One in eight people in the world is suffering from chronic migraines, making it one of the most widespread yet misunderstood health challenges of our time. In her teenage years, Dr. Elena Gross struggled with the worst migraines as well, but her research is now changing everything we know about managing and treating them. She joins Zach Gurick to discuss how she developed a diet-based approach in healing chronic migraines, which focuses on what and how we eat to fully optimize brain health. Dr. Gross also shares about Brain Ritual®, the world’s first and only patented medical food she helped develop to correct nutritional deficiencies associated with migraine.

The information presented in Fully Alive is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before making changes to your health regimen. Guests’ opinions are their own and do not necessarily reflect those of the podcast host, production team, or sponsors.

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How To Deal With Chronic Migraine With Dr. Elena Gross

Welcome back to Fully Alive, where we are unlocking the secrets to your healthier, happier, and longer life. We’re diving into one of the most widespread yet misunderstood health challenges of our time, migraines, and brain health in general. If you’ve ever experienced a migraine, you know that it’s far more than just a headache. Migraines can be absolutely debilitating, stealing energy, clarity, and quality of life.

Our guest knows that reality firsthand. Dr. Elena Gross is a neuroscientist with a PhD in clinical research. She is the founder and CEO of a company called KetoSwiss and the creator of Brain Ritual, the world’s first medical food designed specifically for migraine management. Her journey didn’t start in the lab. It began as a teenager living with unrelenting medication-resistant migraines that only intensified over the years.

Out of that suffering came determination and eventually groundbreaking solutions, which she is now sharing with the world. Dr. Gross has studied at Oxford, Basel, and Cambridge. Her research has been published in leading journals like Nature Neurology. She has won multiple biotech awards, holds several patents, and has pioneered discoveries that target the metabolic root causes of migraine, offering hope not only to migraine sufferers but to anyone who cares about brain health, energy, and longevity.

In this conversation, we’ll explore her personal journey, the science behind Brain Ritual, how nutrition and metabolism affect our brains, and why her approach may not hold the key to not just reducing migraines, but also protecting and optimizing brain health for the long term, treating things like depression, mild cognitive impairment, and even providing energy for our brains moving forward. Whether you or someone you love struggles with migraines, or you simply want to unlock better brain performance and resilience, then this is a conversation you won’t want to miss. Let’s welcome Dr. Elena Gross to Fully Alive.

 

 

Dr. Gross, thank you so much for being on the show. I’m excited to learn from you. You are a wealth of knowledge, expertise, and wisdom. I’m excited to learn from you myself. I’m excited for our readers to learn from you and all the things that we’ll get to uncover with the amazing work that you’ve done throughout your lifetime. Thanks for being here.

Thanks so much, Zach. It’s a great pleasure to be here. You cover a lot of things that are close to my heart in your show. I’m very much looking forward to diving into things that can hopefully make you live healthily and die young, ideally, at a very old age.

Turning Chronic Migraines Into Medical Breakthroughs

We can start at the beginning. You were a chronic migraine struggler with chronic migraines yourself, even in your teen years. Your story goes back to that. Could you share what those years were like and how that motivated you to devote your life to finding better solutions than what was available?

In your show, we are looking for longevity and increasing health span, but when you have chronic migraine at age fifteen, your health span is actually short. I was struggling with chronic migraines, starting with my first migraines that were episodic from age fourteen. It was something that nobody could even diagnose. I started to get these debilitating one-sided headaches that made me wake up at night. They came with nausea, light sensitivity, noise sensitivity, and smell sensitivity, in a way that I could smell something 200 meters or yards away.

It was so bad that my parents thought, “Maybe she has a tumor or something.” We went from one doctor to the next. Depending on where I was, they were doing brain scans. I didn’t have a tumor, luckily. I was doing EEGs. I ended up with a psychologist. “Are you stressed at school?” Eventually, my mom remembered that her mom also had these very bad headaches. We googled at the time. Google was already available. Migraines came up quickly. We have a diagnosis supported by a specialist.

It turns out migraine is very common. You would think a billion people in the world with migraine. Surely, our medical system being so advanced, there should have been a drug or something that you can take. I started fairly hopeful about all this, and then realized, within the subsequent years of taking all the drugs that are not migraine-specific, but anti-epileptic drugs, anticonvulsant drugs, calcium-channeled lockers, all the things, to all the alternative approaches, my parents paid a fortune for Chinese herbal medicine, acupuncture, and all of these things.

Despite all efforts, changing my life around as a teenager, going to bed at the same time, and trying to avoid alcohol, chocolate, cheese, and whatnot, it was getting chronic. By the time I was halfway through my bachelor’s degree, which was in Psychology, I had more than twenty migraine days a month. I didn’t know how to pass the degree. I was missing out on life. There wasn’t a life worth living, because at some point, you don’t know where to go with that pain. I was on anticonvulsant drugs that made me forget the name of my best friend, who was sitting over coffee. I didn’t know what her name was. I would wake up in the morning, and I wouldn’t know where I was. These drugs were giving me dementia.

It was so scary. I decided, “This cannot be my life. This cannot be the solution.” I went into neuroscience. I applied for neuroscience. I was lucky enough to be accepted under a doctor in Oxford at the time, who shared his knowledge and wisdom with me. I did two master’s theses on migraine. My mission started to be, “I need to figure out what migraine is and eventually help find better therapies.” This happened way earlier than I ever had imagined. Towards the end of my master’s degree, I stumbled across something that eventually gave me my brain back and my life back.

That was the oldest treatment for epilepsy. We can discuss what the solution was. Long story short, I wanted to do a PhD on the topic. Oxford said, “It’s way too risky. You can’t do that here.” I ditched my stipend, went to Switzerland, tiny Basel, and did my PhD on the topic there. It looked promising. I wrote my first patent, went to Novartis and Roche, and showed it around. I was like, “Guys, you have to bring this to market because it seems very promising.” For them, it was way too early a stage. They weren’t interested.

Eventually, I founded a startup myself to bring this potential solution to other patients. “I have a PhD on the topic.” Seven years later, we launched in the US. We now have a product for migraine management. We can discuss what this entails, but the general concept can be done without any products. I’m sitting here as a CEO, working 150% of the time without migraine. I have my life back. I’m forever grateful.

Hopefully, what I learned can be passed on to other patients. It’s not just migraine. This is one thing I want to say before I stop waffling. What I discovered and learned about the migraine brain generalizes a lot to brain health in general, or other neuropsychiatric symptoms. In modern medicine, we tend to categorize things based on their symptoms. We become more and more specialized in certain symptom clusters.

This is a migraine with aura. This is the depression. This is whatever it may be. This is Parkinson’s. This is epilepsy. The root causes of these diseases can very much overlap. It looks different because of the genotype. Your genes are different, so the phenotype is different for your problem. Root causes can actually be similar. That’s hopeful because there are certain things that we can do for our brain, not just for migraine, but for brain health in general. In the next hour or so, we can be diving into a few of those.

Thank you for sharing that amazing story of discovery and your own journey there. There are a billion people in the world who suffer from migraines. That means one out of seven people, essentially, are suffering from this. Everyone reading this probably knows somebody, if they themselves aren’t one of those one in seven people who struggle with migraines. What you’ve discovered, as you mentioned, is generalized and is much more helpful for brain health beyond just migraine relief. I’m excited to dive into all of this with you. You went from Oxford to Basel, and then also to Cambridge after that. Is that right?

Yes. Two or so years into starting a startup, I realized I don’t know anything about business much at all. I was a scientist. As a scientist, first, I thought, “All I can ever do is science. I have the science. I need somebody like a pharmaceutical company to bring this to market.” Eventually, we were luckily invited by Novartis. They had this biotech camp challenge. We won this challenge. We played a biotech startup. I realized maybe this business thing can be learned.

I started learning by doing and asking all the stupidest questions. I didn’t know any of the vocabulary or whatever for two years. I thought, “Maybe I have to do this properly.” I did enroll in Cambridge for a mini-MBA. It was a Master’s in Entrepreneurship in Business. Halfway through COVID, it was all online. I also still had to run the startup. I realized I’d learned quite a bit already by doing it. I must admit that I dropped out towards the end because the essays were too much. It was actually not possible to run a startup 100% and do a master’s 100% on the side. I didn’t finish, but I learned quite a bit. It was a good time until COVID hit. Yes, I went to Cambridge, but not all the way to the end.

You learned what you needed to learn, got the master’s you needed, and moved on. You’re running your company and doing the science at the same time, which is amazing. You went from having twenty migraine days a month. I imagine that’s extremely debilitating. As you said, 2/3 of your life is in pain.

You can only take analgesics and painkillers for about ten days a month. Otherwise, your liver is fried, and you get medication overuse headaches and all the side effects. When you can only take them for ten days, and you adhere to the rule, that means the other ten days, you’re stuck with the worst imaginable pain in a dark room. You’re trying not to move and survive. That was the other ten days, or you overuse painkillers, which is also not great. That was my situation back then. It was not ideal. I opted for overusing painkillers where I could, for exams, homework, or whatever, and a couple of days in a dark room as well.

How Ketogenic Diet Can Help Treat Migraines

What was the oldest treatment that you discovered? What was the root cause discovery that led to Brain Ritual?

When I sat in that library procrastinating from my second master’s thesis, for the first time, it was fate. I opened a Nature magazine. Nature is a very renowned journal in science. I was flicking through it, and it had an epilepsy special in there. A whole section is dedicated to the treatment of epilepsy. It had an article on the oldest treatment for epilepsy, which is a ketogenic diet, a diet that mimics fasting. If you are doing that diet for a patient, then the body doesn’t know. Is it basically taking its own fat? Does the fat come from outside and a bit of protein? It’s inducing fasting metabolism.

What they figured out over 150 years ago is that if you fast epilepsy patients, and after some time in many of them, not all of them, but in many patients, the seizure threshold is much increased. Their seizure frequency goes down. They are much better. Some of them are seizure-free. For some of them, it’s much reduced, but you can’t fast or starve a patient forever. That’s why they came up with this diet that mimics fasting. I read about the mechanisms. I already knew at the time that epilepsy and migraine are genetically related.

What this fasting metabolism is doing seems so migraine-relevant. It’s providing an alternative energy source for the brain. It is reducing excitability in the brain. It’s reducing inflammation. It’s reducing oxidative stress. It is increasing the glute transporters, or the transporters that bring glucose into the brain. It’s improving mitochondrial function and mitochondrial biogenesis, the building of new mitochondria. It can improve even the gut and the microbiome. All of these things play a role in migraine.

I must add one more anecdote. I’ve been very lucky to work with chronic migraine patients already at the time in a neuroimaging project. We had been scanning chronic migraine patients to see what’s happening in the brain. For one patient, the scanner broke down. She had to come back. We had a new appointment. In two weeks’ time, that patient came back. Anybody who knows chronic pain patients, and you know it, you can see it. They look a bit sick. They’re crawling. They’re always on edge. They can’t smile.

This woman comes back. She’s walking upright. She was beaming. She has lost weight. I didn’t recognize her. “Who is this?” I realized, “This is her.” I asked her, “What did you do?” She said, “I’ve been fasting for the last two weeks. For the first time in my life, even though I had a glass of red wine, even every night, I didn’t have a single migraine attack.” I couldn’t understand at the time. I was already thinking migraine is probably an energy deficit, because short-term fasting induces migraine, exercise, and all of these things.

How can it be that this patient didn’t eat for two weeks? That should have been the severest energy deficiency. She doesn’t get a migraine. We scan her. Afterwards, we always offer them cookies as a thank you. On the way back, she ate the cookies. That night, she had the worst migraine again. We gave her a migraine. I always hope that one day, the patient is reading, and I can apologize, because we couldn’t help them. We did her so wrong. All the puzzle pieces fell together. Even though this patient hadn’t eaten for two weeks, her brain finally got the energy it needed, because it cannot deal with glucose so well.

Ketone bodies are completely different. Metabolites can go into the brain, fuel it properly, and have a different transport system and different metabolism. For her, her brain was fed, even though she didn’t eat. That led to one of the biggest a-ha moments for me, which is that you can have excess calories. You can stuff yourself with food. If it’s the wrong foods, your cells, and particularly your brain, are still starving. Calories don’t mean energy availability. This is also very important for people who are overweight.

Obesity is an energy deficiency problem, not a calorie access problem, because if your brain is starving, it cannot use the energy you’re giving it. This could be because it’s the wrong macronutrients. It could be because their micronutrients are missing. If something is missing, and the cells can’t make proper energy, or your brain can’t make proper energy, it will signal hunger the whole time. It’s not a willpower problem. Your brain is constantly asking you to eat more because it’s starving.

If something is missing in your body, your brain cannot make proper energy. It will signal hunger until you eat.

If you’re trying to get your magnesium needs from biscuits, you have to eat a lot of biscuits to get your B2, your magnesium, your electrolytes, and your trace minerals correct. The brain, because it can’t talk to you in that sense, will give you a hunger signal until you’ve met all your nutrient needs and until it gets the energy it needs to function well. This is also why, for example, with our product, or with other forms of diets, people tend to lose weight. It’s because their brain is signaling satiety for the first time. This is something that we probably need to let sink in.

The solution basically was, we need an alternative energy source for the brain. Later on in time, I realized ketosis is amazing, but to burn energy sufficiently, you also need a whole other micronutrients for your cells and your brain to make energy. We can discuss this later. It’s micronutrients we have to get right. We have to get the right fuel source into the tank. If you have an electric car and you give it diesel, it’s not going to work. If you have a petrol car and you give it electricity, it also won’t drive very far. You need the oil and the water to cool the tank.

You also need these helpers, these coenzymes, and these micronutrients to have your car drive properly. That’s similar to the brain. That was the discovery, very simple. So far, not many people have thought of it at the time. Still, migraine is thought to be a pain disease, a neurological pain disorder. It is very much a metabolic disease, at least for about 40% to 50%, which we call the metabolic migraine subgroup.

Not all migraines are the same, essentially.

Not all migraines are the same. Not all depression is the same. Not all Alzheimer’s is the same. Another big mistake that we’re making as a civilization, as a human species, or in the field of medicine, is that we try to distinguish diseases by main phenotypes, main symptoms. We say there’s Alzheimer’s, there’s depression, there’s Parkinson’s, or there’s migraine. None of them has anything to do with the other. They’re all completely different in causes, but they are identical within that cluster of symptoms. This couldn’t be further from the truth.

A metabolic migraineur and a metabolic depressed person probably have more in common than a hormonal migraineur to a metabolic migraineur because the root causes are different. If we think about Alzheimer’s, which might be something that your readers are also interested in, there is metabolic Alzheimer’s. I’m almost sure of it. There’s also toxic Alzheimer’s. If you have, for example, too much mercury, aluminum, or lead in your brain, that can also trigger Alzheimer’s and neurodegeneration.

If you have lead in your brain, mercury, or whatever it is, and that causes your neurons to degenerate, if you don’t remove that, or you can do whatever you want, it’s not going to go away. If you are insulin resistant, and your brain cells are starving and cannot use the glucose, don’t give alternative energy sources like ketone bodies, and are also reducing your glucose intake, you’re also not going to get better. It very much depends on what is triggering the disease.

Which disease you’re getting probably depends on not only the trigger but also your genetics. You’re not a slave to genes always. Most of the time, you’re not. You need to adapt your environment in such a way that it matches your genetics, so that the genes are not negatively expressed. That’s what I’m all advocating. There are certain pillars for metabolic health that we can discuss. There are about four or five that I originally developed for migraine and then realized, “It’s for brain metabolism in general.”

Migraine Is The Messenger, Not The Enemy

There’s a lot that we need to unpack because I feel like you said a lot of profound things that, like you said, need a minute to sink in. First of all, talking about even understanding obesity as an energy deficiency, your brain is signaling, “I’m still hungry,” because your brain is still hungry. It’s not getting the right fuel.

 

 

I firmly believe that is true. It’s not a willpower problem. That’s how we can also rethink obesity. If you think about it, “That person is eating too much. Come on, they need to stop eating. What’s wrong?” They are finding a starvation signal. You cannot override a starvation signal. It’s so strong. Even with the strongest willpower, if your brain is constantly saying, “We’re starving,” you can’t do anything else until you’ve eaten. That’s how strong the signal is. That’s not a willpower problem. It’s a metabolic problem. When you fix that, most people can lose weight.

In migraine, about half of the people who suffer from migraines, and it’s also the same kind of metabolic migraineurs you mentioned, have the same issue. They’re missing that energy, that fuel that their brain needs.

The migraine is not the enemy. The migraine is a friend because the migraine is the firefighter or the fire alarm that is telling you, “We’re starving. Something is wrong. You need to rest. You need to lie down in a dark room and shut yourself off until any of your homeostasis has been restored.” The migraine is trying to help you. It’s so terrible that everybody sees it as we need to get rid of the pain. That would be like sending the firefighter home or turning the fire alarm off and keeping the fire burning.

That’s crazy, but that’s how we treat migraine. We numb the pain. Everything that’s out there, even this CGRP monoclone antibody, so you can now get injections that block the receptors for a molecule called CGRP, and that is a pain-eliciting molecule, that’s also blocking pain pathways. The migraine, in a way, is your friend. That’s what I’m trying to preach as well. It’s the messenger. It’s terrible, but the messenger does not have to come on.

The warning signal, the fire alarm, doesn’t have to ring if we’re extinguishing the fire. The fire is the root cause. For 40% to 50% of patients, this will be at least metabolic. It can also be a link. Metabolic can be many things. Some people may be lacking vitamin D or magnesium, and then it’s an easy fix. Some may be lacking many more micronutrients, or some may not be good with glucose metabolism. Some might have more severe mitochondrial dysfunction, with oxidative stress very high. There are many parts to metabolism, but I lump them together because they can be addressed in a similar protocol.

Determining The Right Fuel For Your Brain

The fuel that our brain needs is ketone bodies, right?

It depends. Honestly, there are people around. We may all know them. They need very little sleep. They run around like crazy. They can eat what they want. They’re super slim. They don’t get this afternoon dip. They’re healthy. These are the people who have adapted perfectly to glucose metabolism in the last 10,000 or so years, which is about the time that carbohydrates have been more available in larger quantities.

These people may not need ketone bodies around so much. A lot of us, 10,000 years, about the time when farming and carbohydrates were available, evolutionarily speaking, is a blink of an eye. A lot of us modern humans are genetically way older than 10,000 years. We haven’t adapted to having glucose around as much. That means for us, that’s suboptimal. If we have too much glucose around, we become insulin-resistant.

Just to tell you an anecdote, my partner, my fiancé, is Swabian. If you’re not from Germany, this may not mean anything to you. Swabians are a group of Germans who eat only spätzle, bread, baked goods, and whatever. His family comes from a baker’s family. He has always been like, “I can’t eat like you. I need carbs.” I was like, “This can’t be true. I know this cannot be true. The amount of carbs you’re eating cannot be healthy.” I check his glucose response after two bowls of spätzle, and it has barely come up from baseline.

I eat two carrots, and my glucose is way higher. He’s so insulin sensitive that whatever carbs he’s eating are disappearing from his blood in minutes. It’s almost not measurable. Some people, and I know some of these people, you can actually measure that they can deal with these carbs well. I don’t have an argument anymore, because his blood sugar is so low. It is as long as it’s not highly processed carbs. Nobody should be eating lots of sugar and processed carbohydrates, but a sourdough bread with organic flour might be fine for some people.

That’s including him. For me, certainly not. It is different. What I want to say that applies to everyone is that we should be eating whole foods, real foods with very few ingredients and little processing. This applies to oils as well, especially fats and oils. In general, if you are making a sourdough bread that ferments overnight, and you are a Swabian-like person, this may be fine. Other people are fine with more sweet potatoes or some other lower GI carbs.

That’s what I’m currently eating. I do a more paleo diet. Other people should maybe eat some fruit, some colorful vegetables, and no grains or starches. Other people thrive on a ketogenic approach. It is individual. It’s very important that you know. You should be testing yourself and see how well you can deal with carbohydrates and where you’re at in the last 10,000 years’ worth of adaptation.

It is where you are on that spectrum. Some people are going to be more adapted than others, but what is the fuel? Ketones are what our brain uses, but not everybody. Some people use glucose as well for fueling their brains, right?

Let’s explain what ketone bodies even are. I have to say that coming back to the Swabian example, my fiancé is adapted to carbohydrates. I also have to say that even if he eats carbohydrates, interestingly, his liver still makes ketone bodies as well. His ketone body levels are also higher. They’re not shut off by sugars or starches as quickly. Ketone bodies are small fatty acids that your liver makes to feed the brain during times of starvation and when glucose isn’t available. It’s also the brain’s preferred fuel source when it has a choice.

It’s anti-inflammatory. It’s a good thing to have around anyway. Very importantly, human babies are born in ketosis, meaning they are making that fuel source for brain development. It’s essential. A baby that doesn’t get ketone bodies will never be as smart as it could have been. His brain won’t develop as properly. Mother’s milk even contains a precursor of ketone bodies so that the baby can store that in his fat tissue. When it’s weaned and put on a normal diet for the next two years, it still has ketone bodies coming out of the fat tissue, so that the brain can develop properly. Ketone bodies are essential for humans.

We used to have them around much more because we were fasting and we were starving. That was winter. There were not a lot of carbs around. Before 10,000 years ago, we were hunter-gatherers who would sometimes only have meat, fat, maybe some leaves, and then maybe some honey. We would go in and out of this ketosis state, making this small chain fatty acid the fuel for the brain. To understand why that’s important, it’s also important to say that the brain’s metabolism is a very special one. This is important for everybody to understand who has a brain, so not just migraine patients.

The brain is protected by something called the blood-brain barrier. You might have heard that term before. The brain is supposed to be protected from viruses, invaders, bacteria, but also other things. That blood-brain barrier is fairly tight. Only a few selected fuel sources can go into the brain. These are small molecules. You already know one. One is glucose that can go inside. One is lactate. Lactate is produced during exercise. Anybody who is sick or sedentary will not have a lot of lactate around. That just leaves glucose.

The third category of molecules that can make it into the brain is so-called ketone bodies, as we said. If somebody isn’t so good with glucose and they’re in the current modern world, they have no backup. That’s important. The other important thing is that because the brain is so tightly packed into this, and your skull is so hard, you can’t store any fuel in there. Anybody who knows somebody who has had a stroke, sadly, within minutes, neurons degenerate because they’re starving. The brain is always dependent on the rest of the body to supply it with sufficient energy.

Not a lot of energy can get in there. Big fatty acids coming from your fat stores, big protein molecules, big carbohydrate molecules, none of that can get in there. Your muscles can use that stuff, but the brain can’t. That’s why it’s so vulnerable. Considering all of that, our brain makes up 2% of our body’s mass in terms of weight, but it consumes 20% to 25% of our energy. It’s the most energy-hungry organ. It cannot store energy. It can only get through a selected few molecules to fuel it properly. You can see how that can be an issue in the modern day and age. That’s where ketone bodies are so important.

We used to be like hybrid cars 10,000-plus years back. We would be cars that could use electricity, glucose, and petrol, so fats for energy. When we run out of glucose, the electricity, then we would switch to petrol and go for longer periods of time. We’re now basically all electric cars. We need to find a plug every 2 to 3 hours, otherwise we run out of energy. We need to constantly eat because we’re not metabolically flexible anymore. We’ve lost the ability to use and make that second fuel source for the brain and potentially even lactate because we’re not exercising anymore.

The goal for longevity and brain health should be to be a hybrid car again. This could be with endogenous strategies. This could be with exogenous strategies, meaning the ketone bodies are coming from outside. The modern human should be able to use both glucose and ketone bodies for their brain function and brain health, and that is so simple. Why do I think that will work? Ketone bodies and micronutrients are the future because they’re our past.

We have come from using these things. We have evolved over hundreds of thousands of years to have micronutrients, which are electrolytes, trace minerals, vitamins, fat and water soluble, antioxidants, all of these things around, essential amino acids, and ketone bodies. We don’t. Our soils are deprived of micronutrients. Our foods are, too. If the salad, the grass doesn’t have certain things in it, the cow won’t either.

We’re deprived on a micronutrient level. We’re deprived on a macronutrient level. We no longer have ketone bodies around. On top of all of this, we have also introduced 80,000 new toxins in the last 50 or 100 years. They are damaging our mitochondria, which are the powerhouse of the cells that make energy. Everything is hitting on these common pathways of metabolic dysfunction. No micronutrients, not enough micronutrient variety, not enough amino acids, and then all these toxins that also need to be detoxed using energy. That’s coming full circle in why brain health has never been poorer, and metabolism has never been poorer. It is also why chronic diseases and aging problems are on the rise.

We have introduced around 80,000 new toxins to our bodies in the last 50 years that are now damaging our mitochondria.

Why You Should Take Exogenous Ketones With Caution

That’s fascinating. Thank you for expounding on that. I want to come back, though, because there’s been a bit of a push lately around exogenous ketones or taking ketones or the ketone powder, like the 1,3-butanediol that converts to ketones.

Certainly, not that one. I will explain why.

I’ve done Ironmans before and taken the ketones because then it fuels your brain, so then your body can use everything else for the fuel it needs. It helps your endurance and things like that. You explained to me how some of that is not healthy and causes you to age more quickly, using some of those exogenous ketones. Can you break that down for us a little bit? I want to understand that better.

It depends on what ketone bodies you use. 1,3-butanediol, which is in the ketone esters, and most of the ketone esters that we use and are sold straight up right now, is an alcohol. It is an alcohol. It needs to be metabolized by the liver. You use four NAD+ on the way. It is turned into ketone bodies, but it’s very costly to get there. NAD+ is one of the cofactors that declines with age and with chronic disease. It’s something that you do not want to lose if you want to live long.

If you take something with 1,3-butanediol in it, it’s a great concern because your liver function will go down. Your liver enzymes will rise. You’re putting a strain on your liver. You’re increasing oxidative stress. You’re losing NA+, which is exactly the thing that you do not want to do if you enter ketosis or if you want to live long. If an athlete is doing that before a race and they know, fair enough. You are going to gain and you are going to lose some.

If you promote that as a longevity tool for people who are otherwise healthy or who are not dying or something that they don’t know the consequences of, this is not fair. It’s not ethically right either. Even these ketone esters have 50% butanediol. It’s a liver toxin. It’s an alcohol. When you drink a glass of wine, you’re aware that you’re probably not enhancing your health. Maybe a little bit. There’s all this research on alcohol that maybe one glass a day will help your brain detox longer.

What doesn’t kill you makes you stronger, maybe. Everybody is aware that if you drink a glass of wine, you have alcohol in there. It might impact your health. If you sell these ketone exhaustions, ketone bodies, ketone esters, and this butanediol, people think they are promoting their health. It’s also very expensive and tastes terrible. They think, “I’m doing this to live longer.” With butanediol, the pluses and the minuses might even cancel each other out. In diseases, especially, we see some doctors see quick signs of liver failure in epilepsy patients. There’s more and more research being conducted on butanediol, not a good idea.

Watch the label. If you take beta-hydroxybutyrate, there are these human identical molecules. They’re exactly what your body would be producing. The risk of doing something wrong if you take human identical substances is way lower. That’s why everything I put into my body, and hence also my product, is only human identical, meaning it’s exactly the version that the body would make or use itself. There, the risk is lower.

The only risk I can see with taking beta-hydroxybutyrate is that some people think they can take a product, they can do what they want, and that’s going to save them. No matter what product you take, even if it’s the best product in the world, if you live a super unhealthy lifestyle and live off McDonald’s, French fries, pizza, and ice cream, you’re not going to live very long. No product will undo an unhealthy lifestyle, but some products can help you either adhere to a healthy lifestyle, transition to a healthy lifestyle, or bridge some of the gaps that you may still have despite an unhealthy lifestyle.

No product will undo an unhealthy lifestyle. But some products can help you adhere to a healthy lifestyle transition.

One thing we need to keep in mind is that artificial things, for decades, will probably not be completely undone by natural solutions. If you’re already very sick, you’re full of heavy metals and toxins, your mitochondria are unstable, you’re so inflamed, and you’re so insulin-resistant, it’s going to be hard to get out of it with natural solutions in a quick way. It would take a long time. It would be tough. That’s the reality. For me, even a ketogenic diet is straightforward. I did it, but my body felt terrible.

I was probably lacking a lot of micronutrients because I couldn’t eat any colorful vegetables. My liver was struggling, so I couldn’t get into high ketosis because I had decades of medication overuse. Ketone bodies are produced in the liver. I had high oxidative stress. I had high heavy metals from all the fish and high toxins because my liver was struggling. I tried it the all-natural way. I wasn’t feeling great at all for a while. Now, I don’t even need a ketogenic diet anymore. For me, it helped to kick things off by giving exogenous ketone bodies, but in the human identical version, and adding a lot of other things that my body needed to recover faster. That’s the long-winded answer.

That’s helpful to understand. 1,3-butanediol for exogenous ketones is probably not helpful. It uses our NAD+, which we all hear a lot about, needing that for longevity.

If you’re an athlete, you want to boost your ketone bodies, and you feel great using that one, by all means. For chronic everyday use, think about, “Do I want to drink that much alcohol every day?” That’s how we need to think about it. Think about it more like, “I’m drinking alcohol. Maybe half a glass is fine,” but take it into account.

The beta-hydroxybutyrate version of exogenous ketones is bio-identical and not helpful.

The D-beta-hydroxybutyrate is the human identical, the bio-identical one.

That’s the shape of the molecule. The D is on the left side.

It’s how it’s oriented in space. Like our two hands, some molecules have different functional groups. All my fingers are different. If you have different functional groups on a molecule, that means they have different orientations in space that can never align. This is a little tricky, but even my two hands have the same ingredients and same functional groups, but no matter what I do, I can never fully align them in space. They’re always different. My thumb is always in a different direction.

That happens to molecules as well. The body is handed. The enzymes dock only on one version. That’s why you have L-leucine and L-lysine. You might know these amino acids. They’re the left spinning one. The left orientation in space is the natural configuration. We used to have this for lactic acid, which also has a certain spin. For beta-hydroxybutyrate, it’s the right spinning version. The D or the R is what the body predominantly makes.

It doesn’t mean the L version is toxic. It seems to be fairly safe. It needs to be converted that use up energy, but it could be an antioxidant. We don’t have data from years and years of use of the mix. I’m still opting for the D version because that’s what my body is making. It could be that the L eventually has some other properties. The L-BHB lowers blood sugar more, for example, if that’s your goal. It’s also an antioxidant, but it’s a version that the body doesn’t make in huge quantities.

We want to look for the D-beta-hydroxybutyrate or R. That’s sometimes called R.

For energy, if you look for something that’s bioidentical, that would be the D or the R, exactly.

 

How Brain Ritual® Was Developed And How It Works

Let’s dive into Brain Ritual. What’s in it, and how does it work in helping solve this issue for us? What are the applications? I know you started it for the metabolic migraine treatment, but it has all these other treatments as well that you’re discovering and using it for, or could be using it for in the future. Can you dive into that a little bit for us? How has that affected your own journey as well?

It was originally developed for me basically because I was desperate with the ketogenic diet, not doing exactly what I hoped it to do. It was getting much better, but then there were other problems. I wasn’t getting into high ketosis at all. I looked for a way to use ketones exogenously or make them. We were the first ones to do a randomized controlled trial in patients using exogenous ketone body salt, like the beta-hydroxybutyrate. That’s in the product. Fifty percent of that is this alternative energy source for the brain because what we found in research is that this gene expression changes with ketosis, even happens with exogenous ketone bodies.

Your brain can be fueled so you can start feeling better. That then helps you, hopefully, also do the beneficial lifestyle changes. What I also realized is that ketone bodies are burned inside the mitochondria. If your mitochondria aren’t working, it’s hard to get energy out of ketone bodies. We also then added a whole variety of different things that are needed for energy metabolism. In the migraine product with migraine evidence behind it, there are certain dosages, very high dosages for certain things. For migraine, it’s called a medical food.

A medical food is actually important. It’s a category that sits between a supplement and a drug. It’s generally recognized as a safe ingredient. Everything is safe. In our case, human-identical, bio-identical is the term, but it’s against the disease. You have to have evidence that the disease has a metabolic aspect and that you’re targeting that metabolic aspect of the disease. Supplements, per se, are always for healthy people. With supplements, there is also very little protection. There is little control over supplements. That’s why we opted for medical food in this case.

We put in all the things that you might be lacking in a modern diet, from trace minerals, your boron, your chromium, your selenium, to zinc, to magnesium, calcium, vitamin D, vitamin A, vitamin E complex, mixed tocopherols, vitamin C, and iodine. You have everything in there. We have choline, which is often lacking. We have L-carnitine to shuttle fatty acids into the cells. We have ribose for DNA repair, for RNA. We have glycine to help you sleep better.

We have taurine for liver function. We have coenzyme Q10 as a very strong antioxidant, and so on. There’s a bunch of things in there. It’s basically a one-stop energy metabolism shop in one product. It can replace your multivitamin entirely. We do not have omega-3s or probiotics in there because omega-3s taste awful. You can’t mix that into any drink. This is a powder that you mix in water. Please still take some omega-3s if you want to.

Not everyone needs probiotics. Some people prefer sauerkraut, kefir, or something like that. If you want a probiotic, it also doesn’t have probiotics in here. The star player is the ketone bodies. The helpers are the micronutrients that are also added here. Everything is in one sachet. With this new product, it’s all organic flavors as well. Everything is organic, vegan, bioactive, gluten-free, dairy-free, keto-friendly, no sugars, and no sweetened with allulose.

We went away from stevia because some people seem to be reacting to stevia. Allulose doesn’t raise blood sugar. That’s Brain Ritual developed for me. We found that it seems to be helping people outside of migraines. There will be a brain health product as well. We are currently running a depression trial. We are going to start a cognition and aging trial at the beginning of 2026.

It can be potentially useful for Alzheimer’s, Parkinson’s, dementia, and that sort of thing.

Potentially. Whatever brain metabolism or glucose metabolism isn’t optimal, or people have mitochondrial dysfunction or lack energy, it could potentially help. No trials yet, but anecdotes. We get a lot of case studies from people who have something and who write us. I got a lady saying that it helped her so much with her nausea during pregnancy. Her second pregnancy on Brain Ritual was so much better. Not only did it help with the migraine, but the nausea in pregnancy also went away.

We have people with autoimmune disease or even diabetes who have reached out and said it was helping. Many things about metabolism can be suboptimal, but it won’t help everyone. That’s very important to say. Only the metabolic subgroup of brain health issues will benefit. If your metabolism is optimal, and your root cause is something else, for example, migraine, if you’re lacking hormones to protect you, estrogen and progesterone, and you don’t supplement with biodegradable hormones, it’s not going to help so much. Maybe a little, but you need to always find your root cause as well.

I love how you call it a one-stop shop for all things. Essentially, if someone is taking Brain Ritual, they can replace almost all their other supplements besides omega-3s or probiotics. You’re getting all of those minerals.

It’s a very broad multivitamin, multi-mineral. You have electrolytes, trace minerals, antioxidants, everything is in there. Certain key things are not in there. If you might be taking something specialized, always talk to your doctor before starting anything or stopping anything. Nothing I’m saying should be medical advice. It’s more like a personal experience in science. I want to say that that’s important because everybody’s case is different. Usually, yes, it’s designed to replace any general product. It’s easily a one-stop shop.

As far as getting into a state of high ketosis, if I take Brain Ritual, will I notice that right away? Will I be able to enter into a state of ketosis if I fast or if I take it in the morning?

You will be. There are ketone bodies inside. That’s the beauty. We know exactly what’s inside. Unless you have diarrhea or any other severe absorption issues, this will end up in your blood. How high your levels in the blood will be depends on whether you’re fasting, your cells are starving, or you’ve used ketone bodies before. When you are very efficient and fasting, it will disappear from your blood fairly quickly because your heart loves ketosis. Your heart will take some, and your brain will take some. It won’t be in your blood long.

If you are satiated and not adapted and your body doesn’t know what to do with ketone bodies yet, and generally, your cells are satiated, then it will stick around much longer if you’re sedentary. If you’ve eaten and your body doesn’t know where to put these and how to use them, you will have the highest levels. High levels from an exogenous source are usually not a very good sign, depending on how much you’re ingesting. That means you probably can’t use them as well yet. In our study, after about ten days, levels actually dropped because people who have not been in ketosis for a long time have started to adapt.

In your case, I’m anticipating that you will be using them easily. This is important to say. Some people feel the first sachet or the third sachet. For some people who have been in ketosis, who have been very sick, and who need to fill up their reserves and change gene expression, it can take as long as three months to feel the full effect. On average, people notice a difference between the third and fourth week, which is the first box. For some severe patients, it can take longer. That’s also important to say. Something that has been wrong for decades can’t be fixed in a day. That shouldn’t be the expectation, hopefully.

Something that has been wrong for decades cannot be fixed in a day.

It sounds like this is something that pretty much everybody could be taking and benefiting from.

I think so. It is for maintenance. If you’re sick, then we recommend two sachets a day. If you’re doing it for health, wellness, and longevity, then one sachet is fine. You can drink it throughout the day. We recommend a ramp-up for especially sensitive individuals because now there are 16 grams in one sachet, one stick pack. It’s a lot of nutrients that some stomachs are not used to. The ketone bodies, the minerals, and all of that can cause diarrhea if you ramp up too quickly. We recommend starting with half a sachet and then working your way up over a month to the full two to give your stomach and guts a chance to build the transport systems and adapt to it. That’s the main side effect that you can experience.

Just for brain health, one sachet a day. Put in a bottle of water. You can sip it throughout the day. You can drink it in one. It doesn’t matter. If you’re sensitive, after food is much better. It’s for anybody who thinks that they have a micronutrient deficiency or could use a bit more trace minerals, is drinking filtered water, or might be eating food that is not from the best soil, which can be anywhere. You never know. This can be good. Also, ketone bodies have been shown to be anti-inflammatory and reduce oxidative stress, which are a lot of factors that are involved in chronic disease and aging. For us, my whole family is on it. We get a lot of demand outside of migraine as well, because it’s convenient. It’s one sachet a day. You drink it, and you’re done with all the pills for the day.

That’s amazing. I imagine if somebody is starting to experience mild cognitive impairment or something like that, then give this a try.

The sooner you start, the better. It cannot bring cells that are dead cells back alive, but it can hopefully help brain cells, the ones that are still there, hopefully, not to degenerate. If you have metabolic Alzheimer’s, hopefully, it can be halted or at least postponed so that neurons can be fed again. The earlier you start, the fewer neurons will have degenerated already, and the more you can do to save them. Again, it is not for all Alzheimer’s patients. It’s important to check for root cause, but there’s not much you can do wrong, unless you’re allergic to any of the ingredients. It’s not a drug with a million side effects. Worst case, you’ve fueled up your reserved micronutrients.

Because of the micronutrients that are in Brain Ritual as well, it’s helpful for your heart health, also.

The heart actually is a second organ that loves ketone bodies and antioxidants. It’s the second most energy-hungry organ. It pumps all the time. It’s very vulnerable to energy shortages as well. There has been some research now on the exhaustion of ketone bodies in heart function and heart failure. The output of a failing heart has been quite drastically increased by the addition of exogenous ketone bodies. The heart loves ketone bodies, too. Q10, antioxidants, electrolytes, and so on are also good for the heart. Interestingly, what’s good for the brain is often good for the heart as well.

The heart is the second biggest consumer of ketone bodies and antioxidants next to the brain.

I imagine, too, if someone is an endurance athlete or training for a marathon, an Ironman, or something like that, then taking this is going to be helpful in terms of their endurance.

For any sport, it’s great for recovery because it can help shorten the recovery. There has been a lot of oxidative stress and inflammation. For anything that’s endurance, it’s also good for the actual competition. The only time I wouldn’t take it is if you’re sprinting. For anything that’s anaerobic, it may compete with lactate clearance because lactate and ketone bodies use the same transporters. If you have a burst and a super high increase in lactate, because you have a sprint, I wouldn’t take it before. I would take it after, or two hours before, not just before the race.

Anything where you have longer endurance periods, like cycling, even soccer, or anything where you have to run for a longer time, and it’s not all out, this could even be helpful during the competition, and otherwise for sure for recovery. Yes, we have had cyclists reach out who have been cycling faster in the competition than they had even been fasting using this. We’ve had a golfer reach out. He has had two sachets and said he has played the best golf of his life because it’s also about concentration during golf.

I know when I take exogenous ketones, my brain is functioning. I feel more locked in, more focused, and more in that flow state. I’m excited.

We’ll definitely send you a box.

It seems like something that can help everybody in some way.

Hopefully, a lot of people. We’re always looking for feedback. If you do try, let me know. We are also offering a discount, so they can save on their first box. We also have a money-back guarantee because we’re confident that it will probably help. If it doesn’t, you can get your first order money back, no questions asked.

Get In Touch With Dr. Gross And Brain Ritual®

Elena, this has been so fascinating. You’ve shared so many amazing things that are so helpful to all of us. There’s a lot that we’ve covered and probably need to even unpack more. Where can people find Brain Ritual? How can people connect with you? This is available now, so everybody can order it and get it shipped to them right away.

Yes. It’s available now. We’re out of stock for seven weeks because demand has been higher than expected, but we’ve restocked. Everything should be good now. You can find more about Brain Ritual at BrainRitual.com. It is Brain Ritual because you have to do something for your brain every day, so better to make it a ritual. I have it. Brain Ritual is on all social media everywhere. Dr. Elena Gross is my name, and I have a website. I have a book coming out called How to Master Migraine: Feed the Brain to Free Your Life. This has all the strategies.

It’s all the lifestyle. It’s not so much product focus. It’s more about all the things that you can do to improve your metabolism, as well as the actual scientific explanation, all the research, and why migraine is metabolic, or what has been found. It talks all about this ancient fuel, the ketone bodies, if you’re interested in what they are. Half of the book is almost all about all the different things you can do from all the different dietary approaches to anti-nutrients to ways to improve mitochondrial function with sauna, cold exposure, detox, all the different things, lights, how to protect yourself from toxins, and so on. It is all the strategic things that you can do.

It’s written for migraine, but honestly, if you follow this advice, it’s going to be very good for your brain health. That’s coming out. We have a Facebook group that you can join where I give advice personally, or you can come with your questions. We have a community there. I’m Dr. Elena Gross on all social media as well. You get a free migraine mastering guide. If you want to, you can download that from the website. I’m generally reachable, probably best via social media because I have a team that helps me stay on track. We’re always looking forward to info at Brain Ritual. You can also ask our customer service any questions you may have about migraine or the product. They’re all in it with passion and their whole heart. You will get an answer quickly. They will be there for you.

Thank you so much for the amazing work that you’ve done and the research you’ve done. I love that you started to treat yourself, and you were able to treat yourself. You’re now sharing that with the world. Thank you for the great work that you’re doing and the way that you’re impacting and changing people’s lives, and for many people, giving them their life back.

Thank you so much for helping me spread the message. Migraines can be preventable, and other diseases, too. I’m trying to follow my mission. I have my life back, so now it’s my mission and it’s my duty to bring that to other people, spread the news, and, as you say, help people reclaim their lives from the clutches of debilitating pain or other symptoms they may have.

This has been so fascinating. Thank you so much. It’s wonderful to talk with you. Thanks for sharing this.

—

What a fascinating conversation with Dr. Elena Gross from Brain Ritual. We covered a lot in there. I know there was a lot of biology and chemistry talk in that one. There’s probably some unpacking to do or some further research to do, but a few things stuck out to me. Our brain can use three different types of fuel, which are glucose, lactate, or ketone bodies. Oftentimes, if we’re not exercising enough, we don’t have lactate. Sometimes, we don’t have enough ketone bodies as well. That’s the root solution that she found to treat her own migraines.

What an amazing story. I can’t imagine being debilitated like that and having that excruciating pain twenty days a month, to where your life is robbed from you. I’m sure that because one in seven people struggles with migraines that we all know someone who struggles with that. I love that what she’s discovered and what she has created is not just about treating migraines, but it’s for depression, mild cognitive impairment, and brain health in general. We can actually use her product to optimize our brain performance on a day-in and day-out basis. I love that what she put together includes those ketone bodies, but a very safe and healthy version of those. They’re bioidentical.

It’s D, which is the orientation and space of the molecule. The D is the right-handed side, D-beta-hydroxybutyrate, making sure that we don’t have the racemic kind. That is available as well, but it’s in Brain Ritual. There are also all the other vitamins, minerals, and nutrients that we need that maybe are lacking in our diet, so that they can get into our mitochondria and make our mitochondria healthier, so that we can have the fuel that we need for our brains to be energized.

I thought it was so fascinating to think about and somewhat counterintuitive that even something like obesity is an energy deficiency. Our brains are saying, “I’m still hungry,” because we’re not getting enough of those ketone bodies into our brains. This can be a solution for many things across the board. Check it out, BrainRitual.com. You can get a significant discount on your first box and give it a try. You can connect with Dr. Elena Gross on all the social media platforms, as well as Info@BrainRitual.com. Connect with her team there. Thanks so much for tuning in. We’ll see you back here next time on Fully Alive.

 

Important Links

• Dr. Elena Gross’s Website
• KetoSwiss
• Brain Ritual
• Dr. Elena Gross on Instagram
• Dr. Elena Gross on Facebook
• Dr. Elena Gross on LinkedIn

 

About Dr. Elena Gross

I’m Dr. Elena Gross, a neuroscientist, PhD in clinical research and most importantly – a former chronic migraineur. The lack of tolerable and efficacious treatment options for migraine led me to pursue a MSc in Neuroscience at the University of Oxford and a PhD in Clinical Research at the University of Basel, with the goal of having better understanding of this common and debilitating disease and ultimately improving clinical care.

I am particularly passionate about the therapeutic benefits of ketosis and other nutritional interventions, the role of mitochondrial functioning and energy metabolism in brain health & neurological diseases (particularly migraine), as well as increasing our health span via disease prevention.

I am the inventor of four patents, founder & CEO of KetoSwiss and Brain Ritual. My migraine research papers have been published in high-ranking journals, such as Nature Neurology.