A Cure for Migraines?:

The weekend was happy for us, because a number of readers left word of health improvements.

Raynaud’s Syndrome, Constipation, and Other Problems Relieved

Becky reported that her Raynaud’s was better:

Hat tip and thank you: After I started reading your blog, and adding in “safe starches”, my Reynaud’s largely cleared up with temperatures over 20F. This wasn’t the intention, but a wonderful side-effect. Last month, when the sun came out and the temps got over 25, I enjoyed a successful 2-mile snow hike for the first time in three years. =)

Kate reported the same:

I too have had Raynaud’s all my life … In the past two months, I have modified my diet in line with Paul’s suggestions for Migraine. I now eat 200 calories worth of safe starch, all the recommended supplements, and as much coconut oil as I can stomach. I am also doing the 16/8 fast. My Raynaud’s has further improved, as measured by the fact I sometimes forget to turn the heat up in the morning, and cold extremities don’t always alert me to my forgetfulness!

Bill, who last October reported a variety of health complaints which persisted after he adopted a Primal Diet in May 2009, has experienced a big improvement:

I definitely feel 100% better with a more appropriate caloric intake and some starch.

Betty reported her constipation was gone:

You have blessed my life. I had one final symptom that was chronic all my life. Constipation. I e-mailed you last week and you offered up some suggestions. PRAISE THE LORD! I have had NO IBS, or constipation since following your advice. I am, and will be forever grateful.

I’ll discuss my constipation advice in Thursday’s post. Today I want to discuss migraines.

Migraines

You may recall that reader Rob Sacks cured his migraines through ketogenic dieting. I asked Kate if her migraines had responded. Here was her reply:

Thanks for asking about the Migraines. They are in fact vastly improved, which I attribute solely to your recommendations. I can say that, because I have tried virtually everything else in the past.

Kate sent me a full account of her experiences by email. It is fascinating and she has given me permission to share it. The next section was written entirely by Kate.

Kate’s Story

Thanks for asking about the migraines.  They are in fact vastly improved!  Since they have been so intractable in the past, I guess I was waiting to make sure the effect was stable before I reported my results. But clearly something remarkable is happening, thanks to your recommendations!

A little history.  I started getting these headaches in my late 30s.  (I am now 52).  In the beginning I thought I had the stomach flu, because in addition to the headache I would always throw up or have dry heaves.  The worst headaches would keep me immobilized in bed for up to two days.  My brother-in-law, a neurologist, convinced me they were migraines. I finally consulted a doctor, who put me on midrin, which did not help, and a few months later I started on imitrex, which did help, at least at first.  Eventually, my headache pattern evolved, and I had at least a mild headache every day, punctuated by the occasional doozy.  Apparently, this is a pretty common progression, especially with women my age.  I always suspected there was something wrong with my lifestyle or diet, and over the years I have tried numerous experiments, but nothing ever worked.  Here is a summary of what I have tried, more or less in order. Unless noted, these were all for three months.

What I tried The inspiration The results
Chelated Magnesium and riboflavin Mauskop’s book What Your Doctor May Not Tell Your about Migraines nada
Expensive German butterbur preparation Magnum website (www.migraine.org) nada
Forever Well Gut Brain Therapy (a mix of probiotics, peptides, and a state of the art supplement to support the organs of elimination) Magnum website I think I slept a little better.  No help with headaches.  Was surprised that the president of the company called me to see if the supplements were helping
Amitriptyline, a tricyclic anti depressant—my first foray into pharmaceutical prophylactics My doctor insisted I consult a neurologist Tried for 4 months. Slept like a zombie, and acted like one.  No help with headaches.
45 minutes of low intensity aerobics 6 days a week Inspired by Crowley and Lodge’s Younger Next Year—Never mind I had been exercising regularly all my life. Got a heart rate monitor and got after it.  No help for headaches.
No caffeine, alcohol, triptans, or over the counter analgesics Buchholz  Heal Your Headache. I love my coffee, so this was a big step for me. Did this for four months.  Very sleepy for first few days.  Did NOT help with headaches.  However, I felt I could rule out medicine overuse headaches.
Cerapamil—A calcium channel blocker My primary care manager thought it would be worth a try. Tried for four months, and upped dose after a few weeks.  Extreme constipation and painful cramps.  No help with headaches.
Low carb diet Found a reference to a german website of someone who had cured his headaches with a low carb diet.  I had always though low carb diets were ridiculous, but decided to give it a try Immediate improvement within a few days!  Also cured insomnia and acid stomach within a week. Headaches were less severe by about 50%.  Frequency was unchanged however.  Remained on low carb diet and manipulated the variables, but did not find further headache improvement.
Vitex Always felt there was a hormonal connection nada
Natural progesterone cream Same Didn’t help my headaches, but did weird things to my period
Nortriptyline–another tricyclic antidepressant My brother-in-law, a neurologist thought I should try it. Did seem to help a little.  Had to stop in less than a month because it gave me high blood pressure.
Birth Control-Yaz PCM sent me to gynecologist for heavy menstrual bleeding.  Benign fibroids found.  Doc was sure Yaz (without placebo pills) would help heavy bleeding and headaches.  I didn’t care about the bleeding, but I rose to the headache relief bait. Tried for five months. Spotted every day, but got no headache relief.
Inderal-a beta blocker Neurologist Seemed to help, but my blood pressure went too low.
Fish oil, vitamin D, coenzyme Q10, and various other supplements Grasping at straws Tried these at various times. No noticeable effects
Acupuncture same No noticeable effects, but I didn’t really believe
Self analysis, meditation Sarno The Mind Body Prescription I think there is something to this, but no headache relief for me.  Do feel more at peace with myself.
Topamax-epilepsy drug Neurologist Low dose did not help.  Worked up to 100mg over four months. Did not help headaches.  Gave me extreme anxiety about driving on limited access roads.  I didn’t notice the connection, but my college age daughter did.  I immediately tapered off.

Got off the Topamax last summer, and forswore further pharmaceutical prophylactics at that point.  In the meantime I stumbled upon the profusion of “primal” material that is now out.  I had not read any low carb stuff for a couple years, and I enjoyed reading Sisson, Wolf, Cordain, et al.  I started eating more saturated fat. I also read Fallon’s Nourishing Traditions, and started eating liver again, which I had loved as a child.  Her book inspired me to order some kelp tablets for iodine, and I took one here and there when I thought of it.  In January, in my blog travels, I stumbled on your site.  I ordered the book and was intrigued by your and Shou-Ching’s ideas about disease and chronic conditions.  I was already familiar with the idea of a ketogenic diet for epilepsy, so I was immediately interested in trying a more ketogenic diet for myself.

I ordered all your basic supplements, and immediately upped my kelp to two capsules.  I had been using coconut oil for curries, so I started using it habitually.  Started eating 200 calories of starches that you recommended—this was a little scary, after studiously avoiding them for four years!  I was afraid I they might keep me awake at night, but I am sleeping like a log. Started fasting 16/8, which was easy once you absolved me for having cream in my morning coffee!

Within a week of starting this regimen my chronic headache started to disappear! Some days I would only have a headache for part of the day, and occasionally I would have no headache at all!  I read somewhere on your site that NAC is good on a ketogenic diet, so I ordered it too.  I had never heard of this supplement before.  It seems to have made a further positive difference.  I have started taking it twice a day.  Once before bed, and once in the late afternoon, when the headache sometimes starts coming back.  Since I added NAC, I have been nearly headache free.

Another amazing development concerns anxiety.  Over the years I have become somewhat anxious when I drive on highways. I grip the steering wheel tightly, sit forward in the seat, and am generally hyper vigilant. I always chided myself for my lack of nerves, but that didn’t help.  As mentioned above, this was magnified by the Topomax.  I never had this issue when I was younger; indeed I used to fly helicopters in the army.  Two weeks ago I drove up to New Jersey to pick up my daughter, a 3.5 hour trip from where I live in Northern Virginia.  I stopped two hours into the trip to make a pit stop, and I suddenly realized I was totally relaxed, and had been for the entire trip!  The PHD is strong brain medicine indeed!

Thanks for all your research, insights, and ideas.  I think the Perfect Health Diet is going to be a game changer for many people.  Hopefully it is the start of a sea change at how we approach the chronic maladies of our times.

Mechanisms

Thank you, Kate! That’s a fantastic chronicle of your history.

This is already a long blog post, so I won’t go into an analysis of why and how the ketogenic variant of the Perfect Health Diet can cure migraines, reduce anxiety, and improve sleep. I’ll only add a few things.

First, there is a case report in the literature of a ketogenic diet helping migraines. [1]

Second, the diet helps in part by getting around mitochondrial dysfunction. Some other nutritional supplements that support mitochondrial function have a chance to help:

  • carnitine [2]
  • riboflavin [3,5]
  • CoQ10 [4,5]
  • alpha lipoic acid [4]
  • magnesium [4, 5]

I realize that you’ve already tried those, Kate, and didn’t notice an effect, but you may notice a benefit now that your diet is better. If in the past they reduced headache severity from 100% to 99%, you wouldn’t have noticed a change. If now they reduce severity from 2% to 1%, or 1% to 0%, the improvement might be obvious. So you might re-consider them now.

Finally, in the interests of full disclosure I should note that some doctors expect improvements from diet and nutrition to be short-lived: “high-dose vitamin and cofactor treatment and, where applicable, high-fat diet, are well tolerated and possibly effective in the short term, but ineffective in the longer term” against mitochondrial disorders. [6]

I believe that fading benefits are likely a result of eating the wrong diet, and that on the ketogenic version of the Perfect Health Diet the good effects will prove permanent. But time will tell.

Conclusion

We believe that diseases are generally caused by food toxins, malnutrition, and pathogens. The Four Steps of the Perfect Health Diet eliminate food toxins, optimize nutrition, and enhance immunity; therefore they remove most of the causes of disease and should render most diseases curable.

But we had no idea, last October when our book was released, which cures would appear first.

It’s interesting that migraines are appearing so early as a curable disease. I think this says a lot about the discipline, and eagerness for a cure, of Rob and Kate. Rob was willing to fast for 30 days (!); Kate read the book in January and was able immediately to make substantial diet, lifestyle, and supplement changes.

It seems that a painful but non-debilitating disease will create the most dedicated, venturesome patients.

I’m very grateful to Kate for trying the diet and sharing her story. Hopefully we can bring the good news to others, and gather more evidence to prove that diet is the best therapy – for migraines, and for many other diseases as well.

References

[1] Strahlman RS. Can ketosis help migraine sufferers? A case report. Headache. 2006 Jan;46(1):182. http://pmid.us/16412174.

[2] Kabbouche MA et al. Carnitine palmityltransferase II (CPT2) deficiency and migraine headache: two case reports. Headache. 2003 May;43(5):490-5. http://pmid.us/12752755.

[3] Triggs WJ et al. Neuropsychiatric manifestations of defect in mitochondrial beta oxidation response to riboflavin. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):209-11. http://pmid.us/1564483.

[4] Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. http://pmid.us/19454881.

[5] Taylor FR. Nutraceuticals and headache: the biological basis. Headache. 2011 Mar;51(3):484-501. http://pmid.us/21352223.

[6] Panetta J et al. Effect of high-dose vitamins, coenzyme Q and high-fat diet in paediatric patients with mitochondrial diseases. J Inherit Metab Dis. 2004;27(4):487-98. http://pmid.us/15303006.

Leave a comment ?

104 Comments.

  1. Hi Paul,

    Just reading through this feed and am just a little confused. If it is in fact a bacterial infection that is causing symptoms then an antibiotic is an easy cure, but what if the infection is viral? Does that mean one is doomed to a lifetime of ketogenic dieting?

    Thanks,

    Lindsay

    • Hi Lindsay,

      Well, if it’s viral options are limited. Also, different viruses have different responses to diet. Ketogenic diets help against some viruses but hurt against others (eg the ALS virus, hepatitis B and C).

      If you would prefer our normal diet than I would eat that, until you could get a definite diagnosis.

      If the issue is migraines, it’s not likely that the reason ketogenic diets help is an antimicrobial effect. Rather, it’s probably relieving either a metabolic substrate deficiency or (more likely) clearing an excess of glutamate.

      You might find that intermittent fasting with a bit of coconut oil is good enough. Experiment to see what works for you.

  2. Thanks Paul,

    Migraines are not really an “issue,” yet, but more of an odd and random occurrence. I have only had 2 in my life (I am 30) and I think the only tie that binds is stress. My migraines are with aura and are not debilitating, but are extremely annoying. I am basically trying to figure out what other neurological symptoms I have. The only other things I can identify with that you or others have written about is short term memory loss, as in I will go to do something and forget what I am doing… sometimes it takes a full minute to recover my initial intentions. Additionally, I have mild anxiety. But other than that, nada. I thought maybe it was related to hormonal fluctuations, but my research indicates that such a thing would be caused by estrogen dominance or too low progesterone, but I have no other symptoms.. I don’t even get cramps! So, I wonder.. can some people just be more prone to getting migraine without it being something bigger? I know that my mother gets migraines which makes me think I am more susceptible. Or is your thinking that there has to be a greater cause such as infection?

    I have been eating a PHD diet with a splash of Ray Peat for over a year (including supps) and was Paleo before that. In that regard I am inclined to just start the Doxycycline just to see if it helps…. that way at least I can start eliminating possible causes. Do you think this is a good idea? I find that self experimentation is often the best bet. Thanks for your thoughts.

  3. Also, not sure this is relevant at all, but I have noticed that suddenly caffeine gives me a headache (just a headache, not a migraine) . I have gone from a regular coffee drinker to getting a headache when I do drink caffeine, particularly in the morning. Think there is any connection?

  4. Paul,

    Sorry, but I keep having further thoughts about this topic. You mention glutamate excess in the brain. I have been reading about symptoms of glutamate excess for the past hour or so and WOW do the symptoms ever describe me! One paper explained glutamate excess symptoms to include sensory perception disorder (I am terribly intolerant to “odd” light levels.. some restaurant lighting can actually make me feel extreme anxiety.. also, I am extremely intolerant to things touching me, namely other people or funky clothing materials), restlessness (I have a near inability to sit still), anxiety (yep). I have never read something that described me so completely, nor have I ever had an explanation for my weird thing with lighting levels and a tendency toward sensory overload. So, I am convinced I have a glutamate excess which is most likely also causing rare migraines.

    So, you would recommend a ketogenic diet for clearing an excess of glutamate? Will I achieve the benefits with just fasting while supplementing coconut oil/MCT oil or do I have to the full diet? I am hesitant to do the diet because I am extremely athletic and find I do a lot better with tons of carbs. Will the ketosis eventually “cure,” the glutamate excess or are there other steps I can take? One doctor recommended supplementing 5-HTP, but I recall Emily Deans warming against this.

    Thanks a lot for helping me to this realization!

    Lindsay

    • Ketogenic diets do relieve glutamate excitotoxicity. Yes, I would recommend a daily intermittent fast with some coconut oil, otherwise eat normally. Get enough carbs in the feeding window and your athleticism will be supported. Get coconut oil and fasting once a day and the glutamate will be removed.

      I don’t recommend 5-HTP.

  5. Great, thanks so much! If I may ask, how much coconut oil during the fast and how can I make it palatable.. it tends to give me a stomach ache. Also, will the increase in overall caloric intake from coconut oil mean that I need to limit calories for the rest of the day?

    • As little as you feel appropriate. It can relieve hunger. It shouldn’t be enough to give you a stomach ache.

      If you’re trying to lose weight, you may need to restrict calories. Otherwise eat to appetite.

      • Hi Paul,

        Just because I like to have a framework in mind–How long should it take to notice a difference with ketogenic style fasting? Assuming it is a glutamate excess should I notice pronounced neurological changes?

        In other words, will I wake up one morning a genius 😀 ?

        Thanks again!

        • Hi Lindsay,

          I never noticed any quick changes but I believe it should pay dividends over months and years.

          It is more about slowing the growth of infections and normalizing neurotransmitter levels than about immediate fixes.

          I.e., more stable mood and less cognitive degeneration with aging, maybe slightly better reaction times and balance, those are the sorts of things I’d look for.

          • Hi Paul,

            It has only been a few days, but I have noticed with putting a few tablespoons of MCT oil in my coffee in the am, I feel a bit.. loopy. A few months ago I was doing IF fasting and was handling it just fine, but then went higher carb during a stressful period and now that I am back to IF with the oil I feel weird. Any thoughts on why this might be?

            Is there a way to reap the benefits of the MCT oil without fasting? I was really starting to like breakfast. Basically, I am asking is there a way I can eat pretty high carb without fasting, but still address the glutamate excess issue?

            Thanks!

  6. Paul,

    A further update… since starting ketogenic style fasting with a couple of tablespoons of MCT oil daily the feelings have gone from kooky to full blown anxiety symptoms. It started by making me feel a little strange and has moved into making me downright strung out. My heart races, I get random tingling in my feet and hands, I have extensive brain fog. It is bizarre to say the least. Have you ever heard of anyone going through a transition period with ketogenic fasting? Any thoughts you have would be helpful. I guess it could just be a coincidence, but the changes occurred suddenly on the first day of implementing fasting with MCT oil.

    Thanks,
    Lindsay

    • Hi Lindsay,

      I apologize for failing to reply to this at the time. It sounds like you are reacting badly to ketosis. I don’t know why that is but one possibility is some kind of eukaryotic infection – Toxoplasma for instance, or malaria. It could be other things too, but I would try to get tested for possible protozoal or parasitic infections.

      • Paul,

        No worries, you’re a busy guy.

        That is interesting that you mention a eukaryotic infection could be to blame. I am certain I have a yeast issue.. Yeast is a eukaryot, yes? I am in the process of trying to get rid of it, but it does feel like beating my head against a wall. Also, I recently have had an outbreak of shingles! Shingles! And I swear I am generally very healthy. Biology is so complex. Anyway, do you think yeast could be responsible for the negative response to ketosis?

        As always, many thanks.

        • Hi Lindsay,

          Candida is possible, but usually more serious symptoms are due to protozoa or worms. Candida usually produces a milder effect. Of course you can have multiple infections. I would suggest a stool test and maybe some bloodwork.

  7. I have been following the ketogenic diet described here for a couple of weeks, hoping it will help my frequent migraines (3 or so a week). So far, no improvement. I don’t want to quit too soon but am finding it hard to stick to it, in the absence of any indication that it’s helping. I would really appreciate it if people who have had success with this diet for migraines could indicate how long it took before they saw results.

    • Hi Kathryn. I wanted to join this blog just to let people know my story and to give hope. I have had headaches off an on my whole life. Then migraines the last 7 years with chronic daily headaches and migraines. I tried topamax three different times in the 7 years but couldn’t take the tired drug feeling. Then Elavil or Amitriptyline. And Botox shots, sinus surgery , migraine diets and many other ways to get rid of them. My Daughter who is 27 years old also had them. She was watching Dr. Oz who had a guess speaker on there named Dr. Fuhrman He said all his patients recover from migraines in three months by following his nutritional advice. I knew this was not going to work. But my daughter bought his book (Eat To Live) followed it and recovered. So I tried it and now I am 9 months migraine free. no meds!!!! What also compelled me to try his way was he wasn’t selling any magic herb or snake oil or promoting any one thing. He simply tells you how to get rid of them buy going to the grocery store yourself and buying the right food and getting rid of toxins.I used to get very insulted when people told me I had the power to cure myself with food or just drink more water suggestions. So I know oversimplifying migraines can be angering. I thought there is no way Im changing my diet just to try one more thing that has little chance curing me, since migraines stole my life all I have left to enjoy is food and I don’t want to deprive myself further. Dr. Fuhrmans program is more than diet as you will see in his book. But My daughter who lived with me keeps cooking this yummy food and she felt great. So with a panic attic in the grocery store trying to buy new foods and mourning the oreo’s. I kept my promise to her and weened off the Elavil. and started Dr. Fuhrmans program And now I write you completely cured and not selling anything but hope. If you are interested, Read his book for the info.( I found his book at our library) He has a web sight at Dr.Fuhrman.com. PS we also lost weight on his plan. Good luck don’t give up and settle for medications like I did!! Write me anytime.

      • Thanks for the recommendation. I have looked into the ‘Eat to Live’ diet and it does sounds like a lot of people have found it helps their migraines. I started a week ago and have had a couple of migraines since (normal frequency for me). How long did it take before you started to see an improvement in your migraines?

  8. @Kathryn

    Give the keto diet at least 2 months. I know it took me that long to fully adjust and start seeing some benefits. This is probably due to my super high sugar diet for the first 31 years of life (think huge bowl of Cinnamon Toast Crunch every day.)

    The diet has greatly reduced my migraines, though I had another ophthalmic (ocular) migraine recently. Of course, this was after drinking a number of heavy beers and probable dehydration. I may have to give acetylcysteine a try, as I’ve felt some ‘pressure’ in my eye/brain area recently (maybe allergies/bright sun.) Ocular migraines are scary — even though this last time I knew what was happening.

  9. I started a ketogenic diet for other reasons, but the first and most obvious change was that my migraines stopped. I had no idea this would be a possible benefit, but now, it is my primary motivation for staying on the diet. I have no interest whatsoever in going back to frequent, debilitating, migraines.

    • hi Linda

      Did your migraines really disappear ? I have them very bad every few monnths and am desperate for them to stop after over 20 years of suffering.

      regards
      Marie

  10. Hi Paul and Shou-Ching,

    Thank you for writing such a great book! I have ordered NAC and Branched Chain Amino Acids, and am excited to potentially cure my migraines, but have a few questions before I start the ketogenic diet. One thing I am wondering is when I should take these two supplements…in the morning? while fasting or with food? Secondly I believe I told you at the potluck how I am currently on a regimen of amino acid supplementation per Julia Ross’s program “The Diet Cure”. I am unsure if you have heard of it, but this is what I have been taking every day for the past month:

    Wakeup 1500 mg L-Glutamine
    1000 mg DLPA
    500 mg L-Tyrosine

    8am Breakfast
    Fish Oil, Vitamin D, Vitamin C, Vitamin B complex, True Balance Multi

    11am 1500 mg L-Glutamine
    500 mg DPA
    500 mg L-Tyrosine

    12:30 Lunch
    Vitamin C, B, Multi

    3pm 1500 mg L-Glutamine
    500 mg L-Tryptophan
    1000 mg DPA

    6pm Dinner
    Fish Oil + Vitamin D, Multi

    9pm Bedtime
    500 mg L-Tryptophan
    500 mg GABA
    5mg XR Melatonin

    Since starting this regimen I have been able to wean off of my antidepressant and stimulant medications…I have lots of energy and am alert during the day and am sleeping 8 hours. My migraines are slightly better. Her diet advice is similar to yours except that she recommends eating breakfast, and doesn’t mention anything about ketogenic diets. Of course I wasn’t looking to cure my migraines with her plan, but to eliminate my sugar/carb cravings and fix my mood/attention/sleep issues. Anyway I am wondering if you think it would be okay for me to add on the NAC/Branched Chain Amino Acids to this, and if you have any idea if taking them together with any of the other supplements I am taking will decrease their efficacy? She advises not to take L-Tryptophan with L-Tyrosine, for instance, because the brain will favor the L-Tyrosine and so taking L-Tryptophan with it will be useless.

    Also do I need to fast in the morning in order to stay in ketosis, or is it just preferable? I was fasting every morning for the past week, but it kept causing me to binge eat by the end of the day. I was also eating some white rice and potatoes and am worried that it was making my carb cravings worse. Do I just need to increase the MCT oil more? Or am I doing something wrong? Also the one time I did a 30 hour fast (just after the potluck) I got a massive migraine about 12 hours in….It was one of the worst ones I have ever had, and now I am scared to try it again! Is this common with migraine sufferers? Sorry for the long post, but I really appreciate your help!
    Elaine

    • Hi Elaine,

      NAC should be taken fasting, BCAAs with a meal. Yes, I think you can add those into your program. Both can be taken with/near tyrosine and away from the tryptophan.

      It’s great that you’ve gotten off antidepressants and stimulants. You might want to experiment with what supplements you can drop from her regimen while retaining the benefits. I would say that melatonin, D, C, and B vitamins are the most likely to be highly beneficial with minimal risk.

      It’s not necessary to fast; if you have glycemic control issues or if it induces binge eating then best to eat some breakfast. But if you are not hungry then you can delay your breakfast.

      More often than not white rice and potatoes decrease carb cravings. An increased carb appetite may be a temporary effect (as your brain recognizes that these foods are fixing a deficiency and seeks to get more; once you are replete in glucose-based molecules the appetite may disappear; this may take a month or so).

      Hypoglycemia can trigger a migraine and it seems you are prone to hypoglycemia in the latter stages of a fast. You might want to get a glucose monitoring kit from your local pharmacy (if you don’t mind pricking yourself) and test your blood glucose to get an idea of fluctuations. Then you can pursue with your doctor to try to find the causes. Possibilities include (a) liver dysfunction, (b) pancreatic dysfunction, possibly due to small bowel infection, or (c) HPA axis dysregulation, eg adrenal fatigue, which may be connected to hypothyroidism. Many of these conditions are partially treatable.

      You might want to google “hypoglycemia migraine” and read up on what others experience.

      By monitoring blood glucose you may be able to detect hypoglycemia before it triggers a migraine and eat some food to head it off; or it may help you detect patterns and diagnose the root cause(s) of your health problems.

      Best, Paul

      • Hi Paul,

        Thanks for the speedy response. I actually tested myself every day for a week and a half (while not restricting carbs and sugar) and my fasting blood glucose level was between 78 and 85 every day (average=82), and glucose 1 hour post a high carb meal was between 81 and 95 every day (average=88). Also tested AIC which was 5.8%. Not entirely sure what to make of this, but let me know if you have any ideas or suggestions for how to test differently.

        I agree that hypoglycemia can trigger a migraine in me, but it is not always the cause, because I do not usually fast and I get migraines 1-2 times a week. Sometimes I wake up with one, but more frequently I develop it by the end of the day.

        Thanks for explaining about rice and potatoes, I will give them another shot! thank you for your help,
        Elaine

        • Hi Elaine,

          Are your serum lipids low? TC < 200 mg/dl?

          • Hi Paul- not sure, I have never had them tested. Why do you ask, and is that something a doctor would have to order? If so, what symptoms would I need to be having in order to convince a doctor that I need the test?

          • Just curious, some things that cause low blood sugar can also cause low blood lipids (parasitic infections, hyperthyroidism).

            It’s a routine test, most doctors do it annually in physical exams.

          • So does my AIC indicate that I must have low blood sugar at times, or does everyone have low blood sugar when they don’t eat for awhile?

            By the way, I was wondering about starches being at least 200 calories of the day’s worth of calories. Do calories coming from glucose sugars also fit into this category? Is Xylitol acceptable? Thanks!

          • Also what about coconut products…flour, dried coconut, and coconut aminos?

          • Hi Elaine,

            Not everyone has low blood sugar after fasting.

            Yes, calories from glucose sugars count against the starch total.

            Xylitol is acceptable but not encouraged. Coconut products are good, except coconut sugar.

          • Thank you!

      • hi Paul,
        i know this is a very old comment,
        but i was just browsing & noticed mention of tryptophan…

        i thought it was a bad idea to supplement with tryptophan (& prob even worse to supp with 5-htp)…or are there exceptions…?

        thx Darrin

  11. Hey Paul- I have a good update for you! I have been doing the ketogenic diet since the end of December and have not had a migraine since that one I got after the 30 hour fast I did to kickstart the diet. In 5 days it will have been a month since my last one! This obviously is amazing news, but I am still having fairly bad headaches 3-4x/week. So the frequency has increased, but intensity has decreased and the headaches are not developing into migraines like they typically would. Most of the time they are across my forehead and also around my temples/eyes/nose (sinus area). Mainly just feel like a lot of pressure…I am unsure what to make of them.

    As far as the diet goes, I haven’t had any sugar since Jan 1st and have had a small bite of fruit twice, but otherwise no fructose that I am aware of. I am trying to take as much MCT/coconut oil as I can stomach. It gives me bad cramps if I have too much. Some days I feel like I am eating too much starch….I go by the “at least” 200 calories of starch a day, but I am unsure of what the maximum should be? How do I know that I am not overdoing it and kicking myself out of ketosis?

    Also I have been measuring my ketones with the urine strips, and have not been getting very high readings, but I read somewhere that they sometimes aren’t an accurate way to see whether or not you are in ketosis. Is there any sure way to know? Could it be that I am only in ketosis sometimes, and so this is why I am still getting headaches? Do I need to have a stricter schedule of making sure I get some mct oil throughout the day?

    Thanks!
    Elaine

    • Hi Elaine,

      It’s usually not necessary to have ketones in the urine, if the brain is taking them up you won’t have an excess available for the kidneys to excrete.

      I think you have to experiment a bit. It’s possible that dehydration could be factor in the remaining headaches, so be sure to drink water and take sufficient electrolytes (salt, potassium from tomatoes and potatoes, bone broth for calcium and phosphorus, magnesium, lithium).

      I would also focus for a while on eating white potatoes as your starch source, they have resistant starch which supports ketone production.

      Also, take some branched chain amino acids supplements, at least 5 g per day.

      Once you’re doing those things, then I would experiment with reducing carbs and different timings of MCT oil, see if that helps the headaches.

      Finally, you might Google other headache causes or supplements that help migraines, like magnesium. These may do you more good now that ketones have taken the worst of the headache away.

      Glad to hear you’re not in as much pain! I hope you can figure out the remaining issues soon.

      Best, Paul

      • Hey Paul,

        I am taking BCA’s by Now Brand. The bottle says serving of 4 capsules = L-Leucine (1600mg) L-Isoleucine (800mg) L-Valine (800mg). I have been taking 6 a day but guess I need a whole lot more? Do you know of a brand that has closer to 5g, or should I maybe consider just buying L-Leucine in a higher dose? I suppose I could buy the powder, but I don’t know what to add it to in order to make it palatable.

        I will add potassium, magnesium and lithium and let you know how it goes. I am drinking bone broth every day and will hopefully be adding fermented foods soon. I am also taking NAC (1200mg/day).

        Thanks so much! Elaine

        • Hi Elaine,

          Sounds like 6 a day is reasonable, 8 might be better. (4 capsules = 3.2 g, 6 capsules = 4.8 g, 8 capsules = 6.4 g).

          I think that’s a good plan. Let me know how it goes.

          • Hi Paul,

            So I figured out that coconut has been causing my remaining headaches. I had made “coconut bars” (each one had .5 cup coconut, 1T MCT oil, 1T Coconut Oil) and was eating two a day in order to get in all that oil. The headaches were a a delayed reaction so took me some time to figure out the culprit, but turns out it’s the shredded coconut. I have suspected coconut before as a headache trigger, but I guess I didn’t use to consume so much all at once until these last few weeks. So good news is that since cutting it out I am feeling much better. However this worries me since now I’m unsure if I need to cut out the rest of the coconut products I am consuming (milk, aminos, oil). And MCT oil comes from coconuts too! Do you think it’s still wise for me to consume Coconut and MCT oil if I have determined that I am sensitive to coconut meat?

            Also I am now struggling more to consume all of the mct oil that I need now that I can’t eat the bars, because taking it without any food gives me bad cramps/diarrhea. I had to leave work early today because it was so bad….(I had a spoonful of oil just before eating 2 hard boiled eggs). Sadly I can’t eat raw veggies so using it as a salad dressing is out, so I just have to pour it on cooked veggies, meat, and rice, and I’m really not sure how much longer I can keep this up. If you have any suggestions I am all ears, because I still haven’t had a migraine yet and I really want to continue the diet.

            Lastly I have begun having this weird symptom after I have had MCT oil where my eyes feel like there is a lot of pressure behind them…almost like they are overstrained and my contacts prescription is suddenly too high for my eyes. At least I think it occurs after I have had the oil. Regardless it is a brand new symptom. Any ideas on what this could be?

            Thank you for your continued help and time!
            Elaine

          • Hi Elaine,

            I think coconut oil and MCT oil should be fine. Usually the MCT oil is not derived from coconut oil.

            You could try making some kind of “ice MCT oil” similar to ice cream but with MCT oil.

            You might be taking too much MCT oil as it is. You might want to get ketostix and find the dose of MCT oil that is just shy of giving a reading in urine. At that dose the brain will be getting all the ketones it needs but you won’t have an excess that needs excretion.

  12. i really like your website and this is from Africa, and told me recently before two weeks that I have signs of migraine and since i am new to it don’t know how to deal with it and so please what can I do to treat my headaches? what are the simple treatment which I can do from this place infact some of the conversation you had Paul with the people are really strange to me so tell me simple what can i do? thank you so much

  13. Hey Paul,

    I’m wondering if you can offer me some direction or make some general suggestions based on the following…

    – Dilantin completely cures my depression, fatigue but always completely stops working after some time. Sometimes after a few days and more recently after a few months. This has happened 4 or 5 times over the past year and it is always dramatic and prompt.

    – My first dose of Doxycycline caused the most agonizing depressive episode, a level of hell I would say.

    – I’ve recently come off safe starches and switched to Trehalose as a glucose source and my stomach no longer churns and gurgles at night

    I have attempted your ketogenic diet multiple times but have had difficulty tolerating necessary amounts of MCT oil/Coconut Oil. How long should I be in Ketosis before I can draw a conclusion?

    There’s plenty more info I can share but I think these bits appeal most to your expertise

    P.S. I recently got your book into the largest health food store in NYC, Willners Chemist.

    Blessings Paul,
    Andrew

  14. Paul,

    I’ve been a sugar addict for a while and really like alcohol, both seem to relieve depression and adhenonia for me, the alcohol especially. On a diet without I find myself feeling so blah, depressed, have a hard time finding interest in things. I’m thinking a possible brain infection? A short stint on ray peat made me realize a glass of orange juice makes me happy and relaxed but I was worried about all that fructose so I stopped. I’m interested in the ketogenic version of the diet, how much mct oil do I add? My diet’s Phd already about 55% fats, 15% protein and 30% carbs and roughly 2200 calories.

    Also, do you think the ketogenic diet would be a good idea for me, with my symptoms?

  15. To be more specific, can I eat the normal Phd diet, minus 400 or so calories, take 4 tbsp’s of MCT oil and be in ketosis? Or am I misunderstanding this?

  16. Anyone have experience with diminished tintinitus on this diet?
    Thx
    Tom

  17. Paul,

    As a PHD person, I believe you can heal the body with food first, but this situation is very bothersome. I was put on Temazapam for sleep issues almost 2 years ago. It was a fairly low dose at 15 mgs. In October I asked to have my dose reduced since I was beginning to use circadian rhythym entertainment. At the time, I thought it was a coincidence I began to wake up with severe migraines and very blurry vision. Last week I went off it cold turkey not realizing the withdrawl effects even at that low dose. My headaches have been brutal, I have used Maxalt with fair success. My blurry vision has worsened.

    From my understanding the pain is caused from excess glutamate. From your postings on migraine cures, I did learn Intermittent fasting and ketogenic diet can clear excess glutamate, which I am doing right now. I went cold turkey 8 days ago. I’m wondering if there are additional ways or specific supplements that can help this process. I was unaware of the damage this class of drugs can cause and only wish I had not so eagerly trusted my physician. But what is done is done, and now I want to get rid of these terrible headaches and nausea.

    If you read online, you can become quite concerned about permanent damage to your brain. As a PHD follower, I appreciate your realistic critiques.

    Thank you,
    Pat

  18. Thank you. It was very gracious of you to take the time to explain as much as you did. I agree with you, the pain of getting off these is excruciating, and a further taper is necessary. What is interesting is that I wake up with the headaches, and has something to do with sleep hormones and further release of glutamate. You would understand better than me. I am going to use your supplement recommendations to ease the process, as I’m already doing the intermittent fast and ketogenic diet.

    Thank you,
    Pat

  19. Hi,

    I have fibromyalgia, and I’m looking to wean off of my medication. And I have another at least 15lbs to loose before I’m in a healthy weight range, too. (I’m 5’9″, 175lbs) I’m currently on the autoimmune protocol, but I’ve plateaued at 50lbs lost, and my pain is still affected by my periods, the weather, etc. I’m already at a fairly low carb point, I eat a medium sized sweet potato every day. I’m worried I also have a candida infection, but haven’t been checked. But anyway, I’d like to reduce my headaches and my fibro pain. Can you give me any advice?

    • Hi Holly. I wanted to join this blog just to let people know my story and to give hope. I have had headaches off an on my whole life. Then migraines the last 7 years with chronic daily headaches and migraines. I tried topamax three different times in the 7 years but couldn’t take the tired drug feeling. Then Elavil or Amitriptyline. And Botox shots, sinus surgery , migraine diets and many other ways to get rid of them. My Daughter who is 27 years old also had them. She was watching Dr. Oz who had a guess speaker on there named Dr. Fuhrman He said all his patients recover from migraines in three months by following his nutritional advice. I knew this was not going to work. But my daughter bought his book (Eat To Live) followed it and recovered. So I tried it and now I am 9 months migraine free. no meds!!!! What also compelled me to try his way was he wasn’t selling any magic herb or snake oil or promoting any one thing. He simply tells you how to get rid of them buy going to the grocery store yourself and buying the right food and getting rid of toxins.I used to get very insulted when people told me I had the power to cure myself with food or just drink more water suggestions. So I know oversimplifying migraines can be angering. I thought there is no way Im changing my diet just to try one more thing that has little chance curing me, since migraines stole my life all I have left to enjoy is food and I don’t want to deprive myself further. Dr. Fuhrmans program is more than diet as you will see in his book. But My daughter who lived with me keeps cooking this yummy food and she felt great. So with a panic attic in the grocery store trying to buy new foods and mourning the oreo’s. I kept my promise to her and weened off the Elavil. and started Dr. Fuhrmans program And now I write you completely cured and not selling anything but hope. If you are interested, Read his book for the info.( I found his book at our library) He has a web sight at Dr.Fuhrman.com. PS we also lost weight on his plan My Daughter has fibromyalga And this plan is also suppose to cure it. So far It has not. But has lessoned the flare ups. Good luck don’t give up and settle for medications like I did!! Write me anytime.

  20. I’m late to this party, but I have a question/problem that I hope someone has a suggestion for.

    I have severe migraines as well as genital lichen sclerosus.

    I have started the PHD-ketogenic diet and have seen improvement with the migraines, but my lichen has flared up very badly. [This is my first flare up in 3 years].

    I am reluctant to back off of the keto diet because of the good results I’m getting with my migraines, but the lichen flare is pretty bad. I’m caught between a rock and a hard place.

    Does anyone have any ideas of how to reconcile the two?

  21. Hi everyone
    I have just stumbled upon this site as I was researching the benefits of bcaa as I train in my gym regularly and take supplements. Im 47 years old and have suffered from debilitating migraines every couple of months since I was a teeanager. I have spent a fortune on products and pills to try to cure them. I am left in bed for days on end, I vomit, then dry heave, shivering then sweating, aching all over. Then when migraine goes I left without energy and exhausted. Im now on prescribed Ramipril 10mg daily for high blood pressure. Can you advise me if a Ketogenic diet really is the answer to my prayers before I invest my time into it. Many thanks Marie

  22. Soul Search and Research – Luna's Journey to Self-reinvention - pingback on October 29, 2017 at 7:08 pm

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