Beyond migraines, the ketogenic diet has been commonly considered beneficial to address many health issues, including weight and glucose control, with few adverse effects, good adherence and tolerance to it in older adults.
“The ketogenic diet and the actions of ketone bodies are considered beneficial in several aspects of health, including migraine prevention, but studies on the ketogenic diet in migraines are not standardized and poorly evidenced,” wrote researchers from the Polish Mother’s Memorial Hospital—Research Institute and the Medical University of Lodz. “Apart from papers claiming beneficial effects of the ketogenic diet in migraines, several studies have reported that increased levels of ketone bodies may be associated with all-cause and incident heart failure mortality in older adults and are supported by research on mice showing that the ketogenic diets and diet supplementation with a human ketone body precursor may cause life span shortening.”
They added: “Despite reports showing a beneficial effect of the ketogenic diet in migraines, such a diet requires further studies, including clinical trials, to verify whether it should be recommended in older adults with migraines.”
A ketogenic diet is essentially a high intake of fat, moderate protein intake and low intake of carbohydrates, consisting of 70–80% fats, 15–20% proteins and 5–10% carbohydrates.
“The limitation in carbohydrate intake may result in decreased insulin secretion, a transition into a catabolic state and the induction of gluconeogenesis and ketogenesis,” the researchers noted. “However, if the internal production of glucose is not sufficient to provide the necessary amount of ATP, the metabolic pathway switches to ketogenesis, which produces ketone bodies to replace glucose as the main supply of energy… in the context of migraines, it is important that ketone bodies can penetrate the blood–brain barrier to provide energy to the brain, whose deficit is typical for migraines.”
Additionally, a ketogenic dietary intervention can ameliorate vascular health, which may play a role in the beneficial effect of a ketogenic diet on migraines.
Despite these attributes, the researchers revealed that in one study an increased all-cause mortality was associated with a rise in fatty liver index, a proxy for non-alcoholic fatty liver disease. This increase was partly mediated by circulating ketone bodies.
“A recent study reported a dose–response relationship of a 50% increase in all-cause mortality between the lowest and highest quintiles of ketone body concentrations in White and Black Americans,” the researchers wrote. “Moreover, the levels of ketone bodies were associated with incident heart failure and higher all-cause mortality. These associations suggest a potential detrimental effect of ketone body metabolism in aging.”
The ketogenic diet is likely the only diet that is recommended for migraines. Yet, studies performed so far are not standardized to allow a comparison between different outcomes.
“Many of these studies are criticized due to their weak evidence, problems with the control group, small sample size and risk bias,” the researchers asserted. “Moreover, there are neither clinical trials nor case-control studies presenting research on the ketogenic diet in an older population. Therefore, currently, there is not enough evidence to recommend the ketogenic diet in the elderly suffering from migraines.”
The ketogenic diet as a dietary intervention should be controlled both quantitively and qualitatively, as it may lead to an uncontrolled rise in ketone bodies, they added.
2023, 15(23), 4998; doi: 10.3390/nu15234998
“The Ketogenic Diet in the Prevention of Migraines in the Elderly”
Authors: Michal Fila et al.