Hello Elena. Glad you took the time today to tell us a bit about migraines and the keto diet. You are a real pro in this area.
Oh well. If you’re doing a clinical trial and you’re studying that, then that has to be the case. But four years ago I had no idea either. I didn’t even know then that proteins can be converted into glucose and where carbohydrates are in it at all.
How did you actually come to choose this scientific field? Was it because of your own background with migraines?
It was actually a big coincidence! I was sitting in the library, avoiding writing my second master’s thesis for a bit, and instead I was flipping through a “nature” magazine. In this issue there was an epilepsy special, describing the oldest form of therapy for epilepsy: The Ketogenic Diet!
So what has been observed with this therapy through the Keto Diet?
About 100-150 years ago, it was found that when an epilepsy patient fasts, the epilepsy attacks reduce significantly and in some even disappear completely. Of course, no human being can fast forever, otherwise he will die of hunger. However, this is the origin of the classic ketogenic diet. One tries to imitate fasting in a diet form in such a way that one takes quasi 80% of the calories from fat to itself, 15% from proteins and the remaining 5% from coal hydrates. The reason for this is that the body does not necessarily know whether the fat comes from outside or from the body’s own fat reserves and the proteins from outside or from the muscles or the intestines. Unfortunately, due to the appearance of new pharmaceutical products such as antiepileptic drugs, this form has been somewhat forgotten.
So how did you come to apply this diet to migraine?
Well. I looked at the mechanisms and thought to myself, Man, this must be relevant to migraine as well. That migraine and some forms of epilepsy have, at least in part, similar genes was already known. I myself was already chronically affected by migraine during my master’s degree and that’s why I went into migraine research; I did both my master’s theses in the field of migraine, but not yet in ketosis. When I read that, I wanted to write my doctoral thesis about it. This was not so easy at first, because many doctors and classical neurologists had not heard of ketosis. Accordingly, everyone was still very skeptical.
You still made it though…
Exactly! Then it worked out in Basel. I had to turn down all my other scholarship offers, but I was able to investigate this in a side project; also to make Basel more attractive. The investigations went so well that it has now become my main project. Now we are investigating ketone bodies as a possible migraine prophylaxis.
So what makes the ketogenic diet so effective for migraine?
There are many possible pathways / mechanisms by which ketone bodies could positively affect migraine. Ketone bodies lower brain excitability; they provide an alternative energy source in addition to glucose; further, they are potential antioxidants. Oxidative stress is something I’m sure everyone has heard of. Too much of it is harmful and increased oxidative stress is also associated with migraines and their trigger factors.
The keto diet virtually helps prevent the energy deficit that is thought to occur in the brain during a migraine. I always like to compare this to an electric car. Nowadays we – especially we migraineurs – are all electric cars because of our carbohydrate-heavy diet, and if we don’t get new electricity or something to eat every few hours, we stop and the migraine attack comes. The goal of the keto diet is for us to become hybrid cars again, so that when the storm – glucose – is empty, we can switch to gasoline – fats – and still keep driving without being crippled by migraines. Dual fuel so to speak, and gasoline as we know we can store much more than Storm, so our fat stores in the body are also much larger than the glucose stores. So in short, a ketogenic diet achieves that the brain has an alternative source of energy available that it can constantly access and also blood sugar fluctuations are avoided.
So is the keto diet applicable to any form of migraine?
That’s a good question! Migraines are multigenic: That means there are a lot of different genes involved. You should always look at the trigger factors. If the migraine is triggered by, for example, exercise, skipping meals, alcohol, or not drinking much, then it is relatively likely that energy metabolism plays a role. If that is the case, then it is also more likely that a ketogenic diet will help.
Do you really have to do the keto diet consistently for life, or can you allow yourself a cheat day?
So a cheatday makes little sense with migraine, because it can be that you fall up to a week completely out of ketosis and accordingly no ketone bodies produced. But at least, in my opinion, you have to stay in ketosis for life. It takes 2-6 weeks for the body to really be completely in ketosis and for the body to get used to the ketone bodies and the switch. Anyone who wants to try it should definitely try it consistently for 6 weeks!
Is it possible to keep a balanced diet despite the keto diet?
So I have to say personally I really missed fruit. It’s not necessarily about the carbohydrates per se. If you only eat meat and fat, you have to make sure that you also eat raw organic liver, for example, so that you get your vitamins, because they’re not in the muscle meat. So you have to be really well informed. So if you go to McDonald all the time and you leave the bun out of the burger, you’re not going to be healthy even if you’re in ketosis. So you have to make sure you have good quality food. Also, don’t eat too much fish, as it is often contaminated by heavy metals. I would rather go for organic products when it comes to animal products. Vegetables should be consumed as much as the body tolerates for maintaining ketosis. A little bit of peppers and tomatoes or a small amount of berries would already be good, in my opinion.
So how should you proceed when you decide to start the keto diet?
It also depends on the type. There are people who start overnight and go directly to under 50g carbohydrates per day and are still top fit after a week. For me, however, it went better if you slowly introduce it over 6 weeks. At the beginning first all white flours and sugar away and slowly from “low GI” to “low carb” to ketogen durchzuarbeitet. The advantage of this is that it is easier to see whether “low carb” or “low GI” might not already be sufficient as a diet. The body also needs time to get used to the change. That is a bit like smoking: It is also harder to quit completely overnight than to gradually wean yourself off. Many people also make the mistake of eating too little salt. You should really make sure that you take enough salts so that you still have your minerals. It is best to take high-quality salts such as rock salt or Himalayan salt. Cheap table salt would not be the best option.
Before your ketogenic realization, did you resort to other means? Be it medications or other forms of therapy?
Oh but hello (laughs). I tried everything from acupuncture to any pharmaceuticals. Sometimes also with blatant side effects such as dementia-like memory loss. Once I even forgot the name of my best friend. This went so far that I sat in my lectures at Oxford with anti-epileptic drugs, because otherwise I would not have made it with the migraine.
That must have been insanely frustrating…
Totally! I was really thinking to myself: I HAVE to find something, because the way it is now – this is no life. The side effects and the pain itself are so unbearable. I had migraines up to 30 days a month permanently and that can’t be ignored anymore either. Also many self-experiments went wrong in the beginning. But when it worked then: Madness! From then on I fought to make it public! Ketosis is really an option with fewer side effects.
Is there actually a ketogenic snack you can no longer do without?
Oh well, I haven’t really gotten out of the habit of snacking yet either. I used to have a sweet tooth. Nuts are always very good, although you have to be a little careful with cashews because they are very sweet. What also works well is a very nice Spanish Serrano ham with which you wrap walnuts. This is super yummy! You can also make your own chocolate, although you can now buy good 90% chocolate. The taste receptors change over time, which has the advantage that things seem sweeter than you were used to. You can always make some vegetable sticks with homemade mayonnaise as a dip. That’s awesome, too. But my favorite is the nuts.
Dear Elena, thank you so much for taking the time, despite your tight schedule, to answer so many questions about the keto diet and migraines. If you would like to read more about the current study by Elena Gross (MSc in Neuroscience, University of Oxford; BSc in Psychology, University of York), you are welcome to do so at the following link: https://www.headache.ch/migraket
