What is the ketogenic diet?
The ketogenic diet is a low carbohydrate diet that is high in fat and moderate in protein. The intended result of this way of eating is to generate nutritional ketosis. If you aren’t currently on a ketogenic diet, your metabolism is using glucose (blood sugar) as its primary fuel source.
When you eat, your body digests your food and uses the carbohydrates from the meal for fuel. If there isn’t enough, your body takes the fuel it needs by using stored glycogen from your liver and muscles. When you haven’t eaten in a while the glycogen is converted for needed blood sugar.
After prolonged periods without adequate food and/or extreme exercise, you may start using your body’s fat storage. When your body uses its fat, the fuel source is from ketones. Fat does not breakdown to blood sugar so your body switches fuel sources from blood sugar to ketones.
What foods are on a well-formulated ketogenic diet?
The keto diet excludes all added sugars, grains and starchy vegetables. Because of the natural sugars in fruit, small amounts of berries are the only suggested fruits. Although avocado is technically a fruit, it is allowed.
Keto includes lots of fat and fatty foods. All meats, poultry and seafood are allowed as well as full-fat cheeses and cream. Low-carb veggies and leafy greens are allowed. Getting into consistent, sustained ketosis is what I consider as Phase 1 of keto. For most people this will take at least a few days and will depend on your own metabolism as well as how low your carbohydrate level has been.
The goal of maintaining the diet is to switch your metabolism so that you become a fat-burning machine instead of a carb-burning machine. Phase 2 of the ketogenic diet happens when your personal “hybrid engine” goes through a process referred to as “keto-adaption.”
Based on the research and observation of Dr. Stephen Phinney, one of the most prominent doctors in the field of low-carb and therapeutic ketosis, this process can take several weeks but is usually complete by 8 weeks.
During this second phase of the ketogenic diet, your brain and other organs and your biochemistry adapt to the different energy source. The body adjusts to have the appropriate amounts of enzymes for the different types of chemical interactions that keep us healthy and feeling good. For most people, the Phase 1 transition period is not notable but others may have some symptoms like lethargy and headaches.
While overblown and anxiety-provoking, “keto flu” happens in this early phase. It will be discussed later.
The “magical” effect of ketones
Nobody truly knows why being in nutritional ketosis is helpful for so many. Perhaps ketones alter cell metabolism thereby bringing relief. It is thought that some people with migraine may have faulty or impaired mitochondrial function. If you recall from biology class, the mitochondria are critically important powerhouses of our cells. Certain preventive medications we take as well as some suggested nutritional supplements (i.e. riblofavin) effect these important organelles. Ketones have been shown to enhance mitochondrial function.
Additionally, the keto and migraine link may be due to neurotransmitter (chemical messenger) balance. Ketones may act protectively in the migraine brain by altering the brain chemistry in a favorable way.
Of course there is no real “magic,” but being unfazed by my usual migraine triggers while in ketosis felt truly miraculous. I could take joy in eating foods like raw onions and parmesan cheese again.
Carbs and migraines
Some of us have altered glucose metabolism. There is no denying that there is a relationship between simple carbs and migraines for a significant percentage of people.
Perhaps the keto diet for migraine works for some people as it addresses this flaw in their metabolism.
Dr. Alexander Mauskop, an authority on headache disorders, in his recent book, The End of Migraines- 150 Ways to Stop Your Pain, he states:
Sugar is not always an obvious trigger. Many people develop migraine hours after a carbohydrate-rich food. Three-quarters of people with migraine have reactive hypoglycemia. This means that their blood sugar drops too low after a carbohydrate-rich meal.
Inflammation, keto and migraines
There is great controversy about what actually constitutes an anti-inflammatory diet. In general, the Mediterranean diet is often recommended to minimize inflammation. This is a very good diet recommendation for the general population. Because it’s a way of eating based on whole foods with limited sweets and highly processed foods, it would be expected that some people with migraine would improve.
However, for some people with frequent migraine attacks, the “magic” is in the ketones. Their metabolism, and possibly overall inflammation is improved with a well-formulated ketogenic diet.
Keep hydrated and focus on your electrolytes
When starting the ketogenic diet, your body goes through many changes as it becomes a fat-burning machine. For many people, the keto foods they choose to eat are whole foods and much less processed than foods they used to eat. This often means that their sodium intake is lowered without them realizing it.
In these early days, the lowered carb intake and burning-off of the body’s stored carbs signals the kidneys to make more urine. So, many people notice that they are needing to pee more as well as feeling the urge to drink more.
For overall health, as well as to avoid some of the common side effects of keto, it’s important to boost your fluid intake as well as your electrolytes (sodium, potassium and magnesium). DietDoctor.com recommends drinking 3 liters per day (~101 ounces) for the first week of keto. As someone who struggles with drinking enough, that amount seems daunting but it’s just during the first week of keto.
Paying attention to electrolytes is also very important for overall health and an easier transition to ketosis.
What about keto headache?
Keto headache is usually from dehydration headache or shifts in electrolytes. Sometimes people feel lousy and have “keto flu.” Keto headache doesn’t last long.
As stated above, for some of us, there is a relationship between carbs and migraine. The headache may also be due to a “detox” effect combined with being a bit sad about not having some carby favorites. Treat yourself to a nice “fat bomb” to get yourself through. In Phase 2 you will be feeling better and will be making changes to your routine meals and snacks.