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Paying attention to what you eat and drink may help prevent headache or migraine attacks.

What to Eat and What to Avoid If You Get Migraine Headaches

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Migraines are far more than just a bad headache. Experts believe migraine headaches are caused by abnormal brain activity, including dilation and constriction of the blood vessels within the brain. An attack can last from several hours to several days and affects a person’s ability to function at home and at work. A migraine can generate feelings of nausea, vomiting, sensitivity to light and sound, throbbing head pain, aura, and visual distortion, causing a person to want to withdraw and seek immediate relief. If you have never experienced a migraine headache, consider yourself lucky, but for those who do, finding a way to manage the pain and lessen the frequency is a top priority.

Knowing what triggers your migraine headaches is the best defense in avoiding them, especially since triggers can be cumulative. While there are a number of potential causes of a migraine – including hormones, stress, weather, medications, and environmental factors – for many, dietary triggers are a major contributor. Keeping a detailed journal for several weeks may sound tedious, but the effort you put in will be well worth it. With some careful recording, a pattern should be detected. Doing this, along with a thorough physical exam to look for possible nutritional deficiencies (migraine sufferers tend to be deficient in magnesium, vitamin B (riboflavin), vitamin D, and CoQ10), and a detailed discussion with your physician or migraine specialist will put you well on your way to regaining the quality of life you have lost.

When considering how you can reshape your diet to improve migraine symptoms, the bottom line is to eat fresh, not processed, food. The more work that goes into preparing foods for the consumer, the more likely it is that it will have an additive that may be a trigger for you. In general, the following food guidelines will benefit most migraine sufferers.

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What to Eat

Halibut, mackerel, and salmon

Opt for the fattier fishes at the grocery store to make sure you are getting enough omega-3 fatty acids. Diets high in omega-3s and low in omega-6s have been found to lessen the frequency and occurrence of migraine headaches,

Cashews, almonds, and pumpkin seeds

Because of their high magnesium content, cashews, almonds, and pumpkin seeds are the nuts to turn to if you suffer from migraines. Aim for 1 ounce per day.

Steel-cut oatmeal

Drops in blood sugar can be a trigger for many migraine sufferers. To maintain steady blood-sugar levels, eat foods with a low-glycemic index, like steel-cut oatmeal and oat bran.

Spinach

Popeye ate it for energy and iron, but migraine sufferers will appreciate spinach for its high folic acid (B9) content. A 2024 study folate’s relationship with the frequency of migraine found that participants who increased their intake of folic acid experienced an improvement in their migraine symptoms. A review of 11 studies regarding the role of vitamin-B supplementation to treat migraines found it to be an effective treatment for adults, with few side effects. Other dietary sources of vitamin B include mushrooms, asparagus, and eggs.

Incidentally, spinach is also high in magnesium, doubling its migraine-fighting properties. Whether it’s steamed, fresh, or sautéed, try adding a spinach dish to the menu once a week!

Water

Staying hydrated is one of the most important things you can do for your body in general, and you’ll see that it will help with migraines too. Eight glasses of water each day is recommended, but if you consistently miss that mark make sure to snack on foods with high water content, like cucumbers, apples, and pears!

What to Avoid

Alcoholic beverages

Red wine, beer, and whiskey, in particular, have been cited in numerous studies to be triggers for migraines. Alcohol is the most frequently reported trigger by those suffering from migraines, with most studies finding a prevalence rate between 29 and 36 percent.

Baked goods

Wheat flour, found in most traditional baked goods, contains the protein gluten. If you are sensitive to gluten (approximately 6 percent of the population is) or if you have the autoimmune disorder celiac disease (it is suspected that there are more people with undiagnosed celiac disease than diagnosed), even small amounts of gluten can set off an inflammatory response in your body. While celiac disease can be diagnosed through specialized testing by your physician, there are no specific tests for gluten intolerance. Eliminating all gluten from your diet for at least two weeks and monitoring your symptoms is the only reliable way to make the diagnosis of gluten-sensitivity at this time. Along with intestinal problems, neurological presentations—including migraines—are common to both diseases. If you think gluten may be the cause of your migraine, talk to your physician before you adopt a gluten-free diet for a better understanding of how it will affect your overall health.

Processed meats

In order to maximize the shelf life and flavor of processed meats and fish, such as hot dogs, sausages, bacon, deli meats, and smoked fish, manufacturers add the food preservatives sodium nitrate and sodium nitrite. When we consume foods with nitrates and nitrites the result is an increase in nitric oxide, which has been linked to an increase in the occurrence of migraine headaches. Furthermore, a very interesting study found that people whose intestinal microbiome contained a higher level of particular bacteria that facilitates the breakdown of nitrates were more likely to suffer a migraine attack after eating food that contained them.

Aged cheeses

Cheese lovers, beware! Certain aged cheeses, such as blue, Brie, cheddar, provolone, Gorgonzola, and Parmesan all contain tyramine, a naturally occurring substance found in aged and fermented foods that have long been linked to an increase in migraine headaches.

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MSG

It’s not just in your Chinese food! Monosodium glutamate, which has a long, proven history of causing headaches and migraines, is a flavor enhancer that can be found in food items from marinades and salad dressings to chips, seasonings, even canned tuna! It has so many aliases – natural flavoring, hydrolyzed plant protein, komu extract – that unless you are an expert in food labels, it’s hard to know if you’re eating it or not. The bottom line—if you eat a lot of processed, packaged, or restaurant foods, you’re likely eating a good amount of MSG.

Artificial sweeteners

They are found in beverages, baked goods, candies, and scores of other processed foods, and for many, artificial sweeteners such as aspartame are a migraine trigger.

Citrus fruits

It may surprise you to see citrus fruits on this list, but octopamine, a chemical compound found in certain citrus fruits, can cause migraines with aura for those who are sensitive.

Bottom line

The only way to improve the frequency of migraines is to understand what is causing them. Our providers have years of experience treating patients with chronic migraines and we can help you uncover the root cause of your pain. To speak to an experienced nurse today, please give us a call at 703-532-4892.

Watch now: Dr. Lisa Lilienfield on “The Mystery of Migraines”

Praise for Dr. Kaplan’s book – Why You Are Still Sick: How Infections Can Break Your Immune System & How You Can Recover

“Gary Kaplan is not only a pioneer in his field, he’s a badass who is changing the face of medicine. This book holds everything I wish I knew twenty years ago about autoimmunity. It’s an incredible resource for anyone with chronic pain and illness. It will bring hope and health to so many people.”

– Dave Asprey, founder, Bulletproof 360

References

Finocchi C, Sivori G. Food as trigger and aggravating factor of migraine. Neurol Sci. 2012 May;33 Suppl 1:S77-80. doi: 10.1007/s10072-012-1046-5. PMID: 22644176.

Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. doi: 10.1097/AJP.0b013e31819a6f65. PMID: 19454881.

Haghdoost F, Togha M. Migraine management: Non-pharmacological points for patients and health care professionals. Open Med (Wars). 2022 Nov 23;17(1):1869-1882. doi: 10.1515/med-2022-0598. PMID: 36475060; PMCID: PMC9691984.

Saedisomeolia A, Ashoori M. Riboflavin in Human Health: A Review of Current Evidences. Adv Food Nutr Res. 2018;83:57-81. doi: 10.1016/bs.afnr.2017.11.002. Epub 2018 Feb 2. PMID: 29477226.

Razeghi Jahromi S, Ghorbani Z, Martelletti P, Lampl C, Togha M; School of Advanced Studies of the European Headache Federation (EHF-SAS). Association of diet and headache. J Headache Pain. 2019 Nov 14;20(1):106. doi: 10.1186/s10194-019-1057-1. PMID: 31726975; PMCID: PMC6854770.

Chen YS, Lee HF, Tsai CH, Hsu YY, Fang CJ, Chen CJ, Hung YH, Hu FW. Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis. Nutr Neurosci. 2022 Sep;25(9):1801-1812. doi: 10.1080/1028415X.2021.1904542. Epub 2021 Mar 29. PMID: 33779525.

Tian S, Yu X, Wu L, Zheng H, Zhong X, Xie Y, Wu W. Vitamin B6 and folate intake are associated with lower risk of severe headache or migraine in adults: An analysis based on NHANES 1999-2004. Nutr Res. 2024 Jan;121:51-60. doi: 10.1016/j.nutres.2023.11.008. Epub 2023 Nov 15. PMID: 38042023.

Zaeem, Z., Zhou, L. & Dilli, E. Headaches: a Review of the Role of Dietary Factors. Curr Neurol Neurosci Rep 16, 101 (2016). https://doi.org/10.1007/s11910-016-0702-1

Bagdy G, Riba P, Kecskeméti V, Chase D, Juhász G. Headache-type adverse effects of NO donors: vasodilation and beyond. Br J Pharmacol. 2010 May;160(1):20-35. doi: 10.1111/j.1476-5381.2010.00643.x. Epub 2010 Mar 19. PMID: 20331608; PMCID: PMC2860203.

D’Andrea G, Gucciardi A, Leon A. Elusive amines: migraine depends on biochemical abnormalities. Neurol Sci. 2022 Nov;43(11):6299-6304. doi: 10.1007/s10072-022-06241-2. Epub 2022 Jul 16. PMID: 35840874.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

This article was originally published in March, 2017. It was reviewed and updated in Jan 2024.

Benefits of working with Certified Nutrition Specialist

What Can a Certified Nutrition Specialist Do for You?

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Good nutrition is essential for preventing disease and attaining optimal health in any individual, and it is especially critical for those with chronic diseases such as Diabetes, fibromyalgia, Celiac disease and heart disease. Nutritional deficiencies, genetic weaknesses, food sensitivities and allergies can all contribute to chronic pain in two major ways: 1) by causing tissue inflammation and 2) by interfering with the proper absorption of the nutrients you need to stay healthy.

Certified Nutrition Specialist (CNS) is the most advanced certification for personalized nutrition practitioners, having met the standards set by the American Nutrition Association® through its Board for Certification of Nutrition Specialists. Certified Nutrition Specialists have the expertise and training to evaluate your unique medical history and assist in making the necessary dietary and lifestyle changes you need to improve and maintain your health using science-based advanced medical nutrition therapy, education, and research.

Here are a few examples of the benefits of working with a Certified Nutrition Specialist:

  • A Certified Nutrition Specialist can order and interpret the results of functional testing – a series of testing that assesses multiple areas of health – and suggest foods and supplements to support their health based on those results.
  • A CNS will recommend a treatment plan specifically tailored to meet your medical needs and give you the structure, support and encouragement to help you reach your goals.
  • If you have food allergies or sensitivities, a CNS can advise you on what you can and cannot eat while teaching you what to watch out for on food labels and still making sure you are maintaining a healthy, balanced diet.
  • If you have a chronic condition, a CNS can help you understand how your diet may be contributing to your illness and will guide you in adopting an anti-inflammatory diet that provides all the proper nutrients to manage your illness.
  • A CNS can create an eating plan that will allow you to lose weight – and maintain that weight loss – safely and effectively.
  • At the Kaplan Center, our CNS, Chardonée Donald, collaborates with physicians, nurses, and other healthcare providers to make sure every patient is receiving the most appropriate “holistic” healthcare plan.

Chardonee-Donald-CHN-CNS-LDNMeet Chardonée!

Chardonée is a Board-Certified Nutrition Specialist and Licensed Dietitian Nutritionist. She is also a 3rd year Ph.D. candidate in the Integrative and Functional Nutrition Program at Saybrook University. Chardonée has a Bachelor of Science in Biomedical Science with a Minor in Nutrition and a Master of Science in Human Nutrition. Read more about Chardonée –>>.

 

 

Regardless of where you stand in defining and pursuing your personal nutritional goals, you may find that the path to proper nourishment is oftentimes fraught with obstacles. Let us help you overcome those challenges and successfully achieve your goals. To make an appointment today, call 703-532-4892.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

 

Dealing with Anxiety

8 Commonly Overlooked Causes Of Anxiety and Depression

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With the right treatment, people seeking relief from depression or anxiety can live happy, productive lives. But if you’re one of the many Americans seeking relief from depression or anxiety, you’re no doubt aware of just how elusive successful treatment can be. It is estimated that as many as 30% of depressed patients do not respond to treatment, raising an important question: could it be that we’re thinking about — and therefore treating — these conditions in the wrong way?

A growing body of research suggests that depression and anxiety might not be mental disorders in and of themselves, but rather symptoms of a physical inflammation stemming from increased microglial activity in the brain. Microglia are the immune cells of the Central Nervous System (CNS) and are responsible for producing inflammatory chemicals in response to infection or other CNS damage.

This gives the medical community and those living with these debilitating conditions new hope. In thinking about depression and anxiety as symptoms, we’re afforded new insights into potential root causes, as well as alternative methods of treatment.

Here are eight often-overlooked causes of depression and anxiety that you should consider:

1. Celiac disease or gluten intolerance.

About 1% of Americans have celiac disease, an autoimmune disorder caused by the body’s negative reaction to gluten, the protein found in wheat, barley and rye. And gluten intolerance — also called non-celiac gluten sensitivity — is estimated to impact six times as many Americans.

While we don’t yet understand the mechanism of gluten intolerance in the body, the impact can be very similar to that seen with celiac disease. While intestinal complaints are most common, research is showing that some people with these conditions may, in fact, present with anxiety and depression as the only symptoms.

You can test for celiac disease with a simple blood test. The only way to test for gluten intolerance is to go gluten-free for six weeks and watch for any improvement. (Before making any major dietary changes, make sure to consult your provider or a registered dietitian.)

2. Sleep apnea.

There are two types of sleep apnea. Obstructive sleep apnea is the more common form and occurs when the soft tissue in the back of the throat collapses, thereby blocking the airway during sleep. Central sleep apnea, although not as common, is a result of the brain forgetting to tell the body to breathe. Studies confirm the relationship between sleep apnea and depression.

If you get plenty of sleep but never feel quite rested, or you find yourself often nodding off, a first step you can take is to answer the 8 questions on the Epworth Sleepiness Scale. If your score is equal to or higher than 10, the results should be discussed with your provider.

3. Lyme disease.

Lyme and other tick-borne diseases are becoming increasingly prevalent. While the most common symptom is joint pain, these diseases can also be associated with depression and anxiety disorders (affective disorders).

This link between Lyme disease and neuropsychiatric disease was first documented in 1994 in the American Journal of Psychiatry and has been widely documented since, but the potential connection is frequently overlooked when diagnosing those with psychiatric illness. If you are suffering from chronic pain and a mental disorder, this diagnosis should be considered.

Questions? Give Us a Call!

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4. Unhealthy diet.

A study published in PNAS (Proceedings of the National Academy of Sciences of the United States of America) confirmed that “…frequent fried food consumption is strongly associated with a higher risk of anxiety and depression.”

On the other hand, eating a diet high in omega-3 fatty acids (fish oils, walnuts, and flaxseed) and antioxidants (colorful fruits, berries, and greens including spinach, broccoli, and collards) can help provide the brain with the nutrients it needs to repair free radical damage and optimize function.

5. Thyroid disease.

Both an under-functioning thyroid (hypothyroidism) and an over-functioning thyroid (hyperthyroidism) can present as depression or anxiety — not to mention other symptoms like weight changes and exhaustion. If you suffer from depression or anxiety, you may wish to have your thyroid hormone levels checked to rule out any disorder.

6. Medications.

It’s also possible that regular medications may be causing or worsening your depression or anxiety. Beta-blockers used to treat high blood pressure are known to cause depression, and acne-fighting Accutane, birth control pills, and even statins all list depression as a possible side effect.

If you take medication regularly, I recommend talking with your provider about the chances that your medication is bringing you down or making you anxious.

7. Toxic mold exposure.

Exposure to certain indoor molds can result in a wide range of symptoms, including depression, ADHD, difficulty concentrating, fatigue, chronic sinus infections, and various pulmonary and neurologic issues. If you fear that you’ve been exposed to indoor molds, it’s critical that you speak with a physician who is familiar with mold toxicity disorder.

8. Coffee.

Several studies have demonstrated a link between coffee consumption and heightened anxiety. While most people can tolerate one to two cups of coffee per day without issue, if you are prone to anxiety, you may want to rethink your morning pick-me-up. Try cutting out coffee altogether for at least two months and observe whether or not your mental state changes as a result.

This article first appeared in Dr. Kaplan’s column on MindBodyGreen.com in September 2015. It was reviewed and updated in May 2023.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Additional Resources

Harding CF, Pytte CL, Page KG, Ryberg KJ, Normand E, Remigio GJ, DeStefano RA, Morris DB, Voronina J, Lopez A, Stalbow LA, Williams EP, Abreu N. Mold inhalation causes innate immune activation, neural, cognitive and emotional dysfunction. Brain Behav Immun. 2020 Jul;87:218-228. doi: 10.1016/j.bbi.2019.11.006. Epub 2019 Nov 18. PMID: 31751617; PMCID: PMC7231651.

Temple JL, Bernard C, Lipshultz SE, Czachor JD, Westphal JA, Mestre MA. The Safety of Ingested Caffeine: A Comprehensive Review. Front Psychiatry. 2017 May 26;8:80. doi: 10.3389/fpsyt.2017.00080. PMID: 28603504; PMCID: PMC5445139.

food_allergy_intolerance_sensitivity

Food Allergies, Sensitivities, Intolerances and When to See a Doctor

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Food plays an essential role in our lives. Apart from the energy it provides, it keeps the body healthy and fit. Food nourishes and it heals. However, our relationship with food is not always straightforward. Sometimes the things that we eat can also lead to other health problems.

Food allergies, sensitivities, and intolerances are extremely common. They can happen to anyone regardless of age, gender, or health status. The symptoms can be obvious, but they can also be vague and non-specific. Consider some of the following symptoms:

  • Diarrhea
  • Stomach cramps
  • Weight loss
  • Migraines
  • Tiredness or fatigue
  • Itching
  • Sneezing
  • Bloating or gas
  • Skin rashes

Symptoms that are not as obvious are pain problems, mood disorders, and even mild cognitive impairment caused by generalized inflammation in the body. For example, headaches, arthritis flare-ups, anxiety, depression, brain fog, and muscular pain can be indicative of a food allergy or intolerance but are often overlooked as a symptom.

Food allergy vs. food sensitivity vs. food intolerance

In general, people tend to use these terms interchangeably, but in actuality, they all differ.

Questions? Give Us a Call!

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Food allergies

A true food allergy is an immune reaction to a single ingredient or a whole food group. Signs and symptoms can be immediate and vary from mild to fatal (also called anaphylactic).

Symptoms include:

  • Swollen or itchy tongue
  • Rash, hives or runny nose
  • Abdominal pain, vomiting
  • Difficulty breathing, wheezing or closed airways

The sole treatment for these reactions is total avoidance of the trigger food/foods, and extreme caution when eating out at restaurants and buying packaged food. In case of exposure an auto-injection of epinephrine, also known as an epi-pen, is administered.

Common food allergies are peanuts, wheat, shellfish, soy, eggs, and others less common like sesame and strawberry. Animal bites and bee stings can also be allergenic to certain people.

Food intolerances

Food intolerances are non-immune reactions to certain food components, such as sulfite in alcohol, lactose in milk, or even histamine in food. This generally occurs when the body lacks certain enzymes or nutrients that break down those molecules. This category also extends to artificial colors, fillers, preservatives, natural and artificial flavors.

Symptoms of a food intolerance can manifest as inflammation (joint pain), flushing, cold or flu-like symptoms because the body is struggling to metabolize those components but is lacking the tools.

Identifying the food trigger by keeping a food/symptom log, then eliminating it and tracking improvement is the best way to manage food intolerances. Working with a professional will guarantee a successful outcome through personalized supplementation and food plans.

Food sensitivities

Food sensitivities are a two-tier issue; they generally involve the gastrointestinal (GI) and immune systems, and their reactions can be delayed by hours or even days. These reactions are initiated by an imbalance in the GI system, which then triggers an immune response. One common imbalance is Functional Bowel Disorders (FBD), a more recent terminology for Irritable Bowel Syndrome (IBS), or leaky gut. Symptoms can be unique to each patient and vary widely based on the food consumed. Some people experience migraine headaches, dizziness, mood swings, depression, fatigue, difficulty sleeping, sinus and ear infections, indigestion, diarrhea/constipation, acne, and other symptoms not listed here.

Food sensitivities are commonly seen with the consumption of dairy products, eggs, gluten, soy, shellfish, tree nuts, and others.

Addressing food sensitivities starts by eliminating all potential food triggers, followed by functional GI testing to identify the imbalance and treat any active problems (ex. infection, parasite), then repair intestinal lining and eventually reintroduce those foods after.

When to see a doctor

If you have experienced any of the symptoms mentioned above or have never received a diagnosis in relation to those symptoms, then make an appointment to speak to one of our doctors. At the Kaplan Center, we understand the role that nutrition can play in causing and alleviating certain medical conditions. After taking a thorough history, our physicians will investigate possible underlying nutritional problems and carry out a diet assessment. This will give us a better understanding of your lifestyle and the foods to which you are regularly exposed.

Investigations for food allergies, sensitivities, or intolerances

In addition to taking a full history and examination, testing that we may recommend includes:

  • Food Sensitivity/Allergy Testing
  • Blood tests to measure vitamin and mineral levels such as iron, B12, folate, vitamin D, and magnesium
  • Antibody testing to see if your symptoms are related to an autoimmune condition
  • Comprehensive stool analysis to reveal any abnormalities in the body’s gastrointestinal functioning

Furthermore, we may recommend keeping a detailed food diary or journal for a few weeks to help better pinpoint the cause of your symptoms.

Treatment/Management

Based on your medical history, physical exam, and the results of any testing that was carried out, we will develop a better understanding of your digestive profile. Once that occurs, we will suggest treatment and management options that may include:

  • An elimination diet (ie. removing the suspected food item from your diet for a period of time to see if symptoms improve)
  • Maintaining a food diary that will help us spot any patterns related to problem foods
  • Stress management techniques to help restore balance to an overactive immune system
  • Nutritionist support to:
    • Improve nutritional deficiencies that have been identified
    • Rebuild gut integrity with a gut repair protocol
    • Create a personalized anti-inflammatory diet tailored to your needs and goals

Our relationship with food can be complicated but it doesn’t have to be. With time and patience, it is possible to figure out what foods are causing your symptoms and how best to manage the situation. Our doctors will take a functional and integrative approach to deal with food allergies and sensitivities that include looking at all aspects of your health.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

overlooked causes of migraines

5 Overlooked Causes Of Migraine Headaches

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With migraine headaches, it’s important to look beyond the symptom to target the disease.

Lindsay was 23 years old, fresh out of college, and working at her dream job in Washington, D.C., as a congressional aid. Working in Congress, 10-hour days are the norm and for Lindsey, typically the first to arrive in the morning and last to leave in the evening – that was a short day.

She was in charge not only of the Senator’s schedule but also required to be at his side taking notes at all his meetings, as well as keeping him informed as to who he was meeting with and why.

Young, energetic, with an excellent memory and a gift for attention to detail, Lindsay was a rapidly rising star in the highly competitive world of Capitol Hill. When we met, Lindsay was clearly intelligent, completely charming, and terrified that everything she had achieved could be completely undone by progressively crippling migraines.

She had suffered from migraines since she was 16 and had seen several physicians, including neurologists. Yet despite trials of numerous medications, the headaches had become more frequent and debilitating within the last year.

According to the American Migraine Foundation, 1 billion Americans of all ages suffer from migraines. Women are disproportionately affected, impacting approximately 1 in 5 American women versus 1 in 16 men.

For most migraine sufferers, the attacks occur one to two times a month or less, but about 4 million people agonize with a migraine 15 days or more a month. Migraine headaches are regarded as one of the top 20 of the world’s most debilitating medical illnesses.

Most physicians treat migraines as a disease, when in fact, they may be a symptom. By this, I mean that if you go to your doctor complaining of headaches that are diagnosed as migraines, the appointment typically ends with a prescription for medications to either prevent the occurrence of the headache or treat the acute headache, with little if any testing.

It’s rare for any consideration to be given to why you get the headaches. But, if you can find the underlying cause, you have a much better chance of finding the cure.

Questions? Give Us a Call!

703-532-4892 x2

Here are five frequently overlooked causes of migraine headaches:

1. Celiac disease and gluten intolerance

Celiac disease is an autoimmune disease to gluten, a protein found in the grains wheat, barley, and rye. About 1% of the population suffers from Celiac disease and unfortunately, it’s estimated that over 80% of the people with Celiac disease are undiagnosed.

Gluten intolerance (GI) affects about 6% of the American population. GI, while not associated with the damage to the lining of the small intestines as seen in Celiac disease, can make you almost as sick as Celiac disease.

Because eating grains causes Celiac disease and GI, we tend to think that this is an intestinal problem and expect to see people complaining of abdominal symptoms such as bloating, diarrhea and abdominal pain. In fact, both these diseases can present with minimal or no gastrointestinal symptoms and a large number of other symptoms including migraines, peripheral nerve damage, seizures, anxiety disorders, depression, and even schizophrenia. This was documented in an excellent review published in 2012.

You can screen for Celiac disease with a simple blood test, but we do not have any reliable testing for GI as of yet. Treatment for both conditions is the elimination of all gluten-containing foods from your diet.

Questions? Give Us a Call!

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2. Magnesium deficiency

This may play a role in the occurrence of migraines in up to 50% of the people who suffer from this condition. (An excellent summary of this research was published in 2012.)

Magnesium is essential for a wide range of functions in the body and unfortunately, it’s easy to become deficient in magnesium and difficult to measure with a blood test.

Low nutritional intake, excess consumption of coffee, sodas, and alcohol, chronic stress, chronic illness, and intestinal problems (such as Celiac disease creating problems with absorption of magnesium) can all lead to deficiency.

The foods highest in magnesium, such as halibut, mackerel, boiled spinach, bran breakfast cereal, and nuts such as almonds, cashews, and pumpkin seeds, are not foods that typically make up much of our diets.

I encourage my patients suffering from migraines to make the necessary dietary changes and to supplement with between 250 and 500mg of magnesium a day.

One of the side effects of taking magnesium is diarrhea. If you develop diarrhea while taking magnesium, decrease the dose or try switching the type of magnesium you are taking.

We also treat many of our migraine patients with IV magnesium.

3. TMJ disorder

The temporal mandibular joint (TMJ) is the joint where your jaw connects with your skull. The joints are located in front of your ears on either side of your face. If your teeth are misaligned or you grind your teeth, a condition called bruxism, you can develop dysfunction and pain at the TMJ.

Symptoms of TMJ dysfunction include popping of the joint, pain at the joint, difficulty opening your mouth, and headaches. Proper diagnosis and treatment require that you see a dentist familiar with this condition. The headaches caused by TMJ can be misdiagnosed as migraines and TMJ can be a trigger for migraines.

4. Thyroid disease

Both low and high thyroid levels can cause headaches. Thyroid disease, usually associated with fatigue, dry skin, and hair loss when thyroid levels are low, and rapid heart rate and anxiety when thyroid levels are high, may present with migraine as the only significant symptom. This so-called subclinical presentation of thyroid disease can also be seen in adults and children.

Diagnosis can be made with a simple blood test.

5. Mold toxicity

This is highly controversial, but in my experience, mold toxicity is a significant cause of many diseases, including migraines. Molds can produce allergic reactions when inhaled, but the bigger concern is the toxins called mycotoxins that are chemical toxins present within or on the surface of the mold.

Mold toxins can affect almost every organ in the body, but the brain is almost always affected, resulting in neurotoxicity. People with mold toxicity have complaints that vary from mild cognitive impairment to symptoms that look like multiple sclerosis.

Headaches are a common complaint of people suffering from mold toxicity. Mold toxicity should be considered in anyone who has migraines and a history of exposure to water-damaged buildings where mold grows. Unfortunately, very few doctors know about this condition or how to evaluate a patient for the problem. For more information on mold toxicity, see the Biotoxicity and Neurotoxicity page on this website or visit Dr. Shoemaker’s website SurvivingMold.com.

As it turns out, Lindsay’s migraines were a result of being gluten intolerant and having low magnesium levels. Once she eliminated all gluten from her diet and improved her magnesium levels with magnesium IVs, her migraines dramatically improved.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Dr. Lilienfield discusses Irritable Bowel Syndrome Treatments

Treating Irritable Bowel Syndrome: A Functional Medicine Approach

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Irritable Bowel Syndrome (IBS) is a chronic disorder that can cause considerable discomfort for those who are affected. Symptoms include abdominal pain, cramping, bloating, constipation, and diarrhea. However, once diagnosed and under the proper treatment, people with IBS are able to reduce the frequency of their flare-ups for a better quality of life.

At The Kaplan Center, we have been successfully treating IBS for years using a Functional Medicine approach.

Functional Medicine physicians look for signs of imbalance and areas of health that can be optimized. If and when they are found, the next step is looking at factors that could be supporting or exacerbating the disease – like environment, diet, past infections, medications, and levels of stress for example. Once the underlying causes are identified and removed normal digestive function and health can be restored.

In this video, Dr. Lisa Lilienfield explains the Functional Medicine approach to treating IBS.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

 

Dr. Kaplan Invited to Discuss the Role of the Immune System & Microbiome in the Onset of Autoimmune Disease Following Infection

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For the second consecutive year, Dr. Gary Kaplan was invited to present at the Walter Reed National Military Center’s monthly acupuncture webinars. The purpose of these webinars is to bring experts in the fields of chronic pain and acupuncture to share their expertise and treatment strategies with the medical staff at the center.

This year, Dr. Kaplan elaborated on the concept of autoimmunity and the role of the adaptive immune system and the gut microbiome in the onset of autoimmune diseases following an infection.

Autoimmunity is when the body loses self-tolerance and starts attacking its own tissues and organs resulting in either an organ-specific autoimmune disease, such as Type 1 Diabetes or a systemic autoimmune disease such as Multiple Sclerosis (MS) and Systemic Lupus Erythematosus (SLE).

About 5% of the US population suffers from an autoimmune disease, although Dr. Kaplan believes that this percentage may not account for all of the autoimmune diseases that are caused by viral and bacterial infections.

Dr. Kaplan also discussed the mechanisms of autoimmunity by which the immune cells get activated in a disorganized manner and start mistakenly attacking healthy cells, the tests we utilize here at The Kaplan Center to determine if there is an autoimmune process going on, and how to translate the data into actionable treatment strategies.

The title of Dr. Kaplan’s presentation was “Autoimmune Encephalopathy of Infectious Etiologies and their Role in Chronic Pain and Depression.”

"What Gluten Does"  An Excerpt from Total Recovery

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The following is the third in a series of excerpts on gut health from Dr. Gary Kaplan’s book “Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression.”

“Leaky gut has been implicated in the growing number of food and environmental sensitivities affecting almost 25 percent of American adults. These are not food allergies, but delayed hypersensitivity reactions.1

As many as 40 percent of Americans are sensitive to gluten. One in 100 of those has a severe reaction in the form of an autoimmune disease, celiac disease.2

“Imagine gluten ingestion on a spectrum,” says Dr. Allesio Fasano, head of research at the University of Maryland Celiac Research Center. “At one end, you have people with celiac disease, who cannot tolerate one crumb of gluten in their diet. At the other end, you have the lucky people who can eat pizza, beer, pasta, and cookies – and have no ill effects whatsoever. In the middle, there is this murky area of gluten reactions, including gluten sensitivity or intolerance. This is where we are looking for answers.”3

Most doctors don’t know the difference. Some are unaware that gluten sensitivity can genuinely contribute to hundreds of diseases and that the symptoms may not manifest in the gut, but in other parts of the body.4

Years ago, we believed that celiac disease was a rare childhood syndrome. Today the average age of diagnosis is in individuals between ages 40 and 60. Celiac disease affects more than 2 million Americans – 1 in 133 people.5 Researchers have already confirmed that the dramatic rise in figures is not due to greater awareness. By testing old blood samples, they have shown that, in the last 50 years, the rate of celiac disease has increased fourfold.

Gluten intolerance is now estimated to affect 6 to 9 percent of the American population. Furthermore, people in their seventies, who have eaten gluten without problems their entire lives, are now experiencing gluten sensitivity.6

Unfortunately, gluten intolerance is sometimes viewed with skepticism. When the tests come back negative for celiac disease, many doctors dismiss their patients’ complaints rather than investigating further. Part of the problem is that, like allergy tests, gluten intolerance tests are not consistently reliable. While gluten intolerance is not an allergy to gluten, we have not yet found a definitive means of identifying it in the blood.

The only absolute way to determine gluten intolerance is to completely remove gluten from the diet for 6 weeks and see if the symptoms improve. It can be hard to tell. If there are other food intolerances and nutritional deficiencies at play, removing gluten may only eliminate some of the symptoms.

Peter Green, MD, director of the Celiac Disease Center, estimates that research into gluten intolerance is about 30 years behind celiac research.7 Without better research, patients are too often told it’s “all in their heads.” With a burgeoning series of product lines of gluten-free foods, estimated at $2.6 billion in sales last year alone, it is easy to assume that gluten intolerance is nothing more than a fad.8

It’s widely known that agricultural changes in wheat production over the past decades have altered wheat significantly and raised both its protein and gluten content.9 Some ascribe gluten sensitivity to the increase in our consumption of wheat. Gluten can now be found in everything from bread and canned goods to hand lotion and makeup.10 But the evidence is inconsistent. And the cause may lie in the bacteria in the gut itself. We’re beginning to suspect that gut bacteria determine whether the immune system treats gluten as food or as a deadly invader.11

In his studies of celiac disease, Dr. Fasano made an important discovery. He studied 47 newborns who were genetically at-risk for developing celiac disease. By the time they were 2 years old, these children had a fairly impoverished and unstable community of intestinal bacteria.12 As he continued to monitor their bacterial levels, the levels of lactobacilli declined in two children.

Both developed autoimmune diseases. One got celiac disease, and the other type 1 diabetes (which has a genetic proclivity similar to that of celiac disease).13

Dr. Fasano and his colleagues were excited. “Imagine what would be the unbelievable consequences of this finding,” he said. “Keep the lactobacilli high enough in the guts of these kids, and you prevent autoimmunity.”14

The questions is, was it the chicken or the egg? Which came first, the imbalance of bacteria or the autoimmune disease? Some studies show that intestinal inflammation accommodates bacteria that keep the inflammation going.15 As we’ve already observed, bacteria learn and fight hard to survive.

It’s a living system, where different choices can be made at any stage. Our genetics help determine our bacteria, but the bacteria can change us – turning genes off and on, adapting as they go. According to Bana Jabri, director of research at the University of Chicago Celiac Disease Center, even if the chicken comes first, the egg can contribute. “You have the same endpoint,” she says, “but how you get there may be variable.” Such complexity both confounds notions of one-way causality and suggests different paths to the same disease.16″

1 Lipski, Digestive Wellness
2 A. Fasano, “Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer,” Physiological Review 91, no. 1 (January 2011): 151–75, www.ncbi.nlm.nih.gov/pubmed/21248165.
3 Ibid.
4 Ibid.
5 A. Fasano et al., “Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States,” Archives of Internal Medicine 163, no. 3 (February 20, 2003): 286–92, www.ncbi.nlm.nih.gov/pubmed/12578508.
6 Melinda Beck, “Clues to Gluten Sensitivity,” Wall Street Journal, March 15, 2011, http://online.wsj.com/news/articles/SB10001424052748704893604576200393522456636.
7 Ibid.
8 Ibid.
9 Ibid.
10 Moises Velasquez-Manoff, “Who Has the Guts for Gluten?” New York Times, February 23, 2013, www.nytimes.com/2013/02/24/opinion/sunday/what-really-causesceliac-disease.html.
11 Ibid.
12 Ibid.
13 Ibid.
14 Ibid.
15 Ibid.
16 Ibid.

Reprinted from Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression by Gary Kaplan, D.O., with permission from Rodale Books. Copyright (c) 2014 by Gary Kaplan, D.O..

To read Part 1 of this series, “Gut Feelings,” click here.
To read Part 2 of this series, “Hidden Immune System,” click here.

gut microbiome

“Gut Feelings”: An Excerpt From Total Recovery

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The following is the first in a series of excerpts on gut health from Dr. Gary Kaplan’s book “Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression.”


“We now know that our intestinal tract has 100 million nerves – more than our spinal cords or peripheral nervous systems. With this radically new understanding, scientists have tentatively begun to refer to it as the body’s second brain.

As Michael Gershon, MD, explains in his book The Second Brain, the intestinal tract is far more independent than anyone had realized. It is even equipped with its own senses and reflexes.1

Surprisingly enough, our digestive systems manufacture just as many neurotransmitters as our brains. With the advent of “designer drugs” – such as selective serotonin reuptake inhibitors (SSRIs) – we have come to think of depression, anxiety, and insomnia in relation to the amount of serotonin circulating in the brain. Only recently has it become apparent that 95 percent of the body’s serotonin is manufactured not in the brain, but in the gut.2

Now it makes sense that the side effects of SSRIs often include intestinal problems.

In America more than two million people have irritable bowel syndrome (IBS), which may be caused, in part, from too much serotonin in the intestinal tract. As Adam Hadhazy points out in Scientific American, this means IBS – like other diseases caused by an imbalance of neurotransmitters in the gut – could almost be considered “mental illnesses” of the second brain.3

IBS may also signal an inflammatory process in the spinal cord or brain itself. An emergent theory on the cause of IBS is that it is a form of central sensitization. Inflammation in the spine increases sensitivity of the nerves controlling the muscles that line the intestinal tract and ensure the smooth flow of food throughout our digestive system. When the nerve signals from the spinal cord and brain to the intestines are disrupted, it can cause the intestinal muscles to spasm, resulting in pain and cramping. The muscles respond by becoming overactive (diarrhea) or underactive (constipation).4

As researchers have turned their attention to serotonin levels in the gut instead of in the brain, it has led to even more surprises. In a study of rodents at Columbia University Medical Center, scientists found that when they gave rodents with osteoporosis a drug that inhibited the release of serotonin in the gut, the disease disappeared. Gerard Karsenty, MD, lead author of the study and chair of the Department of Genetics and Development at Columbia, admitted, “It was totally unexpected that the gut would regulate bone mass to the extent that one could use this regulation to cure – at least in rodents – osteoporosis.”5

Dr. Gershon says, “We have never systematically looked at [the intestinal tract] in relating lesions in it to diseases like we have for the [central nervous system].”6 Once we have had time to investigate the implications of the second brain, important connections to diseases will be linked to the state of our gut.

We know that problems in the intestinal tract can go much further than heartburn and indigestion or constipation. Crohn’s disease, IBS, and ulcerative colitis also arise from imbalances in the gut.7 Early studies have suggested that imbalances in intestinal bacteria can cause “arthritis, diarrhea, autoimmune illness, B12 deficiency, chronic fatigue syndrome, cystic acne, colon and breast cancer, eczema, food allergy or sensitivity, inflammatory bowel disease, irritable bowel syndrome, psoriasis, and steatorrhea.” None of these conditions were previously recognized as being related to gut bacteria.8

Gradually, physicians reading the latest research are becoming aware that migraines are frequently triggered by food sensitivities that inflame the gut.9

Diseases like chronic fatigue syndrome, asthma, and fibromyalgia have a significant relationship to the intestinal tract. When balance is restored, the symptoms are often resolved. Any improvement in the health of our intestinal tract increases the effectiveness of our immune systems.

The question currently being investigated by researchers is: Can we analyze the stool to create a map of all the different types and amounts of bacteria in the gut and use it to predict illness? We’re hoping it can be done.”

1 Michael D. Gershon, MD, The Second Brain (New York, HarperCollins, 1998).
2 Lipski, Digestive Wellness.
3 Hadhazy, “Think Twice.”
4 Ibid.
5 Ibid.
6 Ibid.
7 Lipski, Digestive Wellness.
8 Ibid.
9 Ibid.

Reprinted from Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression by Gary Kaplan, D.O., with permission from Rodale Books. Copyright (c) 2014 by Gary Kaplan, D.O.

To read Part 2 of this series, “Hidden Immune System,” click here.