Minding My Mitochondria: Nutrients for the Brain

Editorial Note — Freedom of Research and the Right to Be Heard. This page documents the research, writings, and claims of Dr. Terry Wahls, the American physician and University of Iowa clinical professor who developed the Wahls Protocol diet after her own diagnosis of multiple sclerosis, in the spirit of open scientific inquiry. The First Amendment’s protection of speech, and the long American tradition of medical dissent that runs from Semmelweis to Barry Marshall to Linus Pauling, exists precisely so that minority and unpopular research can be examined on its merits rather than silenced by institutional consensus. We present her facts and claims as she stated them, attributed to her, drawn from her papers, books and talks. Readers are presumed to be intelligent adults capable of weighing evidence, consulting their own physicians, and making informed decisions about their own bodies. This page is provided for educational and historical-record purposes; it is not medical advice and does not endorse self-treatment. Censorship of a researcher is not refutation of the research. — MyHealthcare.com

Terry L. Wahls, MD, MBA, is an American internal-medicine physician and clinical professor of medicine at the University of Iowa Carver College of Medicine who has secondary progressive multiple sclerosis (MS) and who built a nutrient-dense diet and lifestyle program, the Wahls Protocol, that she credits with her own recovery.

This page covers the first public form of her idea: the book Minding My Mitochondria (second edition, 2010) and her 2011 TEDxIowaCity talk “Minding your mitochondria”. It sets out, in plain language and in her own and her research team’s words, the argument that the brain’s energy factories (the mitochondria) and the insulation around nerve fibres (myelin) need particular nutrients; how that argument became the “nine cups” vegetable rule; her own study of brain micronutrients in a traumatic brain injury clinic; what her later trials measured about nutrient intake; and the published research on mitochondria in progressive multiple sclerosis and on micronutrient “triage” that forms the background to her argument.

The Book Minding My Mitochondria
The 2011 TEDx Talk
The Personal Story Behind the Book
How Wahls Links Mitochondria, Myelin and Food
From Brain Nutrients to Nine Cups of Vegetables
Sulfur, Nutritional Yeast, Seaweed and Organ Meat
Her Brain-Micronutrient Study in Traumatic Brain Injury
What Her Trials Measured About Nutrients
Mitochondria in Progressive Multiple Sclerosis: The Research Background
Micronutrient Triage and Related Research
Key Research Papers
Connections

1. The Book Minding My Mitochondria

The full title of the book is Minding My Mitochondria: How I Overcame Secondary Progressive Multiple Sclerosis (MS) and Got Out of My Wheelchair. The second edition was published in 2010 by TZ Press in Iowa City and runs to 235 pages (ISBN 9780982175088). The year of the first edition is not confirmed in the catalogue records this page draws on, so it is not given here.

The University of Iowa’s own research catalogue, Iowa Research Online, describes the book as a practical guide to mitochondrial health and to the steps readers can take to support brain function. Its subject headings are brain, multiple sclerosis, diet therapy and mitochondria. On her own website, Wahls writes that the book “explains the key roles mitochondria play in maintaining a healthy brain and body.”

The book came before her better-known title, The Wahls Protocol (2014, written with Eve Adamson), and before her randomized diet trials. In that sense it is the first written statement of the idea that runs through all her later work: that the cells of the brain and nerves have specific nutritional needs, and that a diet built deliberately around those needs is part of how she believes she recovered function.

Her research papers disclose business interests in her books, website and programs, and conflict-of-interest management plans with the University of Iowa and the Iowa City VA.

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2. The 2011 TEDx Talk

In 2011 Wahls gave a talk titled “Minding your mitochondria” at TEDxIowaCity, an independently organised local TED-format event. The Iowa Research Online record for The Wahls Protocol notes: “Her 2011 TEDx talk about her recovery became widely viewed online.” The exact date of the talk and its view count are not confirmed in the sources used for this page and are therefore not given.

As that catalogue record says, the talk was about her own recovery. No verified transcript of the talk was available for this page, so its content is described here only through the written sources below, and no quotation from the talk itself is reproduced.

A 2013 summary of the talk published on Health Rising, a patient-community health blog, reports that she described three groups of nutrient needs: mitochondria needing B vitamins, sulfur and antioxidants; myelin needing vitamin B1 (thiamine), vitamin B9 (folate), vitamin B12, iodine and omega-3 fatty acids; and brain chemical messengers (neurotransmitters) needing sulfur and vitamin B6. That blog summary is a secondary source — it is the blogger’s account of the talk, not a transcript — and it is reported here as such.

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3. The Personal Story Behind the Book

The subtitle of the book — how she got out of her wheelchair — refers to her own illness, which she has described in published form. Wahls writes that she was diagnosed with relapsing-remitting multiple sclerosis in 2000 and that “By 2003, I had transitioned to secondary progressive multiple sclerosis.” She underwent chemotherapy to try to slow the disease and, because of weakness in her back muscles, used a tilt-recline wheelchair for four years.

She dates the turning point precisely: “In December 2007, I began the Wahls Protocol®.” She continues: “Within a year, I was able to walk through the hospital without a cane and even complete an 18-mile bicycle tour.” Her University of Iowa lab page says she restored her health “using a diet and lifestyle program she designed specifically for her brain.”

Her case was written up in a medical journal in 2009 as a case report. It describes a 52-year-old woman with secondary progressive multiple sclerosis who had depended on a scooter and cane for four years. After neuromuscular electrical stimulation and then nutritional changes “to lower oxidative stress and excito-toxicity”, the report says, after 8 months she no longer used a scooter or cane and “rode her bicycle routinely 8 miles, including hills.” A 2019 paper by her research team states that this case report documented Dr. Wahls’ own use of the diet, dietary supplements and neuromuscular electrical stimulation. A case report describes one person; it is not a trial. The fuller story of her career and illness is on the Life and Career page.

In 2011 she also published a short personal essay, “The seventy percent solution”, in the Journal of General Internal Medicine; its keywords are secondary progressive multiple sclerosis, recovery and nutrition.

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4. How Wahls Links Mitochondria, Myelin and Food

Mitochondria are the small structures inside nearly every cell that turn food and oxygen into adenosine triphosphate (ATP), the cell’s energy currency. Nerve cells use a great deal of energy, and the long nerve fibres (axons) of the brain and spinal cord are wrapped in myelin, a fatty insulating layer that multiple sclerosis damages. Wahls’s central argument is that both the energy supply of these cells and the repair of myelin depend on a steady supply of specific vitamins, minerals and fats, and that ordinary modern diets often fall short of them.

Her research team put the B-vitamin part of this argument in a 2019 review written with Catherine Chenard and Linda Snetselaar: B vitamins “are key nutrients for mitochondria and ATP energy production and improved neural repair.”

A second 2019 paper from her team lists what the Wahls diet was designed to do. In their words, it “was designed to reduce oxidative stress and excitotoxicity, nourish the mitochondria, prevent nutrient deficiencies, minimize food allergies and reduce toxic load, feed the microbiome, activate anti-inflammatory genes and increase nerve growth factors.” “Nourish the mitochondria” is the phrase that ties the later diet directly back to the book’s title.

The 2019 review also states her starting theory directly: “Dr. Wahls initially theorized that detailed guidance to increase intake of specific foodstuffs would facilitate increased intake of nutrients key to neuronal health (Wahls™ diet).” In other words, instead of telling people to take a long list of single nutrients, she set out to tell them which foods to eat, and how much, so that the nutrients would come with the food.

The same paper records that the Wahls diet was “originally developed in 2008”, based on the tenets of the Paleolithic (“Paleo”) diet and on her own review of the medical literature.

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5. From Brain Nutrients to Nine Cups of Vegetables

The practical result of the “feed the mitochondria” idea is the rule her diet is best known for: nine or more cups of vegetables and fruit a day, split into three groups. Her 2019 review describes how the Wahls diet differs from a usual Paleo diet: it calls for nine or more cups (about 1,950 grams or more) of fruit and vegetables divided among leafy, sulfur-rich and deeply coloured kinds; it encourages seaweed, algae and nutritional yeast; it eliminates eggs, which a Paleo diet normally allows; and it has a lower meat and fish intake. The original version allowed limited servings of gluten-free grains and legumes.

The three groups, as written in the Wahls Elimination diet rules used in her later randomized trial, are:

Leafy greens — two to three or more cups a day of dark-green leafy vegetables.
Sulfur-rich vegetables — two to three or more cups a day of cruciferous (cabbage-family) vegetables, allium (onion-family) vegetables and mushrooms.
Deeply coloured fruit and vegetables — two to three or more cups a day of produce coloured all the way through, such as carrots, beets, sweet potatoes, cherries and berries.

White fruit and vegetables come only after these three groups are met. The Health Rising summary of her talk, mentioned above, reports the same structure as “three cups” each of greens, sulfur vegetables and coloured vegetables, and says she singled out kale as an especially nutrient-dense plant for its calories.

In 2015 she developed the stricter Wahls Elimination version. Her team writes that it eliminated “gluten-free grains, legumes and nightshades (e.g., tomatoes, white potatoes, eggplant, peppers and seed spices) to reflect the theoretical benefits of a low lectin diet”; it also excludes cow, goat, mare and soy dairy products. These are the rules as written for the trial, reported here as hers; the full food rules and the diet levels are covered on The Wahls Protocol page.

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6. Sulfur, Nutritional Yeast, Seaweed and Organ Meat

Several of the less usual foods in her diet are there because of a particular brain nutrient she wanted to supply. Her 2019 review gives the reasons in the team’s own words:

Sulfur vegetables. The review states that cabbage-family and onion-family vegetables and culinary mushrooms “are rich sources of organic sulfur”, and that sulfur “may protect from neuro inflammation and/or neurodegeneration.”
Nutritional yeast. It is “encouraged on the WahlsElim diet to boost the B vitamin content of the diet.” The trial rules call for one tablespoon a day.
Organ meat and cod liver oil. These are included as sources of preformed vitamin A. The trial rules encourage 12 ounces of organ meat a week.
Seaweed and algae. The trial rules include one serving of seaweed (a quarter teaspoon of dried powder) and one serving of algae (half a teaspoon) daily. The Health Rising summary reports that she described seaweed as a source of iodine and selenium; iodine is one of the nutrients she links with myelin.
Omega-3-rich fish. The trial rules encourage 16 ounces of omega-3-rich fish a week; omega-3 fatty acids are among the nutrients she links with myelin.
Fermented food. One serving a day, from a list that includes yogurt, kefir, kombucha, sauerkraut, pickles, kimchi, natto, miso and tempeh.

The supplements given to participants in her randomized trial were cod liver oil (one teaspoon), a multivitamin and mineral, methylfolate (1,000 micrograms), methyl-vitamin B12 (1,000 micrograms) and vitamin D3 (5,000 international units). These amounts are reported as the trial’s protocol, not as a dosing guide; section 8 sets out what the researchers later measured about intakes, including intakes above upper limits.

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7. Her Brain-Micronutrient Study in Traumatic Brain Injury

Wahls tested the brain-nutrient idea in a group of patients other than people with multiple sclerosis. In a 2014 study in the journal Nutritional Neuroscience, she and colleagues assessed the diets of patients who came to a traumatic brain injury clinic for evaluation. They chose 14 micronutrients that they considered important for the brain and compared each patient’s intake with the Recommended Dietary Allowance (RDA).

None of the 39 patients met the Recommended Dietary Allowance for all 14 brain-important micronutrients. Lower intakes of folate, magnesium, vitamin C and vitamin K went along with worse somatic (bodily) symptom scores.

This was an observational study: it measured diets and symptoms at one point and found an association. It did not test whether changing the diet changed the symptoms. Wahls has presented it as part of her own research on dietary adequacy for the brain.

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8. What Her Trials Measured About Nutrients

Because the diet was built to raise nutrient intake, her research team checked what the diet actually supplied:

Menu analysis (2019). Analysing sample menus of the Wahls Elimination diet against the healthy U.S.-style eating pattern, Chenard and colleagues found the menus met nearly all Recommended Dietary Allowances; vitamin D and calcium were below the Recommended Dietary Allowance for some age and sex groups.
Trial participants (2020). In people with multiple sclerosis following a modified Paleolithic diet in her studies, Titcomb and colleagues found food intake was below needs for vitamin D, choline and calcium, while some participants exceeded tolerable upper intake levels for certain nutrients through supplements. The safety fact the paper reports is that combining a nutrient-dense diet with supplements can push some nutrients above their upper limits.
Vitamin K. In the 2017 randomized pilot trial of a modified Paleolithic diet in relapsing-remitting multiple sclerosis (Irish and colleagues), serum vitamin K rose in the diet group. Her team also published a laboratory assay paper (2020) for measuring vitamin K1 and menaquinone-4 in human plasma and applied it to her clinical study.
Homocysteine, folate and vitamin B12. A 2023 secondary analysis of her WAVES trial, which compared the Wahls Elimination diet with the low-saturated-fat Swank diet, examined the association of serum homocysteine, folate and vitamin B12 with mood following the two diets.
Micronutrient change (2021). A further WAVES analysis used weighed food records to measure how micronutrient intake changed as people with relapsing-remitting multiple sclerosis adapted to the Swank and Wahls diets.

The trials themselves — their design, size and results for fatigue and quality of life — are covered on the Randomized Diet Trials and Multimodal Pilot Studies pages.

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9. Mitochondria in Progressive Multiple Sclerosis: The Research Background

The idea that mitochondria matter in the progressive stage of multiple sclerosis is not hers alone; it is an active area of neurology research, written up mainly by groups working on brain-tissue pathology. These papers are not about diet and do not test the Wahls Protocol; they are the background against which her book’s title makes sense.

Mahad, Lassmann and Turnbull published a 2008 review, “Mitochondria and disease progression in multiple sclerosis”, in Neuropathology and Applied Neurobiology.
Campbell and Mahad reviewed “Mitochondrial changes associated with demyelination: consequences for axonal integrity” (Mitochondrion, 2012), and Campbell, Ohno, Turnbull and Mahad published “Mitochondrial changes within axons in multiple sclerosis: an update” (Current Opinion in Neurology, 2012).
Mahad, Trapp and Lassmann reviewed “Pathological mechanisms in progressive multiple sclerosis” in The Lancet Neurology in 2015, a review that includes mitochondrial injury among the mechanisms discussed.
Campbell and Mahad returned to the subject in “Neurodegeneration in progressive multiple sclerosis” (Cold Spring Harbor Perspectives in Medicine, 2018).

Wahls’s own group later co-authored a 2023 narrative review, “Overview of diet and autoimmune demyelinating optic neuritis”, which looks at diet in autoimmune inflammation of the optic nerve with loss of myelin.

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10. Micronutrient Triage and Related Research

A related line of research, by the biochemist Bruce Ames and colleagues, argues that shortfalls of vitamins and minerals that are too small to cause a classic deficiency disease may still harm long-term health, including the health of mitochondria. Wahls’s argument that modern diets under-supply the brain fits this line of thinking, although the Ames papers are not about multiple sclerosis:

Ames, Atamna and Killilea, “Mineral and vitamin deficiencies can accelerate the mitochondrial decay of aging” (Molecular Aspects of Medicine, 2005).
Ames, “Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage” (Proceedings of the National Academy of Sciences, 2006) — the paper that set out the “triage theory”: when a micronutrient is scarce, the body is proposed to allocate it to functions needed for short-term survival at the expense of long-term ones.
McCann and Ames, “Vitamin K, an example of triage theory: is micronutrient inadequacy linked to diseases of aging?” (American Journal of Clinical Nutrition, 2009) — relevant because vitamin K is one of the nutrients that rose in her diet trial and that tracked symptoms in her brain injury study.
Ames, “Prolonging healthy aging: Longevity vitamins and proteins” (Proceedings of the National Academy of Sciences, 2018).

Other nutrients on her list have their own research record in multiple sclerosis. Two double-blind randomized trials by Sanoobar and colleagues tested coenzyme Q10, a compound used by the mitochondria in energy production, in people with multiple sclerosis: one examined inflammatory markers (2015) and one examined fatigue and depression (2016). For vitamin D, Munger and colleagues reported on vitamin D intake and the incidence of multiple sclerosis in the Nurses’ Health Studies (Neurology, 2004), and Simon, Munger and Ascherio reviewed the epidemiology, immunology and genetics of vitamin D and multiple sclerosis (2012). These are independent studies of single nutrients; they are not tests of her diet. B vitamins in multiple sclerosis are also discussed on this site’s page about Frederick Klenner’s B-vitamin treatment of multiple sclerosis.

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Key Research Papers

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. — PubMed PMID: 19918474
Wahls TL. The seventy percent solution. J Gen Intern Med. 2011;26(10):1215-6. — PubMed PMID: 21253878
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):252-9. — PubMed PMID: 24074905
Wahls TL, Chenard CA, Snetselaar LG. Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic. Nutrients. 2019;11(2):352. — PubMed PMID: 30736445
Chenard CA, Rubenstein LM, Snetselaar LG, Wahls TL. Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern. Nutrients. 2019;11(3):537. — PubMed PMID: 30832289
Titcomb TJ, Bisht B, Moore DD 3rd, Chhonker YS, Murry DJ, Snetselaar LG, et al. Eating Pattern and Nutritional Risks among People with Multiple Sclerosis Following a Modified Paleolithic Diet. Nutrients. 2020;12(6):1844. — PubMed PMID: 32575774
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. — PubMed PMID: 30050374
Zhang Y, Chhonker YS, Bala V, Hagg A, Snetselaar LG, Wahls TL, et al. Reversed phase UPLC/APCI-MS determination of Vitamin K(1) and menaquinone-4 in human plasma: Application to a clinical study. J Pharm Biomed Anal. 2020;183:113147. — PubMed PMID: 32086127
Titcomb TJ, Brooks L, Smith KL, Ten Eyck P, Rubenstein LM, Wahls TL, et al. Change in Micronutrient Intake among People with Relapsing-Remitting Multiple Sclerosis Adapting the Swank and Wahls Diets: An Analysis of Weighed Food Records. Nutrients. 2021;13(10):3507. — PubMed PMID: 34684508
Shemirani F, Titcomb TJ, Saxby SM, Eyck PT, Rubenstein LM, Hoth KF, et al. Association of serum homocysteine, folate, and vitamin B(12) and mood following the Swank and Wahls elimination dietary interventions in relapsing-remitting multiple sclerosis: Secondary analysis of the WAVES trial. Mult Scler Relat Disord. 2023;75:104743. — PubMed PMID: 37148578
Plafker SM, Titcomb T, Zyla-Jackson K, Kolakowska A, Wahls T. Overview of diet and autoimmune demyelinating optic neuritis: a narrative review. Immunometabolism (Cobham). 2023;5(2):e00022. — PubMed PMID: 37128292
Mahad D, Lassmann H, Turnbull D. Review: Mitochondria and disease progression in multiple sclerosis. Neuropathol Appl Neurobiol. 2008;34(6):577-89. — PubMed PMID: 19076696
Campbell GR, Mahad DJ. Mitochondrial changes associated with demyelination: consequences for axonal integrity. Mitochondrion. 2012;12(2):173-9. — PubMed PMID: 21406249
Campbell GR, Ohno N, Turnbull DM, Mahad DJ. Mitochondrial changes within axons in multiple sclerosis: an update. Curr Opin Neurol. 2012;25(3):221-30. — PubMed PMID: 22543429
Mahad DH, Trapp BD, Lassmann H. Pathological mechanisms in progressive multiple sclerosis. Lancet Neurol. 2015;14(2):183-93. — PubMed PMID: 25772897
Campbell G, Mahad D. Neurodegeneration in Progressive Multiple Sclerosis. Cold Spring Harb Perspect Med. 2018;8(10):a028985. — PubMed PMID: 29440322
Ames BN, Atamna H, Killilea DW. Mineral and vitamin deficiencies can accelerate the mitochondrial decay of aging. Mol Aspects Med. 2005;26(4-5):363-78. — PubMed PMID: 16102804
Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proc Natl Acad Sci U S A. 2006;103(47):17589-94. — PubMed PMID: 17101959
McCann JC, Ames BN. Vitamin K, an example of triage theory: is micronutrient inadequacy linked to diseases of aging? Am J Clin Nutr. 2009;90(4):889-907. — PubMed PMID: 19692494
Ames BN. Prolonging healthy aging: Longevity vitamins and proteins. Proc Natl Acad Sci U S A. 2018;115(43):10836-10844. — PubMed PMID: 30322941
Sanoobar M, Eghtesadi S, Azimi A, Khalili M, Khodadadi B, Jazayeri S, et al. Coenzyme Q10 supplementation ameliorates inflammatory markers in patients with multiple sclerosis: a double blind, placebo, controlled randomized clinical trial. Nutr Neurosci. 2015;18(4):169-76. — PubMed PMID: 24621064
Sanoobar M, Dehghan P, Khalili M, Azimi A, Seifar F. Coenzyme Q10 as a treatment for fatigue and depression in multiple sclerosis patients: A double blind randomized clinical trial. Nutr Neurosci. 2016;19(3):138-43. — PubMed PMID: 25603363
Munger KL, Zhang SM, O’Reilly E, Hernán MA, Olek MJ, Willett WC, et al. Vitamin D intake and incidence of multiple sclerosis. Neurology. 2004;62(1):60-5. — PubMed PMID: 14718698
Simon KC, Munger KL, Ascherio A. Vitamin D and multiple sclerosis: epidemiology, immunology, and genetics. Curr Opin Neurol. 2012;25(3):246-51. — PubMed PMID: 22547098

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Minding My Mitochondria: Nutrients for the Brain

Table of Contents

1. The Book Minding My Mitochondria

2. The 2011 TEDx Talk

3. The Personal Story Behind the Book

4. How Wahls Links Mitochondria, Myelin and Food

5. From Brain Nutrients to Nine Cups of Vegetables

6. Sulfur, Nutritional Yeast, Seaweed and Organ Meat

7. Her Brain-Micronutrient Study in Traumatic Brain Injury

8. What Her Trials Measured About Nutrients

9. Mitochondria in Progressive Multiple Sclerosis: The Research Background

10. Micronutrient Triage and Related Research

Key Research Papers

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Further Reading

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