#103 Chris Irvin Part 2

October 11, 2019

Daisy’s latest extraordinary man, Chris, talks about his role as education manager at Perfect Keto, how he uses exogenous ketones and MCTs as well as recommendations for how best to use them as part of your ketogenic diet if you choose to. 

Chris Irvin is a nutrition science researcher and writer with an expertise in ketogenic dieting. 

Chris holds a master’s degree in exercise and nutrition science and spent his time in graduate school studying the ketogenic diet for performance and therapeutic applications.  Chris is the education manager at Perfect Keto and strives to make the ketogenic diet easy and keto science accessible to everyone.

Use code KETOWOMAN15 to get 15% off your Perfect Keto shopping.


Chris’s website The Ketologist

Follow Chris on Instagram

Anthony Gustin’s Podcast

Chris and Anthony Gustin’s book Keto Answers

Dr Angela Poff – Exploiting Cancer Metabolism with Ketosis and Hyperbaric Oxygen

Dr. Stephen Cunnane – Brain Glucose and Ketone Metabolism

First Do No Harm

Tripping Over The Truth by Travis Christofferson

Malcolm Gladwell’s podcast Revisionist History was the podcast I was trying to remember.

Episode 22 – Burden of Proof

“He called to wish me ‘Happy Birthday.’ Then he said, ‘I’m failing everything.'”

In 2013, Malcolm gave a talk at the University of Pennsylvania on the subject of proof. How much evidence do we need of the harmfulness of some behavior, before we act? The lecture was about the long-ago fight over miner’s asthma — and about the unexpected death of a Penn student named Owen Thomas. Revisionist History returns to the question at the heart of the the talk, with a visit to Owen Thomas’s family.

CTE – Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma (often athletes), including symptomatic concussions as well as asymptomatic subconcussive hits to the head that do not cause symptoms.

Chris’s Top Tips

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#102 Chris Irvin

October 4, 2019

Daisy’s latest extraordinary man, Chris, talks about how he was inspired at grad school by keto and the people working and researching in the field to direct his own career in that direction. He is now the education manager at Perfect Keto and strives to make the ketogenic diet easy and keto science accessible to everyone.

Chris Irvin is a nutrition science researcher and writer with an expertise in ketogenic dieting. 

Chris holds a master’s degree in exercise and nutrition science and spent his time in graduate school studying the ketogenic diet for performance and therapeutic applications.  Chris is the education manager at Perfect Keto and strives to make the ketogenic diet easy and keto science accessible to everyone.

Use code KETOWOMAN15 to get 15% off your Perfect Keto shopping.


Chris’s website The Ketologist

Follow Chris on Instagram

Anthony Gustin’s Podcast

Chris and Anthony Gustin’s book Keto Answers

Dr Angela Poff – Exploiting Cancer Metabolism with Ketosis and Hyperbaric Oxygen

Dr. Stephen Cunnane – Brain Glucose and Ketone Metabolism

First Do No Harm

Tripping Over The Truth by Travis Christofferson

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#101 April Ihly Part 2

September 27, 2019

Daisy’s latest extraordinary woman, April, is back to finish her story about how she has struggled to find a way to make keto work for her.

April is a busy mom of one amazing teenager, two dogs and two cats. She lives in Oregon and is currently working on her third new career in life while still holding down a full-time job and assisting in caring for her mother who has early onset Alzheimer’s. 

She has struggled with weight and emotional issues for over 30 years, bouncing back and forth between diets, depression and anxiety.

In 2016 she found Keto, and although she felt a little better physically and emotionally, she still wasn’t losing weight, and only lost a little inflammation. Being morbidly obese and knowing that she might not have a lot of time left to get healthy, she was determined to figure out what was going on. Who would have thought the answer lied in butter?


The 2 Keto Dudes podcast

More information about KetoAF – KetoAnimalFoods.com

Ken Berry’s YouTube video that April mentioned:

April’s Top Tip

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#100 April Ihly

September 20, 2019

Daisy’s latest extraordinary woman, April, talks about how she has struggled making keto work for her. Most people who have a lot of weight to lose see the weight melt away but not April. She has had to push though years of disappointing results to find the answers. 

Every one of my guests is extraordinary but April holds a special place in my heart so she was the natural choice to share the 100th episode with. Here’s to you and your determination and courage April. xxx

April is a busy mom of one amazing teenager, two dogs and two cats. She lives in Oregon and is currently working on her third new career in life while still holding down a full-time job and assisting in caring for her mother who has early onset Alzheimer’s. 

She has struggled with weight and emotional issues for over 30 years, bouncing back and forth between diets, depression and anxiety.

In 2016 she found Keto, and although she felt a little better physically and emotionally, she still wasn’t losing weight, and only lost a little inflammation. Being morbidly obese and knowing that she might not have a lot of time left to get healthy, she was determined to figure out what was going on. Who would have thought the answer lied in butter?


The 2 Keto Dudes podcast

More information about KetoAF – KetoAnimalFoods.com

Ken Berry’s YouTube video that April mentioned:

End Quotes

#100 April Ihly

September 20, 2019

This transcript is brought to you thanks to the hard work of Joell Abbott.

Welcome April to the Keto Woman podcast. How are you doing today?

I’m great, thank you. Very honored to be here.

Well, it’s lovely to see you. We have spoken before on Zoom so we have had face to face chat. We haven’t met in person yet, but I’m sure we will one day. 

I can’t wait 

So you know how this goes. You’ve transcribed a few podcasts and you’re a regular listener so I know you know how it goes.

Yes, I’m very aware.

Tell me a bit about you.

Well, I had a pretty normal life growing up and the oldest of three daughters. My dad worked for the County, my mom worked whatever job she was able to that allowed her to stay at home and raise the kids, but you know, still be the proud woman that she was. We worked together for dinner every night. Our meals were, my dad was what my mom called a meat and potatoes guy and so we would, you know, have meats and some vegetables, a little bit of starch. We never really had snack foods very often. Processed food just wasn’t really a thing in our house for a long time. My mom believed from whatever information source she had that you should have a starch at every meal. So we would have potatoes or she made the best spaghetti. I could eat her spaghetti forever, but that was pretty normal. 

I didn’t really have a real big weight issue when I was younger.   Started probably around junior high, so seventh or eighth grade. That was also around the time I started getting regular episodes of depression. In high school I played sports, but other than that I wasn’t really an active kid. I was a reader.

What is that sort of mid-teens? I never know exactly what age you’re talking about when you refer to the different grades in America.

7th grade is about 12, 13 and that’s also around the time I got my first period. So a lot of hormonal things going on there. Probably played a part in several of the things that I was going through, like the depression and anxiety.   just kinda worrying a little too much about everything that was going on around me. I started having problems with my self esteem around that time too when I got to high school. So that’s ninth 10th grade, 15,16. 

I, like I said, I played sports, but there was almost always a period of time between when classes ended and practice began or waiting for the bus to take you to the next game you were going to play. And I started to fill my time visiting vending machines and I would fill my bag with snacks because I was bored and there was nothing else to do.

And then when you go for an away game and the bus is taking you wherever with your team, if it’s pretty far away, they’re going to stop somewhere and let you some dinner. And of course it was always fast food. There was a gas station across the street from the school and I took public transportation about 10 miles home. So I would sit at the bus stop and if it was taken long enough for the bus, I just pop into the gas station and grab more food, which is of course it’s always snack food. So not good stuff for you at all. 

And I would do that and I would eat it on the way home and then I’d go home and have dinner with the family. So it was just kind of this cycle of a progression of going from fairly healthy at home, cooking meals to just more and more processed food all the time. And it became my go-to, whatever my emotion was, whether it was boredom,   you know, I had a frustrating day at school or whatever the case may be. I just started turning to food after high school. 

I got my first job and well, my first real job and it was working the cash register at a fast food restaurant. I was in that job for close to 20 years. It was an absolutely horrible job. I did have other jobs at the time, but I always ended up going back to fast food because I was really good at it and it was comfortable for me, but it really was awful. I worked my way up from the front counter person taking orders all the way to the store manager. 

I was a troubleshooter for a period of time, which is a manager who goes from store to store, gets them in line so that they’re performing well again and then moves on to the next store, which is, it can be pretty stressful because you’re moving in over another manager and pointing out everything that they’re doing wrong. And so, you know, there’s some hostility there. 

You’re always kind of the enemy.

Exactly. That’s exactly it. 

And is that the sort of element that was when you talked about it being a horrible job. Is that part of it? 

Very stressful. It was a very stressful job. Customers are horrible. Anybody who works in public service is gonna tell you that even though the customer is supposedly always right, they’re pretty awful about it. I’ve had food thrown at me, I’ve been threatened because one of my employees forgot to not put pickles on somebody’s sandwich. It’s not a good environment. On top of that, how we were treated by the people that we worked for was not stellar by any means. We were scheduled for 60 hour shifts, but as the store manager, I was constantly on call. There were many, many times where I’d get a phone call on my day off somebody who didn’t show up for their shift, so I’d have to go in and work, you know, a double shift. There were a couple of times where I actually worked three shifts in a row. I never got chance to go home and sleep and you couldn’t get time off if you needed it. Everything was about..

It doesn’t sound like the time off that you were thinking that you had off, you know, your weekend as it were, that the time off that you’d expect every week. It doesn’t sound like you could ever rely on it. You couldn’t make plans for proper downtime.

Exactly. You couldn’t make any plans. Like I remember I had to almost bribe somebody to cover a shift for me so I could go to my grandmother’s 90th birthday party and my sister’s college graduation. You know, important things that other people in the world can go to. Right. But your fast food manager, you have to be here whenever we need you. And we don’t care what’s going on in your life. You shouldn’t have a life. You’re supposed to be here.   yeah, it was just, just super stressful. I had a few anxiety attacks because of that job. I ended up in the hospital twice, several years apart, but both times I thought I was having a heart attack. My anxiety was so bad. Managers got free food, so I had lots of access to things that were not good for me. I drank soda all the time and always the sugar sodas, right?

Like I used to joke that when I die, they’d find dr pepper in my veins. And I thought it was funny. Now I’m horrified that those were the, those were the thoughts that I was having. But,   you know, free French fries, burgers, milkshakes, everything.   I didn’t eat a lot, but I was eating it, you know, every single day because I couldn’t afford really to buy much in the way of groceries. And why would I? Because I was getting free food. I didn’t really know that that stuff was bad for me. It was what everyone ate.

And I bet you weren’t allowed the time. Even if you were having that food and you know the kind of choices you made within that environment because as we know there are, there are ways to eat healthily in most fast food joints, but I bet you wouldn’t have been allowed the time to actually sit down and take some time and have a proper meal.

That’s absolutely right.

I bet you were just grabbing mouthfuls here and there pretty well consistently, you know, all the way during the day.

Yes, there were many days I didn’t have any time to sit down and eat and so you’re right. I would just go grab something, pop it in my mouth and then run off to the next thing. Probably a lot of grazing, you know, none of the stuff obviously was the kind of food that I was used to. You know, my mom made home cooked meals every night, but nobody ever really said anything. People commented on my weight. 

Of course I had the standard 15 or 20 minute visit twice a year and the doctor would always tell me, eat less, move more, right, eat more salads and get more. And then that was the end until the next visit. Nobody ever really directed me on, these are the things that you’re doing that are probably not really good for you, so let’s do this instead. I never had any of that until I started getting more and more sick. 

I did go through some time where I was trying a lot of different diets. I did Nutrisystem, I did Slimfast. I never did Weight Watchers because I think I knew even back then that public shaming wasn’t going to be my thing. I had an aunt who was in weight Watchers and she told me, yeah, you go in and you get weighed in front of everybody and then everybody comments on how well or not well you’ve done. And that was not for me.

I was going to say. Yeah, that doesn’t sound like much fun, does it?

No, no.   I even did this weird crazy thing where you attach small metal balls or beads to your outer ear and it was supposed to help curb your appetite or something. It didn’t work.

It doesn’t sound like it would work. No.

Don’t even remember whatever. Supposedly science there was behind that. But you know, I mean I was, I was desperate, you know.

I do kind of remember, actually, I vaguely remember there was supposed to be some kind of pressure points around your ears somewhere. Maybe that’s what it was. Yeah. It must’ve been something to do with that. I do vaguely remember reading that. Yeah.

Yeah. I did Atkins.   I lost 80 pounds doing Atkins, but then I ate a noodle and gained it all back plus some right. At one point later in life, I was engaged to be married. I broke up with a guy about a month before the wedding because I found out that he’d been cheating on me the entire five years we’d been together. 

At that point, I fell into a very, very deep depression. I could hardly function. I was kind of on the outs with my family at the time, so I didn’t really have anyone to turn to you. I was fighting through all of that emotional pain alone. It was so hard. I remember one day I’m working the drive through and I was crying in between customers. I would take an order, start bawling again, take another order, keep crying. I mean it was just, it was so hard going through all of that, but that was the day that I decided, okay, enough is enough. No man is worth what I’m going through and I need to work on me. I need to start healing my heart. And   yeah, so it was tough. But obviously I got through it. 

My son was born in 2003 I was a single parent still working in this very high stress environment. I had headaches all the time. I used to keep up 500 count bottle of ibuprofen on my desk and I ate it like candy all day long. I was fortunate in the fact that I had my parents to turn back to when I would get those late night calls or you know, the weekend calls. My mom eventually became the family babysitter. When my sister started having kids, it was just a blessing. I don’t know what I would’ve done if I didn’t have them finally babysitting for middle of the night phone calls or this is the 12th day in a row you’ve needed me to babysit. You know, the, it’s just impossible and very expensive. It was real great when my mom did that. 

Then in 2009, I lost my job, which of course caused another very, very serious depression, I’m the  kind of person who’s kind of defined by my work and my work ethic. I’m probably more on the extreme side of the work ethic. I had never in my life lost a job. It was just devastating. It was unfathomable to me that I had lost that job. I didn’t really know who I was without work and I had no income.

Well, especially when you, when you put so much into it, despite seriously.

Yes, definitely. I mean, I gave that job my life for almost two decades. All the blood, sweat and tears, and in return I got booted. I mean, it turned out to be a blessing in disguise, right? I mean, I probably shouldn’t have stayed at a job that was giving me anxiety attacks and the stress and depression and all the, all those horrible things, but at the same time we have a comfort zone and even if it’s painful, sometimes we stay there because it’s comfortable and we know it. Right?

Change is scary, isn’t it?

It is absolutely scary, especially something you’ve been doing for so long and then all of a sudden you’re thrust into the unknown and you’re just like, Oh my gosh, what do I do? I don’t even know what to do anymore. I had managed to save a little bit of money so I was still able to pay the rent, but I ended up on unemployment of course. And I was also on WIC, which is government assistance for mothers and their children, and I had to do all that so that I could still pay my bills and keep food on the table. And to me it was very demeaning. The negative self talk I had was so real. I mean, at that point I very literally hated myself for the situation I had put myself into. It was really all I could do to get through the day. And I don’t know if I would honestly be here now if I didn’t have my son at the time. I couldn’t leave him, but I was in a real deep, dark place at that time. 

So I started working whatever jobs I could find. Eventually I ended up working at a convenience store, which is probably not the best place for somebody with a food addiction. So very easy access to more crappy food. I gained 90 pounds in less than a year after I lost my job. Near the end of 2010 I finally found full time work in the finance world. So I had begun a second entirely new career. I had that job for five years, but it was also very stressful and at the end, the work environment was very, very toxic. I was still gaining weight. My food choices were just ridiculous. I can think back now and wonder how it was that I hadn’t killed myself with food by that point. I remember the look on a friend’s face when they saw me dipping Fritos and beef jerky in ranch sauce. It was just incredible. 

My sleep was horrible. I was exhausted all the time. I remember feeling like I was dying when I would try to go to sleep. I actually got to the point where I would say a little prayer when I went to bed thanking the Lord for my kid and asking him to make sure that he’s taken care of if I don’t wake up tomorrow. It was, it was,  it was just awful. I had constant migraines almost every single day. One day I actually fell asleep at work. This was my new job. I was horrified. I went and got tested and I found out that I have severe sleep apnea. When I went to the clinics, CPAP class, the doctor and all his staff said thank God and told me they were glad I showed up because my apnea was so severe that I should have been dead.

Wow. Really?

Yeah, so it’s considered an apnea. If you stop breathing for 10 seconds.


If you have five or more episodes an hour, you’ve got sleep apnea. Severe sleep apnea is defined as 30 apneas an hour. I had over 740 apnea was the night that I was tested, so I averaged about 105 apnea as an hour and each one lasted on average for 13 seconds. So I essentially was having to apnea as a minute, which is basically hold your breath for 13 seconds, take two big breaths and then hold your breath again for 13 seconds and just keep doing that over and over. And that’s what I was doing in my sleep because I was doing that. I was never getting into REM because my brain was waking me up to remind me to breathe. And that’s actually why I felt like I was dying. I kept waking up on the brink of falling asleep and thought that I was drifting away. And I had been doing that for at least four years. It was crazy. 

So after I was diagnosed with sleep apnea, I was also diagnosed with type two diabetes, which was devastating to me because my dad already had it. And both of my grandfathers who had both died from complications from the type two diabetes. I got really thirsty at work one day I just have this unquenchable thirst and I went across the street and bought a half gallon of orange juice and I drank the whole thing in one go. I just couldn’t get enough of it. And my friend said, I think you need to go and get checked out. That really sounds like diabetes. 

And so I did. I got tested and the nurse practitioner called me at nine o’clock at night and said, you have to come in tomorrow morning. We need to talk to you. It’s urgent. Of course, I got real worried and I went in and they told me that my blood sugar was somewhere around 450 my A1C was 14 so they put me on Metformin. 

Fortunately, I never went on insulin. I was able to control the diabetes pretty well with the Metformin despite eating the standard diet that they give to diabetics. Right. I actually gotten my A1C down to  8 one point in 2014 I went through a really traumatic experience with a narcissist and that brought back all the depression and the self loathing and my diet totally went out the window. I had some more medications added to the pile. I was already taking two different medications for anxiety. I was already on a Statin plus the Metformin, Glipizide, a couple others. I can’t remember.

What were you doing from a diet point of view before it went off the rails? You were just trying to white knuckle it through the hole, you know, trying to control it as it were with the typical eat less, move more and dropping the fat content and all that kind of stuff. I guess the typical advice.

Yes, that’s exactly what I was doing. I did the whole chicken, broccoli and rice, you know, lots of rice. Rice is good for you.

So pretty miserable. Before then, there was no real comfort you were getting from food?

No, I never felt good on any of the diets I had been on. I would see some successes as in I might lose a little bit of weight, but I never felt good. I was either always hungry or I’d get irritable, so maybe hangry. I didn’t even realize that I was inflamed until I found keto.

I think the only way you tend to feel good is from that virtuous aspect. The only thing that feels good about it when you’re white knuckling your way through a diet that you’re not enjoying, you feel hangry all the time. The only good thing about it, the only time and the reason that that gives you to have any kind of sort of high spirits is that your sticking to it and maybe things are going well because maybe you’re losing some weight or something. I think that’s, for me anyway, that’s the only sense of any kind of anything that approached being happy. I got out of it.

Agree 100% I was proud of myself for being able to do something so hard despite the fact that it didn’t make me feel any better or heal me even. It was more of an emotional effect than a nutritional effect.

So it’s not surprising. Then when something really hits you from an emotional point of view that there’s just no way that you’re going to be able to continue with something that is so awful to begin with.

Exactly. I remember my dad, of course, he was concerned about my weight. He offered me a brand new wardrobe. If I just lose a hundred pounds and I’d go to him and say, dad, I found this new diet. I’m trying this, I feel good and it’s working and I’m really sticking to it, but then I didn’t because it wasn’t working and I didn’t feel good. I got my first bout with a very serious infection called cellulitis a few years ago, 2015 I think, and that’s a bacterial infection in the deep, deep layers of the skin. It eats away at you from the inside. It can lead to sepsis and if it’s severe it is life threatening. It’s extremely painful. It feels like a million glass shards stuck inside under your skin. 

When I got to the hospital, my fever was 104, I had sepsis. I was there for a week. I was on constant antibiotics. They were giving me, gosh, two or three different kinds of antibiotics through an IV and I think they were giving me some oral antibiotics as well. They were just drowning me in antibiotics for this. It was so bad that I gained almost 50 pounds just in inflammation. Of course my weight was ridiculously high at that point, so when it was time for me to go home, they gave me what’s called a pick line, which is a tube that they insert inside your arm and it runs all the way up your arm and to your heart chamber so that you can inject antibiotics there directly so it gets pumped out right away and that was so that I could continue administering the IV antibiotics myself at home. I was on medical leave for weeks. 

When I finally was able to go back to work, I had to walk with a cane because I was limping so bad. The cellulitis was in one of my legs. I had to keep my leg really elevated, so it was very uncomfortable trying to work a desk job with my leg sticking out to the side. 

Actually I had cellulitis four different times. Once you get it, it’s much easier to keep getting it. Happily though the last one that I had was in 2016 which happens to coincide with when I found keto, so when I found keto, there’s kind of a story to that. 

Someone I knew at the time had told me about this totally crazy diet that he was doing that would supposedly cure all my problems. Right?   And this guy was, he was very fit and healthy, but I didn’t believe anything that he was telling me. Don’t eat carbs. Right? Your brain needs sugar. You know glucogoneo… what? That’s not even a thing!  You’re stupid! 

You know, I just thought I knew everything. Right? You ate an entire package of bacon for lunch and that’s all you’re eating today. Give me a break. My doctor’s already told me everything that I need to know. Right? 

So I was just totally self righteous on this path of he was wrong. And I was right. We had some pretty heated arguments about what was best for me. He pointed me to the keto subreddit. I didn’t use Reddit at the time. I have an aversion to toxic communities.   But I started reading some threads, if not just to have enough information to go back and research somewhere else and prove him wrong. That was really my motivation.   so I started reading some things and enough people were posting successes and defending them with sciencey words that my curiosity got triggered.

People talk about how anecdotal evidence is worthless. Yes, but when push comes to shove, those are the stories that grab your attention. Those are the stories that make you think, Whoa, hold on a minute. If they can do it, perhaps I can do it and perhaps I can get at least some of the results that they’re getting.

Exactly. I’m a very curious person by nature. My two favorite words are why and how I probably get a little annoying with them.

I bet you’re a questioner.

I absolutely am. A questioner. Yes, yes. I actually have a little bit of rebel in me and I can’t remember the other ones, but yeah, I kinda, I kind of go through cycles, so I’m real good at research. So I started paying a little more attention to the articles that people were linking, spent all day Googling, going down all these different rabbit holes, you know, having 30 different tabs open on my browser. I found Dr Berry’s video that’s you know, kind of famous now, which is the really sarcastic video about why you should not do keto and sarcasm is my native language. I loved that video. 

Then I started listening to the 2ketodudes podcast, which was my first ever podcast. I was drawn to it because of the science and like you said, testimonials are the things that get you thinking. Maybe I can do it, but I want it proof. I didn’t just want the testimonials because anybody can say, hey, this is working for me. Right? It’s the internet, everything’s true or not. Right. I wanted to know why it was working or where people lying because I’d been trying different diets. 

I was vegetarian for a while. I was on this quote unquote healthy diet that consisted of gallons of fruit and veggie juices. I was proud of myself for spending a couple hundred dollars on a juicer and a lot of money on fruits and vegetables just so I could make myself a little tiny glass of juice everyday.

Best of the whole virtuous thing again though, isn’t it? It feels so virtuous and pure and clean to be drinking basically a shit ton of sugar. Yes, exactly.

I’m not a cook because I spent so many years in that toxic environment cooking. I just, I don’t want to do it anymore, but I was so proud of myself that I was able to create veggie burgers with a ton of beans and all these other things. You know, I was doing the right thing finally.  I did the whole forks over knives thing. I watched all their videos and their quote unquote science and I totally fell for all of that. This was the only way for me to be healthy, right? Not right.   

I actually went through a period of being pretty angry when I was finding out all this information about keto and all of the things that it could fix in the human body. Because while I was doing this research and learning, that’s when my dad died and he died from liver failure, kidney failure and heart failure, all brought about by his diabetes that he had had for, gosh, I think it was two decades and it made me so mad that this information was out there and nobody was telling my dad. He was on dialysis, he had dialysis at home. There was surgery that he had to insert basically a pouch into his stomach so that he could pump all these chemicals into his system because the system wasn’t working on its own. It was just a horrid ordeal for my dad. His last few years were awful and it was awful to watch him go through that. 

And so I just got infuriated that all of this information was out there, but nobody shared it or at least nobody who could help my dad. And part of my motivation for going through all these other diets was to find something that I could maybe help my dad with. You know? I mean by the end, he couldn’t even eat. He was always a big burly guy. And when he died, he was 90 pounds. It was not,   it was just not a good way for him to go. So,   I really try not to think about that too much because I will still get angry about it.

Of course.

But I don’t think that’s a healthy place for me to be, but it’s part of why I share things in the group is to show other people that you don’t have to live like that. So I learned on the 2KetoDudes that Reddit had done me wrong. In Reddit I was told over and over and over again that if you’re already fat, your keto should be low carb and low fat. Don’t eat any fat because you already have enough. 

Carl and Richard of course said, no, no, no, you need the high fat to get your body primed and used to burning fat. Your body doesn’t know how to access it anymore. And I had been doing keto for almost a year by that time, of course, with no weight loss or any significant loss of inflammation, which were two of the biggest results that I was looking for. 

So I started over, I tracked and I made sure that my fat was higher than my protein. I stayed under 20 grams of carbs, but I was counting net carbs. I was eating mostly good food or what I thought was good food, like you know, chicken breasts, lots of vegetables like broccoli and cauliflower. I did still eat a lot of snacks. They were keto snacks, but I was eating all the time still and I would eat a lot of processed meats like beef jerky, sausages, things like that. I learned about fasting around that time and I tried it, but I wasn’t ever successful at it because I was too hungry all the time and I also had a serious mental block about it. I was literally panic at the thought of not eating. 

After doing that for several months and still not seeing the results that I was looking for. I got really, really discouraged and I let the holidays do their thing. I ate all the food, the bad food. I felt awful. I got sick and one day a coworker said to me, you know, it’s not worth it. That stuff makes you feel awful. It’s just not worth it. And it kinda clicked for me again. She’s right. Even though I’m not seeing all the results I want, I was feeling so much better on keto. I was not walking like a 90 year old woman anymore. I had plantar fasciitis that was gone. My depression was much less severe and it didn’t come around as often as it used to, which was a big deal because I’ve been depressed almost my whole life. And so those results were enough to get me back on track and ready to recommit again. 

I kept coming back to keto even though I wasn’t getting the results that I wanted because the science was there. All the different podcasts that I started listening to, all the research that I was doing following Annette Bosworth, Dr. Berry, of course, 2KetoDudes, Keto Woman podcast, everything included science and everybody pointed to where they got the science from, which is something that I had never seen on any other diet. Everybody just said, well, it works because it works, but it wasn’t working.

Yeah. Just, you know, stop asking. So many questions. Just trust in the process. Trust that it works. Nope.

Right. I want to know why. Right. Faith-based dieting did not work for me. I had no faith in it anymore, so I recommitted again. I was really, really focused on getting the food right. I had decided that, well, I just wasn’t following keto strictly enough, and that was the problem. I’m the problem. Right. My choices are the problem.

 It’s gotta be your fault. Right? 

Right. Exactly. Because that’s what we’re told. Right? If whatever you’re doing isn’t working, it’s your fault. You reminded me that it’s not just about the food and that I needed to look at all the other things. Sleep stress, eating window, you know, there’s a whole list of things that can affect your success. But I was hyper focused on the food and at that time my family situation was particularly stressful. Some toxic relationships there. Still dealing with the loss of my dad and the aftermath of things that happen with that.

Mom’s Alzheimer’s was much worse. She had finally been diagnosed and her decline was pretty rapid. So even though I had all those things going on, I never considered that that affected or would affect what’s going on in my body. I tried fasting again a couple of times, but I still really had a hard time with it. And this time, not only was it hard mentally, but also physically because I had to get sick when I started eating again. 

So I decided I would try carnivore. Still keto but stricter, right? Just kinda trying to dial down more into the why of why isn’t it working? I was bound and determined to figure out why keto wasn’t fixing me. So I went very, very strict. I was always under 20 grams of total carbs on keto. At this point. I thought again that I was getting my fat ratio appropriate, stopped snacking. They were rare. So though I started the carnivore with just meat, a little bit of cheese, some eggs, the eggs made me feel unwell, so I stopped eating them. I had things like pork chops, bacon, chicken breast. Again, because I love the white meat. I prefer it over the dark, steaks, ground beef. I drank beef broth instead of coffee because coffee made my stomach hurt. 

So as I was cutting things out, the things that remained, I was able to tell that they were part of the reason I wasn’t feeling well. I think that when you are not feeling well all the time, you get used to it and you don’t really know that, you’re sick, that you’re not feeling well. The things are making you ill because it’s just what you’re used to.

What did you do? Kind of acclimatise to it, don’t you? It’s only when you take it away for awhile and then you put that food back in and it hits you all in one go that you realize how bad it was. It’s just cause you’d had these doses every day, every day, every day. Your body just adapts to it, doesn’t it? And you, you have this, what is seems like a lower level, but chronically, you know, it’s all the time, but when your body actually gets a rest then you hit it feels like you’ve been hit with a truck.

Yes, exactly. I did things like put heavy whipping cream in my coffee,   which was for the fat content, but also for the sweet content. I was still having a difficult time with sweets, cravings. And I remember you and I had talked about that and you suggested, you know, we’ll try, try not to have anything sweet for a week and see if your cravings go away. So I did this,  carnivore for about three months and I still didn’t see any change in the weight or the inflammation. 

I was definitely feeling better physically. But the weight and the inflammation, those are the results I’m looking for. Not because I’m vain and want to lose weight. So I look better. It’s because I am heavy enough where not losing weight, it’s not an option. My doctor told me, I don’t know if you have enough time left to lose weight slowly, and she recommended me for bariatric surgery and I almost did it. It was not for me. I couldn’t justify to myself cutting out a piece of my body because I couldn’t get a handle on food. And so I said, nevermind, I don’t want to do this. And continued trying to figure out when and how keto would work for me…

#99 Renée Jones – Part 2

September 13, 2019

Daisy’s latest extraordinary woman, Renée, talks about her own battle with emotional eating as well as offering some strategies to help others deal with theirs.

Renée has a Master’s degree in Marriage and Family Counselling and a Clinical Residency. 

She uses traditional as well as contemporary models such as relaxation and horse-assisted methods to help others win at losing extra weight and other baggage.  She spent 40 years on a diet, yo-yoing up and down the scale before finally stopping the self-sabotage and no only reaching but maintaining her goal weight since 2012.



Contact Renée at renee@packyourownbag.com

Bonus video Renée discussed in the podcast packyourownbag.com/friends

Work with Renée – courses

Renée’s TEDx talk

Renée’s book

Renée’s Top Tip

End Quote

#98 Renée Jones

September 6, 2019

Daisy’s latest extraordinary woman, Renée, talks about her own battle with emotional eating as well as offering some strategies to help others deal with theirs.

Kim & Carrie’s Keto Coaching Program – CLOSES SUNDAY 8 SEPTEMBER

Renée has a Master’s degree in Marriage and Family Counselling and a Clinical Residency. 

She uses traditional as well as contemporary models such as relaxation and horse-assisted methods to help others win at losing extra weight and other baggage.  She spent 40 years on a diet, yo-yoing up and down the scale before finally stopping the self-sabotage and no only reaching but maintaining her goal weight since 2012.



Contact Renée at renee@packyourownbag.com

Bonus video Renée discussed in the podcast packyourownbag.com/friends

Work with Renée – courses

Renée’s TEDx talk

Renée’s book

End Quotes

#98 Renée Jones

September 6, 2019

This transcript is brought to you thanks to the hard work of Alison Gover.

Welcome Renee to the Keto Woman podcast. How are you doing today?

I’m doing well, thank you. Thank you for having me.

Oh, you’re very welcome. It’s nice to see you again. We saw each other at Ketofest.

Yes. Lovely to actually see you back and forth.

I know. It’s nice. It makes it extra special when you’ve met in person and when you see someone, well it’s like seeing them again almost. You have that memory of them being literally in front of you.

Indeed. Yeah. Terrific too get to hug people.

Yes. I’m a big hugger. Did you enjoy Ketofest?

Yes I did I mean it was obviously quite hard.

It was very hot.

We’re accustomed to that in Texas. It was a little unexpected there, but yeah, the festival was fantastic.

Yeah, it was good fun, wasn’t it? But like you say, hot.

Sunday was not quite so hot and that was great, but Saturday, yeah, I think I sweated out all my electrolytes.

That’s true. I ended up flipping burgers actually. Well flipping burger buns. I was walking around the plaza seeing how everyone was doing and Julie from Fox Hill Bagels was desperately trying to get all her buns flipped, and was stressing out because she needed help. So I put my apron on and helped her. But you could imagine in full sun in the heat that we had standing in front of the grill.

I was watching you guys, the sun was coming straight down on you. There wasn’t a cover and you were over that grill. And I thought good grief they’re all going to die!

It was incredible. And I wasn’t doing it for very long and I nearly melted. But the reason I brought that up actually was just to mention Chris Bair from Keto Chow. Luckily not far away, was the Keto Chow stand. And he came over with these beautifully cold bottles of water ready, filled with some electrolytes, which was an absolute mercy. Really, really helped. Because as you say, when you’re sweating and it’s hot like that, you’re just leaching out all your electrolytes and that just ends up making you feel worse, doesn’t it? So enough Keto Fest chatter, tell me a bit about you.

I started my first diet when I was 10 years old and my mother thought, well, if we get this sorted out now, then you’ll be good for the rest of your life. And unfortunately, she had been sort of dieting all of her life as well, and wasn’t very good at it either. So that started the diet yo-yo for us, for me, in particular, and we’d get close to our goal and then something would happen and we’d go off somewhere else. And it just was 40 years of the diet yo-yo for me. But in 2012 I was staring down my 50th birthday and I thought, okay, I’m about to turn 50 things change for women. And if I don’t lose it now, it’s never gonna happen. So I thought, right, we’ve got to get this sorted out now. And you know, I started New Year’s Day and I did pretty well for a couple of weeks and then fell off another couple of weeks and fell off. And by April I actually needed a bigger size. So I was going right the opposite direction.

Well that’s what happens, isn’t it? That’s the problem, it’s just one of the known things about, well, I suppose any kind of diet, actually you could include Keto in that, if you do any kind of diet where you lose weight and then you go back to your old habits, you not only regained the weight you’ve lost, but a little bit more as a nice little bonus.

So I decided to do some research and I recognized that my major issue was because I ate for emotional reasons, if I was stressed or upset, I would just go straight to the refrigerator. So I thought, okay, we have to sort this out. I’ve got to get a handle on that. So I did and I started losing weight and I actually reached my goal weight the week before my 50th birthday. And I’ve been there ever since. So it’s now coming up to seven years of staying right here where I am around somewhere between 115 and 119 pounds. So I’m only five foot three so there’s only so much this little body can carry.

And I know in the notes you sent me talking about it, that you actually, that first chunk of weight you lost when you first hit your goal weight, that was nothing to do with Keto, am I right?

No, it was, it was low fat, low calorie deprivation, starvation kind of diet.

Not much fun then.

It was awful. But I thought, okay, this is what I have to do to get there. This is what I have to do. And unfortunately when I was trying to maintain it, it was a real struggle because I’ve found that you lower your calories, I never went below 1200 but still, I just couldn’t seem to eat too much more and maintain my weight. So two years later I was sort of tired and hungry and really cranky all the time. And I thought, okay, there’s something wrong with this picture, I’ve got to do something different. So I got back on the Internet and was doing some more research and I found a metabolic test and when I got the results of it, it said, you need more fat in your diet. And I thought, fat, fat, we’re not supposed to have fat. So I went through that initial thing. But what I found interesting was that they gave me a diet, it was, it was low carb, it was pretty much Keto throughout the day. But in the evening you got some grain, but not a lot of it, just a small portion. And I was having butter and cheese sauce and thinking I’m going to gain weight, but I lost two pounds that week and I was already at my goal weight. 

So I thought this is not supposed to happen, this is weird, I was sort of skating around things and still having some sugar here and there and all of that. And in the New Year, I guess that was 2015 I started finding stuff on Keto and I thought, okay, this sounds weird, but all right. And I would play with it a bit, but I wasn’t willing to give up my sugar yet, so I wasn’t getting, the whole ketone thing. But I finally decided, okay, I made a rule for myself. I only have sugar on Sundays and after about 10 days, the first week was really hard, but after about 10 days I was like, oh, okay. I see how this feels. I really don’t like the effect of sugar on my tongue when I have it, it’s just this funny feeling. So okay, we’ll just give up sugar, go straight into Keto in April of 2015 and I have tried to find my balance. It took me a while to find what I really needed to do, but I love it. It’s fantastic. I don’t feel hungry all the time. I still have to sometimes think, okay, what are you hungry for? You’re not really hungry. What are you looking for? And sort through that emotional side. But it has worked very well for me.

And so presumably that’s just a much more comfortable way of maintaining that weight loss, a happier way.

It’s much happier way. So I get bacon and butter, what else do I want? If I really need a snack, I’ll go do some bacon and that makes me happy.

That’s a problem, isn’t it? If you’re having to eat in a way that, as you just said before, it was making you cranky and irritable and so it’s a bit of a white knuckle ride the whole time trying to maintain it. That’s a lot of energy. You’re losing doing that.

Yeah, but you’re right. I mean there are times when I get hungry on Keto, but it’s because either it’s been a long time since I ate last or I didn’t get enough fat in my meal at the last one and that I’m beginning to recognize, particularly if I’m like at a conference or something and they serve a meal, I have to make sure I get the fat or I’ll get hungry.

That’s interesting isn’t it? Finding out what for you are the things that really keeps you satisfied and I see a lot of people playing around, particularly with the protein to fat ratio. It seems for some people adding more protein is the trick and the fat makes no difference. You know, obviously I’m not talking about them eating low fat, but that doesn’t make the difference. Whereas other people, if they up the protein too much it actually makes them hungry and then it’s all about just figuring out what that perfect balance is for you.

It’s what works for your body, it’s really important.

And so you’d already approached this whole massive area that affects so many of us, of the emotional side of eating before you even started Keto, so you kind of had a handle on that, well, had more than a kind of a handle on it. You had a handle on it going into Keto, but a lot of people, and I’m one of them, it’s still something that I very much struggle with, going into Keto and they see so many people saying, “Oh, I’m not hungry anymore. I eat till I’m full and then I stop. I don’t have cravings, everything’s fine and rosy and dandy and I’m losing weight and everything’s golden” and it seems to work that way for some people it often seems to be men, and I’ll ask you about that if there is any kind of difference in experience between the genders, shall we say, but I think for a lot of us it’s this bit that’s missing in the picture, I think maybe this is a predominantly female thing as well. We think it’s something that we’re doing wrong that we’re failing because Keto isn’t working as well for us as it is for other people, so it must be something that we’ve done wrong and then we start beating ourselves up and obviously that’s going to just fuel back into the whole problem with emotional eating. Perhaps you could just give us some guidelines, I know this is what you do, so we’ll go into all of that. How did you start doing this? Is this something that you’ve always done? Is this something that you started doing via your own experience? I’ve thrown a lot of questions at you there, so you just start where you want to.

The counsellor and coach in me says, no, you’re not doing something wrong. Lose that thought because that’s not going to help you at all. The problem is that from birth, when a baby cries, Daisy, what do we do? We usually put something in their mouths, whether it’s the bottle or a breast or the pacifier to get them to stop crying we put something in their mouths and it works. So very much it is how we are trained, how we are wired. When we are upset, we put something in our mouths and the problem came when we changed out that dummy that pacifier for a donut. So it’s something that’s hard wired in us, this is how we work and just like, I don’t know how it was in school for you when you were first going to school, but we walked everywhere in a straight line, eyes forward, hands beside our side, whether we were going to the playground or to the cafeteria or to another classroom. But as we got older, we didn’t have to do that anymore. We learned other ways to get where we were going to go. So it was what we were taught as children and as adults we have to learn, okay, I’m upset. I want some soothing. How do I get that soothing in a way that is appropriate for me, for my situation, for my personality, for who I am. So that’s kind of the progression. 

And one of the things that I teach to my clients is it’s not hard to overcome emotional eating. We just have to get the hang of it. And I use hang as an acronym. So the H is am I hungry? And if you’re hungry you probably do need something to eat or you need it soon, right? So if you’re not hungry then go to the A, what is your attraction to food right now? What’s going on? Because there’s always something going on. If we’re crash landing in front of the refrigerator, it’s not just hunger. There’s something within us. So what is that driver and then the N, what do you need other than food? What would soothe you right now? What would help you? What would make you feel a little better? And then the G is go, go get that. Because that will soothe you more than any food ever could. And it’s a process. You’ve been doing it the other way for a long time, so give yourself some grace to work your way into it because once you get the hang of that, then it’s like, oh, okay, what do I need? Um, I need some time with my dog, or I need a hug or I need some help with this project, and then you can get that and it’s much more soothing. Does that make sense?

It absolutely does. I’m just trying to figure out, and presumably it’s a question to a certain extent of simply practice and some kind of discipline in kind of forcing yourself through those steps of exploration in the first place. Because it feels to me, and I know this battle’s gone on in my head, and it can be as you’re walking to the fridge or as you’re walking to whatever contains the item of food you’re going for. I’ve had that conversation in my head as I go there. You’re not hungry. I know I’m not hungry. I know I’m not going to it for that reason, but I guess the problem I have is that that argument is very limited. It’s just, you’re going there for the wrong reason, don’t do it. And the other side is, but I don’t care. I’m going anyway. And it’s this battle battle, battle, battle battle and the “I don’t care, I’m doing it anyway” pretty well always wins. But I’m guessing from what you’re saying that that’s a bit of a negative feedback loop in a way. What you need to do is harness that critical voice and turn it into a different practice.

Yes. Well, and if you can, you obviously recognize, “okay, I’m going to do it anyway”. And sometimes that is a choice. You get to make that choice. You’re an adult, you get to choose that and then you can deal with the consequences later. I often reckon it to paying taxes. We do that because the consequences are great if we don’t. So you have to make a choice there. What will be the consequences for me? Well I won’t get to my goal weight or I will gain, and you know what? That’s okay. If that’s where you are today, that’s where you are today. Tomorrow you may be in a different place and it is the perpetual making different choices that get you turned in the direction that you say you want to go. Well if you don’t want to go there, don’t go there. 

But don’t beat yourself up for it because that’s not what you actually want. And I think learning to choose what you actually want in any situation begins to lessen the hold that has on you. Because it is, it is such a mental process in the end and it’s healing some of those wounds that you may not even realize right now. And that’s, you know, that’s how people end up with me for long periods of time is cause we’re trying to figure out, okay, what exactly is going on and why are you bucking against that? There’s something deeper there because in the end it all comes down to what is the driver of this behavior. And once you figure that out, then you can change the driver. But it is a process and beating yourself up only sends you to needing more soothing, right? And then you get into that perpetual cycle of beat myself up, I need soothing so I eat and then I’d beat myself up for that. And it just keeps going.

And how’s the best way to try and start breaking out of that then?

It is a choice in the end, it is, okay, what do I actually want? And if it’s food, then the consequence is that you will probably gain some weight and that can be okay. But giving yourself the freedom, I know it sounds kind of silly, but somewhere within us likely there is a small child who was not given that freedom and we have to soothe her or him and get that taken care of. This became very clear to me right after my grandmother died because when my mother had passed away a few years earlier, I crawled into the refrigerator and I gained a lot of weight. And when my grandmother passed away, and we were tight, oh my Nan and I were really, really close and I thought, okay, I can do that again and gain more weight or I can start breaking some of the connections that I have with food and her and get better myself. So it very much comes down to a moment that affects you and how you choose to go on from there.

And I do think when you were talking about making that choice to sometimes to eat and there’s going to be that potential consequence of gaining weight or if it’s the wrong, in quotation marks, food it could make you feel ill I do think, well I found myself anyway that Keto gives me some kind of freedom in that that is much more limited.


With high carb food, I literally go completely off the rails. You know, the train goes completely off the rails and it goes absolutely crazy. And I can gain weight like you wouldn’t believe in a really short period of time.

I would believe.

But at least with Keto, I’m not saying it’s solved the problem because it hasn’t, but it does limit it and that there’s still some overeating that goes on, but it doesn’t go completely off the rails.

Right, because carbohydrates always want more. You cannot satisfy yourself on all of those carbohydrates. You just can’t, they don’t fill that need in the same way. They’ll fill your stomach in the same way.

Yeah. So it’s that combination, isn’t it, of what you’re still lacking with this needing to fill this emotional need that’s going to exist. If that’s an issue that you have, whatever you’re eating.


But if you can remove the physical side of it, it is going to help, isn’t it? It’s going to make it a bit easier to maybe start tackling the emotional side.

Yes. And it does help when you’re not hungry all the time. It is so much easier to overcome emotional eating when you’re not starving because you don’t have that panic of, your base self saying I’m starving, I need something. Well you’re not gonna be starving. If you’re eating Keto, you’re going to be a little more satisfied once you work out what works for your body. But you also, as you say, if you eat something off plan then it kind of makes it worse.

Yeah. And it can really start a binge type cycle. I mean I see so many people. It’s when you talk about the whole, I think this would be an interesting thing to talk about, the whole question about a cheat day or some kind of planned off plan eating and people as much as the plans they make, it’s just going to be for one meal or one day or one holiday. The risk is, and for some people it does work like that. You know, I’m just going to do this while I’m on holiday for example. And when I come back everything goes back to normal. And there is some kind of logic in that and I’ve, I’ve found for certain things that works for me, I actually do that with chips or French fries as Americans call them. I will not make them at home. I never make them at home. I don’t allow them through the door. But if I’m out somewhere, at a restaurant, I don’t go out that often so it’s not actually something that arises very often. If they look like they’re good, I won’t bother if they’re not good chips, then will have them and that for me works. But for other things, interestingly, the crisps or chips, this whole translation with food thing I find fascinating.

It’s amazing. Yes.

But those that doesn’t work. If I have those, even if it’s out of the home, that will lead to a cycle that ends up with me buying them and bringing them into my home and before I know it it’s every day. So it’s interesting, I think that some people can do that, putting it in a certain box and managing it that way. Some people can do it with certain foods, but a lot of times it ends up just starting this cycle that one day, one week’s holiday turns into, before you know it, weeks, months, years even.

I think if you think about that in terms of other places where you are disciplined, then it might give you the tools to apply that same discipline to this unless you choose not to. And that’s fair enough. I went to a wedding in April and there was literally nothing, nothing that did not have some kind of sugary coating to it. And I thought, okay, I can either be really rude to the hosts and not eat at all. Or I can say, all right, it’s one evening, it’ll be fine. So I went with that, so as not to be rude. I didn’t need a lot, but you know, I tried to enjoy every bite of it. And I think that’s one of the things that’s key. If you’re going to have something, try to enjoy it because you’re going to pay for it later. And two days later I snapped at my dear sweet husband and I said, oh gosh, this is the sugar talking, and he was like, okay. 

And I recognize that when I have the sugars or carbohydrates in excess, well, in sugar, anything is excess, right. It does affect me emotionally that blood sugar high and low makes me ratty. Hence the reason I try to stay away from it, but I try to enjoy every bite and I have to say it was all very good, so I enjoyed it and then had to deal with the consequences of my day of not feeling my best because I was just, oh, everything was irritating that day. It is just not worth it to me to do that in another setting, you know? Unless I’m being rude to somebody, then I was like, okay, I don’t want that awful feeling of being that ratty so I won’t do it.

I think a big part of it is being mindful and aware of what’s going on, isn’t it? I often say to people when they’re in that day afterwards and they’re feeling whatever they’re feeling, whether it’s emotionally bad, physically bad, both, I say to them, record this in some way. You know, make a video of yourself, write it down, whatever it is in the moment when you’re feeling it, make a note of it because we’re very good, aren’t we of forgetting.

Deleting those memories, yes. That particular day was very stark to me, so I thought, okay, now you’ve got your memory to hold onto. So do that.

And this work that you do with emotional eating, is this something that you’ve always done or is this something that developed because of your own experience to apply to the counselling work that you do?

Well, I was a counsellor obviously before that, but yes, the focus on emotional eating just came out of my own experience and recognizing that a lot of other people struggle with that as well. And I think sometimes when you’re in the desert and you find water, you want to share it with others because if I can help someone else overcome their emotional eating, that’s wonderful. Because it’s helping them heal their heart a little bit and there are so few opportunities to do that with people that I want to take everyone I get

Tell us a bit more about that. Tell us a bit more about your work and your business. I like reading your notes. I like the whole, the imagery you have with the packing your own bag, that progression.

I think our bags kind of get packed for us as we go through life. Then we’re dragging all this excess baggage with us for decades and sometimes you have to unpack, just like when you come home from a trip, you got to take all this stuff out of the bag and then you can pack what you want for the journey you want to be on rather than the one that you stumbled into. So if the overeating and the emotional eating doesn’t fit who you want to be doesn’t fit the journey you want to be on, then get rid of it and choose what works for you. I tend to work in three main areas for people. We start with your body because if you don’t work out what works for your body, then you’re going to struggle. So find the thing that works for you in Keto. Find your macros, find your comfortable spot. If tracking works for you, track. If it doesn’t work for you, please don’t do it. Right? 

So find what works for your body and then we deal with some of that baggage because that will affect you. And if we can unwind some of the experiences or the things you think about those experiences so that you can get free of them, you can heal your heart a bit, then you’re set and then your best self. So your body, your baggage, your best. Because if you begin to cultivate who you are at your best and live that way more often, then life gets easier. I was born red headed. I have a temper, I am stubborn and dealing with some of those things helps me have a happier, more peaceful life. And I really liked that and I don’t know about you, but when I am living in my best self, I make much better choices about everything. Including food.

Yes, that’s right. And what does your Keto look like?

Right now in August, I’ve been doing carnivore mostly so it’s sort of 90% meat and fat and animal products and I like seasoning. I like cocoa and I like tea. Those are my plants. So I’ve been pretty carnivore. I think we have vegetables on Sundays at the moment and I feel great, but I probably will go back to having at least a serving of vegetables a day because I just like them. I tend to do a fatty tea at breakfast with some Collagen in it and then I’ll have lunch. I’ve also this month been playing with a reduced eating window, so I’ll have my main meal because I wake up hungry. I think my time, my body clock gets stuck on Welsh time from the years that I spent there. So I prefer to have breakfast and lunch, maybe a late lunch and skip the evening meal. And that works for me because I make dinner for my husband and then I have that for lunch the next day. And it doesn’t bother me to not eat. I sit with him but I don’t have to eat at the same time.

It’s interesting how, just like you say, finding what works for you and also appreciating that that changes as well.

Yeah. At some point I will go back to having dinner, you know, at six o’clock with my husband. Just not right now.

Yeah. I’m really interested with how people do on carnivore because I was expecting to find that it suited me really well because I, like you, was finding that I was eating a lot of the time that way anyway. And so thought sort of taking it to the next level would be just like, you know, dialling it up and making it even better. But it went the other way for me. I didn’t do well at all, especially with my mood, but also obviously screwed around with my hormones cause I started getting hot flushes all the time and I just thought, oh well this, you know, it’s just time for that to start them. But when I stopped doing it they stopped as well.

Oh, you want to avoid that.

Yes, exactly. I do still get a few but just it was like all the time. I said, oh no, this is not fun.

We don’t want to do that. But I tell you, I made a, a bit of a shift earlier this year because I heard someone say that, I think it was Kim Howerton actually, she said we were trained by WeightWatchers that fruit and vegetables are free. So when we come to Keto we know that that fruit must be monitored, but we take all of those vegetables into Keto and wonder why we’re not getting the results that we want. And I thought, oh yes, because I was the queen of the eggs Florentine for breakfast, right, I’d have some vegetables with every meal and it made a difference when I cut those back because they’re carbohydrates too. They may be good carbs, but they’re still carbs and again, dialling in what works for your body.

Yeah, that’s right. I absolutely agree with that. But I found, I think it was Dr Nally who is talking about it on the Two Keto Dudes podcast with Carrie particularly talking about how she tried carnivore as well and didn’t do too well on it and does better with some vegetables. And, and he was saying yes that this, and having a small amount, he wasn’t talking about having massive platefuls of salad, but he was talking about, having some greens, even just a small salad every couple of days could make a big, big difference. But not, having masses. Like you say, having too many can be problematic for people too. So it’s always about finding that balance isn’t it?

Yes, for you. Because your chemistry is different to my chemistry and just because somebody else can can have all the Keto treats and the nut flours and all the rest of it. It’s not a contest of “she gets to have that and I don’t get to have that”. That’s just not the way we need to think about this because what you’re working on is what works best for you.

I think that’s partly what’s enjoyable about Keto and certainly what I see for so many people is that they find it really empowering because they start feeling like they’re getting some control back and starting to make better choices and seeing how their body reacts and finding that they are starting to get some control back over their health, that they felt that they might have lost or was forever gone and they’ve just accepted the fact that they’re on some kind of progressive disorder journey and there’s nothing they can do about it and all of a sudden they start to feel good.

Absolutely. Because I know it made such a huge difference for me because I was no longer hungry all the time. I wasn’t tired all the time and I certainly wasn’t cranky. So it made such a huge difference for me, I can’t imagine ever going back to eating the standard American diet. But what’s interesting to me is my grandmother back in the seventies I guess when we first started, said, Renee, all you have to do is cut your sugars and starches and you’ll be fine. So she knew, she couldn’t do it for herself, but she knew. It’s just been refreshing to come back to that and think, oh yeah, I remember when the low fat thing came out and I was thinking, that doesn’t look good, but we tried it, right. That’s what they told us to do.

Well, and it wasn’t overwhelming. That’s what they told us to do. Backed up with the government health guidelines pretty well around the world. Not absolutely everywhere. But you know, certainly in the States, certainly in Britain and the EU, it’s just this, fat is bad. You need to reduce your fat right down, especially saturated fat because that’s the worst thing of all. You’ve got to eat your five a day, you’ve got to stay away from too much red meat is bad you. But these things have been drilled into us for so long. I think a lot of us, even though we know that fat is fine, even though we know it feels good, we still sometimes feel guilty when we’re eating it. There’s just that automatic response because it’s been drummed in for so long.

There is that, “gee, I hope this doesn’t come back to bite me in about 10 years”, but at the same time I feel so good and the lack of hunger is just wonderful because I was hungry all the time. It worked, I lost weight, but I was not happy on that. And I think food is too big a part of our lives for us not to be happy with what we’re eating.

Yes, and who wants to live in a constant world of deprivation?

Well, one of the things I tell clients when they are like, “okay, I’ve got to have this, this has to be a part of my life”. I say okay, that’s fine, work around it and if you’re going to have something like if you’re going to have your crisps, here’s what you do. You set it aside until you’ve got time and then you put it on a plate and you use the appropriate utensils. You sit down, you lay a place mat, lay your table, make it pretty. Sit down and enjoy every bite of whatever it is you’re eating and if you can do that, have it without any guilt whatsoever. Just enjoy that food. Squeeze every bit of flavour out of every bite because then it will be much more satisfying to you and you don’t have that wraparound guilt thing going on because you’re an adult. You’re allowing yourself to have this particular thing on this particular day. 

The problem is we tend to either eat at the sink or pull up a chair to the refrigerator or watch in front of the television. I had this one client, a fella who had ice cream every night and I said, that’s fine. Just work it into your plan and sit at the table. Well, he said not at all, I want to eat it in front of the TV. I said, are you bored? Are you focusing on the food? Because if you are, if you want this food so badly, then actually enjoy it, focus on it, get all of the sensory experience out of that. If you’re watching TV, you’re not enjoying the food. So just make your choice. What do you want? The TV or the food and if you’re bored watching TV, why are you watching TV?

Yes, I must admit that is my tendency because I live on my own. I tend to, and maybe it’s, you know, it’s a multitasking thing in a way as well, but I don’t really see the point of sitting at the table and just eating because it’s just me, you know? So I’m not talking to anybody or anything. I’m just that, I don’t know, it just doesn’t feel right. So I am always doing something else. Usually watching the TV when I eat, but you’re right, and interestingly enough, when I am eating with somebody else, I’ll eat less, way less. I think that’s partly to do with the speed I eat because I’m talking and eating. So it takes longer to eat what I’m eating, but I would say almost without exception, I eat less when I’m sat down at a table eating with somebody else.

Well, and some of that is just attention. I remember years ago, Oprah had gone to France and she bought two croissants. She said, I knew I would swallow the first one whole and I got the second one so I could enjoy it and I thought, okay, yes, we do that. We get through something and then it’s almost like we haven’t had it because we ate it so fast or because we weren’t paying attention to it. Therefore we need more of it because we want to enjoy it. Well if you just enjoy it the first time, if you allow yourself to have that time when you’re eating, as focusing on the food, you know your eyes on the food that you’re eating. Gratitude for whatever was sacrificed for you. Get the sense of it, the smells of it, listen to your knife and fork cutting. Just get all of that sensory experience. It doesn’t have to take long, but when you’re eating, eat, enjoy the food, and it’s likely that you won’t eat as much because you’re getting all of the sensory experience in that one occasion.

It made me chuckle to myself then, well not chuckle, shiver probably more appropriate word, when you are talking about what Oprah said, because that’s exactly how I feel when I’m eating kinds of foods. It’s actually a sense of panic if there isn’t much of it. If it’s a very small amount, just taking the first, well, just actually the thought of eating it, if there isn’t a large enough stock of what it is, I’m panicked about that because I know that I’m going to run out. And just as you were talking, it made me think, absolutely, you’re throwing away a certain amount of that just sort of trying to fill that need before you even really start tasting it. So you’re having to plan for so much more than you actually need because it’s not actually the need in quotation marks that you’re trying to satisfy, not actually that food that you’re putting in your mouth.

So the question is what is that need?


And that’ll be different for everyone. What is it that that says to you?

And I’ve seen the futility of that. I’ve told this story before, Haagen Dazs ice cream was always the thing that I used to really love, I remember it was in the summer. Supermarkets aren’t usually open here on a Sunday, but in the summer they tend to be because the tourists are here. And I raced to the supermarket to get there before it closed at midday, just about got there in time and got a load of Haagen Dazs and I came back and was sitting eating this and I didn’t really want it I knew I didn’t want it. It was at a time I think where I was on, I think probably the low carb part of my journey. It was certainly way before Keto, and it might’ve even been actually way before when I was just in the normal yoyo dieting of things and on an off period, but just eating this working my way through these tubs, and it was multiple tubs of Haagen Dazs ice cream and certainly wasn’t enjoying it. I had tears streaming down my face, I was desperately miserable. I was shoveling this stuff into my mouth, trying this futile attempt, I guess, of trying to soothe whatever the problem was.

Yeah, and if you can find what you were trying to soothe and unwind that, then it’s much more likely that the food will lose its importance to you.

#97 Elena Gross

August 30, 2019

Daisy’s latest extraordinary woman, Elena, talks about migraines and her PhD thesis and RCT on the efficacy and safety of exogenous ketone bodies in migraine prevention.

Elena has a background in Neuroscience (University of Oxford) and is currently finishing a PhD in clinical research at the University of Basel, Switzerland. 

She is also a migraine patient and a keto enthusiast. 

Frustrated by the available treatment options for migraines, her research career has focused on better understanding this common and debilitating disease, with the ultimate goal of improving clinical care. 

Elena is particularly interested in the role of energy metabolism in migraine pathophysiology, as well as other neurological diseases. 

Her and her lab are currently conducting a randomised controlled clinical trial on the efficacy and safety of exogenous ketone bodies in migraine prevention, the first controlled trial on ketone body salts. 


ORAC Index

Elena’s RCT

Elena’s YouTube channel

Elena’s Top Tip

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#97 Elena Gross

August 30, 2019

This transcript is brought to you thanks to the hard work of Debbie Mitchum.

Welcome Elena to the Keto woman podcast. How are you doing today?

Hello Daisy. Thanks for having me. I’m actually very excited to finally talk to somebody about migraines. Who knows what migraines are herself, which is really cool. 

Oh yes, absolutely. 

There’s nothing better than introspective when you talk about a disease. You actually know what it is like, right.

For sure. We’ve been trying to record this for ages, funnily enough we were laughing about this before. We’ve both had to cancel due to migraines at some point, which is kind of funny. But we’re, we’re finally here and it’s fantastic to be speaking to you. 

Yeah, it’s certainly also been my fault for having to finish the PhD thesis and lots of things going on. So, my thesis in two weeks, I’m still a little bit stressed, but fairly migraine free, so it’s all good. And I’ve been looking forward to this since you asked me like months ago. Yes. 

Yes. It was quite a long time ago when we started talking about it. But the timing worked out quite well in a way because yes, like you say, it’s good to finish your thesis first.

Yeah. And you even skim read it. I’m well proud of you and honored. 250 pages. Well done.

Well I was, I was very interested in, there were, there were all sorts of things in there that we’ve chatted about a little bit before we start, so we’ll have to remember to bring up all the points in our actual recording.

Okay, great. I guess you have a list. Otherwise I’ll pull out the thesis again and we can go through it.

So, let’s start by hearing about you and how you got into keto, how you got into your migraine research.

Yeah. So, as you can imagine, and as I already mentioned, I’m a migraine patient myself. It’s, I think it started about when I was about 14 maybe half a year after I started the contraceptive pill, which is very interesting because having talked to a lot of patients within the course of my study now there seems to be a connection to starting the contraceptive pill and migraine onset or migraine worsening. But I just went to several doctors, nobody knew what was going on, psychologists and whatever brain scans. And finally, I diagnosed myself using the internet actually with migraine and from them then on is basically continuously gotten worse. So despite trying everything, and you know when you’re 16 you’re trying to go out with your friends or have a drink here and there and the least you want is really have a stable lifestyle of going to bed at the same time and not eating all these triggering foods. And, but I really tried and despite all efforts, alternative and medicine or pharmacological therapies, it just got worse. So after I think it was June, my bachelor’s degree, I was always interested in the brain, but I started reading psychology and my bachelor’s degree and my migraines actually became chronic and that’s something where you have more than 15 days per month of migraines or at least eight of those have to be migraines. The rest can be headache and just really crippling. Your migraines are starting to control life. You cannot go anywhere with that pain. I mean you know that when you have a bad migraine you can’t really control or ignore pain in the brain. Really. It’s a, it was quite tough, and you never knew whether you could take exams or whether you would have a migraine that day and plus social life. It was really bad. People don’t understand and so well by the end of the degree I realized that I couldn’t be doing a normal job with these migraines anyway. So, I decided I’m going to change my career path and not become a psychotherapist but go and read neuroscience instead and maybe within my lifespan, figure out more about what is a migraine and what can we do to actually treat it. So more looking into what might be the root causes, where is it coming from and why? Because I went to so many specialists and nobody actually answered that question, what is a migraine, why are we getting it? And of course, you can’t treat it.

Yeah. Cause if you want to really properly treat something, you’ve got to find that root cause.

Exactly. And not just treat the symptoms, not just treat the pain. And as we discussed earlier before this recording,  with triptans, those acute migraine medication or even with analgesics, you cannot take them more than like 10 to maximum 15 but that’s already pushing it days per months without getting medication overuse headache or this risking to get one of those. Because your brain basically adapts and then it adapts to having these chemicals around. And if you don’t have them around, then you get something like a rebound headache. So, your body is anticipating what these triptans do to your serotonin receptors because their serotonin agonists and if you don’t have those around, there’s not enough serotonin anymore to basically endogenously activate those receptors. So, then you get a migraine when you don’t take those drugs, which is even worse. Right? So, it’s like a vicious circle. So, I was stuck in that situation where half the time I could not take anything against the pain and that basically means you’re out for days in your dark room and you can’t do anything. So very unsatisfying. And  this is why I then went into neuroscience and I was lucky enough to have an open neurologist in Oxford who took me on and I did two of my masters, both master’s projects or thesis in migraine research with chronic migraine patients was one in neuro imaging. 

And the other one was STEM cell IPS, CS induced pluripotent STEM cell research with migraine neurons basically, which was also interesting. But for me it was most fascinating to be close to the patients in that neuro imaging. And there was this one incident and I still remember very clearly where the scanner broke down for one patient and she had to come back and she comes back into the lab the second time and I almost didn’t recognize her. She was walking up straight, she was smiling, she’s lost weight, she was like a completely different person. Back then I already started forming my theory that migraines are at least in part an energy deficit syndrome of the brain. She comes back and I asked her, what did you do? And she told me she’d been fasting for two weeks and that completely shocked me. He says, oh my God, she’s not eating for two weeks. And we know that not eating is one of the most potent migraine triggers. Right.

Typical triggers.

Exactly. And she was having a glass of red wine every night and it was fine. She had not a sandwich and I was like, wow, I couldn’t believe it because this is Oxford medical school or psychology medical school both together and the neuro-science in Oxford. We did not learn that the brain can metabolize anything else than glucose. Right. So, I didn’t even come across ketone bodies during the whole year of my studies there. And I was shocked, and I didn’t understand it. And I went about, and I chose the end of the degree. I was procrastinating in the library again as usual and was flicking through a nature magazine and it had an epilepsy special in there. And one of the articles was actually on the oldest treatment for epilepsy, the ketogenic diet. 

And I read upon the mechanisms and this was like the, I think this was the best aha moment I’ve ever had in my life. I was like, okay, this explains his incident with a patient, and this could also be the solution because reading upon the mechanisms, they were all migraine relevant. And few people know that actually migraines and epilepsy are genetically related. So, some kids would grow out of epilepsy and into migraines. It’s almost very similar pathophysiological mechanisms. The two, so some kind of parts of epilepsy are kind of like more severe versions of a migraine attack in a way you could end a lot of epilepsy patients even have migraine.

That’s interesting. How does that work? Why is the link though?

They see epilepsy as a migraine. It’s a hyper-excitable brain. It’s problems with your ion channels in the brain that make your brain super hyperexcitable and this can be exacerbated by energy deficits and when neurons fire in synchrony and they all fire at the same time, you basically get an epileptic seizure. That’s your seizure, uncontrollable firing, right, and a migraine CSD or Chronicle critical spreading depression, which is the correlate of the aura phase in migraine, which is this phase of visual. It could be visual but could be any other sensory deficiency that precedes the headache for about an hour and can be anything between five minutes and 60 minutes long. Basically patients go black on one side of the visual fields or you some go paralyzed. Some could also be like a aura of the body. Or you lose speech or something like this. But that’s also basically in the back of your head. This is basically a cortical spreading depression means that neurons fire in synchrony go over the cortex in a wave and that’s followed by no activity. And that’s basically when you then lose sight or lose control partly of body or loose speech, wherever that wave is traveling to basically. 

So synchronized uncontrolled firing is basically the underlying physiological correlate of an epileptic attack.  Migraines have that component to at least to some degree also antiepileptic drugs or the preventative drugs that are probably the most effective or among the most effective in migraine. So, if you reduce your excitability in the brain, you can help a migraine attack. And there’s also the link between hyperexcitability and energy metabolism because basically what makes a neuron fire the firing of a neuron is called an action potential. And there’s something called a resting membrane potential between a neuron and the outside of the neuron, which basically determines how likely the cell is to fire. Simply put, it’s almost like a wall between say the ocean and the land, the wave are the action potentials. If you have a high wall, the wave is unlikely to go over the wall onto the land, so you’re unlikely to get an action potential, which means your brain is calm. The lower the wall and the wall would be this resting membrane potential. The lower the wall, the more likely the waves are coming out to come over the wall. And whenever the waves come over the wall, the neuron will fire. Keeping this wall high or keeping the membrane potential high, which in the neuron is done by basically carrying out ions against a concentration gradient to basically keep this potential is an electric difference between inside and outside. In order to do that, you need to spend a lot of energy. So, 50% of the brain’s energy demand actually goes into caring ions across their potential difference in the brain, 50% it’s massive. So, if you have reduced energy in the brain, of course this wall is going to come down. When the wall comes down, your neurons are more likely to fire. What does that do? Well, first of all, you might get a migraine attack. But also, most migraine patients have some kind of sensory sensitivities. 

So hypersensitive to light, to noise, to smells.  Why? Because it needs much less of a trigger for the neurons to fire. If the wall comes down, they fight easily. So, life becomes much brighter and noise becomes much louder.  So, I think that’s how you can explain those other issues that come with a migraine attack before and during an attack as well could also be explained by this energy deficiency and by these neurons that are firing more likely. And the genetic predisposition here is a shared one between epilepsy and migraine would be, and there’s so many different ion channels in the brain that basically carry ions across membranes. That’s a function. Right. And if you have some that are predisposing you for a lower wall already or an increased tendency to fire and you put yourself in an energy deficient environment by only eating carbs. Right. Or you have mitochondria damage, then basically those two come together and you get a migraine or, you get more migraines. And I didn’t want to distract from the personal story, but maybe we could come back to this later. I believe that migraines, one says that chronic pain has lost as one in function. That’s what’d you say? Acute pain. Everybody knows it’s very important for evolution and once it becomes chronic, people say it’s lost the wanting function. We just need to treat the pain. But I doubt that. I think that pain always has a warning function. A migraine is a very potent warning of our brain that it’s in an energy deficit, that it’s, the oxidative stress is too high. It’s a very, very powerful means for the body to force us to stop what we’re doing to rest, to go in a dark room, we’re nauseated. We don’t want to move. That’s one of the most migrant symptoms. Movement makes it worse. Light makes it worse so you basically you shut up all sensory input, you conserve the energy you have until the homeostasis in the brain is restored and then a migraine stops and very interestingly during the migraine attack, early studies about 50 years ago and they’ve completely been forgotten about, showed that during a migraine attack, irrespective of what people are eating, ketone bodies are calling up and like policies is going up so it’s like a counter reactive response of the brain saying Oh we have an energy deficit now we need to ramp up some kind of energy that we can actually use. I now know that my migraines are trying to protect me from something and knowing that also helps you to kind of accept what you have. In a way I guess it’s not your body forcing this migraine onto wanting something bad is actually trying to protect you from something that is super harmful. It might increase your risk for Alzheimer’s in the long run or for some kind of brain damage in the long run because there is migraine stroke in patients that have migraines with aura. Typically for a very long time. I’ve been working in neuro imaging as I mentioned before, for some time you find this micro lesion in the brain. People usually say a migraine doesn’t leave a mark, but it actually does, so the more you get them, you actually do get to see it in the brain. Even with like a very course neuro image of like one square millimeter, which a on a on a much finer level, you’d probably see other things as well. Ions accumulate in the brain and all sorts of things.

Yes, I have read that actually and it makes complete sense.  If something is happening that your body is warning you against, it’s likely to leave a mark of some kind. 

Yes, and it hasn’t lost its warning function. It’s just that our environment has become so maladaptive to our migraine warning genes that say that people have it chronically, and of course it’s debilitating, but that also means that they probably have some kind of oxidative stress level in the brain or constant energy deficit. And that’s something you can also measure in migraine with neuro imaging these days, they have about a 20% on average ATP lack in the brain compared to controls, even between attacks. 20% less energy that’s not benign, and that’s episodic patients. That’s not even chronic patients. So, I don’t want to know how much lack of energy in the brain a chronic patient would have, and all the body can do. It cannot talk to you. It can send you pain signals, It turns these ancient mechanisms on, it turns the pain cause Kate on to force you to, to stop whatever you’re doing, to change something and tell you, hey, we’re not doing okay. There’s something wrong here. Right? That’s what pain tells you. And then in chronic patients it’s just that their genetic load is so high, and their mitochondrial functioning might be this bad. And there is other environmental situation with regards to food and energy might be this bad that they are constantly reaching the migraine threshold, the warning migraine threshold basically that the brain is always in such a state that it thinks it needs to warn them. Back to the personal story, just to finish that off, basically I stumbled across ketosis. I was like, this is it. I started self-experimentation. It went very wrong at the beginning because I had no idea what I’m doing and what a cute Jenny died is triggered like the worst migraine ever. I think it was fasting and I wasn’t in ketosis for like 10 days, which is crazy. My body completely had forgotten about how to make ketones or how to get them anywhere. But when I finally got it right, it was pretty amazing. Lots of self-experimentation followed. And then I knew that I wanted to do this in my PhD and nothing else. That turned out to be fairly tricky because everybody was like, Oh, you can come here but you do what we want you to do. I mean, as a pre PhD student, nobody believes you and it was fairly risky project, but then in Basel, and this is why I turned on Oxford in the end, is in Basel they said, if you come here, you can do it as a side project, and then before even starting my supervisor, he has said he has to leave to Germany. He’s, he’s leaving, he’s gone. So, my funding went, but that was basically the possibility then to say, okay, I’m going to make this my major project. I’m going to leave neuro imaging. 

It’s interesting, but it’s too far away from the solution. I want to do this Keto and migraine full time. And in order to get a grant that funds a full phase two clinical trial, which is fairly extensive, we decided to go the exogenous ketone round route, which is basically changing one variable only adding ketone bodies and find out what does the presence of ketone bodies change in a migraine patient with regards to potential mechanisms. And is this enough to show a significant clinical effect in those patients in terms of migraine day reduction and other outcome measures. And that’s been going on for like four years now. I think with the planning and everything and we’re in the last half a year. Last patient cohort is currently, in the study and then hopefully by next year we’ll have the results of that. But that’s basically the journey I’ve been. Now I’m towards the end of my degree and I was able to deep dive into ketone migraine, which is amazing if you can make your disease your passion, it’s kind of cool.

Exactly. So, you not only diagnosed yourself, but you’re going on to find the best treatment for yourself and for others at the same time. Yes, exactly. And we’ll talk a little bit about what your Keto looks like later because I know having had a conversation with you before we started recording, it’s going to play into something to do with what we’re going to talk about. So, I think it’d be better put that in a little bit later, right? Yeah, sure. You have spoken about already a little bit about what migraines are, but perhaps you could just talk a little bit more about that and also the connection you found with all the different triggers associated with migraines.

Yeah. So, migraines typically aren’t. That’s kind of, I maybe one more funny anecdote with regards to what a migraine actually is. Because when I was five or six years, I had a favorite movie called poom tin and Anton, it’s a German movie. And uh, I used to watch it on rainy Sundays with my friends. And in there the protagonist’s mother has migraines and her friend asked the dead, what are migraines? And he says migraines are headaches that don’t exist as in like she’s making this up. So, for the next 10 years following, I actually believe that migraines are a term for a headache that doesn’t exist for a made of headache. And then I had to, once I got there myself, I found out that they’re very real. So, migraines are not headaches that don’t exist. They’re actually even more than a bad headache. Typically, they’re from the headache, from moderate to severe quality pulsating.  They’re typically unilateral meaning they only appear on one side of the head. Typically, it could be some people have it strictly only on the right always and for some people it swaps. But typically, you have a preferred side where it happens, at least at the beginning. Eye pain is very frequent. Then you have kind of a premonitory phase, which precedes the headache attack up to one day or even more. And there you typically have associated symptoms, neurological symptoms like nausea, light sensitivity, noise sensitivity, smell sensitivity. Sometimes moving makes it worse and you have this like feeling of doom. Some people get really agitated. Other people get super tired and super fatigued and those symptoms can last throughout the headache phase. And then they will also typically last for the prodrome phase, which is basically the postdrome phase. Sorry, the phase that follows the headache. There could also be days even while you’re typically very fatigued and sometimes you have gastrointestinal symptoms. Most people have a lot of yawning. Maybe they pee more or increased appetite. It’s like your brain sensing there’s something wrong and now you need to eat as much as possible before the attack comes. A lot of people throw up. It’s much worse than a headache because you can’t ignore it. With a headache it’s like a pressure type of a pain and it’s your whole head typically and moving makes it better in migraine moving any kind of movement makes it worse.   pool sating sometimes stabbing quality is also fairly common. Does that summarize, I mean you could even, you could tell us, would you mind going, it feels like it’s fairly, it’s a fairly individual. This would be like more typical summary. 

 Duration wise, the diagnostic criteria says between 4 hours and 72 hours. So, between 4 hours and 3 days, which is quite correct. Typically, if I have a migraine that’s longer than three days, it swaps sides. So, I know, okay, next attack is starting. It’s not the same. 

You’ve got another one. 

Exactly. So, if that’s how you can tell and some people have an aura phase, you already touched upon this, about a third of migraineurs will have the phase of a visual or whatever, a sensory, defect. It will change. So, it’s only there for about an hour and then it will proceed, it could be a paralysis, it could be typically as visual, so visual disturbances, zag lines, blackout, whatever, these kinds of things. But it could be any sensory quality, losing speech as well. 

That’s fascinating to me because I used to have these incidents when I was younger, and they’ve always been a mystery always. And I may be had about half a dozen in total, but it was my late teens, early twenties. I thought it might be something to do with some type of epilepsy, you know, one of the really sort of low-grade forms of it. I just wasn’t sure. And the reason I didn’t investigate it was because I basically, I didn’t want to have my driving license taken away,  which someone told me if they start investigating thinking you might have epilepsy  that’s going to happen, but it never happened in any way like that. And I always had some kind of warning it was coming, but what happened was that I would kind of black out but stay conscious. Yeah. So, my vision would go completely. That’s a typical aura. My hearing would become muffled and the best thing I could do was just to sort of curl up in a fetal position. Terrifying. It happened once after a very stressful event where it was when I was at university in Liverpool and it happened just, actually on the phone to my mother and I think I terrified her because I said, I’ve got to go, I think I’m going to pass out. And I managed to get myself in the lift. I was on the 11th floor and then it happened. I couldn’t see, I could hear a little bit and luckily my, my roommate was either in the lift or was that, I think I managed to hit the right floor or was there when I got there and I said, you’re going to have to guide me to my room because I can’t see.

Yeah, it’s so scary. It’s so scary.

And it was very, very strange. It was, and I had no idea what that was, and I’ve never associated it with migraines at all.

So, the interesting bit is that all phases of the migraine attack can happen on their own. So, you can have an aura without the headache following. You can have the headache without the aura. You can have premonitory phases without the headache as well. So, people can have isolated auras, which is basically almost like a small epileptic attack. And depending on where this wave is traveling to. So, you have to imagine, right? We said that keeping your resting state with membrane potential upright takes 50% of the brain’s energy. Imagine there’s now a wave of electricity traveling over your cortex at the same time and you then have to rebalance all the minerals in your brain. That takes a lot of energy. I think it increases energy demand by like 200% or whatever and oxygen demand and everything. So it takes some time to basically get those neurons back into a state where they can fire again. If your neuron can’t fire, you can’t see, feel or hear anything. So basically, what probably has happened is that this wave was traveling across your visual cortex in the back because all your vision is basically centered in the back of the head. So that means if something troubles over there and basically enables all these neurons to do anything, that means it’s all vision is gone. That’s very interesting. The studies on the, I think, Second World War, First World War,  British soldier had these very weird helmets that would basically stop at the back of their head. So, you’d have a lot of, or quite a few soldiers coming back that has a wound or a shot into the back of their head and they would lose selective parts of vision depending on where the bullet has hit. So, if something would have hit all of your visual cortex in the back, then you just can’t see because the neurons, they are not working anymore. So, brain function, at least in some regards is localized in the brain.

Oh, how interesting. 

Would you probably have it as an is an aura, a prolonged or maybe even so then you can see it for patients, typically when they have it the first time it’s, it’s terrifying. They think they have a stroke. But the good thing is about an aura phase and that’s, where people shouldn’t be too terrified or worrying too much. That typically function comes back within the hour. So, it is more energy demanding. It does create more oxidative stress, which is probably why often aura phase of migraine headache starts because of all the oxidative stress, all the metabolic strain it puts in your head. Right. I mean, it now has to rebalance all these things after this electrical wave of activity. And that takes a lot of energy. It takes a lot of electrolytes. It takes a lot of oxygen and it takes a lot of things to get back on track, but it usually does. So your vision will come back and you’re feeling in your arm. Will come back and all these things, but it’s a fairly terrifying event. And that will be a prime example for an aura. Quite a bad one.

Yes. How interesting. And it’s, and it’s what I realized that it would pass fairly quickly. It was anything from, you know, 10, 20 minutes. I just knew that, yeah, if I just lay down, I mean, it’s the safest thing to do, isn’t it? Sit down, lie down somewhere.

It’s the best for you brain as well. You rest, you’re not spending energy on walking, for example. That would again, expand energy that your brain would need to restore itself. So, it’s kind of intuitively you do the right thing. How interesting. You’ve solved a mystery. Yeah, yeah. I mean there’s other things I’ve been wondering about and it’s like little puzzles that you can solve along the way. It’s kind of nice if you can explain your symptoms looking back. Because you always end up going to a medical doctor typically doesn’t help because I don’t have explanations as to why things happen. They only have a symptom treatment response. Typically for an aura, there’s some drugs you can take, but it reduces the aura frequency by like 20% or whatever. It’s really not worth it, but it’s good to know that when it happens rest, lie down, don’t do anything. Maybe have some magnesium’s and minerals, maybe if you can get something down.

It kind of makes sense that it happened at that period in my life. Maybe where, you know, a lot of things are changing with your body because it doesn’t seem to have carried on. That was something that happened within a period of a few years.

Yeah. So, your threshold would have been much lower because if you’re stressed, and that’s something that was very interesting to me because there’s psychological stress and there’s physical stress and we always think that these are different things. But actually, they’re fairly similar in terms that all of these stressors or stresses, irrespective whether it’s physical or mental, is basically causing oxidative stress. And oxidative stress is the common denominator of all migraine triggers, irrespective of how unrelated they seem to feel. So, fasting, skipping a meal of course causes hypoglycemia, stressful, oxidative stress, increases stress, mental, physical, aerobic exercise, any kind of exercise. And that’s why migraines typically have an intolerance to exercise, causes a lot of oxidative stress. And if oxidative stress exceeds your antioxidant capacity, so your body’s ability to buffer this oxidative stress, then it will do a lot of harm. So, if your exercise is triggering a migraine, it’s actually doing harm and you shouldn’t be exercising, or you shouldn’t be exercising at this intensity. 

Because what oxidative stress also does is it’s damaging your DNA, it’s damaging your protein, it sets you up for all sorts of potential chronic diseases long term. So, you really don’t want that. Then sleep changes, oxidative stress. Again, you can see that in nurses, in people that change their circadian rhythm, those come with more migraines and metabolic diseases or varying hormone changes. Female hormone changes during this cycle will increase oxidative stress also, and that’s where the pill comes in. I said that was a correlation between pill and a contraceptive pill, which is basically given out like candy to any teenager. I found publications that show that pill onset increases oxidative stress even in athletes by 50% but 50% more oxidative stress. So now if you have a migraine genetics in your underlying system, then taking the pill might be enough to set you off with migraines for life basically.

And talk a little bit about what you were saying about triggers being like a bucket because it really explains, doesn’t it, how some people get them a lot and some people get them rarely.

Yeah, so there’s a few more alcohol, sensory triggers. People have weather changes as a trigger even that makes sense. Because of atmospheric pressure. It decreases or increases the oxygen as in the air and you have alcohol and sensory triggers will also increase oxidative stress, especially blue light for example, is increasing oxidative stress not only in the eyes but also through the skin. So, we can see that all of these migraine triggers that we know are basically working on a similar pathway. Now if something targets a similar pathway, that basically means that you are adding up the stressors and you can think of a migraine threshold maybe as a bucket full of water. Some of us will have the bucket half full already when they’re born because they have migraine prone genetics. Then you’re getting the pill for example, right? So, your migraine bucket is becoming increasingly fuller. 

And then on this bucket you’re now adding, as a female adding this as a cycle in hormones. For example, estrogen is very antioxidant. So, one during the time of your period when it’s high, you’re less likely to have this water bucket overflowing because it’s kind of buffering. It’s a bit like the estrogen is letting out a little bit of the water and increasing your migraine threshold. So, this explains why some triggers like a glass of wine might be fine during some parts of the months. Whereas if you have other stresses at the same time so you haven’t slept well, all of these things you haven’t eaten, you’ve done exercise, you’ve had some alcohol depending on your genetics and your environment and how full your bucket already is. These individual triggers might then set off a migraine, have the bucket overflowing or not. Basically, a full bucket means migraine attack and all these trigger factors together will maybe cause a migraine attack at some point and not at the other point. 

But if you’re born with a bucket that is already full, you’ll have a migraine all the time. Or if you’re born with a, with a bucket that is half full, but then you’re on this worst diet or you have mitochondria dysfunction because of toxins or other things and that sets off that your bucket is full, then you also have a migraine all the time. So, it’s always an interplay between the genetic water load and your environmental water load, and when those two are added together, and environmental could be several different triggers, so many different things coming together. But if both of those come together and make the bucket full, then you have a migraine attack. From evolutionary perspective, it makes sense that some of us have these hyper excitable migraine genes because typically you’re already during attacks. You don’t have this habituation phenomenon, which basically means habituation is a way for the brain to conserve energy, which means that typically one of the rules is that your brain only encodes for change. 

So that means we’re not like a computer, we’re not firing all the time. Basically, a brain is only set up to fire when things change. So, if a normal healthy person looks at a checkerboard, let’s say, or a wide wall and it’s not changing, the brain will just stop firing. But in migraine brain will keep firing. It doesn’t have habituate, so it’s spending more energy, but it’s also basically alerted all the time. And you’ll see that in migraine patient typically is this perfectionist person and always kind of a little bit more sensitive to light noise and on all those things, even between attacks slightly. But if you think about a tribe of people, every seventh person has migraines in the world. There’s like a billion of us. If you think about a tribe being made of, Oh I don’t know, 20 people, you would have three migraine genetic people in there. 

And they would be the first ones to hear when a lion is coming at night because they have light sleep, they pick up very small sensory cues. So those would be the ones that might be saving the tribe from lion because wake up first. There must have been some kind of evolutionary advantage to having these migraine genetics around because if a population is affected, 15% of the population are affected by a certain genetic combination and genotype. There’s no way that didn’t have an evolutionary advantage at some point in time. So that just means that all the environment has changed so much that we’re now at a disadvantage with those genes. But otherwise it would not have stuck around that 15% of the population have this. So migraine really must have had some evolutionary advantage and that was probably maybe on the one hand, and that’s very speculative, but saving the tribe from things that require somebody to be alert all the time, even during sleep, more or less like being hyper-responsive. 

And on the other hand, it’s a preserve mechanism that shows you something’s wrong in your brain where an energy deficit, oxidative stress is too high. We now need to rest. And it’s very interesting how you can, and this is described in this nature and neurology paper that I sent you that was in my thesis. Basically, we cannot even mechanistically explain how we get from attack triggering to the resolution of the attack once. Why adaptive behavioral changes. We are forced to rest and do everything. So that homeostasis is basically conserved. And that is done by via molecule, one of them and neuropeptide that is causing pain called CGRP. And CGRP is basically what now Novartis and Eli Lilly and other pharma companies are blocking with their CGRP monoclonal antibodies, which is these injection-based treatments that have just come out recently. And they call it the migraine with [inaudible]. 

I think it’s an injection you get once per month. This is basically blocking the action of this molecule, but this molecule also seems to be part of mitigating the attack because it’s very antioxidant. Yeah. It’s basically the body sending out a pain signal and the solution in the same time. It’s stopping you from doing things, but at the same time it is kind of treating the initial problem. And another thing that is going on, like the third pillar of the whole migraine attack thing is the metabolic changes that happened during the attack. One of the things that can fairly reliably or was shown like 50 years ago, again to fairly reliably trigger a migraine attack in about 50% of cases is a giving a glucose tolerance test. You get 50 to a hundred grams of pure glucose to migraine patient and 50% of them will develop an attack in the coming hours, like 8 hours. 

It’s always delayed for the eight hours. And if you look at those that develop an attack and those that don’t and their metabolic responses, fatty acids, lipolysis and ketone bodies only go up in the ones that get a migraine attack and they’re eating normally they’re eating the same as the control group basically. If you want to trigger a migraine you give them sugar and then you see that there is a metabolic response. Basically, our body is trying to help us to save us there really because a, it’s changing your metabolism. It’s providing the brain with an alternative energy source because it is increasing glycolysis, increasing ketogenesis. It is sending out this molecule that is antioxidative and other molecules to seizure a piece, just one of them. But at the same time, this molecule also hurts because that’s the only way we would be stopped from running around and doing more damage for the brain. Expanding more energy.

Let it work. Yeah

That’s a long explanation. Sorry, I think I’m rambling on too long. 

No, no, it’s fascinating. And I remember what you cited in the migraines used to be referred to as hypoglycemic headaches. So that makes perfect sense. It’s that crash afterwards. 

Yes. About a hundred years ago. And then, you know, modern studies came along, pharma came along and then this was completely forgotten about for 50 years, almost a decade. And people have thought migraines might be a vascular problem and then it was neurogenetic and now it’s hyper excitable. And yeah, those things do play into the picture. But a hundred years ago this neurologist was treating his patients already with a low carb diet very successfully.

And it makes perfect sense then. And that’s the way I’ve always felt with this stacking system. With the bucket being full of the different triggers that by changing your diet you empty a load of water out of that bucket straight away. Yeah, exactly. Lower your threshold right down because there were all sorts of things that used to be reliable triggers for me for migraines. You know, things to do with the weather, surf, it was really hot or if a storm was coming, smell was one of the biggest things for me. If I walked past someone who was wearing some perfume or cigarette smoke. I could guarantee that I was going to get a migraine straight away. They do still happen, but nowhere near as often and so it makes total sense that by changing that big thing, changing my diet has dropped that threshold down.  It makes sense. What you were saying earlier about the problem when you’re  having the migraine is that lowering in ATP function and elsewhere, you talk about with ketone bodies that they’re capable of increasing relatively speaking to glucose that they can, you can produce more ATP. So, it makes sense. Yes. That by treating, if you like migraines with ketones, you’re getting that energy balanced back in place.

Yeah. You have a more effective energy source there. That’s true per oxygen molecule consumed. Basically, you also circumnavigate any problems or a lot of the problems with glucose metabolism and transport. So dude, one transport is might be deficient, which is the officially the transport system that gets glucose into the brain and, and insulin, insulin is also needed for, for glucose metabolism and ketone bodies are completely independent of these two issues. And then there’s more that comes with this dietary change, right? You also have less hypoglycemia. You have a more constant supply because you can use your fat stores now, which you were not able to use before. You might have more micronutrients in your diet as well. When you clean it up, you have less processed foods, less processed foods mean less oxidative stress again. So just getting ketones high is not the answer. 

We saw this very recently with a study on one of the first ones on cancer, brain cancer and ketone bodies. They were put on this very nasty Nestlé shake product, which is like the worst ingredients that you could ever give to anybody like rap seed oil and processed oils in there. But participants were in very high ketosis, like five millimoles and they would still die as quickly as a control group. There was no change at all from being in ketosis, which is why I stress so much. The quality of your ketogenic diet is key. It’s not just about having ketone bodies presence. You also need the antioxidants, the minerals, the vitamins. You need to make sure that you don’t add trans fats or any crappy fats, which would make matters maybe even worse. A high quality, real food ketogenic diets adapted to your micronutrient needs and to your antioxidant need. 

I think that’s the key. Also checking whether dairy is a problem for a lot of migraineurs. Dairy can be problematic, especially casein. Playing around with a non-dairy, more like paleo ketogenic diet can help.  But there’s a lot of things that this diet can set right. One of them is a mitochondrial functioning. Ketone bodies are antioxidative on their own, so the antioxidants and when you burn them you produce less oxidative stress, which again puts less metabolic strain on already damaged mitochondria. And you have the transport issue, you increase mitochondria biogenesis, so you have more powerhouses in the cell. Ketone bodies are able to reduce brain hyperexcitability via very many different, I think at least four mechanisms are now known. So that’s also another issue that is key for epilepsy and migraine is that you reduce or increase the inhibitory transmitters in the bright and reduces hyperexcitability, which again will empty your buckets of water is one of the ways. 

And, and its anti-inflammatory inflammation plays a role in almost any chronic disease. So again, that’s water out of the buckets. And the nice thing about this ketogenic diet approach or ketosis in general, maybe even in part exogenous ketones, we will have to find out. But is that it targets so many migraines rather than mechanisms, even the gut microbiome. There are about eight migraine mechanisms that we know are targeted or potentially targeted by ketosis. And migraine is a very multigenic disease as any chronic disease. So that means that many different pathways and things are probably involved in an individual migraine patient’s migraine, you cannot treat a chronic disease with a one target drug approach because there’s not one target in a chronic disease. And the beauty about ketosis and ketone bodies is that it targets all of these different mechanisms individually or together and migraine that might be completely different in one person to the migraine mechanisms in another person. 

Both of them might profit because some of their migraine causing mechanisms are effected by ketone buddies and the other person’s as well because they just have such a big variety of metabolic and signaling action signaling being like they change your gene expression or they change hyperexcitability so they’re the signaling and metabolite at the same time alternative energy substrate, but also changing all these other pathways in a favorable fashion. And I think this is why there could be such a potent migraine and even as a neurological disease strategy because they target so many of the known chronic disease or neurological disease pathways that are involved all with one molecule basically. It’s quite fascinating. 

Yes. I was going to ask you about inflammation because I’ve read the migraine is potentially an inflammatory disorder, but it would make sense if you’re causing this damage. 

But that’s again too simple, right? 

Yeah, exactly.

People say it’s a hyper-excitability problem. The, I would say it’s primarily inflammatory. The other people say, Oh, it’s vascular. The other people say, Oh, but it’s purely energetics. It’s too simple. And also, there’s probably migraine subtypes that we just can’t distinguish because the phenotype, so what we see is fairly similar, but this maybe there’s a thousand different migraines. Right. 

And are these also maybe secondary issues? Like what you were saying when we were talking about the triptans, and you just touched on it there, the migraines were thought of as a vascular disorder. Yeah. But your argument is that that’s just a secondary thing that happens because of it. 

See is, you know when you ask a migraine patient, they have this pulsating pain, right? So pulsating pain basically means that some kind of vascular receptors must be involved. Right. So, so when I had migraines 10 years ago, they told me, well, it’s basically that your arteries in your brain are dilating, they’re pressing against the skull and it hurts. 

But that’s the symptom rather than the cause. Yeah. In the dilation. Now they know that the dilation, it doesn’t correlate at all 

the dilation of the arteries and the pain onset is not, the timing doesn’t fit at all. There’s definitely not a vascular disease, definitely not. But the dilation could be the brain trying to get in more blood, more blood meaning more nutrients and more oxygen. Right. So, you have a delayed dilation in the brain. I could just be a secondary effect. As you say, it’s probably not causative, but also the triptans are targeting receptors on arteries. But also, that is a just one thing that we know they do, and they probably do other things as well. They could also inhibit a neuropeptide that is involved in pain for example, or work via completely misunderstood mechanism. We don’t fully understand why triptans are working at all. Really. 

So similarly, to what you were saying earlier, actually part of this pain response that you’re getting but packaged up with that is a potential treatment. So, it symptoms of the cause, but actually what’s happening in your body is helping treat that original cause, treating that migraine and actually by treating those symptoms, potentially you’re dampening the treatment that’s just happening naturally in your body. 

Not with a migraine and not with the triptans necessarily or the analgesic. I would definitely say don’t necessarily suffer through an attack and be like never going to take triptans or ibuprofen or aspirin., I don’t do that because it’s just unnecessary pain and suffering. So I still take those because I know that those don’t target the CGRP, but I think I would personally not do this injection based treatment of CGRP, monoclonal antibodies because I know CGRP, this neuropeptide is also expressed very highly in the gut and it’s not a selective treatment so you basically just block the action of one peptide in the body, which I think is kind of crazy. There’s not a lot of side effects yet, but if you do that for a long time, I’m really not sure what it does because we’re also inhibiting other bodily functions and we don’t really know so I’m going to wait and see, but I know that for some people it really is a life changer in the sense that their pain is gone. 

For others it doesn’t work at all. I think it really depends on what kind of neuropeptide cocktail is responsible for your personal migraine pain, but you need to remember you are blocking the pain and the same goes for triptans. You can see it as a center in the brain and the brainstem that basically lights up. When you get a migraine, you can see that that is still ongoing while you’re taking the triptans, which means the migraine is still there. Triptans do not abort the migraine. It’s just not true. The same as analgesics and this rebound, migraine is not a rebound migraine. When the triptans wear off, the attack is just there and it’s going to be there for that much longer. If you take the triptans and then you go to work and you do your whole stressful day and maybe even do exercise and you’re not resting at all, I will not do that either. You need to be aware that the pain might be gone, but the migraine is still there, so you need to take care of yourself during this attack. If you don’t want it to come back, he would still rest and do things a bit more slowly, in my opinion. So that would be my advice. 

Yes, that’s a good point. So, you’re taking something to get rid of the pain, but you should remember what you would have done where you not to take it, which is exactly that lie down in a dark room. Exactly. 

Don’t endure the pain if you don’t necessarily have to and you can tolerate those drugs quite well.  At least are under 10 days a month I would say. You really shouldn’t be taking them more often day wise let’s say. But yeah, don’t forget that you have the migraine in the first place. That’s a very good tip. Remember what it would be like or what you would be doing if you were still have this attack and it probably wouldn’t be running. You’re going to work, doing the laundry at the same time, picking up the kids and cooking and shopping and everything and like these hours of migraine, probably not. 

Yes. It’s actually still do what you would have done and talking about different ways that you can help. Maybe you could talk about some ofthe preventative treatments you’ve listed in your thesis. There weresome different vitamin supplements, all sorts of different things, including the ketogenic diet. 

Yeah. It’s quite interesting. There are some studies that show that antioxidants basically can help migraines, quite a lot as good as drugs actually. And it’s those could be CoQ10 300 milligrams, that could be riboflavin.  Riboflavin is vitamin B2 400 milligrams, so high dose, but also just a good complex, B vitamin and magnesium can help. Also, it’s responsible for 300 enzyme function and we tend to be too low. So, a good mineral supplement can help and there’s also alpha lipoic acid that has been shown to be my one protective, which is a strong antioxidant. There’s other antioxidants astaxanthin. There has not been a study, but it goes into the similar lines. So that’s something one could think about as well. If one wants to figure out the migraine. A best thing would be actually, I mean these things are just done an edit to the patients. 

I mean CoQ10 you could always do, but there might be other minerals or essential vitamins that are lacking. So I would always try and advise too, if you have the funds, do a blood test, minerals must be checked in full blood and vitamins, you can also check and see whether you might be lacking some of the things or even more. And then you can add a broad spend, high quality multivitamin or selectively take the things that you’re lacking could be zinc as well and that will improve your mitochondrial functioning and mitochondrial functioning is at the key for migraines. And you can add a ketogenic diet if your mitochondria are not working because you are lacking some vitamins or you’re completely toxic, for example. You can add ketones almost as much as you want. It won’t help much because also ketones need to have mitochondria that are producing your ATP. 

It’s like, okay, so in a car, right. It’s a bit like if you are calm and tolerant, if your glucose metabolism isn’t well, it’s like a Petro car and you’re feeding a diesel all the time, it won’t run well. Right. But if you are now giving diesel to a diesel car but the diesel car doesn’t have an engine, it’s still not going to run. So the engine is your mitochondria, you can swap the fuel, but if you don’t have an engine in your car, you can swap the fuel as much as you want. The right fuel won’t do anything. You need an engine that can make energy that can power your car. Right? So, the first step is to get your engine right and then you can change the fuel. So that’s what I was also referring to in this paper that you were talking about is get your mitochondria as best as you can. Antioxidants, whole food diets and supplement either if you have the funds selectively, if you don’t have the funds with a good broad spec multivitamin in a way that has everything that we need. 

And something like magnesium is, is a kind of thing that you can take without doing harm. It’s very obvious when you’ve taken too much, isn’t it? 

Exactly. And CoQ10 is the same. Ubiquinol is the preferred version. There are two versions of CoQ10 which might be worth mentioning. Ubiquinol is the reduced one. You’d ideally want that without maybe a hundred milligrams is enough. If you have Ubiquinol then you probably need to take 400 milligrams because it still has to be converted with the minerals and the or the vitamins more. Always try and take the active version and for example, there’s four different versions of B12 and cyanocobalamin is even toxic. So please also don’t go to the supermarket and take the cheapest multivitamin you find, it’s probably going to do much more harm than it does good because if you have non-active vitamins you liver  needs to detox them again, your liver is already busy with all other toxins and oxidative stress. So yeah, don’t save on that. It’s probably better to take nothing then take a bad supplement. And then there’s other things that you can do. So we talked about vitamins and minerals, we talked about getting antioxidants in your diet, which is basically colorful vegetables if you can. And it could also be in supplement form. 

This brings us quite neatly to a conversation we were having before where I touched upon earlier asking you what your keto diet looks like. We were talking about a few things clicked in in my mind again about what happened when I did my carnivore challenge and one of the things that increased a lot were migraines. I had other issues too with hot flushes and acid reflux and my mood was bad as well. But when I mentioned that to you earlier, your eyes lit up and you said yes it was something that was very common and the people doing a ketogenic diet if they suffer from migraines, need to be aware of and that’s where the importance of these micronutrients might come in. Perhaps you could talk a little bit about that cause you just touched on it there with the fruits and vegetables of different colors. 

Yeah, so basically, I figured out for myself that a very restrictive ketogenic diet that only basically has green and white vegetables wasn’t really cutting it and I mean carnivore would just be unthinkable. I think I did it for a week, it was horrible. There’s something called an ORAC index and that basically measures the antioxidant content in foods, the foods and even coffee has antioxidants. The darker or the more colorful a food is basically the more antioxidants it has. Like blueberries is super high, chocolate, coffee and then other colorful fruits and vegetables and basically if you think about, a migraine patient typically on a regular basis exceeding their antioxidant capacity. So oxidative stress is a good thing in moderation, but whenever oxidative stress exceeds your body’s capacity to fight it, it’s bad. And if you take out all the foods and fats and proteins, they don’t have a lot of antioxidants. 

This ORAC index is very, very low. So basically, that means that likely, even though they have some ketone bodies present and there is somewhat antioxidative, they will still be lacking potentially, or they will still do better with increasing antioxidant via their diet to help the mitochondria fight oxidative stress. I figured I’m doing much better having more food and vegetable colorful because I wasn’t even eating carrots or tomatoes or peppers that really can help getting more of those in it. For me it did. And for some patients also, so then you can either add exogenous ketones or MCT oils or, maybe it’s even enough to just be in ketosis some of the times. Some intermittent fasting might help. A lot of patients also struggled with the fasting because there’s something called glycogen resistance that has been found in migraine. It’s basically the opposite of insulin resistance. 

Glycogen resistance means that you will not turn on ketogenesis and gluconeogenesis as much because you’re resistant to glycogen, which is basically the hormone that tells your body when you’re fasting to produce more energy. And if you’re resistant to that, you get more resistant by fasting. You basically need to do the opposite than an insulin resistant person. You need to eat more to get this fixed. So that’s another interesting aspect in a migraine that is different to other metabolic diseases basically. But yes, so increasing antioxidants can be done with supplements, but also you can use the power foods that come with micronutrients that come with all these polyphenols and flower needs and these things that can be beneficial for migraines. Actually. And for mitochondrial functioning. 

So, you’ve worked your way to, you were saying before we started recording that your ketone levels are lower, but you feel a lot better. You’ve gone through a sort of stricter keto diet to now including, 

and I can still be in ketosis that said though it needed about, and that’s something we find in epilepsy too. It needs about two to five years in an epilepsy kid on a strict ketogenic diet. And then whatever gene expression changes and therapeutic effects they had during the ketogenetic diet is outlasting the duration of ketosis. So basically, if a kid has 80% reduction of seizures, that will be a point in time where they can stop a ketogenic diet completely. And these kids sadly go back to Western diets and it will still have 80% reduction and that might be something that’s happened to me as well. I was in higher ketosis for two and a half years and then was this point where I could go away and still have this reduction in migraine from like I had 20 days on average and I’m now down to maybe three a month. 

I’m not sure if that was the major driver, but even during this stricter ketosis, I would feel better generally. I also like energy-wise in to body ache and like, you know, burning muscles. The more carbs from, not from the grains, I’m not doing any of this or even legumes. I can only beans again and stuff, but I wouldn’t recommend that. But just from more colorful vegetables and having some fruits really helped me. And the only explanation for me is it’s not the carbs, but it’s the things that come with the carbs of fruit and vegetables that you cannot get with the meat. 

Very interesting. And what do you feel about treating when you do have a migraine treating it with exogenous ketones and that, just is a question actually about the trials that you’re doing, are they taking exogenous ketones sort of on a daily preventative basis or are they taking them as a treatment for a migraine? 

It’s prevention. You need to think about, you need to basically on a chronic basis, empty the bucket with the ketone bodies. It’s like it’s my migraine is a cascade of events, right? It could be and I don’t have much evidence and for me it’s hard. It’s work sometimes and sometimes not. If you catch a migraine super, super early and the pain cascade hasn’t started, maybe you can abort it with exogenous ketones. But really what you need to do is increase the threshold or lower the water in the bucket on a regular basis. So, we’re using them as a preventative, increasing the threshold, reducing the frequency. 

Your mimicking what other people are doing with a diet. 

Exactly. If you think about a migraine as a process, like a stone sitting on top of a mountain rolling from a mountain, once the stone gets rolling and it becomes full speed, it’s almost impossible to stop that stone. And it’s a bit like that in a migraine. Once the pain cascade has started, once these newer peptides that caused the pain in your brain have been released, you can take all the exogenous ketones you want. More energy is not going to stop the peptides from being around. Right. It might make the attack less long, less prolonged. It might make it less strong, but it’s probably not going to, it’s not a painkiller. It’s not going to stop the pain because pain basically is these peptides being around and the receptors being activated. So it will be very interesting to see and I would really love to do that trial with patients that are very experienced and can have this like feeling of when the migraine is coming, if they take enough ketones early enough in the whole process, whether it could abort an attack even. 

But we don’t have that data. I only have patients coming to me saying that it’s worked for them and that’s really interesting. Also like on this a ketogenic diet from the conference from Dominic D’Agostino. I had several patients that have seen a video before or read my poster and they’ve done that, and they say it works. But I don’t know if this is a regular occurring thing. I cannot reliably make it work. Sometimes it would, sometimes it wouldn’t, but I’m also now I’m doing so many things. I’m also on the road and I don’t have them with me all the time, so I think I’m taking it too late when it doesn’t work, when the pain is there already, it’s too late. It won’t do anything, 

But it’s kind of something that’s maybe worth a try. It’s just something that I’ve mentioned in my Facebook group. Yeah, and some people have tried and really found it helps. So for me anything like that. Are they taking the racemic or the D, do you know?  Just a racemic type one that you can buy on Amazon, that kind of type exogenous ketones. 

Yeah. Interesting. Interesting. Because the lower blood glucose, the racemic so it’s interesting. 

So yeah. Great. Yes, I mean it seems to me that if you can help with something like that as supplement rather than taking any kind of pain meds, it’s worth a try. Oh, certainly. That’s something that I want to try myself. 

Because yeah, all these pain medications, again, it puts quite a strain on your liver and your liver is already super busy in a migraine patient typically. Any medication has to be detoxed and we typically underestimate how quickly you can kill yourself with ibuprofen because it leads to liver failure. It’s like I don’t know what, you take six of them or eight of them at one go and you can kill yourself. It’s like, it won’t kill you if you take two, obviously, but that doesn’t mean that taking two on a regular basis is not going to somehow negatively impact your liver with time. Right. So if you can find a natural approach to that by all means and a ketones, if even if it’s, if it’s a D BHB, even better because as the endogenous version, the human identical one because then you only have things around that are human identical. So that won’t have any side effects because it’s something that is around anyway. They’re harder to get hold of. Right, they’re harder to get hold of still we’re working on it. I’m working on it because I wanted it for myself. So maybe one day hopefully. But yes, until then, I mean racemic if you don’t take it for like 10 years, there’s also safety data for the racemic is not going to kill you. Certainly not. All right. It’s if it helps by all means.

Perhaps you could round up with what you call the four-step approach to improving mitochondrial functioning and energy metabolism in migraines towards the end of your thesis. I read that the recommendations that you have for everybody who suffers from migraines. 

Oh yeah, certainly. We’ve kind of touched upon the first two, right? The first one we talked about is a individualized supplementation of the micronutrients. And this could also be hormones, so not only vitamins and minerals, but also some people have menstrual migraines which get really bad two days before their period, which is basically the time where your estrogen plummets and you don’t have this oxidative stress protection, your insulin sensitivity changes during that time. So sometimes people with menopause get really bad migraines and maybe they would profit from some human identical. Again, that’s the key. Don’t take synthetic hormones. They’re not the same ones that your body makes. It needs to be bioidentical; hormones can help. So basically, getting the base right, getting your engine working, getting your engines in the body, working, getting the base, giving the body everything, it needs, all the ingredients for good function first. And the second step will then be increasing antioxidant capacity. So that could be with food, with supplements and also would using oxidative stress and that could be toxins. Smoking, too much alcohol. Actually, it’s really interesting if you tolerate alcohol well, it’s basically the best test to see whether your liver is doing fine. If you have alcohol intolerance, that basically means your liver is struggling. It’s kind of nice to check in with yourself sometimes. Can you tolerate alcohol? If yes, your liver is probably doing okay. If not, you might have to increase your antioxidants. The third pillar is stabilizing blood glucose, and this is essential for migraine patients that often get a migraine in the middle of the night because blood sugar plummets. If you have easy carbs like in a glucose tolerance test, typically what comes after is a delayed insulin response that is exaggerated, which then needs to reactive hypoglycemia, which you want to avoid, so basically low GI diet would be essential, so get rid of any. 

Of course, that’s where that one of the biggest triggers is skipping a meal. Exactly. You can just see how eating ketogenically is really going to help so much with that pillar. 

That point doesn’t even have to be ketogenic, that could be low carb. Low carb can stabilize your blood glucose very well. 

Anything you can do just to stabilize it. Stopping several highs and lows. 

The fourth pillar, the final pillar is that if that doesn’t help, then providing your brain with an alternative energy substrate might be key and that’s the ketogenic diet. Potentially if you struggle and your liver isn’t making enough ketones, or you have to put more vegetables into feel better. This is why exogenous ketones could come into the picture and MCT oil if you tolerate it, but if that has not helped yet, then you really need this alternative energy. Then you run better on ketones than you do on carbs due to transport issues or whatever it might be. So that’s when you really should go strictly on a ketogenic diet or get other sources of ketones in if you can. So that would be the four-step approach that I summed up my thesis with. 

Something that just dawned on me  just going back to the beginning when you started talking about those different steps, if somebody has a regular, like with time of the month when they always get migraines, they can reliably know that they’re going to get migraines. Like you were saying that the couple of days before their period say, and that happens every month despite all the other things that they’ve done. Would that be a good example of when you were talking about taking exogenous ketones more as a preventative way or right at the top of that pain cascade getting in there before the pain starts, would it may be good for somebody like that to say take exogenous ketones for those few days when they get migraines every month certainly as a preventative measure.

 For example, before your period, for some people,  period is stressful, estrogen plummets if you have menstrual migraine, it might well be worth experimenting, adding exogenous ketones in two days before the period starts because they know they will get a migraine and seeing if that helps things. That’s exactly what you can do for like a targeted approach where you know, or when you’re extremely stressed, and you know you didn’t sleep well, and you know you’re bound to get a migraine. Maybe not wait for the first symptoms. Just take high dose exogenous ketones and see how you’re doing. 

 Because if you’re saying that for it to be effective, you need to get in there before the pain starts. Exactly. That just suddenly dawned on me. That might be a good way to do it. I would definitely recommend that. It’s been wonderful talking to you, and I could go on all day. Likewise, but I know you have to go. Perhaps you could round us up with a top tip. 

If there’s a numberone tip that I would recommend, and that’s something that I had to learn quite painfully because I was one of those perfectionist migraineurs who’s always listened to everybody else and I took all these, general advice on board, like, sport is good for everyone. Do sports, don’t do that. Don’t do that. Whatever the number one thing you can do and really learn is listen to your body. Your body will tell you what it means. Once you get rid of your addictions or whatever, the best thing you can do is listen to your body. Does this feel good? Does exercise feel good? Does it trigger a migraine? Does cheese feel good to me? Does whatever? Does a very strict ketogenic diet few good or does something else feel good to me? Don’t think because it works for somebody else it’s going to work for you. 

It was so individual, nothing even the color red is going to look different to every one of us. There’s nothing that is basically assured to be the same with you then to somebody else. So, the only person who knows you have to become your own doctor. You have to take care of yourself and your health yourself and listen to your body. It’s going to send the right cues if you listen to it. And the migraine is one of those cues. So, the migraine is telling you something and you need to change things in your environment until you figure out what is good for you. And this could even be getting rid of toxic relationships that chronically stress you and put water in your bucket. So, you really have to sort out through not only your diet, but also your supplements, your relationships, all of these things that stress you and that you might have not been aware of. All these things will make your bucket full in order to get water out of the migraine bucket. If there’s one advice is listen to your body while doing it.


Thank you so much. Yeah. 

 It’s been a great pleasure. 

Thank you, Daisy. Have a good day. 

And you