare this to the silly caricature painted by Dr. Drake. She creates a false dichotomy between curing and managing patients, and another between medication and improved health. Sometimes medications are curative. That, however, does not appear to fit her ideology.

Next up is the downplaying of the effectiveness of medical therapy:

Indeed, by conventional standards, Dr. Wahls received great medical care. She had sympathetic doctors who prescribed cutting-edge drugs. Those drugs cost around $5,000 a week but are only marginally effective. “Studies show these medicines reduce acute relapses, but they don’t affect time-to-wheelchair,” Dr. Wahls told me. “And some medicines can have very serious side effects.

The claim that current MS treatments do not slow disability progression is flat out wrong. Coming from one doctor quoting another doctor, it represents outright incompetence in medical reporting.

We now have many drugs in MS that are considered disease modifying. There are several ways to follow MS activity to see if a drug is helping. We can count the number of relapses, their severity, the number of lesions on MRI scan, disability through a standard rating (EDSS is the most common), and others. In relapsing forms of MS (which is clearly what Dr. Wahls is referring to since she mentions relapses) treatment absolutely slows progression of disability.

In one study, getting consistent disease modifying treatment reduced disability progression by 45% over those getting little or no treatment. Tysabri in particular is very effective, in one study stabilizing disability over five years. A systematic review showed:

As far as efficacy is concerned, the results showed statistically significant evidence in favour of NTZ for all the primary outcomes and for the secondary ones where data was available. NTZ reduced the risk of experiencing at least one new exacerbation at 2 years by about 40% and of experiencing progression at 2 years by about 25% as compared to a control group.

Treatment literally decreases time to wheelchair, in direct contradiction to Dr. Whal’s claims. That doesn’t fit her narrative, however. Her story is that diet is everything. Drake reports:

Soon she realized something that seems patently obvious in retrospect. “All disease begins on a cellular level,” she says. “When cells are starved of building blocks they need—disease begins.”’

Beware of any sentence that begins with “all disease.” Nutrition is but one potential cause of illness, consuming too much or too little of certain nutrients. It is absurd, however, to claim that it is the root cause of most or all disease. Drake continues to quote Wahls:

“We’re not telling patients the truth—that medicines won’t make you well,” Dr. Wahls says. Patients with multiple medical problems who have found themselves standing in the kitchen choking down pill after pill probably have an idea of what she is taking about. “Life is self-correcting chemistry,” says Dr. Wahls. “If we fix the nutrition, this is the real way to address the root cause of most disease.”

Medications serve a variety of functions in medicine, as I discuss above, so this is, again, not consistent with reality. The last sentence begs the question – for most people, even people with chronic illness, is their nutrition broken? Some diseases are dominantly lifestyle diseases, like Type II diabetes. For such diseases the management is also dominantly lifestyle.

But for many diseases there are non-nutritional causes, not matter how far down you dig. There are genetic, toxic, traumatic, degenerative, infectious, neoplastic, and immune mediated diseases without any significant connection to nutrition.

The myth of nutrition gurus, however, is that – if only you were properly fed, you would be a superhuman, immune to all disease, with a flawless immune system and limitless energy. This is fantasy, not reality.

Conclusion

Dr’s Drake and Wahls paint a picture of reality that is at drastic odds with the evidence. It seems clear that their ideology comes first. They downplay the effectiveness of current medical treatment, emphasize the side effects, and elevate nutrition to a magical stature that is not based on a lick of published evidence.

If you could really cure MS with diet alone, it would be easy to demonstrate this in a clinical trial. Drake and Wahls know this, so they have to also endorse (even if just implied) crazy conspiracy theories about Big Pharma, the medical system, and greedy or just pathologically incurious doctors.

They act as if they (and those who agree with them) are the only ones who actually care about their patients and want to help them. It’s an insulting and self-serving narrative that seems designed to sell books, and provide a convenient excuse for the complete lack of evidence to back up their ideology.

In reality, it is a very cynical and uncaring world view. If you truly care about your patients you will want to engage in due diligence, to make sure that your advice is the best you can give, rather than substituting your personal philosophy for careful evidence.

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10 responses so far

10 Responses to “Can Diet Cure MS?”

  1. MikeLewinskion 01 May 2014 at 1:27 pm

    I’ve seen the work of Dr. Wahls used to blame the patient, by moralizing in effect that “If you ate better you wouldn’t be sick and wouldn’t need disability”. Every dietary choice was hyper-scrutinized and wheat was deemed the ultimate evil and cause of all auto-immune dysfunction.

    Needless to say the moralism didn’t result in changing diet, but did drive a wedge in that relationship.

  2. jblumenfeldon 01 May 2014 at 1:37 pm

    The idea of curing things purely with diet and exercise is oh, so seductive. For example, my own type II diabetes recently progressed to where I need to take a dose of insulin once a day. I was pretty dismayed by this and blamed my own lack of management for it. I was so sure that once I got back on track diet-wise I’d be able to get off the insulin. My GP/endocrinologist was sympathetic, but he basically said “it CAN happen, but don’t count on it. If I had to guess, you’ll be taking MORE not LESS insulin as time goes by.”

    This is not because I’m a bad person – it’s because that’s the way diabetes usually works.

    We all want to think we can manage our cholesterol, blood pressure, MS, whatever through pure force of will – and taking care of diet and exercise is of course very important. But the fact is there are all kinds of aspects to these diseases and some very physically fit people are just going to have high cholesterol or high blood pressure. It is not an admission of defeat to take medication for these things! It is a benefit that we get from modern medicine and we should be happy we live in modern times.

  3. nwkeiseron 01 May 2014 at 3:03 pm

    Steve, thanks so much for posting about this, I’ve been interested in your take on the MS/nutrition thing for a while. I am a researcher at the University of Iowa, where Dr. Terry Wahls works, and I have had the opportunity to see her speak locally on several occasions about her diet (amazingly called the Wahls Diet) and the clinical trial she is conducting. Although I’m glad she is conducting a clinical trial (http://www.clinicaltrials.gov/ct2/show/NCT01381354?term=NCT01381354&rank=1), and the movies she showed at her talk showed patients’ gaits improving, the trial used a ton of different dietary changes, supplementation, plus electrical stimulation all at once (mainly to see if the patients could actually adhere to the strict regimen). She herself stated several times that the way the NIH would like her to proceed is to pursue one treatment at a time, but she seemed really resistant to that (despite the fact that it would help us see which treatment was actually working). When I asked her after the seminar to comment on her decision to include all these treatment regimens instead of just one or two, she kind of bristled, and then said, “You know, we’re just trying to help people.” Although I don’t doubt that she may really want to help these patients, she clearly has a huge conflict of interest in this case (to sell her books and diet plans), and furthermore, she has made many statements in the past, and in the article you linked to, that suggest that she sees herself as battling the medical establishment, as if her diet program is the “cure THEY don’t want you to know about.” This type of conspiratorial thinking moves her into quack territory, and seriously calls her philosophy into question. Although I think it would truly be useful to know if aspects of the diet can improve outcome for MS patients, it should be done in a proper, controlled, SCIENTIFIC manner.

  4. norsecloneon 01 May 2014 at 3:19 pm

    I sent Dr. Novella an email about Dr. Wahls about three years ago after she actually gave a lecture to my classmates and I during our first year of medical school. I’m so glad to see she’s finally ended up on his radar. The University of Iowa has actually done very well in staying away from the recent trend across the country of ‘quackademic medicine.’ But they love Dr. Wahls, and so does a large portion of the Iowa City community. She is a hero and paragon of the local alt med community. There is actually a Dr. Wahls salad in the salad bar area at the local Co-Op.

    Dr. Novella, on a more personal note, if you have time, I would love to see a more thorough takedown of some of her rhetoric. I think she’s actually doing some harm in my community and it seems like she is gaining more and more traction in more national alt med groups and discussions. I’m afraid she may be about to ‘break out,’ as it were. Thanks again for all you do.

  5. Bill Openthalton 02 May 2014 at 3:29 am

    jblumenfeld –

    The sense of personal failure in case of health issues is, as far as I can tell, widespread. I have personal knowledge of people who refused even glasses because they saw their visual problems as a personal fault. Maybe this comes from religion — if you are a bad person, you are punished by your god in your health, fortune and friendships; maybe it is profoundly human and is exploited by religions to bind their followers.

    To a degree, it is also empowering to think you have the possibility to fix whatever ails you. Some people seem to prefer the belief in their own powers combined with the observable failure to use them (which could be explained as a choice) over the realisation they might have been dealt a bad hand in life’s game of chance. Come to think of it, it is probably easier to motivate oneself through an illusion of personal power and control, than through the mere observation one has not been as fortunate as most others.

  6. SimonWon 02 May 2014 at 7:23 pm

    Just seen someone asking in patient support group about supplements after describing a diet that clearly has sufficient everything, and seeing “homeopathic doctor” who recommended a load of supplements (at least one of which might aggravate the condition). Argh…..

    I’m probably a bad example, having read the scientific evidence on diet, and exercise, I made a conscious decision to eat more foods that I like, worry less about what is good to eat, and to exercise more. Yes, I’m overweight, in fact slap bang in the bit of the body mass index associated with optimum life expectancy. My food isn’t going to kill me, and it isn’t going to cure me.

    Sure coronary heart disease might get me, but with low cholesterol, low blood pressure, no diabetes or smoking, it’ll be from complications of my existing medical condition. With very little cancer in the family (2 grandparents had it in their late 80′s after 60 years of smoking like chimneys), it is probably a leading contender but not the bogey man it might be. If I was a betting man I’d put my money on medical mistake, try not to make it too soon Doc.

  7. BillyJoe7on 03 May 2014 at 1:46 am

    Simon,

    “With very little cancer in the family”

    That actually doesn’t help much. Most people with a cancer do not have a family history of that particular type of cancer. And those with a first degree relative with a particular type of cancer are mostly no more likely to develop that cancer than anyone else. There are exceptions of course.

    (Note: there is really no such thing as cancer. There are cancers. Pleural. There will never be a “cure for cancer”, but there may one day be “cures for all cancers”. At least that is the position with our present state of knowledge)

    “If I was a betting man I’d put my money on medical mistake”

    You will likely lose your bet…unless you include mistakes made after the medical profession has prolonged your life by diagnosing and treating a potentially lethal condition.

  8. BaSon 03 May 2014 at 12:45 pm

    > Treatment literally decreases time to wheelchair

    I assume this is a typo and should read something like “delays time to wheelchair”. Decreases here seems to indicate they get debilitated faster.

  9. BillyJoe7on 04 May 2014 at 3:51 am

    BaS,

    I missed that completely.

    I’ll blame my dislike for the phrase “time to wheelchair”.
    I’m not sure anyone with MS wants to be reminded that they are heading for a wheelchair. Besides which, that’s not even true. Many with MS will never end up in a wheelchair, even if they live a normal lifespan. For example, my older sister was diagnosed about 15 years ago and she has no obvious impairment. She is fully employed and walks 10km a few times a week.

  10. Kathleen Mon 09 May 2014 at 9:12 am

    Dr Wahls seems to hit on one of my personal pet peeves. If something comes from “pharma” it is merely suppressing symptoms and cannot ever in any way be a cure, especially if you must take it every day. If something can be perceived as “natural” it is always in every case by definition curing the underlying cause of the disease, even if you have to adhere to that treatment plan daily for the rest of your life.

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