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.


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.


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.


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.


[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 ?


  1. Wow! This is exciting news. I have a friend that
    suffers migraine. Trouble is, he is not a very motivated individual. However, I will share this post with him, and his wife. 🙂

  2. This makes me very happy to hear, great stuff. Obviously for any sort of brain troubles a ketogenic diet low in toxins and high in nutrients is the default diet, but I noticed that Kate increased her iodine too. Many people have had good results with iodine supplementation for headaches. I am unsure of the mechanism but hypothyroidism could likely be implicated.

  3. Great story!

    I’m a bit sensitive to weather changes, got often headache when atmospheric pressure was changing fast, especially in spring/autumn. So far this spring only once for half a day and not very strong.

    Btw, I did take some ALA and carnitine a year ago and it would give me headache instantly!
    Magnesium is good stuff though.

  4. Thanks, Stabby, didn’t know that iodine helped with headaches too.

    Hi Franco, interesting! The brain is a complicated thing.

  5. Thanks Paul! I hope this points other headache sufferers out there in the right direction. I’ll be interested to try the other supplements you suggest. One thing I am starting to appreciate is that one needs the entire program in place–a low toxin macro nutritious diet in the right proportions as well as all the right micro nutrients–before synergistic benefits start to accrue. One or two possibly helpful supplements in the context of an inappropriate diet is like trying to put out a big fire with a little cup of water. And my diet for most of my adult life was decidedly inappropriate. In retrospect I estimate I generally ate at best 25% fat, maybe 15% protein and the rest was carbohydrates, mostly from toxic cereal grains. For many years I thought whole grains would somehow be my salvation. In reality, they were probably creating the problem. I am so grateful I found this site and your book.

  6. Great metaphor Kate! Love the big fire – little cup of water comparison.

    I agree completely; one needs the entire program. A lot of little mistakes compound to make problems incurable; fixing all the little things makes cures much easier. Also, for migraines, I think a ketogenic diet will be essential for most.

    I am so grateful you found us! Authors need readers as much as readers need authors.

    Best, Paul

  7. The brain is amazing, but it usually has only one response: swell up.

  8. Paul,

    Could you expand a bit on the dietary and supplement advice you would give to a person with Reynaud? My wife (living paleo/primal for 3 years, not really low carb, and for the rest doing great) would be happy.

    Thank you.

  9. Ten thousand thanks Kate & Paul. I laughed and felt sad as I read Kate’s list — could have written it myself (somebody has gotten rich off us Migraineurs!). I’ve found I can’t go too low on carbs or my body dries up and infections flourish. But I see that I can tweak my supplements some. I look forward to everyone’s updates on this topic.

    Gratefully, Holly

  10. Paul, have you heard about work of Kaisu Viikari MD? She’s a Finnish ophthalmologist whose main thesis goes like this:

    Humans evolved to have quite strong far-sightedness (hypermetropia) so that they could be able to see far even in the night with no nocturnal myopia. Nowadays people read extremely much and that’s quite a struggle for a ciliary muscle, so the muscle gets cramped, which is the main cause of myopia (or “pseudomyopia”) and one of the possible causes of migraine, back pain and some other problems.

    I recommend that you would check the contents list of Viikari’s book Panacea (1978) and check if you find something interesting inside the book: http://kaisuviikari.com/panacea.htm Migraine-related part starts at page 146 (or at page 154 or sth of the pdf file, I own the paper version of book)

    KV also published a new very simplified book in 2010. You may find the review by Bobby Matherne interesting: http://www.doyletics.com/arj/nomyopia.htm

  11. Hi Robert,

    Heh. Yes, a lot of different brain disorders share the same symptoms, makes it hard to ferret out the root cause!

    Hi Pieter,

    I’m not an expert on Raynaud’s but I do have some thoughts.

    First, hypothyroidism usually precedes the development of Raynaud’s and curing hypothyroidism often fixes it. So I would focus on fixing any hypothyroidism, even if it’s mild / subclinical / symptomless — supplement enough selenium / iodine / copper / magnesium to get TSH below 1. Then gradually build up iodine further.

    For diet, high-fat diets with occasional ketosis are good for normalizing body temperature. I would aim for adequate carbs, neither too low nor too high, and adequate protein, but most calories beyond from saturated and monounsaturated fat. Eat coconut oil and some safe starches.

    Raynaud’s is probably a circadian rhythm disorder and so circadian therapies should help. Intermittent fasting, daytime sun exposure, total darkness at night, etc. See my recent Seth Roberts and Circadian Therapy post: http://perfecthealthdiet.com/?p=2820.

    As near as I can tell those are the 3 most important. But other supplements may also matter, so I recommend doing our whole program and seeing what happens.

    Best, Paul

  12. Hi Holly,

    I assume your infections are Candida/fungal. I was in the same situation – very low-carb caused the fungal infections to go wild.

    You can mitigate that a bit with aggressive supplementation of vitamin C, glutathione, iodine. Also, eating MCT and leucine supplements can help make the diet ketogenic even with significant starch consumption.

    A good strategy would be intermittent fasting 16 hours per day, in latter stages of the fast taking MCTs/coconut oil/leucine, then eating your starches and other foods in a 6-8 hour feeding window. This would assure that you are in ketosis for part of every day, while still supplying glucose for anti-fungal immunity.

  13. Hi Valtsu,

    Fascinating, I’ll look into that. I’ve recently taken to going out at mid-day for vitamin D and exercise, but not wearing glasses and practicing long-distance vision. Don’t know if it will help, but at least I get a few minutes a day of natural eye use!

  14. I’ve known people with migraines before and they use to cause them a lot of misery.

    I didn’t know diet could be so very effective in treating it. I wonder how many doctors know about that?…

  15. Do you know of any information out there regarding ketogenic diets helping people with concussions/brain injuries, either to recover quicker or improving what seemed like permanent damage?


  16. Paul,

    I want to commend you on the great website; lots of information, it’s well organized, and your frequent contributions to the discussion make it worthwhile to mine for insights. I ordered your book yesterday and look forward to reading it over the next week.

    I’m fascinated by Kate’s treatment narrative, largely because it follows my own–except for the last part, where she gets better (that one i’m still working on.) I’ve tried 8 of the tabled items to no avail.

    I’m currently diagnosed with chronic daily headache with migraine tendency. I also suffer from insomnia. My doctor’s assume that my insomnia is unrelated to my migraine, which is something I simply do not believe. They assert that anxiety, and not what causes my headaches, keeps me from sleeping. Yet I meditate every day. I practice relaxation and breathing techniques. I work out to relieve stress. Yet I still can’t sleep. I should note that my headaches are not typical. I do get pain several times a day, but What really irks me is that I have all day visual disturbances and facial pressure (light sensitivity and a rolling pressure sensation directly behind my nose). I have always thought that if excess levels of glutamate can cause faulty electrical activity implicated in migraine, why couldn’t the same be true for insomnia.

    I read Dr. Fuhrman’s books (eat to live), because he includes a section on eliminating migraines. His approach is very different from yours. While he also advocates only a little bit of carbohydrates, he emphasizes getting most, if not all, of your protein from veggies. And he is very much against fat. For migraines specifically, his claim is that animal protein causes too much nitrogenous waste, which is toxic to the system and heavily implicated in migraine.

    While I’m certainly not 100% better–not even close, in fact–I have seen some relief by sticking to this diet. Perhaps it was the low-carb effect only? But that leads me to question: if you consider plants to generally have high levels of toxins and he considers animals suffer from the same problem, who is right? By your definition, what are the toxins in plants? I should also note that I recently read Trancendence by Ray kurzweil and terry grossman. While ray may be crazy in many ways that I won’t get into to here, he’s undoubtedly smart. He also believes that the medical literature suggests that plant protein is far more advantageous than animal protein. It’s disheartening when people you consider smart read the same scientific literature and come up with wildly different assessments.

    I have no preference for who is right–I simply want my life back. I should note that Dr. Fuhrman is a very big fan of fasting. So I’m thinking about trying your 16 hour fasts and seeing if i see improvement.

    best of luck and once again, great job on the website.


  17. Hi James,

    Dr. Fuhrman’s ideas are baseless. First, poisons that work against humans also work against other mammals; and since animals will not harbor self-poisons in their body, we can safely eat them. This is why snakes can be poisoned by their own venom, and humans can safely eat snake venom: it is digested to harmless raw materials, but undigested is a terrible poison.

    In contrast, plant proteins are by design toxic to animals, because their purpose is to prevent animals from eating the plant. As animal toxins, they are toxic to humans too.

    All protein contains nitrogen and releases toxic nitrogen waste when metabolized. Plant protein is no different than animal protein in this regard. This is why you shouldn’t eat too much protein — no more than 600 calories per day — otherwise you will overwhelm the body’s nitrogen disposal pathways, and be poisoned.

    But lower amounts of protein are fine. Most people eat ~300 calories/day.

    If you’re low carb and limit protein, you’d better eat fat! The alternative is starvation.

    As we’ve noted, the China Study confirms: plant protein is bad, animal protein is good: http://perfecthealthdiet.com/?p=166. The medical literature supports that.

    Now on to your symptoms.

    You should be aware of the basic biology of infections of the brain. The brain has a special set of immune defenses. Bacterial or viral infections cause expression of a molecule called interferon-gamma, which sequesters tryptophan and prevents manufacture of serotonin and melatonin.

    Melatonin is needed for sleep.

    Brain infection also causes headache by various pathways. So this would be a simple explanation for both headache and insomnia.

    Definitely you should do ketogenic dieting, which is highly beneficial in all varieties of headache. It will help regardless of whether your headaches are caused by infections or by non-infectious causes.

    In addition, you should do two things – mainly for diagnostic purposes, but if they work they will be the foundation of therapy:

    1. Try melatonin supplementation just before bed. If your sleep improves substantially, it will indicate that melatonin deficiency, possibly caused by a brain infection, is the likely cause of your insomnia.

    2. Try antibiotics. Doxycycline is a good broad-spectrum antibiotic that enters the brain. It is a protein synthesis inhibitor, meaning it slows down bacterial functions, which means that you may see an immediate benefit from it. Take 200 mg doxy per day and see if your headaches or insomnia are reduced in severity. This will only work against bacterial infections specifically, but if it does work, it tells you what your problem is.

    I’m glad you bought our book because our diet will be very helpful to you. Try the ketogenic variant (200 calories/day starch, 400 calories/day protein, lots of coconut oil, leucine supplements too if you like) with intermittent fasting. If the 16-hour fast is hard to tolerate, eat coconut oil during the fast, maybe a nibble of starch.

    Experiment with the melatonin and the doxycycline and let me know what you experience. Ideally the diet should come first and antibiotics after.

    Best, Paul

  18. Hi Paul– I have the book and am reading your blog but can’t find anywhere the recommendation for how many mgs leucine to supplement?

  19. Hi Ellen,

    I don’t have a specific recommendation … it’s all experimental at this point.

    Leucine might become unsafe around 50 g/day which is about 10 heaping teaspoons. But I wouldn’t take that much. Maybe 1-2 heaping teaspoons, plus coconut oil or MCTs. Then experiment with no leucine, or a bit more, see what you like best.

    Extra leucine will make the diet more ketogenic, and will help you keep muscle. It’s not very palatable.

    Best, Paul

  20. I have had migraines (with aura) for as long as I can remember. I am 52. About 4 years ago, I went totally gluten-free which eliminated about 90% of the migraines, especially the severe nausea-causing kind with flashing lights and floaters (migraine sufferers will know what I mean). I still have an occasional very mild migraine about once per month (hormone fluctuations), but these are nothing compared to those in the past. Going paleo/primal has helped even more. When I stray into “too-much carbohydrate land,” I get a resurgence. It’s really interesting to see the same responses by some of your other readers. Wouldn’t it be amazing if this news could become more widespread and help other migraine sufferers? My daughter, who suffered from vertigo and migraines as well, has also had almost complete relief on a gluten-free diet.

  21. Hi Laurie,

    Yes, I hope word will spread! A ketogenic diet cures many neurological conditions that are completely intractable on standard diets. It’s a shame for people to suffer needlessly.

    Best, Paul

  22. Paul, I’d like to try to substitute MCT for coconut oil, but don’t know how to go about it. (I know you’ve already answered this question, but Google Reader swallowed it up and I don’t remember which post the comment was on.)

    Do I take 2 T/daily and which of the two on your supplement list would you recommend?

  23. Hi erp,

    Either of the products on the supplement list should be fine.

    1 tbsp MCT oil is similar to 2 tbsp coconut oil. 1-2 tbsp a day would be healthful, would raise HDL levels and improve health, but is not very ketogenic. If you’re trying to cure Alzheimer’s or migraines, take substantially more, say 6-8 tbsp MCT.

    Best, Paul

  24. Paul-
    One shouldn’t cook w/ MCT oil, correct? I’ve seen recommendations else where that it can be used for cooking instead of butter or olive oil. For some reason this doesn’t sound right to me, although I know cooking with coconut oil is fine.

    What’s your take on it?

  25. Hi Ellen,

    It has a low smoke point so I don’t think of it as a cooking oil, and haven’t tried it for that purpose. I just take it as a supplement or dressing/sauce.

  26. Thanks Paul.

  27. Thanks for the input Paul.

    I sometimes feel that discussing the food we eat provokes a highly emotional response from people, and they defend their behaviors from what seems to be ideological preconceptions. But a lot of people who are sick just want to get better (me, for instance); they don’t want to get caught up in the debate.

    I want to give your diet a fair chance. If I see progress I would love to send to you the details of everything I followed so that other chronic migraine sufferers can consider it for themselves.


  28. What a coincidence with this post, Paul.
    I guess you have to add me to the list of migraine sufferers… I started to have these pulsating migraines from time to time and they progressively got worse. I’m so disappointed since I went gluten-free and on PHD I thought I won’t get them anymore. Last night I woke up at 4 am. with a terrible migraine pulsating on my left temple and pain in the back of my neck. I almost went to the emergency room – it was that bad.

    I have to admit that I foolishly added 1 tbsp of soy sauce (which contains wheat) to my pot roast last night. Could it really have caused my migraine??? I don’t know. Maybe it was just weather changing…But now I will definitely have to look into some migraine relief supplements and fine tune my diet. Unfortunately, I can’t eat that much fat like you suggest Paul, since I don’t have a gallbladder, what should I do in this case?

    P.S. Kate, thank you so much for sharing your story and the remedies you tried. It’s really helpful.

  29. Hi Mia,

    Immunogenic foods like wheat or soy might be triggers for migraines, so I do think it’s possible that could have been related. But it’s probably Russian roulette, you could eat the same again and not get a migraine.

    Your case is a hard one. For the migraine you want a ketogenic diet. That’s bound to be a high-fat diet. But without a gallstone, the high-fat diet is hard to tolerate.

    I would try the leucine and lysine supplements, those will reduce the amount of fat you have to eat to be in ketosis. Check out our ketogenic diet posts, especially the recent one for the NBIA kids.

    The other thing you can do is try fasting. A temporary fast sometimes brings lasting relief. I would at least experiment with that – say a 36-hour fast once a week, then eat a high-starch diet the rest of the week.

    Rice is the safest starch.

    I hope this helps. I wish we’d met up before the gallbladder surgery!

    Best, Paul

  30. Thank you Paul!
    Yes, I wish I met you before my gallbladder was removed..
    My case is indeed difficult… Plus I can’t fast since I get hypoglycemic (I’m looking into possible thyroid or adrenal issues like you suggested). I’ve been measuring my temp every morning and it is s little low…97.4-97.7F)…
    Also, I forgot to mention that I had some kind or acid reflux(burping) along with my migraine. I thought it was just a coincidence, but when I googled it it seems to be quite common. Some people even suggest a connection from acid reflux and magnesium depletion in the body leading to migraines http://www.ctds.info/cause-migraines.html
    I used to have acid reflux along with my gallbladder attacks but it went away after the surgery.
    Maybe it’s all connected somehow… Hopefully I will figure it out eventually…

  31. Paul,

    I have a few questions for you.

    1.) When do you take your supplements/medications if you want to practice the daily 16 hour fast?

    2.) Can you practice the daily fast and a 36 hour fast (once a week), or is this pushing it

    3.) For those of us who might want to learn more about the science of nutrition and biochemistry, are there any books that you would recommend?

    By the way, I finished reading the book a couple of days ago. You’ve really done an excellent job. I wrote a review on amazon–I hope you sell a million copies.



  32. Hi James,

    1) I generally take supplements with food.

    I generally take them all at once, but if you’re taking high doses of some (say, vitamin C) then you might want to spread them out, and it might be good to separate minerals that compete (e.g. copper and zinc).

    2) You can do both, but I do think it’s pushing it. It also depends on your health condition. Ketosis is good against bacterial and viral infections, but bad for fungal and protozoal infections. It can also be bad for some viral conditions, like hepatitis C. So benefits can vary – more strenuous fasting would help some but hurt others.

    3) Of course we recommend our book :-). I personally favor Pubmed and articles over books. More and more are free access. They’re more up to date, easily searchable by Pubmed, and generally a more time-efficient way to learn. Searching Google books is sometimes useful. National Academies Press, http://www.nap.edu/, has a number of good free-access survey books – see e.g. the Dietary Reference Intakes books, http://www.nap.edu/topics.php?topic=380.

    Thank you for your review! We would love to reach a million people. I think it would make a big difference to people’s health, and medical practice.

    Best, Paul

  33. Paul,

    I am still doing great. I can’t tell you what a joy it is to wake up every morning without a headache. Finding PHD has really changed my life. I confess I did have a minor relapse for a two week period in April when I was traveling almost constantly. (I blame that on jet lag, sleeping poorly in hotels, and the ubiquity of low fat meat/pufa offerings in modern restaurants from Brussels to Tuscaloosa). However, when I got home and returned to my ketogenic routine ala PHD, headaches immediately receded.

    A few days ago I finally got around to getting some blood work done. The nurse called me this afternoon and told me that the doc had reviewed my blood work and had written me a prescription for weekly vitamin D pills and monthly B12 injections. My D was 27.5 ng/mL for which the Doc wants me to take 50,000 iu of D2 once a week for 12 weeks. B12 was 295 with (211-911) pg/mL being the reference range. Doc prescribed 1000 mcg/mL of cyanocobalamin by injection once a month. I would be very appreciative of any thoughts you might have about this course of treatment. (I’ve been taking 2000 ius of D3 per day, along with the rest of your recommended supplements since mid Feb).

    I was also interested in my Thyroid results and picked up the full lab report.
    TSH 3.09 (.27-4.20)
    FT4 1.03 (.71-1.85)
    FT3 2.3 (2.3-4.2)
    I’ve never had a thought about my thyroid before reading your book, but now I am starting to wonder since my normal body temp has always been on the low side, my resting heartbeat has always been on the low side, I have Raynaud’s, and I definitely have that half eyebrow thing going on. I reread your section on iodine and selenium. I’m up to 2mg/day of iodine. Judging from how I feel (less cold, more energetic), this has improved things. I did get a little push back when I tried to jump to 4mg of iodine(Thyroid area felt noticeably sensitive–not painful, but I was pulling collars away.) So, I think I’m on the right track re thyroid, but again would appreciate any advice you might have.

    Thanks, Kate

  34. Hi Kate,

    That’s great! Hopefully the headaches are gone forever.

    I don’t understand why your doctor wants to treat vitamin levels in the normal range so aggressively. More midday sun exposure would be best for the D; 27.5 ng/ml is low but not that surprising for spring. If you do take D I would take D3 not D2, and much smaller doses. Low B12 is associated with hypothyroidism but I haven’t looked into which causes which. I think it’s a good idea to supplement B12 but I’m not sure why he thinks injections rather than an oral supplement are necessary. Do you have low stomach acid symptoms like acid reflux?

    It seems clear you are hypothyroid, with the high TSH, low T3, and symptoms. I think this is best addressed patiently. I would start with a fuller thyroid panel looking at antibody levels and rT3, possibly also an adrenal panel – saliva levels seem to work best. You might get a low-dose thyroid hormone replacement with mixed T4/T3 while you figure things out. If that clears your Raynaud’s and eyebrows etc you’ll know the issues. Be patient with the iodine and go slow, 2 mg/day is enough to relieve iodine deficiency as a cause and if you don’t have infections that you’re aware of there isn’t a strong reason to go higher. Also, check ferritin levels to see if you have anemia / iron deficiency.

    I would use the thyroid hormone to clear symptoms and focus on nutrition and time to improve the thyroid and hopefully let you gradually reduce and eliminate the hormone supplements. The diagnostic tests can help you trace various possible causes.

    Best, Paul

  35. Paul, thanks so much. I am going to proceed as you suggest. I had asked for the thyroid antibodies test, but apparently SOP is that antibodies are tested only if thyroid issues show up on basic test. If he won’t change his mind, I’ll have it done privately.

    I don’t have any acid stomach issues. I used to, but this problem disappeared rapidly when I started low carbing four years ago. Nor has it reappeared now that I am eating rice, taro, and Asian yams 🙂

  36. Paul,

    I’ve been on the PHD–ketogenic variant–for almost two months with, well, in all honesty, a few lapses here and there. I have also taken the recommended supplements, plus NAC, and incorporated intermittent fasting (16 hour) 5 days a week. I cannot say that I’ve felt much improvement in my migraines or insomnia over my previous diet (mostly veggies, low carb, low protein) but then again I can’t say I’ve gotten worse, which is really good because things used to be much much worse. It’s also hard to tell if but for the diet things would have been worse. Considering summer is approaching and humidity levels are increasing, I’m surprised my migraine activity has remained relatively constant.

    I’m at the point where I’m going to try the course of doxycycline. My concern is that the antibiotic will cause problems with my intestinal flora. Would you recommend, then, 1.) consuming the antibiotic in split dosage–that is, 100mg morning and 100mg night. 2.) taking a pro-biotic in addition to the antibiotic. 3.) eating lots of bacteria rich foods.

    I’m going to try the antibiotic for one month to see if it makes any difference in my migraine and insomnia.

    Once again, thanks for the blog and all the great info.



  37. Hi James,

    I don’t think there’s any benefit to splitting the dosage. Doxy stays around the system a little while I believe.

    Yes, you should take a probiotic and/or eat a lot of fermented vegetables (kimchi!) while on antibiotics.

    I think that’s a good plan. I do believe migraines are mainly caused by infections – probably usually viral but sometimes bacterial – and you should definitely test antibiotics because if yours is bacterial you may have a quick and easy fix.

    The ketogenic diet should also help enhance immunity against infections so I would stick with it unless you get negative symptoms.

    Best, Paul

  38. Hi Paul,

    I suffered a concussion in September and have been dealing with concussion symptoms ever since – mainly dizziness and headaches. So essentially, I have post concussion syndrome. I remember reading somewhere on this blog that following a ketogenic diet can help with traumatic brain injuries, so I’ve been following the ketogenic version of the PHD for four days now. On top of this, I suffer from generalized anxiety and bouts of mild to moderate depression, and the concussion has only made these things worse. I have a couple of questions…

    Instead of taking 12 tablespoons of coconut oil each day, can I consume a total of 12 tablespoons of coconut oil, butter and olive oil, and receive the same benefits/stay in ketosis? I know you’ve made it clear that a heavy dose of coconut oil each day is helpful, but I’m a struggling university student and going through 12 tablespoons of coconut oil each day will most definitely take a toll on my wallet. I was hoping to drop it down to your regular recommendation of 2 tablespoons a day and adding in 10 tablespoons of butter and/or olive oil.

    Secondly, how long should I be staying on the ketogenic diet? If I see benefits, is it a lifetime commitment? Or will it help heal my head so that I can then go back onto the Regular PHD after a period of time?

    I’d appreciate your advice. Your book and blog are great, keep up the good work!


  39. P.S. I’d be great to hear any other advice you have for battling anxiety, depression, concussion symptoms without having to resort to antidepressants (which my parents and doctors are pushing).

    Thanks again,

  40. Hi Jordan,

    I would suggest trying MCT oils. A smaller quantity of MCTs than coconut oil is sufficient to induce ketosis. You can find two brands on our Recommended Supplements page: http://perfecthealthdiet.com/?page_id=1066

    6 tbsp MCT per day should be sufficient. 1 teaspoon leucine per day can help too.

    32 ounces costs $13 and has 63 tablespoons, or 10 days worth. That’s $1.30 per day or $500 per year. It’s a lot for a college student, but if it works it’s worth it.

    You should also try intermittent fasting, 16 hours fasting and 8 hours feeding per day.

    I don’t think it’s a lifetime commitment, but it will often take several years to cure these conditions. It took me 20 years to cure mine, but only a few years after fixing my diet. (Only 3 months after trying antibiotics.)

    You should alternate between the regular PHD and the ketogenic version a few times to see which you do better on. It could be either. Give each one a month at a time.

    I believe these conditions are usually caused by infections. Brain trauma breaks the blood-brain barrier and lets pathogens enter the brain, so it often coincides with the beginning of a brain infection.

    With luck, the pathogen will be bacterial and responsive to antibiotics. So you should give an antibiotic like doxycycline a try. I would get on a well-nourishing grain-free ketogenic diet before trying the antibiotics, and be well adapted to the diet and stable so that you can clearly assess the effects of the antibiotics.

    The other place to look is the gut, since there are many gut-brain interactions, and gut troubles can strongly promote brain infections. Probiotics and fermented vegetables can help.

    I agree that it’s good to look to diet and antibiotics first before antidepressants. Best to fix the problem at its root.

    Best, Paul

  41. Ok thanks a lot Paul! I’ll definitely look into getting some MCT oil.

    Now I have a few more questions from your response.

    How much doxycycline do I take each day and for how long? Hopefully my doctor will agree to give it to me, any advice on that? As well, should I be taking probiotic supplements at the same time as the antibiotics?

    Secondly, when you say a “grain-free diet,” can I still include white rice as a part of my 200 ketogenic carb calories each day, or is it better for me to take that out now as well

    Lastly, if I’m on the ketogenic diet, is it crucial for me to consume 1 pound of meat/seafood/eggs each day, or will the lower end of the spectrum do (0.5 lbs)?

    Thanks for the help Paul!


  42. Hi Jordan,

    Your doctor can advise but 200 mg/day is a standard dose.

    White rice is good. Just follow the book.

    You need enough protein to get you to 600 calories carb+protein, which isn’t quite a pound but close.

    Best, Paul

  43. Hi Paul,

    I went to a doctor today but she refused to give me a prescription of doxycycline! She didn’t understand why I would need it and said it was “inappropriate under my circumstances.” I tried to explain, but she wouldn’t budge.

    Do you know of any information/studies/research out there that explore or show that doxycycline might benefit the brain, depression and other neurological disorders? Since I really want to see if this antibiotic will help me with my depression/concussion symptoms, I plan on going to a different doctor next week, and would like to show up with some info to present to him/her.

    Any advice would be great.


  44. Hi Jordan,

    Give rats a brain infection and they develop depressive-like symptoms, http://www.ncbi.nlm.nih.gov/pubmed/20450961. Same with mice, http://www.ncbi.nlm.nih.gov/pubmed/19339614. In fact, any method of inducing the main anti-bacterial and anti-viral immune pathway, which acts through interferon-gamma, induces depression. For instance, one can simply inject bacterial lipopolysaccharide (LPS) into the brain.

    One of the effects of interferon-gamma is to cause sequestration of tryptophan via indoleamine 2,3-dioxygenase (IDO) and kynurenine (starving bacteria and viruses of tryptophan) which as a side effect produces a deficiency of serotonin which is made from tryptophan. The most effective anti-depressants such as the SSRIs increase levels of serotonin.

    In addition to low serotonin, high levels of kynurenine, the disposal pathway for tryptophan, are associated with depression. See, e.g., http://www.ncbi.nlm.nih.gov/pubmed/21605657.

    Here’s a recent review of the theory that IDO activation (normally, by infections) causes depression: http://www.ncbi.nlm.nih.gov/pubmed/21185346.

    High levels of kynurenine also appear to be linked to migraines and headaches. See http://www.ncbi.nlm.nih.gov/pubmed/21593189.

    This is very straightforward biology and I could compile hundreds of papers attesting to the mechanisms. I guess I’ll have to work up more into a post sometime.

    Trauma to the brain, as in a concussion, often breaches the blood-brain barrier and provides the opportunity for pathogens to enter the brain and start an infection.

    Chronic infectious diseases like Lyme often cause depression and antibiotic treatment can relieve the depression: see eg http://www.ncbi.nlm.nih.gov/pubmed/18971914.

    There are other pathways linking infection and interferon-gamma to depression. For instance, interferon-gamma upregulates a gene called MKP-1: http://www.ncbi.nlm.nih.gov/pubmed/19050284. Emily Deans did a post last year on a Nature Medicine paper showing from brain autopsies that MKP-1 is upregulated in depression patients, http://evolutionarypsychiatry.blogspot.com/2010/10/did-i-mention-that-depression-is.html.

    So, essentially, mechanistically we know that any infection in the right parts of the brain can cause depression and headaches; that concussions greatly increase the risk of such an infection; and that antibiotic treatment can sometimes relieve depression and headaches.

    I don’t know what the odds of success are in your case. But I think it’s worth a try!

    Unfortunately, most doctors today are reluctant to prescribe any unproven therapy. And the “proof”, in the form of clinical trials, is so expensive it will never be undertaken.

    I had the same problem you’re experiencing. In the end I was able to get antibiotics because of bodily, not brain, symptoms that were clearly infectious, even though it was for the neurological symptoms that I really wanted the treatment.

    Good luck!

  45. I love Kate’s story! I’ve suffered with migraine my entire life and then nose-dived into the nightmare migraine-associated vertigo. Couldn’t get out of bed for over a year and lost my marriage because of it. For more info and a real survival kit for migraine: http://www.stoprocking.com

    BE WELL to all sufferers!


  46. I want to help someone try this approach but I am confused about the amounts you recommend:
    “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.” None of those food portions seem to add up to 200 calories. Am I misreading something?
    Thanks for all your work…

  47. Marianne Richardson

    I just learned of The Perfect Health Diet and am most intrigued, specifically because my experiences with migraine headaches have been very similar to Kate’s, who logged her experiences on your site. I, too, have many migraine triggers — many related to food, others to food dyes such as blue or yellow (annato — the worst.) Unlike Kate, I did have considerable success with Dr. Buchholz’s recommendations (Heal Your Headache) when I went off of all foods and then reintroduced them; I learned, for instance, that bananas, pork, asparagus, beets, soy, red beans, onions, fermented products, not to mention a host of additives and spices, were migraine triggers for me. Here’s my one reservation concerning The Perfect Health Diet: I cannot afford organic and/or free range beef and chicken and do not feel that regular beef and chicken is safe to it, having seen the film, “Food INC,” read Michael Moss articles in The NY Times, and listened to the June 7, 2012 NPR Fresh Air with Terry Gross program about safety concerns in U.S. meat. I do think that those of us considering The Perfect Food Diet, who consequently will increase our consumption of beef, chicken, and/or pork, must be aware of these issues.

    • Hi Marianne,

      Grass-fed/organic organ meats are very inexpensive and quite nutritious. There are ways to work these foods in on a budget.

      Also, animal foods are denser in calories than plant foods, so you might find you’d save money compared to a plant rich diet. (I assume that’s what you’re eating if you think conventional meats are unsafe and organic meats too expensive.)

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