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What Doctors Don't Tell You

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July 2020 (Vol. 5 Issue 5)

The diet that kills pain

About the author: 
Joseph Mercola

The diet that kills pain image

If you suffer from arthritis, migraine or fibromyalgia, noted doctor Joseph Mercola has discovered why a fat-burning diet can end pain—and much more.

Whether you're ailing or well, you already know how frustrating it is, and how much confusion you face, trying to sort through all the conflicting nutritional advice about how to eat healthily. The fact is, there's little scientific evidence to support any single eating plan that will work for all people with their myriad health conditions.

If you're in pain—whether from migraines, arthritis, or even puzzling illnesses like fibromyalgia and chronic fatigue—a high-fat diet will go a long way toward dramatically reducing your symptoms and upping your quality of life. It does this by improving the body's ability to produce energy by boosting the functioning of mitochondria.

Meet your mitochondria

Mitochondria are tiny organelles (think of them as micro-organs) contained within nearly all your cells. One of their many critical roles is to produce energy by combining nutrients from the sugars and fats you eat with oxygen from the air you breathe.

Researchers estimate that mitochondria account for 10 percent of your body weight, with approximately 10 million billion of them within the cells of an average adult. If that number is hard to comprehend, consider that more than 1 billion mitochondria would fit on the head of a pin.

The more metabolically active cells are—such as those found in the heart, brain, liver, kidneys and muscles—the more mitochondria they have.

Mitochondria continuously generate energy molecules called 'adenosine triphosphate' (ATP); in fact, they produce about 110 lbs of ATP every day.

Optimal mitochondrial function is key to a well-functioning metabolism. Repairing mitochondrial dysfunction offers one of the simplest and most promising new strategies for improving your health and helping to prevent diseases like cancer from developing in the first place, or repairing problems involving pain.

The role of free radicals

ATP, the body's 'currency of energy,' drives essentially every biological process in the body—from the function of your brain to the beating of your heart.

Your mitochondria host a complex series of chemical reactions that use electrons liberated from the food you eat to produce energy and keep the process rolling. At the end of the chain, most electrons react with oxygen to form water.

However, a percentage of the electrons will form what are called 'reactive oxygen species' (ROS). These are molecules that contain oxygen atoms which have gained one or more unpaired electrons, making them very unstable. These so-called 'free radicals' are highly reactive and potentially destructive (see box, page 30).

But it's not ROS in general that are harmful; it's ROS in excess that are damaging to your health. For this, you can use what I call 'mitochondrial metabolism therapy' (MMT) to optimize the generation and reduction of ROS in your cells. Think of it as the 'Goldilocks phenomenon': not too much and not too little, but just the right amounts of ROS. So rather than suppressing excess free radicals with antioxidants, the ideal solution is to produce fewer of them in the first place.

When you eat a diet high in quality fats, low in net carbs (total carbs minus fiber) and adequate in protein, it optimizes the capacity of your mitochondria to generate a fuel known as 'ketones' that, in conjunction with low blood glucose levels, produce far fewer ROS and secondary free radicals than when you primarily eat carbohydrates. And this can have a major impact on lowering the inflammation that's causing your pain.


Despite their prevalence, migraines are still one of the most poorly understood medical disorders out there. The symptoms are commonly confused with stroke, as sufferers can temporarily lose their vision and experience unusual nerve sensations.

Diet appears to also play a role in migraines: searching the National Library of Medicine's database of medical literature using the search terms 'migraine' and 'food allergies' will net you at least 160 different peer-reviewed studies. One randomized, double-blind, crossover study published in 2010 found that a six-week-long diet that excluded known food allergens led to a statistically significant reduction in the number of migraine attacks and number of headache days.1

More recent research has noted an association between high-fat, low-carb diets and dramatic reductions in migraine attacks. In one 2015 study, 45 women who experienced regular migraines were given a ketogenic diet for one month, then switched to a standard calorie-restricted diet for another five months. The control group in the study ate the standard calorie-restricted diet for the entire six months.

The women eating the high-fat, low-carb ketogenic diet experienced a significant reduction in their number of attacks, number of days with a headache and medicine use during the first month (whereas the standard low-calorie dieters didn't). But once they switched to the standard low-calorie diet, their symptoms worsened again—although they were still improved compared to how they'd been before the ketogenic diet. The group that didn't start with the ketogenic diet did see a reduction in the number of days with a headache, but not until month three, and they did not see a reduction in attack frequency until month six.2

A fascinating 2013 study reported the case of 47-year-old Italian twin sisters who adopted a low-carb, high-fat weight-loss diet. After three days on the diet, their frequent migraines also "unexpectedly vanished." The sisters ate a ketogenic diet for four weeks and then transitioned to a low-calorie, non-ketogenic diet for two months before starting the ketogenic diet cycle again.

Before starting the diet, the sisters suffered from five to seven migraine attacks a month. They experienced no headaches while on the high-fat four-week cycle, while their migraines did recur during the two-month non-ketogenic intervals, although with reduced frequency, duration and intensity.

The researchers theorized that the diet reduced inflammation and oxidative stress in the patients' neurons and enhanced mitochondrial gene expression that, in turn, resulted in a dramatic reduction of migraine attacks.3


Plenty of research shows that improving your omega-6 to omega-3 ratio—an integral part of MMT—has exciting potential to prevent and treat arthritis. According to a 2011 animal study (which of course, may not apply to humans), a diet enriched with omega-3 fats reduced the majority of disease indicators in guinea pigs with osteoarthritis, including both cartilage and subchondral bone changes. The lead researcher noted that there was strong evidence that omega-3 fats may help to prevent the disease and also slow its progression in those already diagnosed.4

In addition, a 2013 study showed that omega-6 fatty acids, when injected into cartilage cells, provoked an inflammatory response where monounsaturated and saturated fats appeared to inhibit cartilage destruction.5

A high-fat ketogenic diet has been shown to reduce pain and inflammation in animal studies.6 This means that adopting a healthy high-fat diet (which includes eating more omega-3s and fewer omega-6s) is a viable and very promising avenue to pursue in the relief of the pain and disability that can be brought on by osteoarthritis.


Science is also beginning to recognize a link between oxidative stress and mitochondrial dysfunction and health issues such as chronic fatigue and fibromyalgia—two conditions that a high­-fat diet takes full aim at by bringing the body back into balance.

Although few studies have looked specifically at the effect of a high-fat diet on these conditions and chronic pain, one promising study was published in the December 2013 issue of the Journal of Musculoskeletal Pain. The diet in this case was expressly non-ketogenic (it wasn't designed to promote the production of ketones through either a high fat content or regular fasting), but it was low-carb. The 33 middle-aged women who followed the diet reported increased energy, less pain and improved symptom scores on the Fibromyalgia Impact Questionnaire.7

There is also some evidence that people with fibromyalgia experience fewer symptoms if they eliminate one or more of the foods that frequently trigger food allergies or sensitivities. The most common offenders are corn, wheat, soy, dairy, citrus and sugar, with the top three being pasteurized milk, soy and gluten (from wheat and similar grains). In one study of 17 fibromyalgia patients, nearly half experienced a "significant reduction in pain" after eliminating corn, wheat, dairy, citrus and sugar.8

Why the diet works

Carbs are a far dirtier fuel than fats. When you adopt a high-fat, low-carb diet and make the switch to burning fat and ketones for fuel instead of glucose, your mitochondrial exposure to oxidative damage drops by as much as 30-40 percent compared with when your primary source of fuel is sugar, as is typical in American and British diets today.

This means that when you have made the transition to burning fat for fuel, your mitochondrial DNA, cell membranes and proteins will remain stronger, healthier and more resilient.

For your body to regain its ability to burn ketones as its primary fuel, you must focus on increasing your intake of healthy fats while decreasing your consumption of carbs to keep your blood glucose levels low. This is what MMT was designed to do.

Limiting net carbs is a crucial part of MMT not just because glucose is a 'dirty' fuel that produces an excess of ROS, but also because excessive net carbohydrate consumption suppresses fat-burning. Notice that I say 'net' carbs: that's total carbs minus fiber. This means MMT is not a low-total-carb diet: fiber is an important carb that's actually converted into beneficial short-chain fats in your intestines. In other words, this is a low-net-carb diet.

The only catch is that, when you replace carbs with fat, you must do it with care. The fats you choose must be high quality and, ideally, organic. But more importantly, they should not be industrially processed omega-6 vegetable oils.

If you look at the nutrition facts label on any processed food, it will list total carbs. But you need to also look at the fiber content and subtract that from the total carbs. This is important to understand because, otherwise, you may end up feeling that your choices are too limited to stick to your MMT food plan.

On MMT, you'll replace those non-fiber carb calories (from foods like sweets, sugary beverages, breads, pasta, crackers, chips and fries) with organic vegetables and healthy fats. This will transition your body to primarily burning fats for fuel, while radically reducing your risk for most chronic diseases.

In general, the high volume of vegetables, together with the nuts and seeds you eat while following MMT (listed on the next page), will provide you with more daily fiber than the average American typically eats.

Beyond Atkins and Paleo

Many other popular diets, like Atkins and Paleo, are similar in some aspects to mitochondrial metabolism therapy (MMT)—yet there are many key differences:

• Too much protein. The Paleo diet calls for a diet of 38 percent protein and 39 percent fat. A high-protein diet stimulates the production of a hormone called insulin-like growth factor 1 (IGF-1). Like insulin, IGF-1 is a powerful stimulus of aging.

Limiting protein also limits the production of mTOR (mammalian target of rapamycin), which suppresses cellular and mitochondrial repair and regeneration (see box, page 33). Protein levels closer to 10 percent during nutritional ketosis are more optimal.

• Not enough caution regarding seafood. The Paleo diet includes lots of fish and other seafood, and the omega-3 oil found in fish is clearly one of the most important and essential nutrients for health.

But as a result of industrial pollutants, including mercury, polychlorinated biphenyls (PCBs) and dioxin, it's difficult to find seafood that is toxin-free. (The safest fish to consume regularly are listed on page 33.)

• Still too many starches and sugars (net carbs). Even though sweet potatoes and fruit—two popular foods on the Paleo plan—are whole foods, they still raise glucose and trigger an insulin reaction, especially when you're seeking to make the transition from burning sugar to burning fat.

But once you're able to burn fat rather than carbs as your primary fuel, this will no longer be an issue and you can slowly reintroduce these back into your diet.

Diamonds and rust

Free radicals react with other molecules in what are known as 'oxidation reactions' to neutralize their unstable electrical charge. Oxidation is essentially 'biological rusting.' It creates a snowball effect—as molecules steal electrons from one another, each one becomes a new free radical, leaving behind a trail of biological carnage.

This rapidly expanding horde of free radicals collects within the cell and degrades cell and mitochondrial membranes in a process known as 'lipid peroxidation.' When this happens, the membranes become brittle and leaky, causing them to disintegrate.

Free radicals also damage your DNA by disrupting its replication, interfering with its maintenance activities and altering its structure. Recent research estimates that your DNA suffers a free-radical attack somewhere between 10,000 and 100,000 times a day, or roughly one assault every second.

Why burn ketones?

Shifting to a fat-burning diet has been shown to spur mitochondrial biogenesis—at least in animal studies.1

Mitochondria then have more energy to focus on processes involved in creating more—and healthier—mitochondria. In a sense, your mitochondria become supercharged.

Ketones are water-soluble energy molecules made by mitochondria in your liver from dietary or stored fats, and are used as an alternative fuel to glucose. (Nutritional ketosis is completely different from diabetic ketoacidosis, a life-threatening complication of uncontrolled diabetes.)

In addition to allowing us to survive periods of food scarcity, burning ketones means:

• far fewer ROS are produced than when you burn glucose

• you reduce the amount of sugar available to cancer cells and the load of ROS your cells are exposed to, making it less likely that cancer will develop in the first place

• a variety of signaling functions happen that can ultimately affect gene expression1

• you reduce inflammation by decreasing, or downregulating, proinflammatory cytokines while increasing, or upregulating, anti-inflammatory cytokines2

• there's a powerful protein-sparing effect, allowing you to consume lower quantities of protein while retaining or even building muscle mass;3 this also inhibits mTOR, an important metabolic pathway that's often overactive in disease states, including cancer, whereas its reduced activity is associated with an improved health span and longevity4

• you enjoy protective benefits for brain cells exposed to hydrogen peroxide—a common compound found in the brains of people with dementia and Alzheimer's disease5

• you upregulate (increase) mitochondrial biogenesis in your brain6—boosting its capacity to make more energy by increasing the number of mitochondria.

Your MMT diet plan

Here's a quick guide to the foods to eat on the MMT diet

MMT-friendly vegetables







Brussels sprouts

Salad greens


Sautéed greens





After you are fat-adapted, you can add back limited amounts of these foods:








Winter squash (very limited amounts)

MMT-friendly fruits

Berries (a small handful in lieu of a serving of vegetables)

Grapefruit (a few sections, again instead of a serving of vegetables)

MMT-friendly fats

Eliminate all industrially processed fats—including vegetable oils like canola, peanut, cottonseed, corn and soy—as well as all trans fats, such as those found in commercial salad dressings, peanut butter, most mayonnaises and anything processed or packaged. If you see 'hydrogenated fat' listed in the ingredients, that food contains trans fats even if they're at a quantity below what must be reported on the label.

Here are the sources of fat that burn clean and help heal your mitochondria:

Organic, grass-fed butter and ghee

Coconut milk

Chicken fat

Duck fat

Coconut oil

MCT (medium-chain triglyceride) oil

Avocado oil

Extra virgin olive oil


Keep your protein intake in any given meal to 0.4-0.5 oz for women and 0.5-0.7 oz for men (assuming three meals per day). However, if you are immune-compromised or recovering from surgery or illness, or have greater physical-activity demands, you will need about 25 percent more.

Avoid any low-fat dairy products or 'lean' meats. Instead, aim to make the majority of your sources of protein high-fat options—chicken thighs with the skin on rather than skinless chicken breast, for example.

For meat, opt for pasture-raised animals (ideally grass-fed) with no added hormones or antibiotics. Nuts and seeds are excellent sources of protein, with an average of 0.1-0.3 oz of protein per 2 oz of nuts (about ¼ cup), while most vegetables contain 0.03-0.07 oz of protein per ounce. With a target of 1.5-2 oz/day of protein, plant sources alone can easily meet your protein needs.



Wild game meats




Organ meats


Safer seafood

As levels of pollutants in our waters (including mercury) have increased, be very choosy about which types of seafood you decide to eat. Among the least-contaminated fish and the highest in healthy omega-3 oils are Alaskan and sockeye salmon. Neither is allowed to be farmed and they are therefore always wild-caught.

Here are the seafoods with the lowest levels of mercury.





Salmon (canned)

Crab (domestic)

Salmon (wild)








Sole (Pacific)





Oyster (freshwater)




Nuts and seeds


(in very limited amounts, as they are high in protein)

Black cumin seeds

Black sesame seeds

Brazil nuts

Raw cacao powder, nibs, butter

Chia seeds


Macadamia nuts


Psyllium seed husks

Pumpkin seeds

Sunflower seeds

High-fat dairy (okay in moderation)

Butter (0.4 oz of fat per Tbsp; minimal protein)

Ghee (0.5 oz of fat per Tbsp; no protein)

Heavy whipping cream (0.2 oz of fat per Tbsp; minimal protein)

Cream cheese (0.15 oz of fat per Tbsp; some protein)

Sour cream (0.1 oz of fat per Tbsp; some protein)

Parmesan cheese (0.05 oz of fat per Tbsp; high protein; use all cheeses mainly as condiments)

Cheddar cheese (0.3 oz of fat per Tbsp; high protein)

Brie cheese (0.3 oz of fat per oz; high protein)

Excerpted from Fat for Fuel by Dr Joseph Mercola, $27.99 (Hay House, 2017)

5 minutes to total fitness image

5 minutes to total fitness

References (Click to Expand)

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