What exactly does the ketogenic diet consist of?
The ketogenic diet, in this case “The Pronokal Method”, is more than a diet. It is a medical protocol for weight loss. It consists of a weight loss plan with very low calorie content (
It encompasses three well-defined steps involving:
- In the first, active weight loss through a very low calorie hypocaloric diet with the creation of a state of controlled ketosis, until the loss of 80% of the total weight to be lost by the patient (representing Dr. Blackburn’s protein fasting diet itself).
- The second (which determines the loss of the remaining 20% of weight) is the key stage of success or dietary re-education, which begins with the end of ketosis and the progressive reintroduction of all foods (including carbohydrates and fats of good quality), which make up a diet balanced in nutrients and trace elements and whose calories are increased in each of the two steps that comprise it.
- Finally, the third stage (once the patient’s appropriate weight has been reached) represents the maintenance of the planned weight as appropriate for the patient together with the transitional discharge and programmed follow-up by the prescribing physician supported by a multidisciplinary team for at least two years.
When is this type of diet recommended and in which cases is it indicated?
It is indicated in:
- Obesity: BMI > 30
- In overweight patients (BMI between 25-30) and metabolic syndrome.
- Preoperative
- Patients refractory to other diets.
- Type 2 diabetes with associated obesity or overweight.
Can this type of diet be useful for migraines?
In Spain and worldwide, the global prevalence of migraine is 12% of the general population. Migraine affects five million people in Spain, 80% of whom are women, with the aggravating factor that between 50% and 92% have some degree of disability depending on the severity of the pain.
Animal milk is a food with the capacity to generate migraine attacks. Some 25-28% of patients with migraine may have it as a trigger. Its withdrawal can be very effective as a mechanism to prevent new attacks when it is identified as such.
Other foods such as wheat, corn, nuts, pork, peanuts, peanut butter, coconut, can cause migraine as well.
Yeast is a common irritant in migraine patients, so breads, pizza and homemade biscuits, if eaten hot, can trigger headache episodes.
The use of certain food additives (sodium nitrate, monosodium glutamate, aspartame as a sweetener) are also described as migraine triggers. Therefore, it is always useful to look at the composition and ingredients of the food you usually buy.
We cannot fail to mention that episodes of hypoglycemia (low blood sugar) caused by prolonged fasting of more than 5-6 h (between meals), sometimes aggravated by the intake of foods rich in sugars that stimulate insulin production in large quantities, are also responsible for migraine attacks. This is relevant in order to always promote food intake every 3-4 hours every day.
For what reasons can it be beneficial?
It has been observed that obesity does not determine an increase in the prevalence of migraines, but that the greater the obesity, the worse the intensity and frequency of attacks as the patient’s BMI (body mass index) increases.
The migraine that accompanies an obese patient is another of the many diseases that improve their clinical course if a ketogenic diet is used. We know that the improvement in the patient’s diet (in quantity and quality) from the moment the Pronokal Method begins, can eliminate many food and psychological triggers (anxiety, low mood, etc.) improving the clinical picture prior to the diet, thus preventing new episodes of pain both in their frequency and intensity.
In a systematic review of 43 studies it was concluded that both alcohol and caffeine use are relevant factors as triggers of migraine crises and on the other hand, low-fat diets such as the ketogenic diet tend to reduce them.
A study of a population of overweight people with migraine showed that ketogenesis was able to improve headache characteristics independently of weight loss. It was confirmed that weight loss, reflected by a reduction in BMI, was paralleled by improvement in headache after 6 months of dieting. However, the most striking finding was that during ketogenesis (first month of ketogenic diet treatment) patients receiving the ketogenic diet experienced a significantly greater decrease in the number of headache days, frequency of attacks and monthly intake of anti-migraine tablets.
The Pronokal Method is a hypocaloric ketogenic diet that may contribute to improving migraines in obese patients while losing weight.
Bibliographic reference:
- Kelman L. “The triggers or precipitants of the acute migraine attack”. Cephalalalgia. 2007;27(5):394.
- Michael J Marmura. “Triggers, Protectors and Predictors in Episodic Migraine”. Curr Pain Headache Rep. 2018 Oct 5; 22(12):81. doi: 10.1007/s11916-018-0734-0.
- Enric Gibert Navarro, Esther Castan Cuella, Laia Gasco Dalmau, Manel Santafe Martinez. “Recomendaciones dietéticas actualizadas en la prevención de la Migraña. Revisión”. Rev Esp Nutr Comunitaria 2019; 25(3).
- Akçay Övünç Özön, Ömer Karadaş, and Aynur Özge. “Efficacy of Diet Restriction on Migraines. Noro Psikiyatr Ars. 2018 Sep; 55(3): 233–237. Published online 2016 Sep 20. doi: 10.5152/npa.2016.15961
- R C Peatfield, V Glover, J T Littlewood, M Sandler, F Clifford Rose. “The prevalence of diet-induced migraine”. Cephalalgia. 1984 Sep;4(3):179-83. doi:10.1046/j.1468-2982.1984. 0403179. x.
- Bigal ME, Liberman JN, Lipton RB. “Obesity and migraine: a population study”. Neurology. 2006; 66(4):545.
- Nada Ahmad Hindiyeh , Niushen Zhang , Mallory Farrar, Pixy Banerjee , Louise Lombard , Sheena K Aurora. “The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review”. Headache. 2020 Jul;60(7):1300-1316. doi: 10.1111/head.13836. Epub 2020 May 25.
- C Di Lorenzo , G Coppola, G Sirianni, G Di Lorenzo, M Bracaglia, D Di Lenola, A Siracusano, P Rossi, F Pierelli. “Migraine improvement during short lasting ketogenesis: a proof-of-concept study”. Eur J Neurol. 2015 Jan;22(1):170-7. doi: 10.1111/ene.12550. Epub 2014 Aug 25.