The Ketogenic Diet for Migraines (Migraine Miracle Moment)

In this episode of The Miracle Moment, I discuss the basics of a ketogenic diet, including the best time to use it in your battle to defeat the beast.

Links mentioned:

MIGRAI-NEVERLAND, our premier resource for those who want to find their pill free path to migraine freedom:

The “KETO BLAST” 30 Day Challenge, starting Oct. 7:

PRIMAL PROVISIONS, our Migraine Miracle meal planning service:

PRIMAL PROVISIONS Pick of the Week (Roasted Salmon with Blueberry Compote and Crispy Kale):

Migraine Miracle Facebook group:

The book that started it all – The Migraine Miracle:

Full archive of Miracle Moment episodes can be found at



[00:00:05] Hello out there in Migraine Miracle land. Welcome to another episode of The Miracle Moment. [4.7]

[00:00:10] I’m your host Dr. Josh Turknett. I’m a neurologist, a migraine specialist, and author of the book The Migraine Miracle, and I’m a migraine sufferer myself. [8.7]

[00:00:19] And the mission of this show, the Migraine Miracle Moment is to help you find your path to migraine freedom without pills. So I’m currently traveling, hence the different background behind me. [11.3]

[00:00:31] And I wasn’t going to be able to come to you live today so have prerecorded today’s episode. And in this episode I’m going to talk about the use of a Ketogenic Diet, or nutritional ketosis, for migraine prevention. [14.7]

[00:00:47] So ketosis can be an extremely powerful weapon against the beast, but it’s also one that is most effective when it’s used at the right time. So I’m also going to be discussing here how to know if it’s a good time to give the Ketogenic Diet a try, and how I personally intend to use it from here on out. [19.9]

[00:01:07] Now, as some of you may already be aware, a Ketogenic Diet has recently emerged as a really exciting therapy for a number of chronic conditions, especially ones that involve the brain. [12.2]

[00:01:20] And it’s being used both for treatment and prevention. So in conditions like Alzheimer’s, Parkinson’s, ALS or Lou Gehrig’s disease, obesity, diabetes, epilepsy, cancer, depression and anxiety, bipolar disorder, schizophrenia, just to name a few of the things. [16.0]

[00:01:36] And because of this there’s a tremendous amount of interest in the scientific community right now in furthering our understanding of its benefits and all of its potential applications. And of course we’ve seen fantastic results in our community of people using a ketogenic diet to control migraines. [16.2]

[00:01:53] And we’re going to be starting what I think is our third 30 day Keto Blast challenge this Saturday October 7th. That’s part of why I’m covering keto this week. [11.4]

[00:02:04] Earlier this morning I posted a poll in our Facebook group just to kind of gauge the level of familiarity with the ketogenic diet and I asked folks to pick the statement that described them best and the options were “I know little to nothing about it.” “I’ve heard about it but I’ve yet to try it.” “I’ve tried it before and loved it” or “I’m keto right now and intend to stay that way. [23.7]

[00:02:28] So as of this recording we’ve gotten I think 28 responses, over half of which were people saying they were in ketosis right then and intended to stay that way. [10.2]

[00:02:39] So I was surprised at just how many folks are doing it right now and are intending to stay that way because they’re getting such great results from it. [7.6]

[00:02:47] So we know that there are probably many others out there who are interested in seeing what the ketogenic diet is all about, but kind of feel overwhelmed by it all. [8.7]

[00:02:56] What foods to eat, measuring the amount of fat protein and carbohydrates in the diet, and so on. And we know that for something like this getting started is really the hardest part, because once you get over that initial hump and establish some new habits and routines that you can start to depend on, things get a whole lot easier. [18.2]

[00:03:15] So our goal with the Keto Blast challenge was to take this thing that can feel hard and a little bit overwhelming and trans transform it is something that’s simple and easy and fun and some you get to do with a group of people who will support you and cheer you on in the process. [15.1]

[00:03:30] And you can learn more about the challenge and read what prior challenge participants had to say about it by going to, and that’s linked in the show notes as well. [13.0]

[00:03:45] So once again that is launching on Saturday October 7th. And if you’re listening to this or watching this and it’s past that day. Don’t fear. We do these Keto Blast challenges regularly so you can still head over to the Keto Blast page to pre-register for the next one. [16.2]

[00:04:02] Or you can join our Migraine Miracle Facebook group to make sure that you’ll hear when the next one is coming. Another thing you could do is become a member of Migrai-Neverland, which is our premier community for migraineurs and gives you access to all of our challenges – unlimited access to all of those, and you’ll automatically be invited to each one each time it launches and so you can learn more about that at, which is also linked in the show notes. [32.4]

[00:04:35] And now it’s time to celebrate Beast Slayer of the week. and it is Leah. [5.6]

[00:04:41] So this one was just posted I think earlier today. And she says during September I had one migraine just one as opposed to the 12 to 15 I was having five to six months ago. [12.0]

[00:04:53] I also had only two days with headaches instead of a headache almost everyday after I discovered Dr. T. It took me a month to wean myself from all the migraine medication and over-the-counter drugs that I was taking. Then four months of a keto diet healing my brain I’m looking forward to the possibility of maybe no migraines next month. [18.3]

[00:05:12] Thank you Dr. T. I wouldn’t be here without your generously giving advice. [3.7]

[00:05:16] Well you are most welcome Leah. [1.4]

[00:05:18] So there are a couple of things that I like about her post. Number one is the dramatic improvement she’s made so going from having headaches nearly every day six months ago to only having had one in September. [14.7]

[00:05:33] And number two is that the first thing she did was tackle the medications. And I know you may have heard me say it before but it bears repeating because it’s just so important. And that is that conquering rebound or reducing and eliminating medication induced vulnerability is so so important as the first step on getting on the path to migraine freedom. [24.1]

[00:05:59] Like I said until rebound is broken nothing is going to work. And one of the main reasons I beat this horse so much is because I sometimes see folks launching into major changes in diet or lifestyle including a ketogenic diet without first addressing rebound as well, and then not seeing results and thinking that it meant that those changes weren’t effective, when the reality is the effects of the medication were preventing any progress like I’ve talked about before. [31.0]

[00:06:30] And I’ve had a couple of episodes devoted to that topic. You can find those at the page on the web site with the archive of all prior episodes, which is [12.1]

[00:06:42] So Leah clearly got that message and focused on the medications first and because she did so, she was then able to reap the full benefits of the plan, and of a ketogenic diet. [12.4]

[00:06:55] And like many others who’ve done our Keto Blast challenge, and many others in that survey, she decided to continue to stick with it. Not only can a ketogenic diet have a really powerful impact on migraines, but it’s also common for people to report significant improvements in energy levels, mood and anxiety, and mental clarity. [20.4]

[00:07:16] And so those are some of the reasons why folks tend to stay with it for longer periods of time. [4.3]

[00:07:21] So on to the topic of today which is the Ketogenic Diet for migraineurs. [5.1]

[00:07:27] So I’m going to start by calling your attention to this study, which was published in The Journal of the American Medical Association, and which was a series of case series of 50 patients with chronic migraines who were treated with a ketogenic diet, and the results were very very good. [17.8]

[00:07:45] So here’s one of the tables from the study which summarizes some of the before and after characteristics of 14 of the study participants. [8.4]

[00:07:54] So you may or may not be able to read this clearly, but we’ll see here that I think 13 of these people were women and one man. [10.0]

[00:08:04] And it gives how they were doing before treatment and after treatment. [5.6]

[00:08:10] So here’s one saying this patient had about one headache per week less than two to three days. This was a 28 year old woman. And then she stayed in ketosis and her attacks disappeared after two months. [14.2]

[00:08:24] This one was 26 year old woman having migraines twice a week lasting about two days, and then going after ketosis headache frequent first six weeks on diet. Nonsense. [10.4]

[00:08:35] Here’s another one from a 53 year old woman one to two a week lasting one to two days, menopause at 38. And then after ketosis after 2 months no headaches. [12.7]

[00:08:48] These are some pretty great results. Much better than what we usually see with the preventative medications, and they’re in line with the kind of results we’ve seen with those in our community who’ve used the ketogenic diet. [13.1]

[00:09:02] But there’s one big problem with this study, which is that it was published in 1930. [5.4]

[00:09:08] So here’s a study showing some awesome results using a ketogenic diet for people with chronic migraines in a major medical journal in the year 1930. [8.6]

[00:09:17] Yet if you’re like most migraine sufferers you’ve probably never heard any medical professional mention a ketogenic diet as a therapy for migraines. And the reason for this is because of the what I call the Great Fat Scare which began not too long after this was published. [17.6]

[00:09:35] And one of the many casualties of the Great Fat Scare. which was essentially the inappropriate demonization of fat, and specifically animal fat or saturated fat, is that it essentially put an end to the research on the therapeutic uses of a ketogenic diet, including research showing the same benefits that many in our Migraine Miracle community have seen with nutritional ketosis for chronic migraines. [25.5]

[00:10:01] And this research was essentially entirely forgotten for nearly a century. [4.0]

[00:10:06] But now fortunately as the curtain continues to close on that unfortunate era in our nutritional history we’re making up for lost time. [8.6]

[00:10:15] So your first question might be what exactly is a ketogenic diet. And the answer is it’s a diet that stimulates the liver to make ketone bodies. Another way to say it is it’s a diet that produces what we refer to as nutritional ketosis. [14.2]

[00:10:30] Now ketone ketone bodies or ketones are produced by our liver in certain situations. And the primary reason that it does so is to provide the brain with another source of energy. [11.7]

[00:10:42] So most of the tissues in our body are capable of using either glucose, which we often refer to as just sugar, since glucose is a type of sugar, and fat, or more specifically fatty acids. [11.4]

[00:10:54] And we’ve talked at length about the importance of metabolic flexibility, which is the ease with which the body can switch between using fat or using glucose for energy. But the brain is unable to burn fat for energy. [13.2]

[00:11:08] It can however burn glucose, but it can also burn ketones, when they are available. And so the reason our liver produces ketones is to provide the brain with an alternative source of energy. [12.0]

[00:11:21] And why are we able to do this? So why exactly did humans develop this capacity to produce and use ketones for energy in the brain? [9.8]

[00:11:31] Well as we’ve discussed the human species has been on the planet for about two and a half million years, and almost all that time we’ve been living in the wild as hunter gatherers, not as farmers, and certainly not as modern day humans with grocery stores. [14.6]

[00:11:47] And living in the wild means that our options for food were the animals we hunted and killed and the plant food that we gathered, which primarily consisted of root vegetables and wild fruits in season. And plant matter is the primary source of carbohydrates in our diet. [15.3]

[00:12:03] Animals are essentially zero carbohydrate foods. [2.9]

[00:12:06] So any glucose that came from the diet came in the form of plant foods that we gathered. [5.1]

[00:12:12] And how much of that plant food we had access to would have varied a lot depending on the seasons and our local environment and geography, resulting in periods of time where it was more abundant and periods of time where it was scarce to nonexistent. Which means there were likely extended periods of time where we’d have had little to no access to carbohydrates in the diet. [22.1]

[00:12:35] And this fits with what we know of some of the hunter gatherer populations that have lived into modern day. [5.0]

[00:12:41] Secondly, it was likely common for wild humans to have to cope with extended periods of reduced availability of food for various reasons. So unlike the standard three meals a day routine that’s an artifact of modern culture, and made possible by the agricultural industry, which helps ensure a steady availability of food in the developed world, this was not the case for a wild human, meaning there were likely significant stretches several days or more where a wild human ate little to no food. [30.5]

[00:13:12] So in both of those scenarios we’d have been eating little to no carbohydrates in the diet for extended periods. [6.4]

[00:13:19] And as I said earlier the brain can burn glucose for energy, but it can’t burn fat, but it can burn ketones, and so it appears that this ability developed as an adaptation for when glucose in the diet was scarce to nonexistent, which as I said was likely a common circumstance for us humans for most of the time we’ve been on this planet. [19.9]

[00:13:40] You may have heard before that while we humans must have protein and fat in the diet, we can live just fine with no carbohydrate in the diet at all. [8.7]

[00:13:49] And that’s likely because we had to be able to thrive during times where they simply weren’t available. [5.4]

[00:13:55] Based on this story, as you might imagine, the two primary situations where the body makes ketones are either when carbohydrates in the diet are very low or where we go extended periods of time without eating. [11.3]

[00:14:06] This means too that our ancestors likely spent a significant portion of their lives in nutritional ketosis. [5.6]

[00:14:13] But as we humans began farming and abruptly switched from a moderate to low carbohydrate diet to an extraordinarily high one, we started spending a whole lot less time in ketosis. [10.8]

[00:14:24] But now that we’re learning more and more about all the health benefits that can come from it along with all the long term dangers of a high carbohydrate diet that’s become the standard. This is finally starting to change. [11.1]

[00:14:36] And as the study that I highlighted earlier points out that ketogenic diets were actually a hot topic in the early 20th centuries, as doctors and scientists were discovering their benefits in patients who had seizures that couldn’t otherwise be controlled, and then they began using them or testing them in other areas like migraine. [19.4]

[00:14:56] So why is it again that we’ve only recently heard about them? [3.1]

[00:14:59] That’s because the Great Fat Scare happened, and one of the many catastrophic consequences was that a ketogenic diet was viewed as unhealthy because it required a higher intake of fat, and so was something only reserved for dire circumstances. [15.6]

[00:15:15] And now that this era is on its way out we no longer see that ketosis is something to be feared. [6.0]

[00:15:21] In fact, the more we learn about it, the more we realize that it’s something that we should embrace. [4.3]

[00:15:26] In particular, nutritional ketosis has special benefits for the brain, which isn’t too surprising since the primary reason our liver makes ketones is to provide the brain with an alternative source of fuel. [11.6]

[00:15:38] And in simplest terms a brain on ketones runs more efficiently and cleanly, meaning the brain gets more energy for less work, and it creates less waste in the process. [10.9]

[00:15:50] Another problem that we run into is that in the medical community most practitioners are much more familiar with a condition known as ketoacidosis than they are with nutritional ketosis. And ketoacidosis is indeed a dangerous condition that can arise in certain situations, most commonly in diabetics who can’t make insulin. [20.4]

[00:16:11] Now both both of those conditions do involve ketones but they are not at all the same thing. Yet many practitioners, when they hear the word ketosis, will immediately jump to ketoacidosis in their mind, and then will typically move to warning about how dangerous it is. [17.0]

[00:16:29] It does seem like this situation is improving, as I’m hearing less of this problem than I once was, but it certainly is something that folks may still encounter. [8.8]

[00:16:38] And it’s really just an issue of needing to educate the medical community about it, which I think will continue to happen because ketogenic diets are only going to grow in popularity over the next several decades. [10.6]

[00:16:49] So the next question then is how does nutritional ketosis fit in with the Migraine Miracle plan? [6.1]

[00:16:56] And in general I view nutritional ketosis as another weapon in our arsenal. So it’s not part of the foundation of the Migraine Miracle plan, but something we can add onto the plan at certain times. [12.2]

[00:17:08] For example, for someone in phase one of the Timeline in Migraine Freedom. it may not be the best time. Typically during phase one the primary focus is on breaking rebound and medication induced vulnerability. [12.3]

[00:17:21] And that alone is a stressor. [1.5]

[00:17:23] Likewise, the transition into ketosis can also be a stressor, especially if someone is coming from a higher carbohydrate diet. [7.4]

[00:17:31] And so too many stressors can just over overwhelm and overload the system. It’s also unlikely to be of benefit while rebound is still an issue as I talked about earlier, which may lead people to falsely conclude that it was ineffective. [12.8]

[00:17:44] I personally think that it makes sense for anyone on the Migraine Miracle plan to try it at least once, just to know how it feels and how they respond, and then to decide whether it’s something to continue with intermittently or not to do. [13.2]

[00:17:58] Different people do respond differently, but as you may have heard me say before, we have several folks who started out doing keto in our last challenge and haven’t stopped to this day because it helped accelerate their progress so much. And because they just feel so much better. [15.6]

[00:18:14] I recently saw someone in my office who came in with her husband and he didn’t have migraines, but he thanked me profusely for getting his wife on a ketogenic diet because he said he never felt so good, and he never planned to go back to any other way of eating. [14.6]

[00:18:29] And I too personally love the energy boost and the mental clarity that comes when I’m in nutritional ketosis, so it will continue to be something that I do periodically from here on out. [11.1]

[00:18:41] That being said, one of the reasons it’s not part of the foundation of the Migraine Miracle plan is because it’s one of those things where the response is somewhat individual. [9.7]

[00:18:51] With health in general, there are some principles that are universal, that will apply to everyonem such as getting a good night’s sleep being important for every single human. [9.2]

[00:19:01] And there will be some things that are individual, such as blood pressure lowering medication only being relevant to someone whose blood pressure has risen too high. [8.3]

[00:19:10] So the foundations of the Migraine Miracle plan are all the things that I consider to be universal principles that will increase anyone’s protection against the beast. [10.0]

[00:19:21] The response to a ketogenic diet, on the other hand, seems to be more individual, meaning there’s more variation from one person to the next. Yet like I said I’d still encourage any migraineur to try it at least once to know what their response is, since that response can be so profound, and because there are other potential health benefits to nutritional ketosis. [21.6]

[00:19:43] So the next question is what do you actually do to get the body into nutritional ketosis? So overall I personally like to keep things simple as possible and try not to overcomplicate matters. [11.6]

[00:19:55] And for most people, just keeping carbohydrate intake to about 20 grams per day or less will be enough to simulate nutritional ketosis, usually in around two to five days. [12.1]

[00:20:08] And some people can do it with a higher carbohydrate level. And that will vary according to their age, gender, activity level, muscle mass, and so on. [8.1]

[00:20:17] Occasionally some folks may need to also be mindful of their protein intake, as too much protein in the diet can prevent ketosis. Oftentimes, the easiest way to address that is simply to increase the amount of fat in the diet. [14.7]

[00:20:32] So if someone isn’t in ketosis after several days of carbohydrate restriction, then increasing the amount of fat in the diet will typically do the trick. [9.1]

[00:20:41] The next question is how do you actually know if you’re in ketosis? [3.2]

[00:20:45] Now there are several different ways of testing, but the simplest and easiest is to use what are known as Ketostix, which can test for the presence of ketones in the urine, which will only be there when you’re in ketosis. [12.6]

[00:20:58] And those are available at most drugstores, and you can simply dip it in the urine, and it’ll give you a yes or no answer. It doesn’t give you a very precise idea of how many ketones you’re making, but for the purposes for most people’s purposes that’s enough. [15.0]

[00:21:13] There are other types of monitors which can give a more precise indication of the level of ketosis including a blood monitor, breath monitors, but for most people’s purpose purposes the urine stick is enough. [13.3]

[00:21:27] Now there is a transitional phase that occurs as the body becomes what’s known as “keto-adapted.” [4.9]

[00:21:33] And the symptoms are similar to what the body will go through when carbohydrates in the diet are reduced. [6.7]

[00:21:40] And one of our goals with the Keto Blast challenge is to kind of help folks through that transition. And we also provide a guide to going keto that includes various strategies for mitigating and minimizing any of those symptoms. [12.6]

[00:21:53] Also, if you’re a member of Migrai-Neverland or a subscriber to Primal Provisions, then you know that each week one of the meal plan options is a Keto plan. So there we’ve already done all the work of designing meals that meet the carbohydrate requirements for nutritional ketosis, and we’ve also made sure that all those meals are tasty. [20.2]

[00:22:14] So as a neurologist who sees people with devastating brain illnesses day in and day out, I definitely plan to continue to use the protective benefits of ketosis from here on out. [12.6]

[00:22:26] As I’ve mentioned, my goal, and the goal for anyone implementing the Migraine Miracle plan and for anyone trying to just achieve optimum health is to try to reduce the distance between our current habitat and the natural habitat of a wild human as much as possible. [15.6]

[00:22:42] And as I mentioned earlier it’s likely that our ancestors spent significant periods of time in ketosis. So one way that we can more closely mimic our natural habitat in our modern world is to use ketosis intermittently. And one kind of natural way to integrate it into your life is just to do it seasonally. [19.1]

[00:23:02] It’s likely that wintertime was a time when many of our ancestors were in ketosis, because that’s a time when there are fewer carbohydrate rich foods available in the wild. [9.7]

[00:23:12] So using wintertime as a time to reduce carbs in the diet is one way to kind of mimic our ancestral pattern. [6.3]

[00:23:20] So my own approach is to do it seasonally, and to use it during times where I’d like to have the extra energy benefit, the boost in mental clarity and focus, or protection from the beast. So I might use it to boost my resilience against migraines during times where I may have less control over other factors that would stress the system like going on an overseas trip and changing time zones. [25.1]

[00:23:45] So now it is time for our Primal Provisions Pick of the Week. [3.3]

[00:23:49] For those of you who don’t know, Primal Provisions is our weekly meal planning service where every Saturday we send out a Migraine Miracle meal plan, along with recipes for all the meals, grocery lists, and prep day instructions for people who want to prepare meals for the week in advance. [16.7]

[00:24:06] And it’s a super easy way of getting started with the Migraine Miracle plan, especially the food part, as it takes all the planning and decision making off the table and saves you time and anxiety, and ensures that you have delicious meals to eat throughout the week. [14.3]

[00:24:21] And as I mentioned before, it also includes three different options for the meal plans, including a Keto meal plan. [6.3]

[00:24:28] And this week’s Primal Provisions pick of the week is our Roasted Salmon with Blueberry Ginger Compote and Crispy Kale. [8.8]

[00:24:37] So all these recipes by the way are designed by my wife Jenny, who is an incredible chef and an incredible designer of recipes. And this one was in fact part of our Keto meal plan, as it comes in at around 10 grams of carbohydrates, most of which are in that compote. [16.7]

[00:24:54] And it also includes one of my favorite things, which is the crispy kale, which is my favorite way to have kale and incidentally a very child friendly way of serving kale, if you have any picky children in your life. [13.1]

[00:25:08] So this is a fantastic dish and you can find the full recipe at [8.9]

[00:25:17] There you can also download a PDF if you want to use it to print out while you’re and have to reference while you’re cooking. [7.0]

[00:25:25] All right, so that concludes this week’s episode all about the Ketogenic Diet. [3.6]

[00:25:29] I’m sure this won’t be the last time we’ll be exploring this topic because it is such an exciting area for migraine sufferers, and because it holds so much promise in so many domains of health. Once again our 30 day Keto Blast challenge will launch this Saturday October 7th, and we’d love to have you there. [20.0]

[00:25:49] You can either click the link in the show notes to learn more and to register and register or go to [11.5]

[00:26:01] As I’ve said, if it’s past the launch date and you’re watching this or listening to this you can still go to that URL and pre-register for our next one. [9.0]

[00:26:11] So that concludes this episode of The Miracle moment. I will see you again on next Wednesday at 2:30 p.m. on Facebook. And until then go slay the beast! [11.3]