Migraine Treatment - Ketogenic Diet
Eating "Keto" is popular these days as a way to lose weight, but did you know that the diet was originally developed as a way to control seizures in children? Let's start with the basics. The ketogenic diet is a low-carbohydrate, high-fat diet that has the goal of putting a person into "ketosis", a state in which the body is burning almost completely fat instead of glucose. This helps with seizures because it is believed to increase the amount of GABA in the brain which inhibits seizures. To put it simply.
In January of 2018, I started the ketogenic diet with the idea that it might help migraines because many of the standard migraine preventative treatments are also seizure preventative treatments. There has also been some research showing that exogenous ketones might help prevent migraines. (Exogenous ketones taste horrible, though!)
The idea of me going on a ketogenic diet really was kind of laughable. I was a complete carbohydrate addict! Show me to some french bread, ice cream, and brownies, and I'd be a happy girl! And throw in some potatoes! But, Patrick and I decided we were going to do it. So, we didn't do it halfway. Patrick cleaned out the entire pantry and gave his mom all of our carbohydrate-laden food. We were on our keto journey!
Nutritionists often don't like the idea of the keto diet because it's not usually a good idea to cut out a complete macronutrient class from your diet. Also, many people who go on keto go right from white bread and potatoes to steak and bacon. Loading up on all of your calories from saturated fat might not be the best idea, but I do tell people that it got me through the first couple of weeks.
The first couple of weeks of the ketogenic diet is pretty tough. Not only was I getting used to not eating things that tasted sweet, but my bodies enzyme systems were all changing over from being used to using glucose as fuel to using fat or ketones (in the brain) as fuel. This led to "keto flu" - fatigue, headaches, muscle aches, etc. And, since I was trying to treat migraine with the diet, the headaches were particularly bothersome.
But, something crazy happened. After I got through "keto flu", my headaches improved. I didn't need any acute headache medications for a month! Unfortunately, the results didn't last (and I'm in the middle of a massive headache streak right now), but I had a month with just minor pain. And, over the course of less than a year, I lost 60 pounds and it has stayed off. Despite the chronic migraine going back to where it was, I generally feel better eating a ketogenic diet, so I'm sticking to it.
But, I don't necessarily recommend it for everyone. I think it's great to try if you have chronic migraine. It's probably helpful for Type 2 Diabetes Mellitus. You can't just jump in and eat only bacon and steak, though. Dietary science is confusing and we don't have good research on the "perfect" diet, but we do know some things.
If you are going to eat keto, do your research. And be strict with it at first or your just going to stay in keto flu and be miserable. I like Craig Clarke. He's probably overkill on some stuff and a little pseudoscience on other, but you could do worse. You need to include the ketogenic diet with exercise, so don't think you get to sit around and eat cheese curds and watch Netflix. Sorry.
You can find lots of recipes and tips for how to live keto online. I'll just tell you a couple of things that work for me. I don't eat much processed food anymore except for a couple of things. I read labels obsessively, but it's a good thing I don't mind cooking from scratch. I mostly shop the edges of the grocery store and then sneak into the aisles for a few things. I have found Lily's sugar-free chocolate bars made with stevia. I'll go through one or two of those a week. And, I like BBQ pork rinds. And, sometimes a spoonfull of natural peanut butter hits the spot.
But, otherwise, we eat real food in our house, just without the pasta, rice, and potatoes. I still like rice and gravy, so I buy cauliflower rice. We put our spaghetti over zucchini noodles. Lots of times, I just add an extra veggie at the meal. We don't eat meat at every meal; sometimes, we have eggs and veggies; other times we have veggies with some variation on a cheese sauce (it's nice to live close to a dairy). We eat lots of veggies, but we use lots of dressing and butter and cheese. I actually eat more "healthy" foods than I used to because I have more room in my diet for the veggies now that the processed carbs are gone.
What I have noticed most of all is how little I actually eat now. I had a hysterectomy right before Thanksgiving and I've been eating low-carb, but not always in ketosis. When I get into deeper ketosis, I don't feel very hungry and I eat much less. There have been times in the last few months that I ate "normal" amounts that was quite uncomfortable. So, I'm starting to get the hang of what low-carb vs. ketosis really feels like, even when I don't check my urine strips compulsively.
When I read negative critiques of the ketogenic diet, they center on a couple of things. First of all, there is concern about the amount of saturated fats that are recommended. In terms of percentage of calories, someone following a ketogenic diet may be getting a fair bit of their calories from sat fats, but, if they are in ketosis and exercising, the absolute number of calories from sat fats is probably pretty low. In addition, most responsible people who recommend keto, do recommend getting as much unsaturated fat as possible as long as it's not trans fats or processed fats.
Nutritionists are also concerned about the emphasis on fats to the exclusion of vegetables which are a big source of carbohydrates for many people. When eating on the keto diet, the calorie source is important, but micronutrients are also important. Above-the-ground vegetables are an important source of those nutrients, the 30-50g of carbohydrates that everyone does need, as well as fiber. In fact, many people writing about keto today are reminding keto dieters to keep their protein intake to a reasonable level because protein can be broken down into glucose and can throw someone out of ketosis. That big ole sirloin may not be the best thing for someone on the keto diet, after all!
Some nutritionists are also concerned about the lack of fruit available on the keto diet. Actually, you can fit seasonal berries into the keto diet without too much trouble. But, no, an apple is just too full of sugar. This isn't a problem for me; I don't like fruit!
Those of us eating keto also need to drink lots of water. Generally, I scoff when people talk about how they need to drink more water to lose weight or be more healthy. Basically, if you are a person who drinks water when thirsty, you are getting enough water. There is no study out there that says that you need 64 ounces of water every day for health. Think of all those bedouins in the Arabian desert - someone should tell them that they are dying!
So, our bodies can adapt to a wide variety of conditions. But, if we are going to subject them to the keto diet, we need to give it one of the most important tools: water. And, along with water, minerals. Basically, breaking down fat is a water-intensive process, so you need lots around. Then, you need plenty of minerals - salt, potassium, magnesium, etc. - to flush through the kidney with the water. While I'm in keto, I truly aim for the 64 ounce number, although the best test is to urinate regularly with light colored urine. And, to not feel tired, dizzy, or light-headed.
That's where I am with the ketogenic diet. It's an eating plan that can be healthy, but you have to work at it. It's really worth it for me. And, maybe if I can get down into deep enough ketosis again, I can get another calm migraine month?
Have you tried the keto diet or any diet for migraine or other reason? What were your results?