The effects of Ketogenic (keto) Diet on Brain Aneurysm related Headaches

Most brain aneurysm survivors continue to suffer from headaches that vary in intensity and duration. It is a pain that we stay hopeful that maybe…, just maybe we will wake up one day to a surprise that the headaches are no more. The sad reality, however, is that most of us have accepted the pain and found ways to live with it. At the same time, the headache comes with its own anxiety. Whenever the headache intensifies, we are constantly thinking of another brain aneurysm rupture. This is by far the worst nightmare that any brain aneurysm survivor wants to deal with.

About 3 months ago, I was introduced to Keto diet by my dear brother who had done it for 3 months and lost 35lbs.

I’m the kind of a person who has tried several diets in the past and never found one with successful longevity thus, my recent skepticism towards weight loss diets. I was very reluctant to try it but after he convinced me enough, I fell for it with a 2 week’s commitment.

Let’s dive right into my Keto journey addressed in a Q/A  format.

When did you start the diet?

I started the diet on the 7th of August 2019. To conserve my muscle mass, I am doing the high protein-low carb version of it. I try to keep my carb intake below 50g of net carbs per day. The first 2 weeks were very difficult but I have learnt to modify it into a lifestyle change rather than a diet with a specific end date. I think it is worth to mention that most western diets and America in particular, are loaded with carbs and sugars. It is amazing what happens to our bodies when we limit or eliminate these food items from our diet.

What changes did you notice within the first 2 weeks?

The first and most obvious change that I noticed on the second day of doing keto diet was the absence of headaches. Typically, I used to have 3-4 days of constant headaches per week. Somedays I would take an Aleve in the morning just to have a pain-free day and somedays, I will just deal with the pain. It was almost too good to be true that I didn’t have any headaches.

After completing my first 2 weeks on keto, I still did not experience any headaches. That alone was my motivation to continue with the diet to date.  I haven’t even had a slight headache. It almost feels as though my headaches have been suppressed with this diet.

When did you suffer your brain aneurysm and how was it fixed?

My brain aneurysm ruptured in July of 2017 and it was fixed with the coiling procedure.

What other diagnosis do you have?

Besides the other small intact aneurysm, I have high blood pressure.

What medications do you take?

On a routine basis, I take Atenolol, Hydrochlorothiazide, Nifedipine, Lisinopril, and Amiloride (all for BP) and magnesium and Vit D3. I also take Tylenol #3, regular Tylenol and Aleve for pain as needed. A lot of changes have happened though within the last 3 months. I have stopped Nifedipine, Lisinopril, and Tylenol #3 completely due to low blood pressure…YES! I have also reduced the frequency of Vit D3 from once a week to once a month. My doctors are impressed!

What other changes have you experienced within the last 3 months since starting the keto diet?

Besides losing a whopping 28lbs as of today, I received a miraculous report on the CT and CTA tests of my brain at the beginning of October. My neurologist ordered me to have an extensive brain study that consisted of a 3-day EEG, CT, and CTA.  This tests were ordered following an abnormal initial 25 minute EEG test which showed some slowing of my bilateral frontal lobes. I would like to point out that the initial EEG was done in early July prior to my journey on Keto. The extended EEG, CT and CTA were both done in September.

According to the results, everything was normal. No slowing of the brain activity in the frontal lobes was observed and both the CTA and CT did not detect any new aneurysms including the small one that had been observed on the scan that was done back in December of 2017. When I say my doctors (nephrologist, neurologist and primary care doctor) are amazed, it’s not a joke. Maybe it’s the diet, maybe it’s a miracle or maybe it’s a combination of both! I don’t know but I will continue doing what I’m doing.

Do you exercise routinely?

I walk about 2 miles 3-4 times a week and the rest of the days I do tai chi or light Zumba. I have some video from YouTube that I use.

Did you have any complications from the Keto diet when you started?

Besides obtaining valuable information from my brother who had done it, I did my own research to know exactly what I needed to do to avoid any possible complications while adopting it as a lifestyle change.

I take magnesium 400mg twice a day, multivitamin, and apple cider vinegar drops in my water about 3-4 times a week. I also drink lemon and ginger water daily before I go to bed. I think the secret to avoiding any possible GI related complications is consuming plenty of fluids. To avoid loosing more muscle weight, I consume a lot of proteins.

Therefore, I haven’t had any complications. My husband had the keto flu in his first week for a day or two but it wasn’t anything too serious.

Intermittent fasting

I have done and continue to do various kinds of intermittent fasting. I have done 48hr water fasting (once a month), and 16/8hr fasting( 2weeks in a month). This is basically fasting for 16hrs and eating in the 8hr window. What I do is skip breakfast or compress all the 3 meals within the 8hr window. I think fasting has a lot of benefits to the body in general such as:

  1. Boosts weight loss
  2. Increases energy
  3. Promotes cellular repair and autophagy (when your body consumes defective tissue in order to produce new parts)
  4. Reduces insulin resistance and protects against type 2 diabetes
  5. Lowers bad cholesterol
  6. Promotes longevity
  7. Protects against neurodegenerative diseases such as Alzheimer’s and Parkinson’s
  8. Improves memory and boosts brain function
  9. Makes cells more resilient

https://www.bulletproof.com/diet/intermittent-fasting/intermittent-fasting-guide/:

Do you have any meal samples?

Basically, I use butter, ghee, olive oil, coconut oil, and avocado oil to cook everything. I use unsweetened almond milk or regular grass-fed whole milk for my tea and coffee. Stevia as a sweetener. For fruits, I use berries and citrus. Once in a while, I will eat some pineapple and mangoes. Cauliflower, green beans, bean sprouts, cabbage, carrots, zucchini, cucumbers, broccoli, Brussel sprouts, collard greens, mustard greens, spinach, lettuce, avocado, coconuts, all kinds of seafood, chicken, beef, pork, goat meat, lamb, nuts, nut butters…etc. are on the long list. I drink a lot of decaffeinated tea throughout the day. My favorite is rooibos tea that I was first introduced to while in the hospital in South Africa due to its tremendous health benefits. The tea is orange and sweet in nature that you don’t need to add a sweetener. I usually get the Fresh Pack brand from Amazon but it’s available in other brands from various stores.

There is a variety of food items to consume once you know your carbohydrate intake limit. My friend, however, decided to simplify things by purchasing a meal plan from https://mealplan.club/ that she shared with me. It’s a 3 month meal plan that includes mainly lunch and dinner. You can modify your breakfast or skip it all together. Not everybody can do the intermittent fasting. If you need actual meal samples, just let me know and I’ll share the meal plan with you or do another segment on it.

What is Keto diet exactly?

Keto stands for Ketogenic. It is a diet that has been around for almost 100years that was created mainly to treat people with drug-resistant epilepsy especially in children. This might explain why it has such positive effects on the brain function. The diet has helped me personally with improved mental focus and clarity. The biggest part is that it has eliminated my headaches!

Below is everything you need to know before starting the keto diet obtained from https://www.ncbi.nlm.nih.gov/books/NBK499830/

History and Origin

Russel Wilder first used the ketogenic diet to treat epilepsy in 1921. He also coined the term “ketogenic diet.” For almost a decade, the ketogenic diet enjoyed a place in the medical world as a therapeutic diet for pediatric epilepsy and was widely used until its popularity ceased with the introduction of antiepileptic agents. The resurgence of the ketogenic diet as a rapid weight loss formula is a relatively new concept the has shown to be quite effective, at least in the short run.

Physiology and Biochemistry

Basically, carbohydrates are the primary source of energy production in body tissues. When the body is deprived of carbohydrates due to reducing intake to less than 50g per day, insulin secretion is significantly reduced and the body enters a catabolic state. Glycogen stores deplete, forcing the body to go through certain metabolic changes. Two metabolic processes come into action when there is low carbohydrate availability in body tissues: gluconeogenesis and ketogenesis.[4][5]

Gluconeogenesis is the endogenous production of glucose in the body, especially in the liver primarily from lactic acid, glycerol, and the amino acids alanine and glutamine. When glucose availability drops further, the endogenous production of glucose is not able to keep up with the needs of the body and ketogenesis begins in order to provide an alternate source of energy in the form of ketone bodies. Ketone bodies replace glucose as a primary source of energy. During ketogenesis due to low blood glucose feedback, stimulus for insulin secretion is also low, which sharply reduces the stimulus for fat and glucose storage. Other hormonal changes may contribute to the increased breakdown of fats that result in fatty acids. Fatty acids are metabolized to acetoacetate which is later converted to beta-hydroxybutyrate and acetone. These are the basic ketone bodies that accumulate in the body as a ketogenic diet is sustained. This metabolic state is referred to as “nutritional ketosis.” As long as the body is deprived of carbohydrates, metabolism remains in the ketotic state. The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small concentrations without any alterations in blood pH. It greatly differs from ketoacidosis, a life-threatening condition where ketone bodies are produced in extremely larger concentrations, altering blood ph to acidotic a state.

Ketone bodies synthesized in the body can be easily utilized for energy production by heart, muscle tissue, and the kidneys. Ketone bodies also can cross the blood-brain barrier to provide an alternative source of energy to the brain. RBCs and the liver do not utilize ketones due to lack of mitochondria and enzyme diaphorase respectively. Ketone body production depends on several factors such as resting basal metabolic rate (BMR), body mass index (BMI), and body fat percentage. Ketone bodies produce more adenosine triphosphate in comparison to glucose, sometimes aptly called a “super fuel.” One hundred grams of acetoacetate generates 9400 grams of ATP, and 100 g of beta-hydroxybutyrate yields 10,500 grams of ATP; whereas, 100 grams of glucose produces only 8,700 grams of ATP. This allows the body to maintain efficient fuel production even during a caloric deficit. Ketone bodies also decrease free radical damage and enhance antioxidant capacity.

Issues of Concern

Adverse Effects

The short-term effects (up to 2 years) of the ketogenic diet are well reported and established. However, the long-term health implications are not well known due to limited literature.[6][7][8]

The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.

Cautions and Contraindications

People suffering from diabetes and taking insulin or oral hypoglycemic agents suffer severe hypoglycemia if the medications are not appropriately adjusted before initiating this diet. The ketogenic diet is contraindicated in patients with pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency. People on a ketogenic diet rarely can have a false positive breath alcohol test. Due to ketonemia, acetone in the body can sometimes be reduced to isopropanol by hepatic alcohol dehydrogenase which can give a false positive alcohol breath test result. 

Clinical Significance

The popular belief that high-fat diets cause obesity and several other diseases such as coronary heart disease, diabetes, and cancer has not been observed in recent epidemiological studies. Studies carried out in animals that were fed high-fat diets did not show a specific causal relationship between dietary fat and obesity. On the contrary, very-low-carbohydrate and high-fat diets such as the ketogenic diet have shown to beneficial to weight loss.

Evidence Behind The Ketogenic Diet

In relation to overall caloric intake, carbohydrates comprise around 55% of the typical American diet, ranging from 200 to 350 g/day. The vast potential of refined carbohydrates to cause harmful effects were relatively neglected until recently. A greater intake of sugar-laden food is associated with a 44% increased prevalence of metabolic syndrome and obesity and a 26% increase in the risk of developing diabetes mellitus. In a 2012 study of all cardiometabolic deaths (heart disease, stroke, and type 2 diabetes) in the United States, an estimated 45.4% were associated with suboptimal intakes of 10 dietary factors. The largest estimated mortality was associated with high sodium intake (9.5%), followed by low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%), low intake of omega-3 fats (7.8%), low intake of vegetables 7.6%), low intake of fruits (7.5%), and high intake of artificially sweetened beverages (7.4%). The lowest estimated mortality was associated with low polyunsaturated fats (2.3%) and unprocessed red meats (0.4%). In addition to this direct harm, excess consumption of low-quality carbohydrates may displace and leave no room in the diet for healthier foods like nuts, unprocessed grains,  fruits, and vegetables.

A recent systemic review and meta-analysis of randomized controlled trials comparing the long-term effects (greater than 1 year) of dietary interventions on weight loss showed no sound evidence for recommending low-fat diets. In fact, low-carbohydrate diets led to significantly greater weight loss compared to low-fat interventions. It was observed that a carbohydrate-restricted diet is better than a low-fat diet for retaining an individual’s BMR. In other words, the quality of calories consumed may affect the number of calories burned. BMR dropped by more than 400 kcal/day on a low-fat diet when compared to a very low-carb diet.

A well-formulated ketogenic diet, besides limiting carbohydrates, also limits protein intake moderately to less than 1g/lb body weight, unless individuals are performing heavy exercise involving weight training when the protein intake can be increased to 1.5g/lb body weight. This is to prevent the endogenous production of glucose in the body via gluconeogenesis. However, it does not restrict fat or overall daily calories. People on a ketogenic diet initially experience rapid weight loss up to 10 lbs in 2 weeks or less. This diet has a diuretic effect, and some early weight loss is due to water weight loss followed by a fat loss. Interestingly with this diet plan, lean body muscle is largely spared. As a nutritional ketosis state sustains, hunger pangs subside, and an overall reduction in caloric intake helps to further weight loss.

Other Issues

Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.  Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.

A ketogenic diet may be followed for a minimum of 2 to 3 weeks up to 6 to 12 months. Close monitoring of renal functions while on a ketogenic diet is imperative, and the transition from a ketogenic diet to a standard diet should be gradual and well controlled.

Enhancing Healthcare Team Outcomes

To counter the obesity epidemic, some healthcare workers do recommend the ketogenic diet. However, the primary care provider, nurse practitioner, dietitian and internist need to be aware of a few facts.

Overweight individuals with metabolic syndrome, insulin resistance, and type 2 diabetes are likely to see improvements in the clinical markers of disease risk with a well-formulated very-low-carbohydrate diet. Glucose control improves due to less glucose introduction and improved insulin sensitivity. In addition to reducing weight, especially truncal obesity and insulin resistance, low-carb diets also may help improve blood pressure, blood glucose regulation, triglycerides, and HDL cholesterol levels. However, LDL cholesterol may increase on this diet.

Also, in various studies, the ketogenic diet has shown promising results in a variety of neurological disorders, like epilepsy, dementia, ALS, traumatic brain injury, acne, cancers, and metabolic disorders.

Due to the complexity of the mechanism and lack of long-term studies, a general recommendation of the ketogenic diet for prevention of type 2 diabetes mellitus or cardiovascular disease may seem premature but is, however, not farfetched for primary weight loss.

While in the short term the ketogenic diet may help one lose weight, this is not sustained over the long run. In addition, countless studies show that the diet is associated with many complications that often lead to emergency room visits and admissions for dehydration, electrolyte disturbances, and hypoglycemia. [9][10][11] https://www.ncbi.nlm.nih.gov/books/NBK499830/

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