A Keto Diet for Pain Relief

It has been known for quite some time that caloric restriction and periods of fasting can relieve pain. We also know that exercise relieves pain. We seldom think of chronic pain as a metabolic problem, yet it seems to be at play during exercise and food restriction.

Reducing glucose in general has a pain-relieving effect. Another reason for this effect is due to the building block adenosine (the “A’ in ATP), which is directly linked to the energy metabolism of cells. Fasting, ketogenic diets, and exercise all boost adenosine signaling. Adenosine itself has anti-inflammatory properties but also inhibits excitatory neurons—both potentially leading to pain relief.

Keto Diet Pain Research

Studies in rats have shown that a ketogenic diet lowers sensitivity to thermal pain when the hind paw is exposed to a heat source. Studying pain in animal models, however, has many challenges. In a clinical trial of more than 100 overweight individuals on a ketogenic diet, there were reported reductions in general bodily pain.

A recent study examined a low carbohydrate diet (which could’ve been called ketogenic since <20g per day of carbohydrates were permitted) in 21 older adults with knee arthritis versus a high carb standard diet. After 12 weeks there was significant pain relief and some improvement in functional ability that also positively correlated with reduced blood markers of inflammation.

A large body of evidence in athletes performing high-intensity training in the keto-adapted state experience reduced muscle soreness and accelerated post-exercise recovery. Many, many anecdotes also report pain relief with a ketogenic diet. Here’s just one example. If you have one, share it below.

Keto Diet for Migraine

Up to 75% of those with ME/CFS experience migraine headaches. The figure is just as high for those with fibromyalgia. In general, migraines are brought about by brain energy deficit and/or oxidative stress that exceeds antioxidant protection. These main factors drive a low-level chronic inflammatory state in the central nervous system. Mast cells and macrophages of the central nervous system release inflammatory mediators that inflame delicate meningeal tissues, and nerve blood vessels, and create that unique head pain many of us are familiar with.

A handful of studies have been conducted on this topic so far, and what has been done is very promising. Just as with body pain, there are also numerous case reports of migraine relief on a ketogenic diet. A 2015, study of 96 migraine patients underwent a one-month ketogenic diet as part of a weight loss program. After the study, up to 80% experienced fewer migraines, less severity, and less reliance on medications.

Of interest is that these effects seem to outlast physiological ketosis. This means that the effect of headache reduction remains in the absence of high levels of blood ketones. This same effect is seen in those who use the diet to control epileptic seizures. This suggests that the effects of a therapeutic ketogenic diet can have lasting effects on metabolism, expression of genes, and protective enzymes.

Caveat.

Low blood sugar (hyperglycemia) is one of the main triggers of migraine. Because of this, it seems counterintuitive to risk hypoglycemia with a very low carbohydrate diet. If you suffer from hypoglycemia-associated headache, a slow gradual dietary change will be necessary before jumping fully into a ketogenic diet.

More research is required to unravel the mechanisms of ketogenic diets as they relate to pain. This is a growing area of interest for many as traditional methods of pain control are largely inadequate. The ketogenic is safe to try for pain control.

References

Barbanti, P., Fofi, L., Aurilia, C., Egeo, G., & Caprio, M. (2017). Ketogenic diet in migraine: rationale, findings and perspectives. Neurological Sciences, 38(S1), 111–115.

Gross EC, et al. (2019) Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention. Nutrients. 11(4).

Masino SA & Ruskin DN. (2013) Ketogenic diets and pain. J Child Neurol. 28(8):993-1001.

Masino SA & Ruskin DN. (2012) The Nervous System and Metabolic Dysregulation: Emerging Evidence Converges on Ketogenic Diet Therapy. Front Neurosci. 6: 33.

Strath, L. J., Jones, C. D., Philip George, A., Lukens, S. L., Morrison, S. A., Soleymani, T., … Sorge, R. E. (2019). The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis. Pain Medicine.

Volek, J. S., Noakes, T., & Phinney, S. D. (2014). Rethinking fat as a fuel for endurance exercise. European Journal of Sport Science, 15(1), 13–20. Pain Medicine, 0(0), 2019, 1–11.