Impact of Diet on Epigenetics

Dr. Terry Wahls

Clinical Professor of Medicine
University of Iowa
VA Healthcare System
 Disclosures
• Grant Funding -Direct MS Charity,
• In kind funding DJO Inc., Pinnaclife Inc., TZ Press LLC
• Copyrights –
– Minding My Mitochondria/ Wahls Protocol
• Trademarks – Wahls Diet Plans, Wahls Protocol
• Equity interest
– Dr. Terry Wahls LLC
– TZ Press LLC

Copyright 2015 Dr. Terry Wahls, all rights reserved

 Disclaimer
• The FDA has not evaluated any of the claims or
statements made in this presentation, on my web
site or by me. Nor are these statements or
claims intended to "diagnose, treat, cure or
prevent any disease,”

copyright 2015 Terry Wahls all rights reserved

• Development of Chronic Disease
• My Story
• Our research
• Therapeutic Lifestyle Clinic
Forager- Hunter 500,000 BC
Main Cause of death
-Infection, trauma
Mean age 30s
45% mortality before age 15

Population and Development Review33(2007):321-65. Kaplan

Forager-Hunter 2007
Traditional diet, no medical care
Main cause of death
Infection, trauma
Often live into 60s and 80s

Population and Development Review33(2007):321-65. Kaplan

Forager-Hunter to Farmer -10,000 BC
↑ fertility, infection; ↓height

Investig Genet 4 (2013):10 .Sajantila; Am J

Prev Med 37 (2009):78-83. Egger
 Industrial Revolution 1800s
↑ sugar, white flour; ↓ breast feeding
↑ obesity, heart disease, diabetes

Investig Genet 4 (2013):10 .Sajantila; Am J

Prev Med 37 (2009):78-83. Egger
 After World War II 1950s
↑ sugar, ↑ vegetable oils, ↑HFCS, ↑ Trans fats
↑ ↑obesity, heart disease, diabetes

Investig Genet 4 (2013):10 .Sajantila; Am J

Prev Med 37 (2009):78-83. Egger
Chronic Medical Diseases
Millions of Americans Affected
• Diabetes 25 M
– Diagnosed 18 M
– Undiagnosed 7 M
• Cancer 25 M
• Heart disease 25 Million
• Autoimmune 75 Million
– Diagnosed 25 Million
Symptoms + Autoantibodies
50 Million
• Overweight/ Obese
– 69% of us - 220 M
1 in 3 children will become severely obese and diabetic
 A Frightening Trend*
?

*K. Weintraub, Nature 479, Nov. 3 2011, 22-24.

 2000- I Became A Patient
• Weakness left leg
• Prior history of dim vision left eye
• Lesions in spinal cord
• Abnormal spinal fluid

Diagnosed with relapsing-remitting multiple

sclerosis
 Vitamins and supplements

Ann Neurol. 2003;53 Suppl 3:S39-47

Neurobiol Dis. 2005 Apr;18(3):618-27.
“…we have been able to identify modifiable behavioral factors,
including specific aspects of diet, overweight, inactivity, and
smoking that account for over 70% of stroke and colon cancer,
over 80% of coronary heart disease, and over 90% of adult-
onset diabetes.”
Willett, WC. Science, 2002:296, 695-697
 Multiple Sclerosis Genetic Risk

• One parent 3%
• Sibling – 5%
• Two parents 30%

Multiple Sclerosis Overview. Stüve O, Oksenberg J.

In: Pagon RA, Bird TD, Dolan CR, Stephens K, editors. GeneReviews [Internet]. Seattle
(WA): University of Washington, Seattle; 1993-.2006 Jan 10 [updated 2010 May 11].
 Epigenetics
• Environmental factors turn genes ‘on’ and ‘off’
changing how our cells run the chemistry of
life and the Phenotype or shape and
performance of organism
• WITHOUT changing the DNA sequence!
 Phenotype
Environmental factors
“Wild type”
Healthy
Disease
Resistant
 Phenotype
Environmental factors
“Wild type” Inflamed
Healthy Sickly
Disease Disease
Resistant Prone
 Epigenetic Marks
Are passed on to our
– Children
– Grandchildren
– Great grandchildren
Food Is the Most Powerful
Epigenetic Factor
When our food lacks the key building blocks
molecules do not get made correctly
 Sugar intake per capita in the United Kingdom from 1700 to 1978 (30, 31; ○) and in the United
States from 1975 to 2000 (32; ♦) is compared with obesity rates in the United States in non-
Hispanic 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 Nutrition

 Essential Nutrient Insufficiencies linked
with Top Causes of Death in the U.S.
• Alzheimer’s: Mg, Se, Cu, Vit. D
• Cancers: Mg, Zn, Se, Cu, Vit. D
• Chronic Lung diseases: Mg, Se, Vit. D
• Diabetes Mellitus: Ca, Mg, Zn, Se, Cr, Vit. D
• Heart Disease: Ca, Mg, Zn, Se, K, Cr, Cu, Vit. D
• Kidney disease: Zn, Se, Vit. D
• Liver disease: Zn, Se
• Hypertension: Ca, Mg, Zn, Se, K, Cr, Cu, Vit. D
KEY
Mg=magnesium, Zn=zinc, Se=selenium, Cu=copper,
Ca=calcium, Cr=chromium, K=potassium, Vit. D=vitamin D

Richard Lord, J. Alexander Bralley: Laboratory Evaluations for Integrative and Functional Medicine 2nd Ed (2008)
Gluten
Gluten sensitivity is characterised by abnormal immune response to gluten in
genetically susceptible individuals. In some individuals, gluten sensitivity was shown to
manifest solely with neurological dysfunction. Also 90% of gluten sensitive 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 sensitivity
can 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 brain

The Lancet Neurology Volume 9, Issue 3 2010 318 - 330

http://dx.doi.org/10.1016/S1474-4422(09)70290-X
 Sugar turns genes ‘on’ and ‘off’
creating an inflamed disease prone body

Increasing the risk of High Blood Pressure, Obesity, Diabetes,

Dementia, Heart Disease, Mental Health Problems, Neurological
Problems, Autoimmunity and Cancer
Since World War II
• >80,000 chemicals have
been registered with
the E.P.A. due to toxic
effects
 200+ Chemicals Found
In Cord Blood/Breast milk
Mom nursing baby

Herbicides
Pesticides
Dioxins
Plastics
Solvents
Heavy metals: lead,
mercury, arsenic

• Environ Health Perspect. 2004

Aug;112(11):1204-7.
 Physical Activity
Women: 2-3 Miles/ Day Men 6-9 Miles/ Day
> 8 Hours / Day Sitting
The most sedentary individuals had higher body mass
index, greater waist circumference, elevated blood
pressure, worse lipid profiles, higher C-reactive protein
level, and more insulin resistance.
 Chronic Stress =
 Inflammation
Recent studies provide clear and convincing evidence that psychosocial
factors contribute significantly to the pathogenesis of coronary artery
disease… 5 domains: (1) depression, (2) anxiety, (3) personality
factors,(4) social isolation, and (5) chronic life stress.
Institute For Functional Medicine
 Myelin Key Micronutrients

Neuroprotection Course

– Omega 3 Fatty Acids Bourre JM. Effects of nutrients (in food) on

the structure and function of the nervous
– Thiamine (B1)
system: update on dietary requirements for
– Folate (B9) brain. Part 1: micronutrients.
– Cobolamin (B12) Part 2 Macronutriients
J Nutr Health Aging 2006;10(5):377-85.
– Minerals
Bowman Nutrient biomarker patterns,
cognitive function, and MRI measures of
brain aging. Neurology. 2012 Jan
24;78(4):241-9. Bowman
 Nutrient
Vitamin A, retinol Alpha carotene Carnitine

(animal form of vitamin A)

Vitamin B1 (thiamine) Beta carotene Lipoic acid

Vitamin B2 (riboflavin) Beta cryptoxanthin Creatine

Vitamin B3 (niacin) Lutein Cholesterol

Vitamin B5 (Pantothenic acid ) Lycopene Alpha-linolenic fatty acid (ALA)

Vitamin B6 (pyridoxine) Zeaxanthin Eicosapentaenoic acid (EPA)

Docosahexaenoic acid (DHA)
Vitamin B9 (folic acid) Iron (Linoleic acid (LA)

Vitamin B12 (cobalamin) Copper Arachidonic acid (AA)

Vitamin C Zinc Gamma-linolenic faty acid (GLA)

Vitamin D Iodine
Vitamin E Magnesium N Acetyl cysteine

Vitamin K Selenium Taurine

 Nutrient
Vitamin A, retinol (animal form of
vitamin A)
Vitamin B1 (thiamine)
Vitamin B2 (riboflavin)
Vitamin B3 (niacin)
Vitamin B5 (Pantothenic acid )
Vitamin B6 (pyridoxine)
Vitamin B9 (folic acid)
Vitamin B12 (cobalamin)
Vitamin C
Vitamin D
Vitamin E
Vitamin K
Main Function Top food sources for
nutrients
Involved in synthesis of visual pigments Cod liver oil, liver
in the retina
Facilitates use of glucose, Organ meat, seeds, nuts
generation of myelin
Helps produce mitochondrial energy Liver, greens
Helps produce mitochondrial energy Liver, chicken
Aids in neurotransmitter production Fish, greens
Facilitates myelin generation Liver, greens, asparagus
Facilitates myelin generation Liver, shellfish, greens
Fights infection, supplies intracellular Liver, shellfish
antioxidants
Aids in proper reading of the DNA, Greens, citrus
protects cells in the brain
Promotes cell signaling, protects Cod liver oil, sunlight
cholesterol-carrying molecules from
oxidation, reduces brain cell death,
which protects against aging
Assists with energy production in mitochondria Nuts, seeds, avocado
Helps strengthen myelin and blood vessels Greens
 Nutrient Main Function Top food sources for
nutrients
Iron Helps supply oxygen to the brain Organ meat, greens, molasses

Copper Promotes iron/copper balance involved in Organ meat, shellfish, nuts, seeds
higher brain functions

Zinc Aids in perception Liver, shellfish, nuts, seeds

Iodine Involved with intelligence and myelin Seaweed, seafood, iodized sea salt
production
Magnesium Stabilizes cells against excess glutamate (too Greens, raw sprouted nuts, seaweed
much stimulation)
Selenium Protects against oxidative stress Brazil nuts, sunflower seeds, seafood,
seaweed
Lycopene, lutein, zeaxanthin, alpha and beta Antioxidants, which protect cell membranes Brightly colored vegetables and berries
carotene, beta cryptoxanthin and mitochondria
Carnitine Assists with energy production in mitochondria Heart, kidney, liver, beef and all other
meats, including poultry
Lipoic acid Assists with energy production in mitochondria Heart, kidney, liver

Creatine Assists with energy production in mitochondria Organ meat, wild game
 Nutrient Main Function Top food sources for
nutrients
Cholesterol Strengthens cell membranes, promotes Animal fats
hormone production
Alpha-linolenic fatty acid (ALA) Helps to generate cell membranes and myelin Walnut, flax, and hemp oils

(This is the vegetarian form of omega-3 fatty

acids)
Omega-3 fatty acids Helps to generate cell membranes and myelin, Wild herring, salmon, grass-fed meats
lowers excessive inflammation
Eicosapentaenoic acid (EPA) Docosahexaenoic
acid (DHA)

(Animal forms of omega-3 fatty acids)

Omega-6 fatty acids (Linoleic acid (LA),
arachidonic acid (AA)
Gamma-linolenic fatty acid (GLA)
Helps to generate cell membranes and myelin, Seeds and nuts (LA)
signals molecules to communicate between
Organ meat, meat (AA)
cells (too much can lead to excessive
inflammation, must be in balance with Omega-
3 fatty acids)
Lowers inflammation Borage, primrose, hemp oil

HARMFUL ANTI-NUTRIENT
Trans-fats Increases the damage to cell membranes and Partially hydrogenated fats, food fried in
mitochondria vegetable oil (especially fast food)
2007

copyright 2010 Terry Wahls all rights

reserved
 NARCOMS QOL Survey

11/23/05 6/2/06 11/28/06 5/5/07

MS Sx Worse Worse Worse Worse

Overall

Fatigue Mod Severe Total Total

Eat 9 Cups Daily
Reduce Toxin Exposure
Improve Elimination of Toxins
Improve Elimination
of Lead and Mercury
 The Wahls™ Diet Plans
For more info www.terrywahls.com
Electrical Stimulation of Muscles
9 Months of Paleo Diet, Exercise,
NMES, & Stress Management
 Home Exercise Program
+
Modified Paleolithic Diet
Neuromuscular Electrical
stimulation

Multimodal
Intervention

Vitamins & Nutritional

Stress Management
supplements
 Study Diet
Food Instruction Servings

3 cups cooked/6 cups

Green leafy vegetables Recommended*
raw=3srvg

3 cups raw or cooked=

Sulfur-rich vegetables Recommended*
3srvg

Intensely colored fruits or 3 cups raw or cooked =3

Recommended*
vegetables srvg
Omega-3 oils Encouraged 2 tablespoons
Animal protein Encouraged 4 ounces or more
Gluten-containing grain Excluded
Dairy Excluded

Eggs Excluded
Side effect – Overweight and obese subjects
lost weight and got to a healthy weight
“Fatigue Severity Scale (7 -1, 1=no fatigue)
decreased by 2.38 from 5.70 at baseline to
3.32 at 12 months (p=0.0008).”
SF-36 energy, SF-36 general health and FSS-9 scores at baseline, and 3, 6, 9 and 12 months after
the intervention and correlation of mean SF-36 energy and mean general health scores with
mean FSS-9 scores at baseline, 3, 6, 9 and 12 months. r= Pearson’s correlation coefficient.
Symbol and error bars= Mean + SE. Significant difference from baseline **p<0.0005, *p< 0.05.

Degenerative Neurological and

Neuromuscular Disease 2015:5
 Provigil reduced Fatigue Severity Scale
score by 0.75 (p= 0.07).
 Subject 3- Baseline and 12 Month Walk

SPMS SPMS
TUG-127 sec. TUG-41.8 sec.
FSS-5.6 FSS-4.4
Subject 3- Stair Climbing at 12 months
 Subject 11- Baseline and 3 Month Walk

SPMS SPMS
TUG-14.9 sec. TUG- 8.6 sec.
FSS-5.3 FSS-1.4
Subject 11- Jogging & Jumping at 6 months
 High "normal" blood glucose is associated with
decreased brain volume and cognitive performance in
the 60s: the PATH through life study.
• DESIGN SETTING AND PARTICIPANTS: 210 cognitively
healthy individuals (68-73 years) without diabetes,
glucose intolerance or metabolic syndrome
• MAIN OUTCOME MEASURE: Baseline blood glucose levels
in the normal range (3.2-6.1 mmol/l) were used to
correlate regional brain volumes and associated cognition.
• RESULTS: Hgba1c > 5.2 was associated with brain atrophy

PLoS One. 2013 Sep 4;8(9):e73697. Mortby

Beyond weight loss: a review of the therapeutic uses
of very-low-carbohydrate (ketogenic) diets.

• Very-low-carbohydrate diets or ketogenic diets

have been in use since the 1920s as a therapy
for epilepsy
• Recent work over the last decade or so has
provided evidence of the therapeutic
potential for conditions: diabetes, polycystic
ovary syndrome, acne, neurological diseases,
cancer and the amelioration of respiratory and
cardiovascular disease risk factors.

Eur J Clin Nutr. 2013 Aug;67(8):789-96.

 Ketogenic Diet Treatment
• The antidepressant properties of the ketogenic
diet. Biol Psychiatry. 2004 Dec 15;56(12):981-3.
• Dietary ketosis enhances memory in mild
cognitive impairment. Neurobiol Aging. 2012
Feb;33(2):425.e19-27.
• Treatment of diabetes and diabetic
complications with a ketogenic diet. J Child
Neurol. 2013 Aug;28(8):1009-14.
• The ketogenic diet is an effective adjuvant to
radiation therapy for the treatment of malignant
glioma. PLoS One. 2012;7(5):e36197.
 Low Glycemic Index Benefits
• Low-glycemic-index treatment: a liberalized
ketogenic diet for treatment of intractable
epilepsy. Neurology. 2005 Dec 13;65(11):1810-2.
• Dietary glycemic load and glycemic index and
risk of cerebrovascular disease in the EPICOR
cohort PLoS One. 2013 May 23;8(5):e62625. doi:
10.1371/journal.pone.0062625. Print 2013.
• Glycemic index, glycemic load, and chronic
disease risk--a meta-analysis of observational
studies. Am J Clin Nutr. 2008 Mar;87(3):627-37.
 Ketosis/ Lower Insulin Levels
Decrease atrophy
Boost nerve growth factors
 Ketosis Studies
• Neurodegenerative
– Seizures, ALS, Parkinson’s, Dementia, MS
• Psychiatric
– Bipolar, Depression
• Metabolic Syndrome, Obesity, Diabetes
• Cancer
 TLC -Group Classes
• One hour introduction to class no labs
• Three hour intake – timeline / matrix with lab
• 2 hour shared medical appointment with lab
• One hour skill classes no labs
• Work with primary care doctors to adjust
meds down as BP, sugars and pain decrease
 Problems Helped
• Pain
• PTSD, mood, mTBI
• Diabetes, obesity
• RA, Lupus,
• Fatigue
• Fibromyalgia
 Summary

• Diet/ lifestyle creates health or

disease depending on your
choices
 Most Favorable Epigenetics
• Diet quality • Hormonal balance
• Toxins- including • Infection
tobacco • Microbiome alteration
• Physical activity • Trauma – physical
• Stress • Trauma -psychological
• Vitamin D • Sleep quality
• Family life • Social networks
 Questions?
• www.terrywahls.com
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