Feasibility and acceptability of a personalised healthy diet versus a medical nutrition therapy ketogenic diet in reducing migraine frequency and severity

During the 4-week ketogenic diet intervention, a calorie level will be determined by a dietitian for each participant based on their age and activity level. To achieve a desired level of ketosis, the diet is calculated in terms of a ratio (3:1), where there is 3 times as much fat as there is protein and carbohydrate combined. Total carbohydrate for the day will be restricted to 5% of total energy intake. The dietitian will assist in developing a meal plan that contains the required fat, protein and carbohydrate for each meal. Each meal plan indicates the exact gram weight of each food which must be weighed on kitchen scales. A typical meal includes a small amount of fruit or vegetable, a protein rich food, and a source of fat such as heavy cream and butter or vegetable oil. Participants will also be provided with recipe suggestions to assist with making food and meal choices outside of the meal plan. The most common adverse effect of the diet is constipation. There are dietary options to prevent this problem including eating high fibre vegetables that are allowed on the diet and drinking enough water. A less common adverse effect is kidney stones. This problem can be prevented by drinking adequate water. The dietitian will discuss these dietary requirements with the participant. Adherence to the diet will be monitored via an image-based food record whereby participant take photos of their meals each day and add a text description of the meal. The images then sync with the research teams account and the dietitian reviews these and contacts participant if changes need to be made. Participants also complete the Australian Eating Survey before and after the intervention, a FFQ assessing food group, macro- and micronutrient intake. Following the 4 week intervention diet, participants follow a 4 week washout diet where they resume normal eating for this duration.