Potential Protective Mechanisms of Ketosis in Migraine Prevention
I don’t get migraines, but some of my friends do. I feel for them and have tried to come up with worthwhile advice. Some advice is straightforward: good sleep hygiene and stress reduction techniques such as meditation or Positive Intelligence. (For a description of the Positive Intelligence approach, see “On Human Potential” and “How Economists Can Enhance Their Scientific Creativity, Engagement and Impact”). Two other recommendations I have made are
acupuncture—which the Wikipedia article “Migraine” says there is a little evidence for and seems to me unlikely to have much of a downside, and
the combination of a low-insulin-index diet and fasting that is a mainstay of my diet-and-health posts. (See “Miles Kimball on Diet and Health: A Reader's Guide.”
A low-insulin-index diet combined with fasting puts the body in fat-burning mode, or ketosis, a fair share of the time. When the body is in fat-burning mode, fasting (going without food but drinking water) is easy. This is dramatically different from fasting when in sugar-burning mode, which is extremely unpleasant, as the Minnesota starvation experiments showed. (The experimental subjects consumed two small high-carb meals a day—just enough to keep them out of fat-burning mode, but too few calories to let them feel OK without smooth fat burning.)
Going without food when in sugar-burning mode leads to low blood sugar, which can trigger a migraine. By contrast, in fat-burning mode, the brain will be able to get plenty of energy from the ketone bodies that are produced when in fat-burning mode.
To emphasize: the trouble with eating sugar and easily-digested starches and with eating all the time is that it leads to a lot of moments of subjective starvation caused by low blood sugar. Moments of intense subjective starvation tend to point to low blood sugar, which can make migraines more likely.
In a seeming paradox, as long as you are eating low on the insulin index, eating nothing is less likely to lead to moments of intense subjective starvation because the cells in your body are well-fed as long as you are (a) in fat burning mode and (b) still have body fat left to burn.
Though full-scale clinical trials remain to be done for the effect of ketosis on migraines, there is decent evidence that ketosis is indeed helpful in reducing migraines. Let me give you a few quotations (with bullets added to separate quotations) from the recent paper “Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention”:
Despite migraine’s primary pathogenic mechanisms being still largely unknown [8], accumulating evidence suggests that migraines could be—at least partially—an energy deficit syndrome of the brain …
Mimicking this state of fasting, the ketogenic diet (KD) promotes the hepatic production of KBs with a high fat, low carbohydrate and moderate protein content. It was developed about 100 years ago after the observation that prolonged fasting has anticonvulsive properties [11]. Within recent years, the KD has received renewed interest, in particular since KBs might be beneficial for a variety of other neurological disorders [12,13,14]. All brain cells have the capacity to use KBs [ketone bodies] as respiratory substrates [10].
Several case studies have demonstrated the potentially migraine protective effects of ketosis [22,33,34,35,36,37]. A one-month observational study of KD in 96 migraine patients as part of a weight loss program found a reduction of up to 80% in migraine frequency, severity and acute medication use [37]. The same intervention in 18 episodic migraineurs induced a 62.5% reduction in migraine days …
In an area such as migraine prevention, sufferers can quickly gather a substantial amount of individual-specific time-series evidence. In saying this, I speak as a macroeconomist: in studying the behavior of GDP, we often have much, much less evidence than a migraine sufferer could gather within a single year from keeping careful track of their own experience about whether a low-insulin-index diet combined with fasting reduced the frequency of migraines.
It is well-established that being in fat-burning mode as opposed to sugar-burning mode puts the brain in a substantially different state. Therefore, a low-insulin-index diet combined with fasting is likely to be a substantial intervention. What evidence there is suggest it is more likely to be in the desired direction of reducing migraines than the opposite. But it is straightforward to find out in one’s own individual case.
Let me caution that one should do the low-insulin-index diet for a while (say six weeks) before trying to skip meals. A good path here is quite similar to what one would do if the objective were to lose weight. See
For annotated links to other posts on diet and health, see: