How to Start
What exactly IS a Ketogenic diet?
Expert on nutritional ketosis, Dr. Stephen Phinney, and the man who has been supporting this diet for the past 35-years, (when you know that wasn't a popular choice), created these videos to explain the science behind ketosis. Watch all 3 parts here if you are new to the concept or want a refresher on the topic. Excellent stuff.
How does this work for the migraineur?
Migraineurs have a the added issue of getting off medication while making the transition over to a fat-adapted metabolism. This can be a bumpy ride. If you have been taking medication regularly, you must discuss weaning off your medication with your doctor.
For me, getting off triptans felt like I was continually taking two steps forward, then one back, for several months. Always improving, yet not cured. Do not give up. It took me a decade to get so sick; it was going to take time to heal.
Although the 'ketone' effect on my brain was noticeable soon after changing my diet: less overall pain, less light sensitivity, increased tolerance to triggers, and many more benefits, I was still vulnerable to getting a migraine around my period or when flying. Only after adapting to a fat-burning brain, and getting my electrolytes balanced did I sail through a flight or my menstrual cycle migraine-free.
Also see Making of a Migraineur for more on my experience.
Time to Talk Macros
A LCHF diet is not just one way of eating. The amount of carbs to fat ratio one eats varies person to person, depending on individual needs. Although the common theme is to reduce overall carbohydrates, moderate protein and eat fat calories to satiety, it will look very different for each individual. Some versions are higher in carbohydrates than say, a strict ketogenic diet but can still be very helpful in reducing migraines. For example, thanks to Dr. Andreas Eenfeldt and his site Diet Doctor, here is what 3 different dinner plates look like on the spectrum of Low Carb.
How low is low carb?
LCHF macros are not set in stone, yet the Classic Keto Macros are usually agreed upon to be:
Protein - 15-20% of daily calories
Fat- 70-80% of daily calories
Carbs - 5 % or around 20 grams a day.
Whereas moderate low carb would be around 20-50 grams a day.
Liberal low carb would be between 50-100 grams a day.
Your migraines may decrease significantly without being in strict ketosis, however I discovered that the fewer carbohydrates I eat, the more powerful the effects on my brain, migraines and blood sugar are. I have found a happy 'carb' place for my personal health and test my tolerance every so often to see the results. Calculate your macronutrients here.
How does exercise affect the migraineur?
Going low carb has been a great way to help me increase my insulin sensitivity, yet a good exercise program has proven to be a valuable ally in my quest for overall health. Before I was fat adapted, at times, exercise could be a migraine trigger. My tolerance for intense exercise was so low! I blame some of it on improper hydration and electrolyte imbalance. I needed so much more water and salt then I was actually getting. Also, since I was not fat-adapted, my blood sugar would drop during exercise yet I couldn't access my stored fat yet. A migraine was likely to ensue.
I have exercised my whole life and it has been an incredible tool to reduce stress, enjoy nature, get stronger and generally improve the quality of my life. As you become more tolerant to exercise on a LCHF diet, the motivation to continue increases and the fear of triggering a migraine will hopefully become a thing of the past. I feel that it's now possible to return to the level of fitness I enjoyed a decade ago.
How exercise can help a fat-adapted migraineur:
Exercise reduces stress = less brain excitability
Exercise promotes a good sleep
(Stress and poor sleep are both common migraine triggers.)
Exercise promotes the body to release endorphins (the body's natural pain killer)
High Intensity Training, like a sprint, assists the body in burning up stored glucose in muscles, expediting fat-burning and boosts ketone production.
Exercising however intense, even walking, will help to lower blood sugar and insulin levels. On a low carb diet, this will lead to the release of stored fatty acids that your liver then converts into ketones. Win-win.