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I was trained in conventional medicine and neurology, and I have always been a staunch supporter of prevention. But rather than pursue a career as a practitioner of traditional Western medicine, I have dedicated my work to the principle that the best way to cure a disease is to prevent it. I believe that many chronic diseases can be alleviated or even completely reversed by using lifestyle modification treatments. This conviction led me to Loma Linda University, a school renowned for its pioneering contributions to medical science, where I obtained a second doctorate, in public health, and became a specialist in preventive care.
I have devoted almost six years to studying the widespread and elusive problem of headaches. Very few people do not suffer from occasional headaches, and many experience them on a weekly or daily basis. Where do they come from? What are their main causes? Is it stress, certain types of foods, too much work, lack of sleep, lack of exercise, caffeine, alcohol, nicotine? Or is it simply a genetic defect we can do little about? What intrigued me about the headache problem was the very wide range of seemingly unrelated factors that can trigger many types of headaches. I theorized that if there were common biochemical imbalances linking the various factors, there must be a uniform treatment for headaches. One of the most important headache triggers turned out to be levels of fat—lipids and fatty acids—in the blood. Fat levels in the body are affected by the same things that can trigger headaches, including lack of physical activity, emotional upset, inadequate sleep, stress, certain types of foods, and poorly balanced nutrition. This led me to conduct a clinical study that explored the nutrition of patients suffering from migraine headaches. However, instead of focusing on specific types of foods, I introduced my headache patients to a balanced program of nutrition, which they followed for a period of several weeks. The result was a dramatic decrease in the frequency, severity, and duration of their headaches. And in many cases, the headaches disappeared completely.
After publishing my results, I began to use the nutrition approach in my clinical practice. I also expanded the lifestyle modification treatment to include other essential components—especially physical activity and stress management. After years of working with patients suffering from headaches and other chronic diseases, I began to realize that one of the greatest challenges in preventive care and lifestyle medicine is to convince patients to take charge of their own health. This generally requires a shift in the patient's lifestyle. Most people know very well what it means to have a healthy lifestyle; but knowing what should be done and doing it are two very different things. To achieve and sustain significant lifestyle modification requires specific strategies that bring about changes gradually. It is my hope that the techniques of lifestyle modification, which I have developed from practical experience, will help headache sufferers throughout the world.
The headache treatment described in this book also has its roots in accidental discovery. The initial idea began to develop at a medical practice specializing in preventive care and lifestyle medicine, where patients with type II diabetes were put on a low-fat diet. When they returned for a follow-up visit, we found that their diabetic symptoms had improved. In addition, some patients who had suffered from migraine headaches before beginning the diet noted that their headaches had become less frequent and less severe.
This unexpected side
effect of the low-fat diet roused my interest. During the 1980s, I had
worked as a physician in the area of neurology. Part of my work included
the treatment of migraine headaches from a purely neurological point of
view. But I had always harbored a belief that most chronic diseases could
be prevented, or their symptoms minimized, through appropriate lifestyle
modification. I believed that most headaches were manifestations of a lifestyle-related
imbalance, and the results of the diabetes treatment convinced me that
I was right. This gave me the incentive to do further research in hope
of supporting my conviction.
During my investigation
of diet and headaches, I found many studies suggesting that the fatty substances
contained in our blood might cause migraines. Indeed, levels of free fatty
acids in the blood are considerably elevated during migraine attacks. This
provided an important clue in my quest to find a better headache treatment.
But more questions arose from this discovery than were answered. Does the
increased blood fat cause the headaches or is it the other way around?
If blood fat is the cause of headaches, why does it become elevated and
how can it be lowered? What about those headaches that do not seem to have
any connection with fat triggers, such as those caused by stress or the
consumption of red wine? After much more research, I was able to answer
some of these questions, and a clear picture of the headache problem began
to emerge. It was becoming increasingly evident that most headaches are
triggered by the same biochemical imbalances in the body, but these imbalances
can be caused by many different factors.
One of the main culprits is an abnormally low level of serotonin in the body. Other important substances that influence blood vessels and blood flow in the brain include prostaglandins, histamine, endorphins, magnesium, and many others. Serotonin is a messenger—a neurotransmitter in medical terminology—that carries information from nerve ends to different parts in the body, where it is detected by special receptors and causes a wide range of reactions. Among other things, serotonin is involved in controlling depression, anxiety, and eating and sleeping patterns. But serotonin also prevents blood vessels from dilating too much. Therefore, when levels of serotonin are low, the blood vessels dilate, which generally brings on a headache. In fact, another term for migraine headache is low-serotonin syndrome. Let us now examine the factors that cause serotonin levels to fall.
Two important conditions determine low serotonin levels. One is a lack of vitamin B6 and tryptophan, and the other is a high degree of platelet clustering. Tryptophan is an essential building block in the production of serotonin, which, in turn, requires the presence of vitamin B6. Low levels of tryptophan result in low levels of serotonin. Vitamin B6 and tryptophan are present in many fruits, vegetables, grains, and legumes.
To understand the second reason for low levels of serotonin—platelet clustering—it will be helpful to understand the basic makeup of blood. Blood consists of a clear liquid called plasma, which contains a variety of different particles. Most people are familiar with two of these particles—red blood cells, which give blood its red color and are responsible for transporting oxygen and nutrients throughout the body; and white blood cells, which enable the body to fight against infection. The particles we are most interested in are called platelets. These tiny round or oval-shaped discs—about one ten-thousandth of an inch in diameter—function as biochemical storehouses for enzymes and other substances, including serotonin.
Platelets usually travel freely and smoothly through the blood vessels. But under certain conditions, platelets start to aggregate, or cluster. When this happens, the platelet walls become damaged, and the chemicals stored there, such as serotonin, start to leak into the blood. The additional serotonin temporarily increases constriction of the blood vessels, and it is during this period that some people sense a headache coming on or experience an aura. But shortly thereafter, the serotonin is degraded and eliminated from the body. And without sufficient serotonin to constrict the blood vessels, vasodilatation and an accompanying headache are the results.
The main cause of increased platelet clustering is a growth in levels of certain fatty substances in the bloodstream. The two main groups are blood lipids, which include cholesterol and triglycerides, and several different types of free fatty acids, including stearic, linoleic, palmitic, and oleic acids. Free fatty acids and blood lipids are mutually connected, and the levels of one generally influence the levels of the others. To simplify our discussion, we will use the phrase blood fat to refer to both groups.
The reason for increased platelet clustering in the presence of fat is easy to understand. Added fat changes the consistency and flow properties of blood so that it becomes thicker. Picture the difference between water and oil. Both are liquids, but water flows more easily than oil. The blood-thickening effect occurs because fat in the blood takes up space in the blood vessels and leaves less room for other particles to maneuver. This makes it easier for the platelets to cluster.
When I realized that
high levels of blood fat were one of the main causes of headaches, I began
to investigate possible environmental and lifestyle factors that may increase
levels of blood fat. It turned out that almost all known headache triggers
cause blood-fat levels to rise. Therefore, blood fat is the common denominator
of all conditions known to cause headaches.
We eat many types of sugar, all of which are broken down by digestive processes into one of the simplest forms of sugar, called glucose, or blood sugar. A rise in blood sugar triggers the release of insulin, a natural hormone that helps metabolize sugar into energy and influences the metabolism of fat in the body. Thus, insulin reduces blood sugar to normal levels. This is what occurs when we eat natural sugars such as those contained in fruits, vegetables, or other unprocessed foods.
Unfortunately, the most common form of sugar consumed today is pure sucrose, which is a combination of two simple sugars, glucose and fructose. Sucrose does occur naturally in many fruits and plants, but it never occurs by itself. It must be extracted from plants, usually from sugarcane or sugar beets, which have the highest concentrations of sucrose. This involves crushing the sugarcane or sugar beets and repeatedly boiling and cooling the juice while adding various chemicals to crystallize the sucrose. The process removes all proteins, minerals, vitamins, and other natural substances. What remains is pure white sugar.
Since sucrose does not occur in this highly concentrated form in nature, the body has difficulty processing it. When you ingest a large amount, it quickly enters the bloodstream and causes the release of an unnaturally high amount of insulin to deal with the excess blood sugar, or hyperglycemia. This removes the additional sugar, but since there is too much insulin, the reaction continues for too long a period. The result is a state of low blood sugar, which causes levels of blood fat to rise. Now we can see the link between blood sugar and blood fat. In short, whenever the level of blood sugar is insufficient to serve as the body's fuel, more fat is released into the bloodstream to fill the gap.
Low blood sugar also causes the release of several hormones, notably adrenaline. This increases platelet clustering and changes the body's metabolism, which intensifies the effect of the increased blood fat and brings on a headache. It is interesting to note that at one time migraines were called hypoglycemic headaches, or low blood-sugar headaches.
Another important substance that links a high-fat diet with headaches is a group of fatty substances called prostaglandins, which are produced by most body tissues. Like cholesterol, there are "good" and "bad" types of prostaglandins. The latter, called Series-l prostaglandins, or simply PGE-l, are potent vasodilators.
Levels of prostaglandins
can be influenced in two ways. First, a proper ratio of omega-3 oils—found,
for example, in fish, flaxseeds, or walnuts—to omega-6 oils—found, for
example, in margarine—can keep prostaglandins in balance. Of course, nutrition
is an essential factor in influencing the balance of these fats in the
body. The second factor influencing levels of prostaglandins is serotonin.
The release of serotonin into the bloodstream causes prostaglandin levels
to rise. This naturally doubles the risk for headache because both serotonin
and prostaglandins are strong vasodilators.
Another common disorder related to nutrition is insulin resistance. As the name suggests, it describes a condition in which insulin can no longer process blood sugar. Thus, despite the fact that the body may produce adequate or even excessive amounts of insulin—a disorder called hyperinsulinemia—blood-sugarlevels remain high. But because the body is unable to use the sugar as fuel, it increases its levels of blood fat to provide additional or alternate fuel. This leads to increased platelet clustering, a reduction of serotonin, and headache.
Chronic hypoglycemia,
or
low blood sugar, is another disorder frequently linked to headaches because
insufficient levels of blood sugar force the body to use more fat as fuel.
Thus, chronic hypoglycemia has the same harmful effect as the insulin-related
disorders described above.
Prolonged hunger is similar to chronic hypoglycemia in that it produces a temporary state of low blood sugar, and since no new sugars are supplied as food, the body must use its stored fat for fuel. The corresponding rise in blood fat then follows the now familiar path toward headache.
Another potent headache trigger is dehydration. The reason is quite simple. Lack of water increases the viscosity of the blood so that it becomes thicker. Therefore, it does not flow as easily, and this increases the likelihood that platelets will stick together and become damaged. Unlike some other triggers, dehydration does not increase the total amount of blood fat, but it does increase its concentration. Lack of fluid is especially critical after meals because many nutrients require water to transport and metabolize food and to store it in the form of fat. When you do not drink water with your meal, your body must use the fluid currently available in the bloodstream. This further increases fat concentration, reduces the blood's flow properties, and increases platelet clustering.
Alcohol is one of the most potent and reliable headache triggers. First, alcohol is a vasodilator—and remember that vasodilatation is a common precondition of headache. Second, alcohol interferes with the function of the liver, which regulates the metabolism of carbohydrates. As a result, it has a hypoglycemic effect on the body, which results in an increase of blood fat. Finally, when alcohol is metabolized and removed from the body, the byproduct of the chemical reaction is fat, which is then added to the bloodstream.
Caffeine, which is found naturally in coffee, some teas, and many soft drinks, is a potent vasoconstrictor. When used infrequently and in small amounts, it can actually be used as a headache medication. A cup of coffee taken at the onset of a headache can sometimes abort it. Caffeine is also added to some pain relievers to improve their effectiveness. But in larger quantities and when consumed habitually—generally more than three cups of coffee per day—caffeine significantly increases levels of blood fat, notably cholesterol. It also increases platelet clustering. As we know, high blood fat and platelet clustering contribute to the degradation of serotonin, which leads to vasodilatation and headache.
Caffeine can also
cause headaches via another mechanism—the withdrawal effect. When you use
caffeine regularly over extended periods, your body adapts to its presence
in the bloodstream by compensating for its constricting effect. The sudden
interruption of a regular caffeine supply does not give the body enough
time to discontinue the compensation, which results in excessive vasodilatation
and the development of a headache.
Another critical factor in controlling headaches is physical activity. It is important to realize that a lack of physical activity, as well as too much of it, may bring about a rise in levels of blood fat. A sedentary lifestyle has a profound effect on the body's metabolism, making it difficult to clear fat from the bloodstream. At the other extreme, excessive exercise induces a temporary state of hypoglycemia because it depletes the body's sugar reserves. The depletion of blood sugar forces the body to increase the level of fat in the blood in order to provide the necessary fuel to muscles and other tissues.
Stress is another well-known headache trigger. Chronic stress can cause a number of biochemical imbalances, which the body tries to correct. Psychological or emotional problems—for example, those resulting from overwhelming amounts of work, difficult relationships, or financial worries—are common sources of stress. A multitude of environmental or physical pressures—including injury, pollution, lack of oxygen, hypothermia, and hyperthermia—can also cause a stress response.
Like all the other triggers discussed so far, stress causes blood-fat levels to rise. In the case of physical or environmental triggers, the body provides additional fuel to cope with the stress situation. In the case of psychological stress triggers, the body prepares itself for a fight-or-flight response to a perceived danger by providing the necessary fuel for the expected physical activity. Unfortunately, stress in our civilized society is rarely relieved by a physical fight or by running away, and so the increased fat remains in the bloodstream. You may already be aware that stress causes a rise in cholesterol, which is one type of fat. In fact, prolonged stress causes an accumulation of all types of fats in the blood.
Finally, some oral
contraceptives and some types of hormonal therapy may produce headaches.
This applies particularly to products containing high levels of estrogen.
By now you may have guessed the reason. Yes, once again, fat is the culprit.
Fluctuations in estrogen levels influence the amount of fat in the blood
and cause headaches.
Can we possibly hope for an intervention that will restore all the body's natural biochemical balances to prevent headaches? The answer is yes. But this will not happen by focusing on specific imbalances. Instead, we must rely on the body's own self-regulating abilities. Each simple stimulus, such as hunger, fright, or just getting up from a chair, sets in motion a chain reaction of complex biochemical processes that regulate heart rate, blood pressure, oxygen and nutrient supplies, and great many other things. The diagram shown above establishes a link between headaches and external stimuli, or lifestyle factors. Thus, it provides the basis for a new treatment—a gradual lifestyle modification that eliminates harmful stimuli and allows the body to restore and maintain its internal biochemical balances.
Headaches occur most frequently and with the greatest severity in people under the age of forty-five. It is interesting that as incidences of headaches begin to diminish with advancing age, many chronic diseases begin to become apparent. Since the various lifestyle factors that cause headaches are the same as those that cause many chronic diseases, headaches can be seen as early warning signs of possible future diseases. Therefore, it is logical to conclude that appropriate lifestyle changes will reduce the immediate suffering produced by headaches and will greatly reduce the risk of developing other problems in the future.
The next few pages discuss some examples of the most common chronic diseases that may be caused by lifestyle factors, including lack of physical activity, excessive stress, smoking, immoderate consumption of alcohol or caffeine, and improperly balanced diets. Repeated headaches indicate the presence of some or all of these factors and thus an increased risk for developing these diseases.
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No More Headaches, No More Migraines by Z. Bic and L.F. Bic, Penguin Putnam Publishing, New York, 1999, $11.95, ISBN: 0-89529-924-0 |
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