Migraine Sufferers Should Try a Ketogenic Diet

Anyone with an impairment of brain or neurological function – whether mental illness, depression, seizures, brain cancer, headaches, neuropathy, brain infections, or any other neurological condition – should try a ketogenic diet to see if it improves the condition.

 “Ketogenic” means that the diet causes the liver to manufacture ketones. Ketones are small water-soluble compounds that are metabolized like fats. Unlike fats, they do not need carnitine transport to reach mitochondria. They can be used for energy by every mitochondria-containing human cell type. This makes them one of the most disease-resistant sources of dietary energy. There are few things that can go wrong with ketone metabolism.

Ketogenic diets have several major benefits for neurological conditions:

  • They relieve neuronal starvation from cognitive hypoglycemia of any cause.
  • They stimulate the innate immune response against intracellular pathogens, helping to heal brain infections.

Recent work has identified a third benefit from ketogenic diets: They eliminate an excess of glutamate. In a carbon isotope study, feeding the ketone beta-hydroxybutyrate in place of glucose caused less glutamate to be formed in the brain:

The amount of (13)C incorporation and cellular content was lower for glutamate and higher for aspartate in the presence of [2,4-(13)C]beta-hydroxybutyrate as opposed to [1,6-(13)C]glucose. [1]

This is important because excessive brain glutamate is “excitotoxic” and kills neurons. Glutamate excitotoxicity causes damage in a host of conditions including

spinal cord injury, stroke, traumatic brain injury and neurodegenerative diseases of the central nervous system (CNS) such as multiple sclerosis, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), Parkinson’s disease, alcoholism or alcohol withdrawal and Huntington’s disease. [2]

Other diseases in which damage from glutamate excitotoxicity is important include epilepsy, schizophrenia and various mood and anxiety disorders.

Migraines and Glutamate

My sister’s husband gets frequent migraines, so I keep an eye out for papers about migraines. A new paper in Nature Genetics finds that people with common migraine tend to have a mutation in a regulatory sequence for genes that control glutamate abundance. [3]

People with the mutation are prone to glutamate excitotoxicity:

[A] DNA variation found between the PGCP and MTDH/AEG-1 genes on chromosome 8 appears to be associated with increased susceptibility to common migraine. The variant appears to alter the activity of MTDH/AEG-1 in cells, which regulates the activity of the EAAT2 gene: the EAAT2 protein is responsible for clearing glutamate from brain synapses in the brain….

“Although we knew that the EAAT2 gene has a crucial role to play in neurological processes in human and potentially in the development of migraine, until now, no genetic link has been identified to suggest that glutamate accumulation in the brain could play a role in common migraine,” says co-senior author of the study Professor Christian Kubisch of University of Ulm, Germany (previously at the University of Cologne where he conducted his research for this study.) “This research opens the door for new studies to look in depth at the biology of the disease and how this alteration in particular may exert its effect.” [4]

If glutamate excitotoxicity causes migraines, then it’s likely that migraine sufferers would benefit from a ketogenic diet.

How Do You Eat a Ketogenic Diet?

The safest and healthiest way to eat a ketogenic diet is by:

  • Restricting carbohydrate consumption to 200 calories per day from “safe starches” like rice, taro, and sweet potatoes.  70 grams of cooked white rice, 150 grams of taro, and 300 grams of sweet potato are an appropriate daily ration.
  • Eating massive amounts of coconut oil. The short-chain fats in coconut oil are the most “ketogenic” of foods, i.e. the most readily turned into ketone bodies. 6 to 8 fluid ounces (12 to 14 tablespoons) per day of coconut oil is an appropriate daily ration.

Supplements with vitamin C and selenium should also be increased on a ketogenic diet.


Research on ketogenic diets as a therapy has focused on epilepsy for decades, with some recent interest in using these diets as a therapy for brain cancer. But really, they are likely to be helpful against nearly all brain and neurological conditions, and probably all solid tumor cancers and many infectious diseases as well.

Rather than waiting for the glacial progress of modern biomedical research, which needs decades to assemble sufficient evidence to get an application for funding for a clinical trial past skeptical reviewers, anyone with a brain or neurological condition should simply experiment with a ketogenic diet themselves to see if it helps. Odds are it will.


[1] Lund TM et al. Availability of neurotransmitter glutamate is diminished when beta-hydroxybutyrate replaces glucose in cultured neurons. J Neurochem. 2009 Jul;110(1):80-91. http://pmid.us/19457063.

[2] Wikipedia, “Excitotoxicity,” http://en.wikipedia.org/wiki/Excitotoxicity.

[3] International Headache Genetics Consortium et al. Genome-wide association study of migraine implicates a common susceptibility variant on 8q22.1. Nat Genet. 2010 Aug 29. [Epub ahead of print] http://pmid.us/20802479.

[4] “First Genetic Link to Common Migraine Exposed,” Physorg.com, Aug. 29, 2010, http://www.physorg.com/news202139760.html.

Leave a comment ?


  1. I find it worthy to try since the benefit could be remarkable but for assurance, I guess it’s better to consult first a medical professional before trying any kind of medication or diet to avoid future problems regarding health condition.

  2. Migraines are gone!

    I tried a ketogenic diet to originally lose weight after the birth of our daughter. I have always suffered from migraines and have tried many different medicines and prescriptions.
    I noticed that after 3 months of being on the diet I hadn’t had a migraine. I was now curious.
    When I went off the diet my migraines came back, I’m postive my diet and eating habits make a world of difference as a migraine sufferer. I highly recommend anyone who suffers from migraines to give it a shot. The first 3 days are the hardest, u might even suffer from a headache but once the withdrawals are over from the sugar you are headed towards a migraine free or at least a less frequent migraine free world.

  3. Paleo and Migraines - Shaggy's Caveman Diet - pingback on July 31, 2013 at 2:34 pm
  4. Paul,
    Thank you for this wonderful post. I am a big fan, have your book, saw you speak at PaleoFx this year. I suffer from exercise induced migraines with aura. About 15-30 min after exercise (jogging 1-2 miles) I start seeing funny lights, have blind spots then the headache and nausea come on and stay for 6-8 hours. I have had my neurotransmitters tested and, indeed, my glutamate is very high, second to norepinephrine. Do you think that adding in 4 TBSP of coconut oil to my daily diet will help me avoid these post workout migraines? I currently only do yoga for exercise but would like to start jogging again. Do I need to add only the additional coconut oil to my Paleo diet (I cook with coconut oil) or do I also need to make sure that I am ketogenic? Thank you in advance.

    • Hi Jamie,

      Ketogenic dieting should help, and adding 4 tbsp coconut oil would probably generate ketones. You might try MCT oil which is a little more efficient at it. I would also do intermittent fasting. It may only be necessary to be in ketosis part of the day.

      • Paul,
        Another question re: excess glutamate causing migraines: I just heard a podcast with Dave Asprey of the Bulletproof Exec. Podcast #183. The topic was how Oxaloacetate helps to reduce glutamate in the brain. If this is true, then it would stand to reason that this supplement could help prevent migraines as well? What are your thoughts on this? Would this help in addition to a ketogenic diet?

  5. Thank you, Paul, I am working to change my diet now and am hopeful that I will be able to enjoy more cardiovascular exercise without suffering a migraine sometime in the near future!

  6. Dear Jamie
    For my migraines coconut oil and the change of diet brought a great relief. For me it is sufficient to have it with a morning coffee. I now switched to MCT oil which taste I support much better.
    I suppose the ketones fron the oil help prevent an energy crisis in the brain. Sometimes, I do wonder if there maybe really is a link between migraines and a hole in the heart. http://migraine.com/stories/the-heart-migraine-connection/
    Do you have any thoughts on this, Paul?

    • Hi Kats,

      That’s interesting, I hadn’t heard of a link with holes in the heart. It is not totally implausible — normally the lungs filter out clots and other impurities in the blood, the heart hole allows these to bypass the lungs and go straight to the brain. Maybe microstrokes trigger migraines, or nutrient or oxygen deprivation, or the immune response to impurities obstructing brain capillaries.

  7. I’ve had hormonal and food allergy migraines my whole life. Thought I was going to just ease into a ketogenic diet because, in the past, any sudden change brought on a migraine. I’ve been totalling up my protein, fat, carb grams for the past 6 days and haven’t gone above 150 grams of carbs on any day. Didn’t design my eating plan specifically to reach that number, I’ve just winged it, by dropping the obvious offenders. Several of the recommended foods are ones to which I’m allergic, which limits the variety, but I’ve felt better than ever these past days. I am experiencing a noticeable increase in energy and even self-esteem.

    Migraines have severely restricted the process of living my life. I am so relieved there seems to be a resolution that doesn’t involve medication or other medical intervention.

  8. I’ve been suffering from silent migraines for awhile now, although sometimes I do also get a throbbing headache. I’ve been eating Paleo for over 2 years now, and have been at a loss as to how I need to tweak my current diet, so I’m really hoping this approach will work for me. I have had a hard time going over 200g of carbs a day, even when I’ve tried. I have known allergies to wheat (which I wouldn’t eat on Paleo or PHD anyway), dairy and eggs. I also try to avoid nightshades because I suspect they cause issues too, and I feel generally better without them.

    I would like to try a ketogenic approach, but I’m having trouble mentally picturing meals. Can someone who eats this way give me a sample of your daily meals? I’m a planner, and have trouble winging this kind of thing!

  9. Hi, Sara,

    Sister sufferer here. You probably have already done the necessary documenting and journaling of the what/when/how/why of your migraines, so I’ll skip that. I do understand your need to know and have ideas to spring off of. I’ve been following a low carb/PHD approach for only 45 days, but have had great results. I only have migraines if I transgress and eat a trigger food. I’m 55, so the hormonal migraines are winding down as well.

    IMHO, this diet boils down to meat and a green veg. Breakfast is still problematic for me. My mental template is coffee and a donut. Eggs are triggers, haven’t tried pork yet. Usually just have tea with soymilk (organic, non-GMO) and some nuts, usually walnuts or pecans. I use soymilk because milk protein seems to be a trigger. Butter is ok, though. Lunch and dinner are easy-peasy. Some grass-fed beef and a green veg., usually kale. Dinner could be chicken, with a serving each of rice and carrots. Generally have another cup of tea with soymilk in the evening. So many of the recommended foods on the PHD fruit graphic are triggers for me, so I keep my foods really simple.

    This isn’t much, but hope it helps. 😀

  10. I am pregnant and suffering from terrible migraines. Is this okay to follow in pregnancy? I am willing to try anything because the migraines are debilitating

  11. Hello and thanks as always for one of the best websites I have ever followed.

    I would like to ask about Amyotrophic lateral sclerosis, a friend of mine was diegnosed with it and given 18 months to live.

    I wanted to know if there is any kind of treatment or reccomendation I could give him to make anything better.

    Thanks in advance as always.


    • Hi Alan,

      It’s mentioned in the book, because it is one of the rare conditions that is aggravated by fasting. Nourishment seems to be very important in ALS.

      However, I don’t think enough is known about the disease to justify a comprehensive program. I would try PHD, including intermittent fasting, but make a point of eating plentiful food during the daily feeding window, and emphasizing highly nourishing foods like egg yolks, liver, seafood, bone and joint material in soups and stews, green leafy vegetables, carotenoid-rich plants like carrots and sweet potatoes, etc etc.

      Best, Paul

      • That is what I reccommended exactly. I wasnt sure if they should minimize carbs to do a keto diet or not. But i was pullling toward not minimizing carbs.
        So the IF would be to recycle cells? Isnt fasting actually bad for ASL?

        Thanks as always!

  12. I tried a ketogenic diet some years ago having thought it might be helpful in helping migraine but did an ‘old style’ ketogenic diet. It didn’t work well for me. The realization that ketones can be abundant without the super low carb and protein limits of the old version, by using MCT/cocnut oil and amino acids seems revolutionary to me! I wish it were front page news. It makes the diet so much safer and more accessible. I’m amazed there hasn’t been more press about it. I’ve been on the diet for three weeks and am having amazing results. I can’t tell you how grateful I am. I intend to write more later when I have had a chance to really see where things are at over time. I’m still feeling disbelief and a kind of fear of ‘jinxing it’ by talking about how well it is working. This comes of having tried so many things over the course of 30 years and being continually disappointed. I am very surprised at how well it is working. Abdominal pain and nerve pain that were a constant companion on the side which I have head pain during migraines are 85% improved. I have had only one full-on migraine and that was just a few days after starting. I feel so much better generally.
    I could almost cry writing this. It is as though I have a new life. Thank you so much for sharing this information, and for free! I have bought PHD and I’m reading it now but got a jump on starting the diet as soon as I read about it here.

    I have a few questions about how to do the diet. And I would absolutely love to connect with anyone who may have trod this path before me if there is anyone who might be willing to do that.

    You say no fructose but is the fructose in vegetables ok, such as carrots and sweet potato, green plantain or should these be avoided also?

    Do vegetables other than starches count towards total carb calories of 200? It would seem not but just want to be sure.

    All recommendations in the book are for minimums, ie. “at least 200 carb calories”. Is more really ok? I thought it needed to be pretty low carb?
    I’ve just been sticking to 200 calories of starchy carbs and unlimited other veggies.

    Is there anyone who has translated the recommendations into guidelines that are expressed as quantities? ie. 1/2 cup of potato, 1/2 cup rice etc… per day.

    Are any branched chain amino acids ok?
    If I were to write down all the supplements recommended in the book and the blog about the ketogenic diet in one list, is this it?
    Vitamin C
    Vitamin D
    Vitamin k2
    branched chain amino acids
    Are they all very necessary or some more than others?

    I am incredibly excited about the results of this diet. Thanks for any help with the questions anyone can give and again, THANK YOU! ! !

    • Hi G,

      That’s great news! I’m so glad you found us.

      Don’t worry about fructose in vegetables, that’s minimal. Please do eat lots of vegetables. The issue with fructose is that the more fructose you eat, the more coconut oil/MCT oil you will need to eat in order to generate ketones; and we don’t want you to get a calorie overdose. But, you can experiment and if eating fruit doesn’t bring your headaches back, don’t worry about it. Table sugar and foods with added sugar are best avoided.

      No, don’t count vegetables as a calorie source.

      You don’t need to be extremely low carb. Do intermittent fasting and take MCT oil/coconut oil. The goal is more to nourish yourself plus generate ketones rather than to starve yourself. Again, you can experiment with how many carbs you can eat while still stopping the headaches. But intermittent fasting, concentrating the carbs into a narrow time window, will help.

      Yes, branched chain amino acids are good, we recommend them.

      See our supplement recommendations page for the basic supplements and “supplemental foods.” There are only a few extras needed for a ketogenic diet.

      Please keep us posted on how you do!

      Best, Paul

  13. Hello,

    If anyone has any thoughts about which of my possible next steps are most worthwhile, I’d be really glad to hear from you!

    I was taken by surprise by Graves disease 4 years ago; it was brought under control with 3 months of pharmaceuticals (I loathe pharmaceuticals). I had a terrible chronic-fatigue like pregnancy. I then went on a low carb, no grain diet and felt a lot better; the Graves has not returned since. I found out about estrogen dominance – I have a non functioning CYP liver enzyme for estrogen metabolism – I addressed that and improved some more(removed all estrogen-like chemicals from my home – cleaning/personal hygiene products, and was careful about not eating certain foods). I responded well to B6 and natural progesterone during another pregnancy and the post-natal period. I have since read that estrogen can also cause mitochondria problems. Then I had a stage of not knowing what to eat and then found the Perfect Health Diet, which I have been doing for about 5 months now, with the exception that I only started with the full plethora of supplements in the last 2 weeks (previously was on D, K2, C and Mg and the supplemental foods – I’m now on nearly all of them now, including NAC)

    However, the main symptom(s) that bother me now is an abnormal sensation in right hand side only of head/face, centered around eye and cheek/ear level, but ‘inside’ head. Feels slow, groggy, foggy, itchy eye, feel need to scrunch eye up (crease/wrinkle on forehead which has been there for years, which makes me think this head sensation is not actually so new), extra sensitive to external stimulus (noise, movement, light), feeling that I can’t keep up with moving things. This is continual but the intensity varies. Painkillers do nothing for it. At best it is a low level background sensation, at worse I feel like I can not think at all. I also have persistent mucus in back/top of nose and top of mouth, which is mainly clear and foamy when some comes out in the morning. Nothing seems to shift the mucus and I just don’t know if it is connected to the head problem.

    Having picked up on the brain infection lead, I can identify with the following symptoms (from Paul’s ‘mice’ post) on a transitory basis (not continually), which are worse when the groggy feeling on the right hand side of my head is worse from those listed under i) hypoglycaemia : nervousness, irritability, anxiety, restlessness, difficulty in thinking; inability to concentrate, really slow,and ii) serotonin deficiency : anxiety, depression, impaired memory, low self esteem, loss of pleasure, poor impulse control.

    I now just call it a headache, when it starts to become more intense, but it is more than a headache. It is really debilitating, because I simply can not function normally or like I used to when it is intense. And even when it is low intensity I feel like I’m still slower than in my past. It is usually worse in the mornings when I get up. I’ve got nowhere with food sensitivities – too many variables, nothing obvious stands out – even with 5 weeks without dairy.

    In some desperation I have read over and over many of the PHD blog pages and posts. I bought some coconut oil and am trying the ketogenic version and intermittent fasting. So far so good (6 days in!) – the symptoms have stayed at low intensity and I feel lighter and more easy going. I’m breastfeeding though and I find the intermittent fasting really hard, unless, it seems, I eat coconut oil in the evening and the morning.

    As there are always so many avenues to try, I wondered If anyone could offer any thoughts on which to proceed next with. What I’m considering are: getting a stool analysis ; trying to find more leads from the International Headache Society (ihs-headache.org) headache classification; asking for a MRI brain scan (to rule out tumors /can they see infections on MRIs?); getting a sinus swab tested; supplementing with Vanadium, Molybdenum, branch chain acids and Melatonin; investigating removal of mercury/amalgam fillings (10 from childhood, oh dear…); continuing as is for a couple of months and then seeing about brain-infection antibiotics if the ketogenic diet keeps it in check.

    Any thoughts or suggestions gratefully appreciated.

    I am a huge huge fan of the Perfect Health Diet book, I recommend it to everyone I talk to about health issues. I think the authors deserve to be on the Queen’s honours list or up for the Nobel price or something equally prestigious. If only the mainstream medical world would catch on!! Thank you!

  14. “If glutamate excitotoxicity causes migraines, then it’s likely that migraine sufferers would benefit from a ketogenic diet.” what a B-S first this study shows that higher glutamate cause migraine but they not say it is in level that cause excitotoxicity. Sure wikipedia is best source … even student dont reference her in paper works. “People with the mutation are prone to glutamate excitotoxicity:” this is only your interpretation

  15. Paul

    What is your opinion about Amalgam filling removal. I have around 10 amalgam fillings and i had gone to bio-dentist. It is going to cost me around 1800 per tooth. What i read is as long as you have mercury in the body you will continue to have fungal infections and I was wondering if all these amalgams are causing the fungal infections.

    • Hi Tessy,

      No, I don’t think fillings cause fungal infections. I had fungal infections for decades, they went away when I fixed my nutrition, even though I have a ton of dental work.

    • I had ringworm and seborrheic dermatitis and lots of amalgam fillings. I still have the fillings, but fungal problems went away on PHD. The ringworm went away immediately. The dermatitis took six months. For a while, it would come and go depending on stress or circadian rhythms. If I stayed up late watching TV too many nights, it would flare up. Hasn’t flared up for at least 8 months now.

  16. Hello,
    I had migraines since I was 11. They got very regular when I turned 28. I now have headaches everyday. It seems that I have all of the triggers of migraine. It’s really bad & had affects my life a lot. I had to stop my PhD study due to the daily headaches.

    I’ve found your site while searching the web for the benefits of ketogenic diet for migraine. I’ve read about its benefits for seizures long time ago & thought it could also be beneficial for migraine. I’ve found it difficult to follow a ketogenic diet given the way it was usually defined using ratios of fats, proteins & carbs. When I’ve read your recommendations, I thought that I should give it a go.

    I’ve been paleo & used coconut oil in my diet since 2008 on & off. I’m now using it regularly in my cooking for at least a year. I didn’t notice any improvement in my headaches & thought that I might not be getting enough of it. I’m currently fasting for religious reasons. I’ve tried one day to drink 2 tbs of coconut oil in attempt to increase my consumption but I got palpitations. I get palpitations regular & It seems that they are hormonal like my migraines. I also notice that I get palpitations when I eat a high-fat meal.

    I actually have a lot of health problems that seems related to my hormones. I’ve vitamin D deficiency, gains weight easily, have cold hands & foots, palpitations, unexplained pain in my legs, knees & lower back, hypoglycemia. I’m on a supplements plan for migraine in addition to progesterone cream. I’ve noticed that progesterone cream does help my migraines but they are still bad.

    I want you your advice on how I can add coconut oil to my diet in order to get the benefits of ketogenic diet without having palpitations. I’ve also notice that you recommend to restrict the calories from starches to 200. I don’t eat starches daily & try to avoid them since I gain weight easily eating them even if it’s very tiny amount. I was thinking that I might get the palps when eating high-fat meal because I’m not eating enough carbs. Could this be the reason?

    I’ll be waiting your advice patiently.

    • Hi anisam,

      I’m not sure I would recommend a ketogenic diet for you at this time. You have a lot of symptoms of starvation and being too low carb. I think you need to experience being well nourished for a while before experimenting with a ketogenic diet.

      I think for migraines, in most cases you may not need to be overtly ketogenic, except for a few hours a day. Just an extended overnight fast, with a few hours of ketosis at the end, will give you most of the anti-migraine benefits of a full-blown ketogenic diet, and in a much safer way.

      The palpitations are probably due in part to electrolyte and antioxidant deficiencies. Get more magnesium, calcium, salt, potassium (eat at least two pounds a day of fruit and vegetables), water, vitamin C, vitamin E, zinc, copper, selenium. The cold hands and feet and hypoglycemia are probably due to being too low carb. Other symptoms suggest malnourishment as well.

      The weight gain may be something you need to accept temporarily on your way to a better place healthwise. You need to support immune function even if it means adding on some weight.

      Best, Paul

  17. Reader Reports - Perfect Health Diet | Perfect Health Diet - pingback on September 12, 2014 at 5:18 pm
  18. Struggling migraine sufferer here! In the past couple years, I have developed a sensitivity to coconut oil. It actually gives me quite a headache…and I don’t know why. Will MCT oil do the same if they have similar properties? I am a very active (running, crossfit, etc.) mom of three small kids, and I definitely need some starches to keep up. I’m hoping I can generate ketones while still eating a few starches. I really struggle to keep my blood sugar up…and I am constantly hungry. I think being in ketosis could possibly really help me.

  19. Michelle McPhee

    Hi Paul, I live in AU and have just ordered your book and am excited to receive it and read it! I suffer migraines regularly and have for years with them becoming more regular since hitting peri menopause. In this initial post you suggest a safe way to do the Ketogenic diet is to consume between 12-14 tablespoons of coconut oil and then in a later post in 2012 you said to someone that 4 tablespoons may be enough. What is your viewpoint on this – should I go hell for leather with 12 tablespoons ? Thanks 🙂 Cheers, Michelle

    • No, I’ve become more concerned about negative effects from high doses of oil. So what I now favor is trying to get into ketosis only about 2 hours per day, at the very end of a 16 hour overnight fast. For the curative effects you only need brief but regular ketosis, not continuous ketosis.

      • In the light of your observation that you are now concerned about the negative effects of large doses of coconut oil would you please tell us the latest keto protocol for neurological condtions? What about lysine and leucine supplementation for example?
        I developed a serious neuro condition in 2014, found your book, read it, found others, researched as much as possible, and have just come full circle to your book again! Nothing else can touch it for even handed in depth advice. I’m now ready to jump in.

  20. I haven’t read he book yet but have it on order, have heard great things. the only thing i am confused about is — if you have multiple sclerosis, swank says under 15-20 g saturated fat a day, so coconut oil, while excellent for most people, would make our symptoms worse bc we cant process sat fat. is there something else people with MS could eat for fat? I have SIBO, MS, Celiac, rosacea, leakygut, and I dont know what to eat! also trying to lose weight :/ some say eat honey, berries, some say NO honey, no berries. oy. can anyone help?

    • Hi Regina, I don’t believe Swank is correct about the saturated fat. However, monounsaturated rich oils like olive oil, avocado oil, and macadamia nut oil are PHD approved.

      Honey and berries are OK in moderation. We recommend eating a pound a day of sweet foods like berries, fruits, and beets.

  21. Hi Paul
    I suffer from Raynaud’s Disease with secondary migraines (sometimes static for days/weeks), chronic fatigue, etc. My body simply slows for 4 months of the year; with regard to health, growth (hair, nails), healing and recovery. During the other months of the year I live a normal active healthy lifestyle.
    1. Just wondering if there would be any disadvantages with only periodical use of this diet?
    I have been considering using the 5:2 fasting diet for weight maintenance, altho a little nervous about what a regular detox might trigger!
    2. I noticed your plan includes short fasting also, but I presume without any sugar, detox shouldnt pose a problem!?
    I would also like to order a copy of your book. 3. Just wondering if adjustments have been made to new editions; with regard to comments above of changed recommendations of lower doses of coconut oil and only brief regular ketosis?
    Lastly; you dont seem to mention cows milk, cheese, or yoghurt.
    4. Are these dairy products recommended or to be avoided, on your diet?
    Appreciate you help.

  22. Hi Paul-

    I am looking into this diet for my 10-year-old son who has suffered from abdominal migraines since he was 6. We have had them largely under control for the past 4 years by simply removing MSG and preservatives from his diet. Following a surgery this year (in which I think we made sure all the meds were preservative free- only MSG in the normal saline), we have lost control. I had begun wondering if it was just glutamate in general rather than just MSG? So, I’ve been reading through the diet plan and supplements and researching a bit but I have one question I can’t resolve. Will adding glutathione, which is partially comprised of glutamate help with reducing the glutamate in one’s system or is that just a general recommendation which wouldn’t apply if you think glutamate is the main migraine trigger? Just trying to understand. Thanks.

  23. I’ve tried ketogenic diet in the past for three weeks and noticed it helped my migraines & daily headaches but couldn’t maintain it since it’s strict and also due to the palpitations I get. I’ve also tried coconut oil but it was causing me hypoglycemia and I already have a problem with low blood sugar. I then tried leucine but didn’t get the effects of ketogenic diet. I recently tried a supplements which is called “Keto/os” and it claims to get you into ketosis in 60 minutes. It primary contains ketones salts, some MCT, sodium & potassium for electrolytes balance. It has been almost one week since I started it and it is too early to tell if it’s helping but what I’ve noticed from the first day is the mental energy I get from it! Having chronic migraines for the last 15 years did affect my ability to mentally focus on a task and I’m happy to feel normal again in this regard which is extremely important for me since I work in the academic field. I did get the palpitations and had to take electrolytes (magnesium, potassium & sea salt) to counter this side effect. I do feel that same effects I got when I started the ketogenic diet last year. I hopeful that I’ll eventually get rid of migraines along with all the pain & discomfort I have in my head in a daily basis. I’m sharing my experience in a hope that it might benefit someone else who is struggling as well. The supplement is quit expensive but for me it is worth its cost in gold.

  24. I’ve been on the Keto diet for quite some time now and also suffer from Aura Migraines. Currently I have no health issues and check my ketone level in my blood almost daily to see the production of kentones within my body. The keto diet ❗ ❗ DID NOT ❗ ❗ stop the migraines but has made them easier to bare. My migraine symptoms are a fraction of what they used to be. Before the ketogenic diet I would have a migraine for 12 hours or more, after they only lasted about 3 hours and are far and few between.

  25. As a physician with a special interest in intracellular infections I was very interested in the claim near the top that ketogenic diets “stimulate the innate immune response against intracellular pathogens, helping to heal brain infections.” I spent the better part of an hour on Google and Google Scholar looking for some confirmation but came up empty. Can anybody point my in the direction of the source literature?

    • Hi Shawn,

      You can find references in our book, also in several blog posts. The main point is that ketogenic diets stimulate neuronal autophagy, which is part of the innate immune response. When scavenging resources, autophagy does not work blindly, but looks for the least desirable things in the cell – bacteria, viruses – to digest and recycle first.

      Best, Paul

      • Stuart Mather

        If you have a long daily fast – a narrow eating window, then for the later part of the fast your body is in ketosis anyway isn’t it ?
        Even people eating ‘normally’ will be in ketosis for the later part of their overnight fasting period?
        And I was under the impression that long term ketosis carries its own drawbacks, deteriorating gut health being probably the most obvious.

        • Hi Stuart,

          Yes, intermittent fasting is very valuable for everyone, and we highly recommend it.

          More stringent ketogenic diets are a specific remedy for bacterial infections of the brain.

          Ketogenic diets are risky because they are at best mildly nutrient starved and, if improperly implemented, can be severely malnourishing. Bad outcomes are common. So they have to be implemented very carefully. You need for example all nourishment for maintaining gut health, and adequate fiber. (Note fiber is ketogenic, so vegetables should be abundant on a ketogenic diet.)

          Best, Paul

  26. Paul,
    My boyfriend has several symptoms including dermatographism, anxiety, stomach pains, etc. Many of his symptoms appeared after weaning himself off Zoloft. He’s been on hydroxyzine for several years which controls his symptoms, but it’s obviously not fixing the problem. He also has a lot of stress and probably doesn’t get enough sleep. I know your diet would be a good starting point for addressing his issues, but do you have any other ideas what may cause these symptoms? Does it sound like a gut imbalance? Any help would be much appreciated.
    Thank you, Renee

    • Hi Renee,

      I do think our diet is the best starting point, also the various circadian rhythm elements and intermittent fasting.

      Diagnosing specific causes requires a more detailed look at biomarkers and symptoms. For example, if has insomnia at 3 am then there is a good chance that pathogens in the colon are contributing.

      Best, Paul

  27. I recently began this diet for weight loss and happened to find that my migraines have decreased by at least 30 percent. That is a huge deal for a chronic migraine sufferer of 20 years.

  28. One glorious month migraine-free by maintaining Paleo ketosis!!! I just wish I’d discovered it sooner.

    I’m very excited that tomorrow will be my 1st Paleo anniversary. Having been stalled for 7 months after only 14 initial pounds lost, I did a 5-day fat fast one month ago. I lost and kept off 8 pounds with 2 pounds the following week with 2 fat-fasting days. I’ve remained at very happy keto macros of 80/15/5 with my daily protein grams between 50 and 60 where before the fat fast I was between 90 and 100 daily. Anyway, I just realized a few days ago that I haven’t had a migraine in weeks!! Not even around my lady time, which is pretty much a monthly guarantee that I’ll be popping Imitrex like M&Ms for a good 3 days.

    I’m thinking my protein intake was keeping me from keto because no matter how low I kept my carbs, nothing was changing. Soooo if too much protein means my body is making the glucose and keeping me outta keto, then lowering my protein to between 50 and 60 and keeping my net carbs below 20 seems to be my migraine miracle.

    I’m keeping my fingers crossed and remaining in Paleo ketosis. Still no dairy, grains, sugars, legumes or veggie oils. I get my fats from avocado oil, Olive oil, ghee, coconut oil and of course, salmon, grass-fed 85/15 beef and crispy chicken thighs while watching the protein. Lots of organic salad greens, the occasional 1/2 sweet potato (wedges wrapped in uncured bacon) and mashed cauliflower with roasted garlic. It’s never boring 🙂

  29. This post is many years old, hopefully I can still comment and be read.
    I looked at your recommendation for the amount of carbs allowed on the ketogenic diet, and it came to over 100 grams. From what I have been reading, I am not supposed to get over 20 g, or at least not over 50, in order for it truly to be ketogenic and help my migraines. You think it is still effective for me to eat that many carbs? I really miss at least some carbs, but my migraines are so horrible that I am willing to do anything to stop them. Since eating 20 – 50 grams of carbs a day, and LOADS of good fats, I have not had hardly any headaches. Thanks!

    • Hi Julia,

      You have to experiment. It’s good that you’ve found that a ketogenic diet helps your migraines, now you have to experiment to find how many carbs you can restore. As the quality of your diet and lifestyle improve, you’ll find that you can add more than before.

      Migraines are caused by inflammation of the brain and although ketogenic diets are one way to relieve that inflammation, they are not the only way, and it’s better for long term health to find a more carb-heavy diet that also relieves the headaches.

      Best, Paul

  30. Benefits of a Ketogenic Diet for TBI – TBI Journeys - pingback on January 30, 2017 at 8:07 am
  31. I am keen to try this..except I get terrible diarrhea from coconut oil! I have had severe intractable migraines since my teens and my diet is already very restricted. What would you suggest?

    • Hi Mocha,

      First, re ketosis and migraines, good nutrition is very valuable against migraines, so you should (a) adopt PHD to achieve good nutrition, and then (b) do intermittent fasting and try using MCT oil (Not coconut oil) late in the fast to induce a few hours of ketosis.

      Re the diarrhea, it may take a little experimentation to determine exactly what is going on. First step may be to distinguish between steatorrhea (diarrhea due to undigested/unabsorbed fat) and bile acid diarrhea (https://en.wikipedia.org/wiki/Bile_acid_malabsorption).

      First step, supplement glycine, taurine, and vitamin C and eat 3-5 egg yolks per day to provide the nutrition you need for bile synthesis and conjugation. Better synthesis should eliminate steatorrhea, while better conjugation should eliminate the non-microbial causes of bile acid diarrhea.

      If that doesn’t solve the diarrhea, you probably have a problem with your gut bacteria. Inflammation from the gut bacteria is contributing to the migraines, and gut bacteria are causing the diarrhea by deconjugating bile. You need to reshape the gut microbiome. Optimize vitamins A and D, optimize circadian rhythms, do intermittent fasting, eat lots of raw organic fruits and vegetables, eat green leafy vegetables and spicy foods. Supplement C, N-acetylcysteine along with glycine and taurine to support glutathione.

      Reshaping the microbiome will take time, so I would eat regular PHD for a while to help that along rather than rush to a ketogenic diet.

      Best, Paul

  32. Carolyn Jorgensen Potter

    I have been doing the ketogenic diet for over 30 years. You must limit your carbs to less than 20 a day. The goal is to reduce insulin levels so that your body will burn fat. Cut out all grains, bread, pasta, root vegetables, milk and yogurt. Eat meat, fat and leafy greens.

  33. Paleo and Migraines | Paleo Leap - pingback on January 27, 2023 at 2:40 am

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