What is the history of the ketogenic diet? Is it true it works for epilepsy?
The ketogenic diet was designed in the 1920s to help control seizures in epileptic children. The traditional treatment for epilepsy was fasting (going for an extended period of time without eating), but researchers hoped to find a way to treat seizures in children without starvation. It was found that a ketogenic diet had the same effect on seizures as fasting did. The diet has since seen a resurgence in popularity as a panacea for many modern health problems.
What is the ketogenic diet?
It is a high-fat, moderate-protein, low-carbohydrate diet. When carbohydrate foods (grains, legumes, fruit, starchy vegetables, etc.) are strictly limited, or when a person fasts, the body goes into a state of ketosis. Glucose, from carbohydrate foods, are the body’s preferred source of fuel.
In ketosis, however, the body burns ketones for energy instead. Ketones, or ketone bodies, are organic compounds that are released from fat cells in the body. Eating high fat foods has the same effect, as the fat from the food is the source of the ketones.
Why would ketosis be good for migraine?
Effect on the brain chemistry: inflammation [1], oxidative stress [2], hyperexcitability
Ketone bodies provide the body and brain with more energy than glucose does, meaning the muscles and brain work more efficiently. This is especially important for migraine [3] patients, as there is often an energy shortage in brain cells of migraineurs.
Ketones are also said to be anti-inflammatory [4], and inflammation is at the core of migraines. Adopting a ketogenic diet has been shown to have an anti-inflammatory effect on the body.
Effect on weight loss
Research suggest that the ketogenic diet is an effective weight-loss tool. This is important as there is an association between being overweight and obese, and suffering from chronic migraines (See this post [5], and this one [6]). This being said, as with any diet, weight loss is very difficult to sustain. A ketogenic diet can be a phase in a weight loss journey.
What is the evidence that the ketogenic diet works for migraine?
When looking at a treatment, there are many levels of evidence. Here are preliminary observations on the ketogenic diet suggesting a benefit for migraine.
- Anecdotes on the ketogenic diets can be found online and in the social media.
- In 1930, Barborka, one of the pioneers who popularized KD among adults, reported outstanding improvement of migraines following the initiation of KD in a study of 50 patients.
- The ketogenic diet stabilized the electric activity of the brain in a study on 18 migraineurs using a technique with evoked potentials
A study comparing ketogenic to low calorie non-ketogenic diets
A true comparative trial is the only way to demonstrate that a treatment works. One study of this kind has been recently published. (Di Lorenzo, Nutrients 2019)
A study from 2019 done by an Italian team compared two low-calorie diets in a group of 35 obese people with migraine. Patients did one month of low-calorie diet (LC) (non ketogenic), one month of no diet and one month of Ketogenic Diet (KD) in a specific sequence.
- These people did NOT have chronic migraine [7]. They had a mean of 7 headache days per month.
- All patients were obese.
- 6 patients could not complete the study.
- The ketogenic month led to more decrease in headache days (-3) compared to the low-calorie
- 75% of patients had a 50% response during the KD month compared to 8% during the LC month. That is quite striking.
- Both diets led to weight loss. Researchers suggest that the effect of the ketogenic diet is related to ketones more than weight loss.
This is a small but well done study in obese people with episodic migraine. It cannot predict what would happen in non-obese people with chronic migraine.
Basics on the ketogenic diet
In order to reach a state of ketosis, a person must fast or limit carbohydrate intake to less than 50g per day. Each meal should be made up largely of high-fat foods, some protein foods, and a small amount of carbohydrates. See a list below.
Are there risks associated with the ketogenic diet?
There are risks to this diet that are recognized by many organizations and health care researchers:
«The keto diet could cause low blood pressure, kidney stones, constipation, nutrient deficiencies and an increased risk of heart disease. Strict diets like keto could also cause social isolation or disordered eating. Keto is not safe for those with any conditions involving their pancreas, liver, thyroid or gallbladder.» (See this link [8])
It is highly recommended that you only try this diet under the supervision of a health care professional to prevent potential nutrient deficiencies.
Also, since the diet is quite restrictive, it may be that you will follow it for a while and then go back to a more regular diet.
Consider adopting a healthy diet before choosing more extremes approaches.
Look at our basic Checklist See this post [9]
Summary
- The ketogenic diet is a current focus of research in neuroscience and migraine care. There is research to support this diet and it could be considered, especially by an obese person.
- The ketogenic diet has risks and is not easy to sustain.
- Any person interested to try this diet should do so with professional guidance.
REFERENCES
- Di Lorenzo C, Pinto A, Ienca R, Coppola G, Sirianni G, Di Lorenzo G, et al. A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones? Nutrients. 2019;11(8).
- Barbanti P, Fofi L, Aurilia C, Egeo G, Caprio M. Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci. 2017;38(Suppl 1):111-5.
Basics of the ketogenic diet
You can eat the following foods on the ketogenic diet
High-fat foods
- Avocado
- Butter
- Cheese
- Coconut, coconut milk, coconut oil
- Pastured/organic eggs
- Wild-caught fatty fish
- Lard
- Grass-fed/organic meats
- Nuts & seeds
- Olives & olive oil
Protein foods
- Pastured/organic eggs
- Wild-caught fish
- Grass-fed/organic meat
- Seafood
Low-carbohydrate vegetables:
- Asparagus
- Avocado
- Broccoli
- Brussels sprouts
- Celery
- Cabbage
- Cauliflower
- Cucumbers
- Herbs & spices
- Leafy greens (lettuce, spinach, kale, Swiss chard, etc.)
- Mushrooms
- Peppers
- Tomatoes
- Zucchini
The following foods should be strictly avoided on a ketogenic diet
- Dairy products (except butter and some cheeses)
- Factory-farmed meats
- Fruit
- Grains
- Processed foods (chips, crackers, cookies, ice cream, soda, etc.)
- Starchy/sweet vegetables (potatoes, sweet potatoes, beets, etc.)
- Sugar (table sugar, honey, maple syrup, etc.)
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