Video: The Role of Mitochondria in MS-Related Fatigue

Over 80% of patients with multiple sclerosis (MS) report fatigue, and most prescription medications have been reported to have low efficacy in changing that number.1 This situation has changed little since 2000.2

In the video below, Terry Wahls, MD, an IFM Certified Practitioner, shares how she approaches patients with MS and why lifestyle may be so important for fatigue symptoms.

Dr. Wahls is a researcher in this area, currently leading a randomized control trial on the effects of dietary interventions on fatigue in MS patients.3 She is also a practicing clinician and an educator.


Chronic fatigue is a common problem that I see in my MS patients.

There’s been a long history of trying to understand what is the root cause of this fatigue. There’s increased recognition that the fatigue is related to central brain issues.

What are those central brain issues? We don’t really know, precisely; however, there’s increasing evidence that this has to do with inadequate mitochondrial function and inadequate mitochondrial performance—so there’s not as much energy being generated.

There’s also evidence that fatigue is related to the levels of inflammatory cytokines that are present. For that reason, fatigue, and improvements in fatigue (that is, more energy), is one of the first things that we see as we get people to eat the way that we advocate, which is: lots of vegetables in a very specific way, and the elimination of sugar, the elimination of high glycemic index foods, and foods that restore the mitochondrial performance, a lot of minerals, a lot of fats, a lot of coenzyme Q—organ meats are a great source there.

Restoration of energy, that is, the reduction of fatigue, responds very, very well to dietary and lifestyle measures: food, targeted supplements, and gradual training up for exercise to gradually train up those mitochondria.


  1. Yang TT, Wang L, Deng XY, Yu G. Pharmacological treatments for fatigue in patients with multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci. 2017;380:256-261. doi:1016/j.jns.2017.07.042
  2. Brañas P, Jordan R, Fry-Smith A, Burls A, Hyde C. Treatments for fatigue in multiple sclerosis: a rapid and systematic review. Health Technol Assess. 2000;4(27):1-61.
  3. 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. doi:1186/s13063-018-2680-x

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