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 ?

80 Comments.

  1. Rob, I can imagine your desperation and the need to do such a fast, but your perseverance is truly admirable! Did you do this under a doctor’s guidance? Did you pick 30 days for a particular reason? Well, congratulations with the good results!

  2. I was curious about your statement that “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.”

    Just as a lay person, I would think that small doses of protein would preserve lean tissue on a fast, as that is what lean tissue is made of. Why would coconut oil help maintain lean muscle etc?

    I’m not disputing your statement, I’m just curious about how that is the case.

    For instance, I have seen others (the bodybuilder site “tnation”) recommend small doses of a product that appears to be a fancy casein blend protein shake during a fast. Of course they would recommend chugging huge quantities of protein blend products, constantly, but I offer their idea as an example.

  3. Hi Mike,

    Protein is consumed for calories or for conversion to glucose or ketones to meet brain needs. Coconut oil supplies both calories and ketones which substitute for glucose, diminishing consumption of protein.

    If you’re overweight, stored fat can meet most calorie needs, but is an inefficient source of ketones and not a source of glucose. So there is always protein metabolism going on during a fast.

    If protein is consumed during a fast, I would recommend whey rather than casein, as it is more ketogenic. However, I think the benefits of the fast would be greater if protein is eliminated and coconut oil consumed.

    Best, Paul

  4. Thanks Paul! Will have to try the coconut oil during fasts.

  5. I have suffered from migraines as far back into my childhood as I can remember. For years, I avoided the supposed triggers – caffeine, cheddar cheeses, wine, etc. Nothing worked and they were increasing in frequency and intensity. At age 48, I chanced across an article linking gluten with migraines. I eventually went entirely gluten-free, dropped 15 lbs almost instantly, and got rid of 90% of the migraines, along with joint aches and pains, skin problems, etc. The few remaining are very mild and almost always coincide with monthly hormonal changes. Eating a paleo/primal diet helped even more which points to the ketogenic diet as a possible cure. I’ve got to get rid of the remaining sugar addiction, but elimination of grains and beans and any gluten products solved most of the problem

  6. This post by Ned Kock may be relevant. Apparently, one doesn’t lose all that much protein on a 30-day fast.

    Another data point for burning fat is the healthy way to live. I wonder if the Rosedale Diet would be effective without going full keto?

  7. Fasting and the Ketogenic Diet for Migraines | Healthy News - pingback on December 22, 2010 at 5:17 am
  8. I just did a 24 h fast with a few teaspoons of coconut oil (finally got some!) and some whole cream (in my coffee). Nothing else except water of course.
    From my observation I did indeed loose less water (and thus muscle glycogen?) as compared to the protein modified fasts I did earlier that year for the same amount of time. Scale weight was changed by less then 1 pound (compared to 1.5-2.0 pounds with PMF).
    What hasn’t changed is the brain fog ~17-18 hours into the fast.

  9. Hi Claire,

    Thanks for the grats! I did this on my own without a doctor. I tried to be very cautious and stopped while there was plenty of fat and muscle left, and before my waist measurement went below what it had been when I was naturally lean as a young man.

    The thing that struck me most about the whole experience was how normal I felt during the first couple of weeks. There was no hunger at any time during the fast, not even the last day.

    It was like discovering that I had a superpower all my life without knowing it — the ability to go weeks without eating with only slight discomfort.

    The experience left me with no doubt that our bodies are designed to fast. It’s a normal part of our evolutionary inheritance. Fasting seems strange and frightening because we never do it except when we’re sick, and we’re unaware of how easy it is.

    Gradually, as the fast went on, the symptoms became more unpleasant.

    I didn’t plan ahead of time to fast for 30 days. I took it one day at a time.

    I stopped at 30 days because (1) the symptoms of fasting became so severe that I felt bad, (2) my waist measurement got down to what it had been at age 20, and (3) a desire arose for sea salt in my drinking water, which I thought might be a sign that electrolytes were becoming unbalanced.

  10. Hi js,

    That’s a very cool paper; kudos to Ned. It’s interesting that water loss is still significant at 28 days. The fat-protein proportion is not surprising in someone who has stored fat, but eventually the faster would get down to lean tissue and have to pull equal amounts of fat and protein.

    Hi Franco,

    To realistically test whether ketones will prevent the brain fog, try 10 tablespoons of coconut oil.

    Hi Rob,

    What were the symptoms that caused you to end the fast?

  11. Hi Paul,

    Thanks very much for blogging about my experiment!

    Regarding ongoing water loss, muscle is mostly water, so I imagine the body liberates water when it sacrifices muscle protein to make glucose.

    People often report lack of thirst while fasting. There were days when I drank only a few ounces. Presumably my body was drinking its muscles.

    The unpleasant symptoms, in order of appearance, were:

    1. Lethargy and weakness. The body creates the feeling that exertion is impossible, that you are too weak to get out of bed. There is even a reluctance to think — it’s too much work! At the beginning, the feeling is illusory — if you force yourself, you find that you can do things normally. Apparently it’s a trick the body uses to conserve energy. But gradually real weakness develops and it’s hard to disentangle the two things.

    2. Orthostatic hypotension. This is apparently normal during a fast, but it’s scary. I never fainted but came close several times.

    3. Horrible taste in the mouth. I assume this is caused by acetone. The taste kept getting stronger for weeks, and by the end of the fast it was very unpleasant.

    4. Lingua villosa (hairy tongue). Dead cells which normally slough off the tongue stay in place, giving the tongue a peculiar appearance. I didn’t find this symptom unpleasant but some people might.

    5. Insomnia. This symptom developed late in the fast on day 26. I barely slept the last four days.

    6. Irritability. Starting on day 26, I was uncharacteristically impatient and rude to people.

    7. Desire for salt. Starting on day 28, I desired sea salt in my drinking water. I thought this might indicate that my body was losing its ability to keep electrolytes in balance, which is apparently the main danger during a fast.

    8. Inflammation. Starting on day 29, the roots of my teeth felt inflammed. (I have a long-standing problem with unexplained bone loss around my teeth.)

  12. Hi Paul,

    sounds like a lot! But I believe you speak about leveled tablespoons? I eat the coconut oil at room temperature and actually like the creamy mouth feel (better then butter and I love pure butter since I was a kid!).
    As I’m fasting purely for health reasons and not for fatloss, I figured once per week 24 h should be enough.
    So, next week will try your suggestion.

  13. Hi Rob,

    It sounds like you were not taking enough electrolytes and water. We recommend 1 tsp/day salt during a fast, plus copious water. Protein metabolism consumes a lot of electrolytes, as sodium and chlorine are lost along with nitrogen.

    I think in the study Ned cited electrolyte losses might account for the water loss.

    I had some of the symptoms you list even on very short fasts when I was ill. Irritability I took to be a sign of hypoglycemia in the brain – perhaps you were running low on the ketogenic amino acids or otherwise conserving protein and thus making less glucose. I would get fungal infections on fasts, it seems they do well when glucose is scarce. The teeth inflammation implies some sort of infection. Insomnia may be caused by electrolyte deficiencies (including calcium and magnesium) or by hypoglycemia (see http://www.arltma.com/InsomniaDoc.htm).

    I think on future fasts you might try taking medium chain triglycerides for glucose conservation, more electrolytes and more water and it might go better.

    Tremendous work, Rob! I’m sure other people with migraines will be inspired by your experience to try ketogenic dieting.

    Best, Paul

  14. Hi Franco,

    A 24-hour fast is pretty short so you don’t need much coconut oil; I suggest it mainly as an experiment to see if late-fast symptoms go away. If so you might consider extending the fast to 36 hours (over two nights) and eating 10 tbsp of coconut oil. This longer fast would probably be just as tolerable with the coconut oil, and might deliver more benefits.

    I used to do the 36-hour fasting once every two weeks, but nowadays I’ve gotten comfortable with daily intermittent fasting. Most days I go 16 hours without food (eating 2 meals), some days 22 hours (eating 1 meal).

    I might do a long fast sometime as an experiment, but it won’t be 30 days! I’m very impressed by Rob’s perseverance.

  15. My migraines were never that severe – probably because my diagnosis of migraines was wrong! – but they were bad enough that I would pop 1 or 2 Midrin when I felt them coming. When I follow a lax keto diet (meat and veggies only, with HWC in the occasional cup of coffee) my “migraines” never evolve beyond an annoying headache and I rarely have those.

    It’s extremely important to ensure you actually have migraines and not some other form of severe headache. Doctors are often quick to slap on “migraine” if you have excruciating headaches. If it isn’t a true migraine, the initial meds will get rid of the pain until you become resistant.

    Some back-story: Eventually, the Midrin stopped working. I went from 1 pill working in twenty minutes, to half an hour, to never. Same with 2 pills, and in desperation I began taking 3. This was after years of developing a resistance to acetaminophen and ibuprofen. Aspirin never touched them. I began combining pills (4 ibuprofen, 3 acetaminophen, 2 aspirin) and after two months that didn’t work. Switchen to Excedrin Migraine, and was up to 4 pills (double the dose) within 3 months. Finally, I discovered naproxen. 1 works within 45 minutes every time…because they aren’t migraines, they’re SEVERE tension headaches and the naproxen has a muscle relaxant effect.

    The keto diet works almost all the time, but my next step is to get to a chiropractor to reduce the tension in my shoulders, back and neck.

    So, for 8 years – from the time I was 16 to the time I was 24 – I ran under the diagnosis of “migraines” and treated those, but I was pursuing the wrong treatment (and enduring pain and dumping money down the sink) the entire time.

  16. Rob, Thank you for the detailed account! I have done 3-4 day water fasts and was also rather lethargic each time and had the low blood pressure and insomnia usually starting the 3rd day. In contrast though, I was hungry often – especially the first 2 days and would dream of food 😉 But that may be because I don’t have a lot of reserves and/or was slightly malnourished. I found the intense hunger after the breaking the fast really difficult, not the first day after, but the next one. You wrote about no longer being in danger of refeeding syndrome, but how did you know when that was? Is there a guideline for this (say 1/3 nr of days you fast)? And how are you feeling now? I hope you’re still doing really well and are migraine free!!!!

    I was thinking if fasting helps kill off pathogens and if you knew which pathogens you had – would it then be an idea to do a ketogenic fast for the duration of the pathogens life cycle?

    Paul, if fungal infection is a problem then would it help to drink occasional oral rehydration salts as they contain a bit of glucose or even just a cup of tea with dextrose (no table sugar as to avoid fructose)? Would it be advised to continue with multivitamins and other supplements? From what I read in your book it seems like sipping on water with vitamin C during the fast would also be beneficial.

    I am considering a modified fast (no foods/fiber, but with coconut oil and maybe homemade broth) as my gastroparesis symptoms have returned after 12 wonderful days (with only 1 mishap :))of ketogenic dieting, supplements and intermittent fasting (14 – 22hrs). I suspect the switch is hormone related rather than from one allergic reaction as the symptoms persist. I do minifasts pretty often when my symptoms get really bad. I recently would fast on tea with honey and apple juice – which I’ve now learned is not the way to go with a suspected pathogen 😉 No wonder water fasts work best!

  17. Hi Becky,

    Thank you very much for sharing your experiences. Headaches are complicated beasts and it’s great you’ve found a formula that works.

    Naproxen is a COX-inhibitor and that suggests that minimizing omega-6 and getting some omega-3s may also help you.

    By the way, re stiffness a few things I’ve found helpful are Esther Gokhale’s book Eight Steps to a Pain-Free Back; some of the mobility exercises at http://mobilitywod.blogspot.com/; and these shoulder mobility exercises: http://stronglifts.com/shoulders-dislocations/.

    Best, Paul

  18. Hi Claire,

    Yes, I would continue with micronutrient supplements during a fast. Overnourished is better than undernourished. Electrolyte supplements are especially important.

    Hunger could also be a lack of adaptation to fat burning and ketone production. If you’ve been on a low-carb diet previously it’s easier to fast.

    Yes, I do think you should drink calorie-free fluids like tea and water. Putting some lemon slices in your water for citric acid should be helpful. Coconut oil won’t interfere with the fast. Calorie-free foods like spinach might also be helpful depending on your gut situation.

  19. Hi Claire,

    I’m feeling great! Thanks for asking! I’ve been migraine free for 73 hours without drugs and without fasting. This may not sound like much, but this is the first time in many years that I can say that!

    Regarding hunger at the beginning of a fast, I don’t want to make assumptions about you, but it will save time if I tell you my guess and you can correct me if I’m wrong.

    I’m guessing that you eat a fair amount of carbs, and that the reason you felt hungry was because your brain is accustomed to operating on glucose, and when you cut off the supply of starch and sugar, your brain created a craving for them.

    This is the same thing that happens when people start a low carb diet. It’s like the induction phase of Atkins. Atkins dieters don’t fast, but they feel like you did on your fast because their brains want glucose.

    In my case, it’s different. Whenever I stop eating for a day or two, it hardly bothers me. Every few hours I feel a mild hunger for a few minutes and then the feeling goes away.

    Why am I different? Because I’ve been eating very low carb diets for years. Some people would call me keto-adapted.

    Years ago, when I stopped eating carbs, I felt like you did on the first three days of your fast.

    Maybe it’s a good idea to become somewhat keto-adapted before starting a fast. Unfortunately it can take weeks of very-low-carb eating to get past the worst cravings for carbs.

    Regarding refeeding syndrome, I’m not an expert but my understanding is that it’s caused by insulin. The body hasn’t seen much insulin in weeks and it’s not prepared to handle large amounts. If you eat a lot of carbs and generate a lot of insulin, lethal (yes lethal!) electrolyte problems can occur.

    What I did, therefore, was start with meals that release only small amounts of insulin. Each successive meal had a little more carbohydrate. I got this idea from one of Petro Dobromylskyj’s blog posts:

    http://high-fat-nutrition.blogspot.com/search/label/David%20Blaine%20and%20refeeding%20syndrome

    The first post-fast meal was 35 g tallow and an egg. (Incidentally, I waited 16 hours after that meal and never became hungry; maybe insulin is the signal that tells the body the fast is over, and there wasn’t enough insulin to create the signal.) The second meal was similar except I added 6 g of potato — I was very cautious. The third meal was liver with a little more potato. The fourth meal was sashimi with strawberries — fruit, yay! And so on. By the third day I was eating normally.

  20. Robert all you symptoms are very common during starvation.
    I found this interesting article with many citations from the book “The Biology of Human Starvation”:

    http://180degreehealth.blogspot.com/2010/03/ancel-keys-and-biology-of-human.html

    Did your body temperature and sex drive diminished?

  21. Hi Kratos,

    Yes, my experience was typical. I didn’t mean to suggest that it wasn’t.

    My sex drive disappeared during the fast. I can’t answer your question about temperature because I never bothered to measure it, sorry.

    By the way, I don’t mean to quibble, but just for accuracy, the quotations in your link come from Ancel Keys’s book about the Minnesota Starvation Experiment. The subjects in that experiment didn’t fast. They ate a hypocaloric diet.

    Wikipedia has a good short article about that experiment, and there are some videos about it on the web with footage and interviews of the subjects.

    http://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment

    If anybody wants to read a good short paper about what happens to people who fast, I recommend the following. It has a good bibliography about fasting. (By the way, Paul, it contains a lot of info about the stability of electrolyte levels and the body’s tendency to retain them.)

    http://www.robsacks.com/fast/kerndt%20et%20al.fasting.1982.pdf

    And here’s a fascinating paper about the longest recorded medically supervised fast. This guy fasted for 382 days!

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/postmedj00315-0056.pdf

  22. Hi Rob,

    Great links!

    The guy who fasted 382 days lost 276 lb which works out to 2132 calories per day if it was equally from protein and fat.

    Of course in his case it must have been mainly from fat. But it seems like 3/4 lb per day is a plausible rate of weight loss under total fasting.

    So it would be risky to engage in a fast longer than the number of pounds you’re prepared to lose.

  23. Hi Paul,

    I agree with you completely that people should be very careful not to run out of muscle or fat.

    Here’s something that illustrates the risks. I ran across this shortly after my fast began, and it made me very mindful of the dangers.

    http://www.robsacks.com/fast/lex_rooker.html

  24. Hi Rob,

    That guy’s rate of weight loss works out to 8500 calories/day. Interesting that he continued the fast to such an extreme, it’s hard to believe he wasn’t hungry.

    Looks like you’re going to have an interesting web site, Rob! Let me know when it’s ready for public viewing, I’ll do a post on it.

  25. Hi Paul,

    Thanks. I’m not sure that I’ll create a website. Those links go to my personal site that I’m using temporarily to collect articles and links.

    I started collecting stuff for a new site because I felt obligated, from a public service point of view, to make it possible for migraine suffers to easily find in Google a web site that tells them, “At least one person cured his migraines with a ketogenic diet, and maybe you can too.”

    But now your blog does that, so I’m off the hook! 🙂

    I’ve found only one other mention on the web of a person whose migraines were cured by a ketogenic diet. Unfortunately it’s behind a journal firewall.

  26. Robert – those are amazing articles you’ve linked. Thank you! I’ve read quite a bit about semi starvation but not as much about fasting so very interesting!

    Paul – I find that intermittent fasts longer than 16 hours result in quite debilitating cold intolerance (icy feet and hands, and uncontrollable shivering at times). I’ve even added a bit of coconut oil to tea at the 16 hour mark and it doesn’t seem to make any difference. Robert – did you have cold intolerance during your fast too? The semi-starvers did but obviously that is a different kettle of fish.

  27. Robert, it is so wonderful that you are doing so well! I really hope it continues 🙂 And luckily now you have a coping strategy that helps if it does hit again. The information you posted is really helpful and clear for someone who’d want to try a (ketogenic) fast! Thank you.

    Emily, I get the same cold intolerance – even if I’m just doing a high calorie liquid diet. You of course may know more about this as a doctor, but my feeling was that active intestines provide a lot of body heat, so when my digestive system didn’t have much fiber or things to break down it would slow down and I’d get really cold. Eating cooked veggies would help me.

    After reading about the importance of keto-adaptation and that one should be careful not to fast longer than the weight you can/want to lose I think its not a good idea for me. I definitely still crave carbs and if I lose more than 5 pounds I’ll be underweight. I’m going to try fewer carbs, do some extra supplementation as suggested by Paul (http://perfecthealthdiet.com/?p=1338#comment-10434) and wait for the results of a recent test for parasites.

    Best of health to you all, Claire

  28. Hi Emily,

    I love your blog! I look every day to see if you’ve published something new.

    I didn’t experience cold intolerance, but there are posts on various diet-related forums in which people say pretty much what you said. For example:

    http://paleohacks.com/questions/9398/cold-hands-and-feet-during-if#axzz18weSWzgI

  29. Hi Claire,

    I think you are wise not to fast. It makes good sense to try moderate approaches first that have less potential for harm.

    The only reason I resorted to fasting was because I had tried everything else and nothing had worked. Even so, my fast was probably unnecessary. A ketogenic diet could probably have done the job. I had tried ketogenic diets earlier, and they didn’t work, but I now realize that those diets were insufficiently ketogenic because they didn’t incorporate calorie restriction or protein restriction.

    Good luck with your treatment plan! I hope you get permanent relief from your gastroparesis very soon!

    Best wishes,

    Rob

  30. Hi Emily,

    I don’t know what might be causing that, I’ll have to mull it over.

    It’s telling that it happens at 16 hours right when liver glycogen gets scarce, and at precisely that time in multiple people (men as well as women).

    It’s certainly not a desirable adaptation, so it must be a sort of pathology.

    Are there any skin color changes in your hands and feet as in Raynaud’s (http://www.mayoclinic.com/health/raynauds-disease/DS00433/DSECTION=symptoms)? If so it might indicate a vasospasm. Do you have any history of health problems that might provide a clue? Any thyroid issues?

    I think it’s worth experimenting to try to track down causes. It’s a minor condition in itself but it might indicate some underlying issue which you can fix and which might otherwise lead to something down the road. Some experiments you can try:

    1) Much larger doses of coconut oil throughout the fast. If that delays the onset of coldness it would confirm that glycogen depletion is the trigger.
    2) High-dose arginine supplementation when the cold symptoms start to appear for nitric oxide production, see if that relieves the symptoms.
    3) High-dose magnesium supplementation, to relax muscles and prevent magnesium-deficiency coldness.
    4) At the onset of coldness try eating some starch — not much, say 100 calories, just enough to transiently raise blood glucose levels. Does the coldness disappear? How long until it reappears?
    5) Get a blood-testing meter and check if your blood glucose drops significantly coincident with the cold symptoms.
    6) Get a thyroid panel after a 12 hour fast and after a 20 hour fast to see if hormone levels change dramatically.

    I’m sure we could come up with more but this is the kind of self-experimentation I have used to track down causes and find solutions.

    Best, Paul

  31. Interesting. The cold intolerance feeling is very similar to the 3-4 am shakes and cold I used to get while staying up all night on call. I don’t have health problems except I do get cold-induced vasculitis on my toes (chilblains) and I am on the hypoglycemic side (never had a glucose measured higher than 100, hbA1c was 5.0, OGTT glucose at 1 hr was low 80s for both pregnancies and horrible hypoglycemic, weak, fainty feelings at 2 1/2 hours after the tests and if I eat high sugar stuff (which I have been careful about for 15 years due to these symptoms.) BP runs on the low side, usually 90-100s over 60 or so. it makes me think perhaps low grade chronic hypocortisolism, but I don’t have fatigue or mental fog. I think my last TSH was 1.1 or somewhere thereabouts. May be hereditary – mother has a sweet tooth but low lipids, low bp, icy hands and feet, gains weight but low hba1c and nl glucose.

  32. Hi Emily,

    Sounds like it is a glucose regulation issue, unfortunately those are rather complicated and poorly understood. One of my projects for the new year (please don’t ask which year!) is to learn more about glucose misregulation. If you decide to do any experiments, please let me know, I would be glad to try to understand your experiences.

  33. You really need to follow up the work of dr mary newport with coconut oil. Coconut oil is converted in the liver into ketones. A high coconut oil diet is a ketogenic diet.Much easier than thirty day fasts.

    Really amazing what mct oils or coconut oil is doing for neuroligical diseases. Eating thai duck curries is far more fun than fasting.

    Cheers PoS

  34. Hi Pigofsteel,

    > You really need to follow up the work
    > of dr mary newport with coconut oil.

    I’m not sure if that’s directed to me, but if it is, I was familiar with Dr. Newport’s work before I fasted. I’ve read her site and admire her greatly. Because of her, I’ve also read some of Dr. Veech’s papers and looked into his work on ketone esters.

    > A high coconut oil diet is a ketogenic diet.
    > Much easier than thirty day fasts.

    I tried ketogenic diets with coconut oil twice before I resorted to fasting.

    In retrospect, I can think of three reasons why they didn’t work:

    1. Coconut oil may be a migraine trigger for me. It was difficult to tell because I used to get migraines every day no matter what I did.

    2. I didn’t restrict protein or calories. Even though coconut oil elevates blood ketones, if the body has a surplus of protein, it may turn more than minimally required amounts of protein into glucose and the desired metabolic changes in the brain may not occur. The classical medical ketogenic diets used at Johns Hopkins, which is the main center in the US for this sort of thing, usually restrict protein, total calories, and liquids, but I didn’t know that at the time. The doctors restrict these things for a reason. Ketones alone aren’t enough, or at least they had reason to believe this.

    3. The maximum level of ketones that can be achieved with diet is about 4 mmol/l whereas prolonged fasting (longer than approximately 20 or 25 days) typically gets them to 7 and sometimes as high as 10. I may have needed a higher level than diet could induce.

    Despite all of the above, I agree with your overall point that my fast was probably unnecessary. I said that here yesterday in my post to Claire. With what I know now, if I could return to last October and construct a ketogenic diet that restricts protein and calories, that might have worked as well as the fast. On the other hand, maybe it wouldn’t have.

    Alas, I don’t have a time machine and we’ll never know.

    Nevertheless I don’t regret the fast. It had several beneficial effects besides stopping my migraines.

  35. Hi Robert, I’m curious to know what beneficts have you had while on fasting (beside migraines stopped).

    I would expect your gut flora improved a lot.

  36. Hi PigofSteel,

    Dr. Newport’s success with her husband is cited in our book, and we have very extensive discussions of the benefits of ketogenic diets for neurological conditions and some other diseases. It is the main “therapeutic variant” of our diet. And we are big fans of coconut oil, as you’ll see on our “Supplement Recommendations” page.

    But there’s always more material to cover on the blog … thanks for the suggestions, I agree we should write more on it since it may be the most overlooked therapy out there.

    Best, Paul

  37. Hi Kratos,

    My gut flora were fine before the fast and seem about the same now. I worried before the fast that the little critters would starve to death but Paul assured me that they would pull through and he was right.

    The benefits were:

    1. A bad varicose vein in my left leg is almost normal now.

    2. My left eye used to tear almost constantly and fluid collected under the skin below the eye in a visible bulge. Maybe there was a low grade dacryocystitis. The problem is pretty much gone now.

    3. I have a new appreciation of food. Last night, just for fun, I spent an hour browsing the aisles of a supermarket that has food from all over the world (I live in a part of New York City that has many immigrants). Before the fast, I never did anything like that in my life.

    4. If Thomas Seyfried is right, the fast killed a lot of cancer cells and may have prevented a future tumor.

    5. I’ve always been curious about the reported spiritual effects of prolonged meditation. Now I’ve seen those effects — some of them, anyway — and my curiosity is satisfied.

    6. Although I can’t see it, I believe that autophagy probably removed a lot of extraneous pathological material. (I should mention that I had hoped it would remove the floaters in my eyes, which are bothersome, but they are unchanged.)

  38. Oops. I meant spiritual effects of prolonged fasting, not prolonged meditation.

  39. Thanks, Paul. One other thing – I look quite young for my age, and my mother also looks very young (both of us are often taken for 15-20 years younger than we are – I watched my mom have to show an ID for alcohol at the age of 45 or so – and they weren’t carding many people). I wonder now if we don’t collect AGEs as readily as most folks. It is funny that we may not get glucose spikes, and yet can’t tolerate glucose well (though reasonable amounts are fine mixed with other food – a coke on a fasted stomach is a recipe for disaster in a few hours.)

  40. Paul, Thank you so much for all the great work that you share. I will forward this article to a friend of mine who has been suffering for a long time. I know that this will help her if she can stay on track as Rob has. Best! J

  41. Thanks for posting about your experiences Robert! That’s wonderful! 🙂

    Getting cold during fasting comment:

    I belong to a private fitness/weight loss forum for women called “Venus Index”. It’s run by Brad Pilon and John Barban. They advocate using IF for fat loss and/or weight maintenence via one or two 24-hr fasts a week. Brad Pilon is the author of ‘Eat Stop Eat’.

    One of the most popular threads in that forum is titled “When I Fast, I Freeze!”

    SO many women post about how cold they get when they fast, yet they have different diets and health profiles. Some of them complain about light headedness too, but only one of them described something that sounded debilitating (hypoglycemic sounding I mean). Even for her, it didn’t last very long, but she was advised not to fast as long to see if it helped, and to track what she was drinking during her fast, etc. to see if that was the problem.

    John and Brad have stated that it’s common for men to experience this as well (coldness during a fast).

    The women who are experiencing this are learning to keep a sweater nearby, or hot drink, to help during that time. Some of them really shiver!

    I used to experience that too, but not quite enough to shiver badly. I usually would feel anxious and light headed. It was usually at the 19 hour mark into a 24-36 hr fast, but it lasted only about 15-30 minutes. I found that a quick burst of activity helped me with the lightheadedness, oddly! A few pushups, for example.

    For some reason I rarely experience that now. Maybe I’m more adapted. For about 6 months I’ve been doing something similar to what you describe, Paul: daily IF for about 21 hrs or so, then eating 1 big meal. I rarely feel much hunger in between. I enjoy having a big meal because I’m a small person so I can’t pack a lot of calories in w/o gaining. I get to feast this way. 🙂

  42. Have you considered food allergies as your migraine source? By fasting, it makes sense that depriving yourself of the foods that you may be allergic to would make the headaches go away, along with some inflammation, overdoses of some vitamins and minerals in foods, etc.

    It also makes sense that when reintroducing foods, the headaches come back (albeit in various strengths). Food may just be your problem–all you need to do now is triangulate to find YOUR triggers, and not just the most common ones, like wine, aged cheeses, etc.

    I’m not a doctor, but I play one when House is on TV.

  43. Hi Lillea,

    Thank you so much for posting about those experiences. It’s great to hear the experiences of those following Brad’s advice.

    Hypoglycemic symptoms seem to be very common. Chris Kresser has written that many of his patients experience blood glucose swings while fasting.

    I do think that the body is always trying to normalize itself, so that fasting will trigger attempts to recover from / fix these symptoms. So it’s possible the fasting could be therapeutic for some broken pathway. On the other hand, maybe it won’t fix the underlying issue and sufferers will experience negative effects from fasting indefinitely. It has to be tested by experience.

    Very interesting about the lightheadedness and pushups. Thanks Lillea!

    Hi Wenchypoo,

    Thanks for the suggestion! One difficulty with the approach of identifying “triggers” is that people with food sensitivities tend to have many of them, since every foreign protein or sugar can trigger an immune response and a leaky gut will let them all in. So even if the immune response triggers the headaches, the solution may be to fix the gut. Once the gut is healed, there may no longer be any triggers. Of course, avoiding the most immunogenic foods may be a key step toward healing the gut.

    Best, Paul

  44. Hi Wenchypoo,

    > Have you considered food allergies
    > as your migraine source?

    Certain foods are migraine triggers for me, but they are not the only triggers. Things like delayed onset of sleep and a certain type of emotional stress are also triggers.

  45. You’re welcome Paul. 🙂

    Brad and John note that in studies on short term fasting, blood glucose levels will go down, but not dangerously so in most people.

    But obviously in some people they might.

    I have wondered what is happening to the thyroid when people are getting cold during a fast, even though it’s just for a short time.

    I find Ray Peat’s thoughts on the thyroid and fasting, below (from an interview Mary Shomon) interesting.

    http://www.thyroid-info.com/articles/ray-peat.htm

    Mary Shomon: You have written that for some people, there is a problem converting T4 to T3, but that diet can help. You recommend a piece of fruit or juice or milk between meals, plus adequate protein, can help the liver produce the hormone. Can you explain a bit more about this idea and how it works?

    Dr. Ray Peat: The amount of glucose in liver cells regulates the enzyme that converts T4 to T3. This means that hypoglycemia or diabetes (in which glucose doesn’t enter cells efficiently) will cause hypothyroidism, when T4 can’t be converted into T3. When a person is fasting, at first the liver’s glycogen stores will provide glucose to maintain T3 production. When the glycogen is depleted, the body resorts to the dissolution of tissue to provide energy. The mobilized fatty acids interfere with the use of glucose, and certain amino acids suppress the thyroid gland. Eating carbohydrate (especially fruits) can allow the liver to resume its production of T3.

  46. Hi Lillea,

    Ray’s ideas are indeed very interesting. I doubt the connection between hypoglycemia and poor T3 conversion is simple, but will have to look into it.

  47. Yes, I wonder if he’s fully right about that. Worth a look at least 🙂

  48. Perfect Health Diet » Experiences, Good and Bad, On the Diet - pingback on January 7, 2011 at 12:58 pm
  49. Just finished reading the Perfect Health Diet with great interest, since I have been plagued with migraines for years. I started eating low carb four years ago, because I read somewhere it helped migraines. It did help me–headache severity was roughly halved, and they were a little less frequent. In the meantime, low carb eating was a revelation for me. My longstanding problem with insomnia disappeared, I kicked the acid blocker habit in less then a week, my “pre hypertension” normalized, and my hot flashes went away. Needless to say, I become a convert, but have always been looking for tweeks to help the headache issue. I plan to try all the migraine suggestions in the book, including fasting, which I have already experimented with somewhat. (Glad to hear heavy cream with my hot beverage doesn’t count!) However, I am a little confused on the vegetable/safe starch issue. 1) Why don’t the carbs in vegetables count? Since we are not ruminants, I imagine we don’t equal them in our ability to change vegetable matter to short chain volatile fatty acids. 2) Where is the demarcation between safe starch and vegetable? If potatoes and sweet potatoes are safe starches, how about winter squash? (Also wondering about beets, carrots, rutabagas, and turnips–as well as yucca and plantains.
    Anyway, thanks for the great book. Love the footnotes!

Leave a Comment


NOTE - You can use these HTML tags and attributes:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

This site uses Akismet to reduce spam. Learn how your comment data is processed.