Fasting and the Ketogenic Diet for Migraines

We’ve previously argued that people with migraines should try a ketogenic diet. There are two reasons: (1) ketones can evade certain mitochondrial defects which might cause migraines, and (2) ketones reduce glutamate levels, and glutamate toxicity is implicated in migraines.

Reader Rob Sacks has had lifelong migraine headaches. As an experiment he turned to desperate measures – a long fast. Here’s his story:

I fasted for 30 days.   When I say “fast” I mean that I stopped eating all food.   I consumed only water and occasionally sea salt and potassium tablets.

As part of the fast I stopped taking Imitrex which I had been using almost daily to control my migraines.   I did this because I thought Imitrex was increasing the number of migraines due to a rebound effect.   I also stopped consuming caffeine to which I was addicted.

As the fast went on, my migraines lasted for shorter periods of time, and they became less painful. 

By day 23 I became free of headaches.  There was still some sort of migraine activity — I could often feel the sensations that in all my previous life, had always been followed by a headache — but no headache resulted.   Judging from what I could feel, there is a cascade of events that leads to a migraine, and the metabolic changes induced by the fast were interrupting the cascade at a certain point.

I was quite happy with this result and continued the fast as long as I could in the hopes that this would increase the chances that the change would be permanent.

Unfortunately, after the fast ended, the headaches gradually came back. I think this happened because after the first few post-fast meals, I made no effort to keep my diet ketogenic. An intense craving for fruit developed and once the danger of refeeding syndrome seemed to be over, I gave in. This was interesting because before the fast I had been on low carb diets since 2007 and hadn’t craved carbs in years.

When I saw the gains slipping away, I fasted again for two days to get back into ketosis as quickly as possible. Then I started following a diet similar to those used by neurologists at Johns Hopkins to treat children with epilepsy, with calorie restriction, frequent meals, and a ratio of fat to protein (by weight) of four to one. After two days of this diet, my headaches stopped again. That was only 48 hours ago but I’m sure the diet is working because I challenged myself last night with a sure-fire migraine trigger by staying up past my bedtime to watch the eclipse. Normally this would create a debilitating headache, but the only result was a slight migrainy feeling that was easily controlled with two aspirin. Before the fast, aspirin had no apparent effect on my migraines.

The next step will be to try more moderate diets and find the least extreme one that controls the headaches.

The fast proved that migraine headaches can be stopped by the metabolic changes induced by fasting.  Hopefully I can find a way to make that same metabolic state occur permanently.

Incidentally, the fast had some unexpected beneficial effects.  A bad varicose vein is dramatically improved, and a teary eye problem (which I think was caused by a clogged tear duct, and which I previously controlled with large amounts of vitamin C) has resolved almost completely.

I think this kind of experimentation is extremely important. Through experiments like Rob’s we can learn more about the causes of these seemingly incurable health conditions and find dietary and nutritional methods for healing or mitigating them. Experiments in lab mice are important, but the mice don’t tell us what they’re experiencing!

Rob lost 22 pounds during his 30-day fast, equivalent to 2200 calories per day if taken equally from protein and fat. Such an extended loss of lean tissue can be quite dangerous. If he had taken coconut oil or medium chain triglycerides during his fast, he would have conserved lean tissue mass and might have actually increasing ketone availability.

Fortunately it looks like ketogenic dieting is the key to Rob’s migraine relief, so extreme fasting should not be necessary.

Fasting does have therapeutic actions apart from its elevation of ketones. For instance, it promotes autophagy. It is possible that the fasting, not the ketones, was responsible for Rob’s cure of his varicose vein and teary eyes.

Rob might wish to experiment with protein restriction and other techniques for autophagy promotion, in order to see if they might also be beneficial in addition to ketosis.

Also, experimenting with micronutrients is important. Magnesium and riboflavin are often helpful for migraines.

Good luck Rob! Keep us posted.

Leave a comment ?

76 Comments.

  1. Hi Kate,

    Welcome!

    Calories in vegetables do count of course, but:
    there aren’t many of them; up to half the calories in vegetables are consumed by the digestive tract just to digest them; gut bacteria intercept others; the immune system consumes some glucose due to its increased activity to control the gut bacteria that ate vegetable fiber.

    The result is that eating vegetables isn’t an effective way to meet the body’s glucose needs. Several pounds of vegetables might add 30 glucose calories net, which is small compared to the 600 we need daily. I don’t think it’s worth the trouble to count them.

    Re your second question, most of the vegetables deliver carbs as sugars rather than as starch.

    The best way to get to know foods is to visit nutritiondata.com or a similar site and look up your favorite foods. There you can get calories per 100 g and composition. The key is that starch has no fructose, whereas sugars generally do.

  2. Thanks! Your explanations make perfect sense to me.

  3. I feel good in ketosis and am often am in it either from very high fat low carb meals or during fasting periods. Someone on a low carb forum posted the study below questioning Warburg’s theory and claiming that ketones feed cancer cells and this is why diabetics get cancer more frequently than non-diabetics. I come from a family of type 2 diabetics and they only showed ketones in conjunction with high blood glucose. Although this is completely different process than the “benign dietary ketosis” that low-carbers experience, I am concerned about the view that ketones fuel cancer cells. Thoughts?

    http://www.physorg.com/news202553643.html

  4. Hi Annie,

    I saw that work and have been reserving judgment on it. It’s a very surprising result and contrary to the consensus understanding of cancer metabolism. It contradicts a host of work showing that cancer cells die when their mitochondria burn ketones.

    As you say, diabetes has many other ways to promote cancer, and it’s entirely speculative to suppose the ketones might contribute.

    Until proven otherwise, I’ll go with the bulk of work showing that ketones are protective against cancer and retard tumor growth.

    Best, Paul

  5. I too was surprised at that study but it might explain some of the studies showing problems with autophagy — purportedly good for some tumors, bad for others. Is it possible that not all cancers use the same fuel and that a diet that is good for combatting one type of cancer would worsen another type? Oncologist Nicholas Gonzalez uses different types of diets depending upon the cancer — I’m really simplifying — but in general, he mentions patients with “hard tumors” such as breast, prostate require a more vegetarian regime while those with the blood cancers and leukemias require meat in the diet. I also seem to recall Ray Peat criticizing the idea that “cancer feeds on sugar” as overly simplistic because some cancers don’t and cancer cells can adapt to their environment — I can’t remember exactly but something to that effect.
    It’s also possible the scientists involved in the study I referenced have a preconceived conclusion bias — ketones fuel cancer– and then searched for evidence to back the conclusion — such as, the breast cancer cells and stroma etc. This is att odds with the clinical observations of Wolfgang Lutz MD who states in his book that breast cancer was the most common cancer amongst his patients and that with the exception of one who already had spread at the time of diagnosis — none of the others following a low carb diet had any kind of metastasis and did not require treatment other than surgery — no chemo, no radiation. He followed these patients for years — while he doesn’t advocate ketosis — the low level of carbs he prescribes certainly can cause ketosis.

  6. Hi Annie,

    Well, there are certainly differences among cancers — blood cancers are very different from solid tumor cancers, GI tract cancers different from others, and some like breast and prostate tend to be hormonally sensitive.

    Diet and cancer is something I want to learn more about so I will look into Dr. Gonzalez’s ideas.

    Cancers do feed on sugar, but they can also feed on amino acids and it’s impossible to deprive them of sugar since blood sugar levels are maintained. So we can only modulate their nutrient intake a little. But I think any hyperglycemia, even postprandial, definitely feeds cancer growth.

    This work wouldn’t repudiate that, it would just say that the glucose was feeding the fibroblasts who feed the tumor, instead of feeding the tumor directly.

    Also, metastasis is almost a second disease — a critical modification of the cancer — and so a diet could prevent metastasis even if it does nothing against cancer. Keeping omega-6 low is crucial for preventing metastasis.

    With ketosis we also have to ask if non-metabolic effects, like acidity, can affect the tumor.

    It’s complicated which is why the scientists haven’t figured it out for us yet! My guess is the Lisanti et al work will prove to be wrong, but I would like to hear from specialists and see if their results can be reproduced.

    Best, Paul

  7. Paul,

    Quick question here: will coffee or water consumed in the morning interfere with autophagy? In other words, is it best to avoid any beverage until the 16 hour intermittent fast is over?

    best,

    james

  8. Hi James,

    You should certainly drink water during a fast, it is needed.

    Caffeine promotes autophagy: http://www.ncbi.nlm.nih.gov/pubmed/21081844, http://www.ncbi.nlm.nih.gov/pubmed/17952024.

    I think it’s OK to drink coffee during a fast.

  9. Hi Paul,

    Heavy cream does have a little carb and protein – could you please comment why that’s okay for a fast?

    Thanks,
    Mark

  10. Hi Mark,

    Cream does diminish the intensity of a fast. But a small amount won’t matter much.

    Think of fasting as a continuum … it doesn’t need to be zero calories. If you need 2000 calories a day to maintain weight, 100 calories from cream in coffee isn’t going to dissipate the fast much.

  11. Hi Paul,

    Thank you for your reply. Now I would like to ask you about Ketogenic fasting for migraines. I have had migraines all of my life, terribly debilitating. I am now 60 years old and still get them, but not quite as bad (result of menopause?) I have tried fasting in the past, and got one of the worst migraines ever, so I’m a little afraid of trying one again. Could you be a little more detailed about how to do the Ketogenic fast i.e. what to eat, when, how long, quantities? Thank you so much for your reply. I also have IBS/diaharrea…so my gut is extremely sensitive.

    Sally

  12. Hi Sally,

    First, have you read this post: http://perfecthealthdiet.com/?p=2921.

    For migraines I don’t recommend fasting, but dieting in a way that generates ketones. A few posts on how to make a diet ketogenic:
    http://perfecthealthdiet.com/?p=2479
    http://perfecthealthdiet.com/?p=2638

    In general you want the minimally ketogenic diet that has a therapeutic effect. The basic strategy is to eat precisely 200 calories per day from safe starches like rice or potatoes; and to eat lots of coconut oil or MCT oil, say 4 tbsp per day is usually sufficient.

    Unless you are trying to lose weight, you should eat a normal number of calories, or extra calories.

    Intermittent fasting is good to include – a 16 hour period each day in which you eat nothing except a few tbsp of coconut oil/MCT oil. Then all your food in the 8 hour window, along with a few tbsp more of coconut oil/MCT oil.

    Also, be sure to supplement magnesium, say 400 mg per day, this is very important in migraines.

    In your case we have to allow for another possibility. The IBS/diarrhea may be due to an infection that gets worse on a ketogenic diet. Eukaryotic pathogens like fungi, protozoa, and worms can cause IBS/diarrhea; they also like ketones and infections with those will usually get worse on a ketogenic diet. This could be why fasting was so hard for you before. It’s possible the infection is causing your headaches in some fashion, and that they are not true migraines but infection-related.

    In that case, you shouldn’t do a ketogenic diet, but should diagnose the pathogen and get it treated.

    For diagnosis I recommend a stool test. This is good: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology. It will find the most common protozoa/worm/fungal pathogens.

    Once you know your pathogen, you can treat the infection that is causing your IBS/diarrhea. Hopefully after that your headaches would go away.

    The order in which you attack these issues is up to you, experiment to find what helps, but I would try to get a stool test as soon as possible. Knowledge is power in these cases.

    Best, Paul

  13. Dear Rob, There is no talk or tyramine or tannin here. I suffer from “Chronic Daily Headache” due to medication overuse. I’m 66 yo and continue to have migraine. I know hormones play a role here too. I use very little medicine anymore and watch what I eat, knowing some of the triggers. The “Starving” article in Harpers this month lead me to find this site. My question is in the ketogenic diet do you also keep the tyramine and tannin down? Nancy

  14. Just wanted to comment on the idea of a ketogenic diet being high protein. If following the “New Atkins” plan, it is not high protein. Rather, it is high fat, and .6 to 1.0 grams of protein per lean body pounds.

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  17. There is now a product almost on the market that puts exogenous ketones into your system without having to use dietary measures to get you into ketosis. Within an hour. It can be tested with ketone test strips (available OTC in any pharmacy) before and after taking the product. It was originally developed to prevent our Navy Seals from experiencing seizures during deep dives. It’s available by invitation only at the moment before it’s launched. The price will also go up to retail soon. It’s available now for wholesale (until 8/31/15). Here is a 7 minute video about the subject.
    https://pruvit.wistia.com/medias/akyqf0ja10

    If you want any further information on the research or with any other questions, you may email me at becsdrm@comporium.net

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