Talk:Terry Wahls

Reliable medical sources

She does have a lot of WP:MEDRS research https://www.ncbi.nlm.nih.gov/pubmed/?term=wahls+t --Nbauman (talk) 22:26, 26 April 2018 (UTC)

The Wahls Protocol Diet

It is written that, "Wahls' promotion of her diet and lifestyle regimen as a cure for MS". As far as I know, that is a false portrayal. I've only ever seen her claim the reversal of symptoms, not a cure. In speaking of her own MS, she clearly states that she still has the condition even as it is in remission. — Preceding unsigned comment added by Benjamindavidsteele (talk • contribs) 12:36, 3 February 2019 (UTC)

She does appear to claim it is curative. E.g., Ref 5, which describes her treatment as a cure. She is being interviewed so it is not likely she disagrees.Michaplot (talk) 19:52, 20 February 2019 (UTC)

adjective 'curative' not supported by citation to web md (currently reference 6)

The section The Wahls Protocol Diet starts with the sentence

  The curative diet promoted by Wahls to treat MS is a modified paleo diet, relying primarily on grass-fed meat, fish, leafy vegetables, roots, nuts, and fruit and restricting dairy products, eggs, grains, legumes, nightshade (solanaceous) vegetables, starches and sugar.[6]

Reference 6 is to a Web MD article.

That Web MD article does not say that Wahls claimed that it was a 'cure'. In fact, it reports that she 'says it helped with her symptoms'. This is of course a much weaker statement. So i think the word 'curative' should be dropped, or given a citation from a 'reliable source' (in the wikipedia's view) that actually explicitly says she claims it is a 'cure'.

(I am aware of an earlier discussion of what i think is exactly this point, but i'm not sure what the old reference 5 is. However, an interview in which she does not disagree with something the interviewer says would not suffice to justify the word 'curative'. That would be a deduction from a primary source, if i understand the wikipedia methodology correctly. What is needed is a secondary source---something besides an interview---in which that secondary source itself draws the conclusion that she is promoting it as a cure. Such a thing might exist, but she seems to be careful in what she says even in popular talks, so i think it should be uncovered and cited to before using the word 'curative').

Son of eugene (talk) 05:32, 17 September 2019 (UTC)

regarding "no good evidence" for diet treatment of MS

Regarding the "no evidence" for diet interventions in MS, that's actually not an accurate portrayal of current research. The American Academy of Neurology (the top journal in neurology) has a 2018 study linking diet intervention with positive outcomes, at least in patient quality of life. Here is the study: https://n.neurology.org/content/90/1/e1.full Wahls protocol is not supported by research, but other diet interventions (i.e. healthy eating generally) are. Can we reword this to clarify?

I am fairly new to editing, just want to be sure the correct MS information is here, as I'm currently reviewing dozens of clinical studies on MS intervention, and diet is an important intervention. I am happy to bring in other studies also if that would help.

trumpeter832 (talk) 09:54, 23 July 2020 (UTC)

Any source for WP:Biomedical information would need to be a WP:MEDRS; primary sources such as clinical studies are generally unreliable. The "no good evidence" is cited to a Cochrane systematic review, which is pretty much the gold standard. Alexbrn (talk) 15:38, 23 July 2020 (UTC)

2023 review

This review was added on the article by Terry Wahls herself [1]. The problem with this review of trials was the low-quality of evidence. "Several dietary interventions may reduce MS-related fatigue and improve physical and mental QoL; however, because of the limitations of this NMA, which are driven by the low quality of the included trials, these findings must be confirmed in high-quality, randomized, controlled trials." This is low-quality. It isn't worth citing this until we have stronger clinical evidence. Psychologist Guy (talk) 12:55, 6 July 2023 (UTC)

Suggestions to improve article (June 2024)

I have a personal connection to Dr. Terry Wahls, and have a few suggestions to improve the accuracy of her page, and to bring it more aligned with other biographical Wikipedia articles. I have reviewed and will follow the Wikipedia Conflict of Interest policy.

1. In the Wahls Protocol Diet section, please add a new second paragraph:

Wahls has claimed that the diet - in addition to exercise, reduced stress, supplements and neuromuscular electrical stimulation- reduced the symptoms of her own multiple sclerosis. A 2022 meta analysis in BMC Neurology that reviewed the efficacy of Wahls’ and similar diets found that the diets reduced fatigue in patients with multiple sclerosis. A 2022 meta analysis in BMC Neurology that analyzed the data of eight studies, including a modified paleolithic dietary intervention studied by Amanda Irish, Wahls and three other researchers, found that dietary intervention is associated with reduced fatigue in patients with multiple sclerosis. In 2022, Wahls received $2.5 million for further studies into the efficacy of diet on relapsing MS patients from the Carter Chapman Shreve Family Foundation. A 2023 meta-analysis in Neurology of the efficacy of eight different dietary interventions, which included Wahls’, found that the Paleolithic diet was “consistently shown to be favorable” in reducing MS-related fatigue and improving mental and physical QoL in participants.

Why: Added two meta-analyses, independent of Wahls, that specifically studied Wahls’ research and supported its claims. A meta-analysis of medical research findings is the one of the criteria for including a medical claim on Wikipedia under WP:MEDRS.

References

Why: A meta-analysis of medical research findings is the highest standard of proof for including a medical claim on Wikipedia under WP:MEDRS. “The best evidence for efficacy of treatments and other health interventions comes mainly from meta-analyses of randomized controlled trials (RCTs).” I suggest adding two meta-analyses, each of which includes Wahls’ research. In the first, the study is referred to as “Irish” in the meta-analysis because Wahls is one of five researchers with Amanda Irish. See citation 80 in the paper if you wish to confirm Wahls is a co-author. The inclusion of the Irish study is confirmed in Tables 2, 5 & 6 and through the article. In the second meta-analysis reviewed If you read eTable 5 and eTable 6, citation 46, and eReferences 3,5, and 11 for the Neurology meta-analysis, you’ll see that Wahls is one of the authors of three studies included in that meta-analysis.

Why: Added a meta analysis, independent of Wahls, that specifically studied Wahls’ research and supported claims. A meta-analysis of medical research findings is the one of the criteria for including a medical claim on Wikipedia under WP:MEDRS.

I also added new information from 2022 about the continued funding of Wahls’ research.

2. Please rename the Wahls Protocol Diet section to: The Wahls Diet

Why: The Wahls Protocol is the name of Wahls book, but not the diet itself. In scientific peer-reviewed articles and meta analysis, the diet is referred to as the “Wahls Diet.”

3. In the new The Wahls Diet section, please replace the first sentence:

The diet promoted by Wahls to treat MS is a modified paleo diet, relying primarily on grass-fed meat, fish, leafy vegetables, roots, nuts, and fruit and restricting dairy products, eggs, grains, legumes, nightshade (solanaceous) vegetables, starches and sugar. Wahls has claimed that the diet alleviated the symptoms of her own multiple sclerosis.

With the following two sentences:​​

After being diagnosed with MS in 2000, Wahls created the Wahls diet. The diet is a modified paleo diet that excludes gluten, sugars and dairy.

Why: First, the paragraph says the diet was “promoted” by Wahls, but the source actually says Wahls created the diet after being diagnosed with multiple sclerosis in 2000. I slightly rewrote for clarity and accuracy, and added missing citations for both the first and second sentences. I have also added a meta-analysis citation supporting the diet, as per WP: MEDRS.

4. In the Wahls diet section, please remove the last sentence of the second paragraph:

A 2020 Cochrane review found no research supporting efficacy or effectiveness of diet or vitamin supplementation for treatment of MS.

Why: This source does not evaluate the Wahls diet - it looked at other studies, therefore it doesn’t belong in this article about Wahls. WP: Coatracking. This sentence does not attempt to tie the Cochrane review article to Wahls, so is off-topic on its face, but to be sure there’s nothing relevant in it about Wahls, I reviewed it. Wahls’ research is only mentioned as an ongoing study whose results have not been published yet. As an aside, this sentence on WIkipedia is a misrepresentation of the Cochrane review, which primarily finds “evidence is uncertain”. This source is also out of date since Wahls research (and similar research) has since been published and later confirmed in a meta-analysis. (See Request #2)

5. In the Wahls diet section, please remove the last paragraph:

Clinical neurologist Steven Novella has commented that Wahls "paint[s] a picture of reality that is at drastic odds with the evidence" and elevates "nutrition to a magical stature that is not based on a lick of published evidence".

Why: This information is pulled from a personal blog, which is not considered a reliable source according to Wikipedia’s reliable source policy WP:Reliable sources. It’s also very out of date – it’s a blog post from 2014, and Wahls has since published multiple peer-reviewed studies, and some of her findings confirmed in meta-analysis. (See Request 2). This sentence is written as though it’s an evergreen criticism of her current work, when in fact, it references a period from before her published research.

6. To Select Publications, below the current entries, please add the following:

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

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

Why: This includes the peer-reviewed research referenced in the meta-analysis. It’s appropriate to use Select Publications for scientific research. Lola1950 (talk) 19:22, 13 June 2024 (UTC)

The trials you are citing fail WP:MEDRS. There is no good clinical evidence on diet and MS. It is still early days on this type of research. We are not going to cite one new trial. The meta-analysis you cited hardly mentions the Wahls diet. This is what it says "Wahls recommends using the modified Paleolithic diet for fatigued patients with RRMS. The Waves clinical trial, get improvements in EDSS and MFIS. Swank and Wahls diets contain a lower proportion of some nutrients compared to those needed in the usual diet, especially magnesium supplements and vitamins A, C, D and E. Deficiency of these micronutrients should be controlled". [2]

There is no reason to mention the WAVES trial. If there were 10 or 20 trials with consistent data from a systematic review then this is worth including but citing one trial is not going to happen on Wikipedia, we do not cite primary sources. This is not the way evidence-based medicine works, citing one trial. We need to look at the totality of the evidence, not just one new study. In 10 years we will have more data. Psychologist Guy (talk) 20:24, 13 June 2024 (UTC)

MEDRS states: “The best evidence for efficacy of treatments and other health interventions comes mainly from meta-analyses of randomized controlled trials (RCTs). Systematic reviews of literature that include non-randomized studies are less reliable.”

The user above did not read the meta-analysis carefully enough to see that Wahls’ research was included in the main data of the meta-analysis. They have cited a description of her research in the paper but that’s secondary to the selection of her research for inclusion in the data of the entire meta-analysis. That combined data was the basis for the conclusions on the meta-analysis. I think the user did not see that the “Irish” study was co-authored by Wahls.

Following this user’s comment, I 1) clarified that the study is called “Irish” in the meta-analysis, with Wahls being one of five researchers with Amanda Irish the first listed; and 2) added a second meta-analysis to the passage that also includes a study co-authored by Wahls.

Details about exactly where to confirm Wahls’ participation can be found by reading the revised explanations above,

The first meta-analysis uses the data from eight studies. Table 2 shows the specific studies selected. (You must click to expand the tables unless you download the PDF). The “Irish” study is referred to in many places on this meta-analysis. In the second meta-analysis, which I added after the comment above, table e1 shows the specific studies selected and table e2 shows the original description of the study diets investigated by the research team. eReferences 3,5, and 11 show that Wahls is a co-author of the three studies included that investigated the Paleolithic diet. As this is not the page about MS, but a bio, describing the conclusions of the meta-analyses and the role of Wahls’ research within these, is the only way to meet the high burden of MedRS and also describe her particular research. If one of the authors of the meta-analysis were the researcher who wrote an underlying study, it would be excluded under MEDRS as primary. So using both a meta-analysis or systematic review plus a description of the BLP research included in the larger study is the only way under policy that an individual’s own medical research can be included on their Wikipedia page .Lola1950 (talk) 18:42, 19 July 2024 (UTC)

References

Come back to us when you have 5 or 6 meta-analyse and systematic reviews with significant results. As stated we are not going to link to one weak meta-analysis that hardly mentions the Wahls diet. Psychologist Guy (talk) 21:24, 19 July 2024 (UTC)

 Not done I am closing this edit request (while having no opinion myself) since consensus of other editors seem to be that sources given fail WP:MEDRS. Rusalkii (talk) 00:39, 16 August 2024 (UTC)

@Lola1950 pointed out on my talk page that only some of these requests concern MEDRS, which is entirely fair. (And also that "editors" plural is incorrect, though it doesn't change my conclusion wrt to the MEDRS-related sources). Looking over the other points now. Rusalkii (talk) 16:41, 3 September 2024 (UTC)

1. Directly MEDRS related. Skipping.
2.  Done, not entirely convinced that this is the WP:COMMONNAME but seems unobjectionable.
3.  Partly done I do broadly prefer you rewritten phrasing, but your suggested rewrite removes Wahl's claim that the diet helped Wahls with her own MS, which doesn't feature anywhere else in the article and very heavily in all the sources. It also cites a source that as far as I can tell doesn't mention the Wahls diet anywhere, could you point out to where it's mentioned?
4.  Partly done I have clarified in the text that the review doesn't cover the Whals diet. I do think this is potentially relevant, I will leave to other editors to decide.
5.  Done the blogger is "an academic clinical neurologist at Yale University School of Medicine" and thus arguably a subject matter expert and so valid to use for commentary, but I'm not sure it's due weight here and definitely doesn't itself pass MEDRS. Removed.
6.  Partly done I am unsure what standard we hold selected publications to in this context. Tentatively adding the first, but eluding the second, which is just a preregistered study design and not the study itself.

Rusalkii (talk) 17:17, 3 September 2024 (UTC)

@Psychologist Guy, you reverted this change as whitewashing. Could you please explain which parts you object to? The parts that seem potentially slanted to me are #4, which clarifies that the review doesn't specifically mention the diet, #5, and #6. The first two changes are basically trivial copyediting. For #4 I feel that the previous wording strongly suggested that the Cochrane Review specifically found that this diet doesn't work, which wasn't accurate. For #5 I believe that criticism of a medical claim needs to itself pass WP:MEDRS. For #6 I don't feel strongly about including this publication but it is in fact a publication of the subject presented without any editorial endorsement. Rusalkii (talk) 18:44, 3 September 2024 (UTC)

It was I who reverted. I think this is a case where WP:PARITY is important. We are after all dealing with claims that MS can be treated with a diet somebody has conjured up!? The point of the Cochrane review is that there is no evidence diets/supplements effectively treat MS. It's important to state the accepted knowledge in this area of extreme FRINGE, for NPOV. Bon courage (talk) 18:50, 3 September 2024 (UTC)

My understanding is that subject experts can be quoted on BLP's. Steven Novella is considered an expert in this area. There isn't any clinical evidence for anything Terry Wahls claims, if there was there would be multiple systematic reviews supporting good outcome data etc. As for the Cochrane review it did mention the Wahls diet. The conclusion of the review was "at present, there is insufficient high‐certainty evidence as to whether dietary interventions change the course of MS". In other words the statement on the article currently is accurate per the source. There is no clinical evidence right now that diets are effective to treat MS. As stated above this may change in the future with new research but that is a long way off if it happens because there is no consistent data. Psychologist Guy (talk) 19:01, 3 September 2024 (UTC)

Wahls' premise "If we fix the nutrition, this is the real way to address the root cause of most disease" is - shall we say - hugely implausible, thus we are into the realm of WP:ECREE. Meanwhile, this nonsense needs to be properly contextualized by e.g. Novella. Bon courage (talk) 19:23, 3 September 2024 (UTC)