Causes and Cures for Constipation

Posted by on April 4, 2011 288 comments

Constipation seems to be very common; we’re frequently asked about it. Constipation can afflict low-carb dieters: It was widely reported among Atkins dieters, and is the most common side effect reported on clinical ketogenic diets for epilepsy. [1]

Fortunately constipation is usually easily cured. There are a few common causes, and most of them have simple fixes.

Antioxidant Deficiency

Among the most common causes of constipation among low-carbers is deficient antioxidant capacity.

The gut is a challenging environment, full of oxidizing compounds. If glutathione and other antioxidants become deficient in intestinal cells, then the gut becomes leaky [2], leading to inflammation and the potential for constipation. Oxidative stress can also lead to loss of neurons or neuronal axons from the colon and consequently a loss of motility. Constipation is a common symptom of irritable bowel syndrome.

The cure is simple: supplement. Specifically:

  • Selenium, 200 mcg/day (perhaps 400 mcg during a starting period). Selenium is needed for glutathione peroxidase, a glutathione recycling enzyme.
  • Vitamin C, 1 g/day (perhaps 4 g/day during a starting period). Vitamin C and glutathione recycle one another.
  • Zinc and copper. Total zinc intake should be 30-50 mg/day including food and multivitamin; copper intake should be 2-5 mg/day. Food typically provides 15 mg zinc and 1 mg copper.
  • Cysteine and glycine. These are the component amino acids for glutathione. For constipation I would suggest eating some beef gelatin for glycine, and taking one 500 mg capsule of N-acetylcysteine per day.

Egg yolks also increase glutathione production [3], and eating a dozen per week is highly recommended. Lipoic acid may also help. [4]

Glutamine, a supplement frequently recommended for gut ailments, can also enhance glutathione production [5]. However, I would generally avoid this, because it can promote proliferation of pathogenic bacteria.

Hypothyroidism

Hypothyroidism may be the most common cause of constipation.

A vicious circle often develops: Gut problems lead to autoimmune hypothyroidism, and constipation is only one symptom of the damage hypothyroidism does to the gut. The vicious circle can be broken by treating the hypothyroidism.

The cure:

  1. Eliminate wheat, soy, and other autoimmune-promoting or goitrogenic toxins from the diet.
  2. Supplement with thyroid supporting nutrients like:
    • Selenium (as above).
    • Magnesium (citrate or chelate) 200 mg/day.
    • Zinc and copper (as above).
    • Iodine.
  3. Improve circadian rhythm. Circadian rhythm therapies for hypothyroidism were discussed in two posts, Intermittent Fasting as a Therapy for Hypothyroidism (Dec 1, 2010) and Seth Roberts and Circadian Therapy (Mar 22, 2011).
  4. See your doctor to consider replacing thyroid hormone and investigating related problems. Your doctor can prescribe thyroid hormone and can explore related problems that may contribute to hypothyroidism, such as adrenal fatigue or iron deficiency.

As always, a few cautions about iodine supplementation. Before starting iodine, eliminate wheat from the diet and supplement with selenium, copper, and magnesium. If you have thyroid-related effects from copper supplementation, before proceeding further supplement copper until your thyroid no longer reacts. Start iodine at a low dose, say 500 mcg (0.5 mg) per day. Increase the iodine dose no faster than one doubling per month. When you increase the dose, if you have a reaction to the higher dose, phase it in: say, alternate between 0.5 mg and 1 mg for a week before trying 1 mg/day every day. Go slowly, plan on spending 4 months to reach 3 mg/day, which is a quarter Iodoral tablet. Tablets can be cut into pieces with razor blades and liquid solutions can be diluted; don’t hesitate to reduce doses.

Insufficient Dietary Fat and/or Bile

Not long ago Jamie Scott (That Paleo Guy), a very smart nutritional advisor, discussed his solution for constipation. There were several gems in there, for instance, that foods that stimulate opioid receptors can cause constipation [5b]:

For example, both gluten grains (and I suspect grains in general) plus dairy contain opiate-like compounds that serve to reduce the motility (movement) of your gut.  This effect is commonly seen in those who have to take the likes of codeine (also an opiate) for any length of time.

Chocolate also has opioid peptides. But don’t worry, chocolate isn’t usually the cause of constipation!

But Jamie’s main advice was:

[M]any of the people I work with just are not eating enough fat….

People are a bit skeptical when I suggest increasing fat intake to overcome constipation.  Thankfully I can now point to a clinical study in which a high fat diet, in very short time, increased gastrointestinal transit time, reducing the likelihood of constipation occurring;

Gastrointestinal transit, post-prandial lipaemia and satiety following 3 days high-fat diet in men

High-fat diets promote stool passage for several reasons.

  1. Just a tiny bit of undigested fat can help grease the passage of stool through the colon. Even modest amounts of fat in the stool make it difficult to retain feces and cause fecal incontinence. This is why indigestible oils, like jojoba oil or Olestra, cause diarrhea.
  2. A second factor is that bile is released into the intestine when fats are eaten, and bile acids have a laxative effect. Both the primary bile acid chenodeoxycholic acid (CDCA) and the secondary bile acid deoxycholic acid (DCA) act as laxatives by inducing water secretion in the colon. An excess of bile therefore causes diarrhea and an insufficiency can cause constipation. [6] This is why people who have had their gallbladders removed typically develop diarrhea: bile is constantly leaking into the digestive tract.

Just be sure that the high fat you eat comes from healthy natural sources, not high-omega-6 industrially processed seed oils.

Also, bile acid metabolism has a diurnal rhythm. [7] Improved bile acid metabolism may be another pathway by which circadian rhythm therapies could help constipation.

Insufficient Gut Flora

Fiber is often recommended for constipation, and though I believe insufficient fiber is rarely the primary factor in constipation, it can help by several mechanisms.

First, bacteria, dead and alive, form a large fraction of the stool, and the more fiber you eat, the more bacteria you will have. Bacteria are surrounded by fatty cell membranes which are a little bit slippery.

Second, and probably more important, gut bacteria tend to increase the laxative effect of bile.

This is because the body controls water secretion in the colon in part by sulfation of bile acids; sulfation eliminates the induction of water secretion.

Gut bacteria usually want more water in the colon than the body does, so they’ve evolved sulfatase enzymes that desulfate human bile acids. [8, 9] The desulfated bile causes water release and the stool becomes soft and loose.

Some bacterial species do this more than others – especially virulent strains that spread by inducing diarrhea – and I’m sure everyone’s experienced at some time in their lives what happens when one of these species overpopulates the gut. We often call this “food poisoning” and it can be treated by large doses of probiotics, to displace the bad species with bacteria that release fewer sulfatase enzymes.

At the opposite extreme, if gut bacteria are lacking then bile acids will be excessively sulfated and won’t induce water secretion. Constipation may develop.

Thus, antibiotics can induce constipation. Presumably a zero-carb, zero-fiber diet would also make constipation more likely.

Adding some fiber to your high-fat diet, therefore, can relieve constipation.

Choline

Even though choline deficiency is not a proven cause of constipation, I’ll put this in because choline is so important for health. Choline is needed to produce the neurotransmitter acetylcholine. A deficiency of acetylcholine is associated with loss of colonic motility and constipation. [10]

Egg yolks and liver are good sources of choline. There’s nothing wrong with choline supplementation either.

Hypercalcemia

Some people over-do vitamin D supplementation and/or calcium supplementation. Elevated blood calcium levels, which can be brought about by too much vitamin D, will cause constipation. If you supplement either vitamin D or calcium and have constipation, ask your doctor to check serum 25OHD, 1,25D, and calcium levels.

Gut Infections

Some pathogenic bacteria are able to paralyze the gut and induce constipation. Some bacterial species that induce diarrhea can also induce constipation when they choose – for instance, C. difficile. This is one reason why patients with bowel disorders such as Irritable Bowel Syndrome or ulcerative colitis often experience both constipation and diarrhea.

Antibiotics like vancomycin that work well against Clostridium have successfully reversed cases of constipation. [11]

Infection-induced constipation may also cause bloating, gas, acid reflux, and gastroparesis, so if your constipation is accompanied by these symptoms you should see a doctor.

Don’t over-use laxatives

It can be risky to over-use laxatives. The riskiest is probably senna, which promotes bowel movements by (a) inhibiting water absorption by the colon and (b) promoting muscle spasms in the colon wall. Unfortunately, senna is a toxin that can cause lasting damage, notably to nerves.

If you must use laxatives, magnesium citrate liquids are the best. This will restore your body’s magnesium status as well as promote clearing of the bowels.

Conclusion

With good diet and nutrition, and normalization of thyroid function, constipation is usually easily cured. The exceptional cases are those of chronic gut infections; these may require some detective work on the part of a doctor.

I’m sure this reads like a laundry list, but it should give those with constipation some ideas!

References

[1] Neal EG et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 Jun;7(6):500-6. http://pmid.us/18456557.

[2] Rao R. Oxidative stress-induced disruption of epithelial and endothelial tight junctions. Front Biosci. 2008 May 1;13:7210-26. http://pmid.us/18508729.

[3] Young D et al. Egg yolk peptides up-regulate glutathione synthesis and antioxidant enzyme activities in a porcine model of intestinal oxidative stress. J Agric Food Chem. 2010 Jul 14;58(13):7624-33. http://pmid.us/20540508.

[4] Chandrasekharan B et al. Colonic motor dysfunction in human diabetes is associated with enteric neuronal loss and increased oxidative stress. Neurogastroenterol Motil. 2011 Feb;23(2):131-8, e26. http://pmid.us/20939847.

[5] Cao Y et al. Glutamine enhances gut glutathione production. JPEN J Parenter Enteral Nutr. 1998 Jul-Aug;22(4):224-7. http://pmid.us/9661123.

[5b] Tuteja AK et al. Opioid-induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil. 2010 Apr;22(4):424-30, e96. http://pmid.us/20100280.

[6] Hofmann AF et al. Altered bile acid metabolism in childhood functional constipation: inactivation of secretory bile acids by sulfation in a subset of patients. J Pediatr Gastroenterol Nutr. 2008 Nov;47(5):598-606. http://pmid.us/18955863.

[7] Abrahamsson H et al. Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation. Scand J Gastroenterol. 2008;43(12):1483-8. http://pmid.us/18788050.

[8] Huijghebaert SM, Eyssen HJ. Specificity of bile salt sulfatase activity from Clostridium sp. strains S1. Appl Environ Microbiol. 1982 Nov;44(5):1030-4. http://pmid.us/7181500.

[9] Ridlon JM et al. Bile salt biotransformations by human intestinal bacteria. J Lipid Res. 2006 Feb;47(2):241-59. http://pmid.us/16299351.

[10] Burleigh DE. Evidence for a functional cholinergic deficit in human colonic tissue resected for constipation. J Pharm Pharmacol. 1988 Jan;40(1):55-7. http://pmid.us/2896776.

[11] Celik AF et al. The effect of oral vancomycin on chronic idiopathic constipation. Aliment Pharmacol Ther. 1995 Feb;9(1):63-8. http://pmid.us/7766746.

Creamy Steamed Egg Soup

Posted by on April 3, 2011 9 comments

This is a sort of hybrid of an omelette, the steamed egg custards which are popular in Asia, and a soup.

It is a good for busy families because:

(a)    it is quick and easy to make;

(b)   it can be eaten at any meal – breakfast, lunch, or dinner; and

(c)    it can satisfy a diversity of tastes, since each family member can choose a personal set of ingredients and cook the meal in his own bowl.

Ingredients

Here’s a sample set of ingredients:  eggs, cream, and bone broth (for a great broth, get bones with as much fat and collagen attached as you can!); scallions, tomatoes, and shrimp.

The volume of the cream and broth should be equal to the volume of the eggs. Water or milk can be substituted for broth if it is unavailable. Other ingredients we frequently use are shiitake mushrooms, onions, smoked gouda or pecorino romano cheese, bell peppers, bacon, meats, and fish. Not shown are herbs and spices to taste.

Start by mixing the eggs, cream, and bone broth:

Pour these into a bowl through a strainer. This breaks the egg white up into tiny pieces, mixing it into the fat and broth and preventing chunks of uncooked protein from appearing in the soup.

Then, mix in the other ingredients and spices to taste:

While you’re doing that, start a little water boiling in a wok:

You’ll need a steaming tray to put in the wok; this elevates the bowls above the boiling water.

If you have a large pot with a steaming basket, that will work equally well. We used the wok because it has a glass cover and we can take pictures as it cooks.

It comes out looking like this:

And here it is served:

You want to cook just long enough – 5 to 10 minutes depending on the size of the bowl – so that protein is cooked.

We’ve tried cooking this in the microwave, but it doesn’t taste as good: the egg comes out tougher.

Buffet-style family dinners

If not everyone has the same taste in food, set out ingredients buffet-style and let them build their own meal. Here are a few alternative ingredients:

Our wok fits three soup bowls:

This is what the finished product looks like:

Individual bowls take about 5 minutes to cook, one large bowl about 10 minutes.

Accompaniments

For complete macronutrients in one meal, potatoes or sweet potatoes with butter or sour cream, or rice with seasoned seaweed, and vegetables such as kimchi can be served alongside. We buy kimchi at an Asian supermarket on weekends and it relieves us from having to make vegetables during the week.

Conclusion

Steamed egg custards are very popular in China, Japan, and Korea, but they are generally made without cream or broth – just eggs, water, and salt. This particular version is our own invention, and we think the bone broth, the cream, and the delicate texture of the steamed egg make a delightful combination.

Around the Web, Evil Vegan Plot Edition

Posted by on April 2, 2011 33 comments

(My apologies: I have been busy with work and the post on constipation I had planned for Thursday will appear Monday.)

Here are items that caught my eye this week:

[1] Interesting posts this week: Dr. Steve Parker offers a history of the Mediterranean Diet. Did you know that Ancel Keys invented it? Frank Hagan of Low Carb Age reminds us of the dangers of giving too much protein to children – a topic I expect to blog about again soon. The New York Times explains what video of slipping birds teaches us about running form. Mary Shomon lists the 10 Mistakes of Thyroid Doctors. Kevin Brown of Liberation Wellness argues that doctors may be the leading cause of death. Andrew Badenoch of evolvify assembles evidence that gluten is harmful to non-celiacs. J. Stanton of gnolls.org explains why snacking makes you weak.

[2] Low-Carb for Fatty Liver Disease: An oldie but goodie from Michael Eades: Four patients with extremely high triglycerides due to fatty liver were cured in days on a low-carb diet. Yet another condition that is impossible to cure by drugs, trivial to cure by diet.

[3] Is Fruit Paleo?: Melissa McEwen notes what wasn’t on the Paleolithic menu:  fruit.

I might add that it’s not clear that fruit was ever a major part of our ancestors’ diet. The ancestors of chimpanzees and gorillas may have been begun eating fruit after their divergence from the “chuman” human-chimp-gorilla common ancestor. Human ancestors may never have lived in the forests, where fruit is available.

What might Paleolithic Europeans have eaten instead? Melissa casts a vote for raw liver.

[4] What happens if you skip the liver?: On Tuesday morning, Shou-Ching asked me to highlight the story about the French vegans whose breast-fed baby died of pneumonia caused by malnourishment. The baby was severely deficient in vitamins A and B12.

A few hours later Richard Nikoley blogged the story. Vegans, head over there for some sense.

It is possible to be a healthy vegetarian – our book has an appendix explaining how to do it – but it helps immensely to include eggs, dairy, and nutritional supplements. To exclude all animal-related foods, and not to supplement key animal-derived nutrients, is slow suicide – sometimes, as the French story shows, quick infanticide.

[5] 30 Bananas a Day not immediately fatal: Thanks to Richard’s post I looked at a video of a 30 Bananas a Day retreat. I was pleased to see them drinking coconut milk (healthy saturated fats) and, on sandwiches, replacing bread with melon slices. A zero-grain saturated-fat-rich diet – it might be malnourishing, but at least it’s low-toxicity:

You know it can’t be all bad if Stephan has converted!

[6] The French resistance lives: The Guardian:

[I]t is not easy being vegetarian in France, the land of steak-frites, foie gras and other solidly carnivorous fare…. A non-scientific survey of Facebook reveals that the British-based Vegan society has 60,978 fans, while the French Vegetarian Association has 1,518 and the Vegetarian and Vegan page 1,173. (By comparison the French “Slap a Vegetarian with an Escalope” page has 168,294 fans.)

Maybe we should take a trip to Paris, to check out the food. It sounds good!

[7] Insulin Wars!: O Primitivo gives this name to the dust-up that started with CarbSane assailing Gary Taubes and picked up recently at Peter’s blog. He offers an amusing cartoon:

As it happens Shou-Ching and I went to hear Gary Taubes talk on “Why We Get Fat” last Wednesday, and I may review it this week. Those who would like to hear a nearly identical talk can go to Gary’s site and view the “IMS Online Lecture” on YouTube.

[8] Good News From Japan: A dog was rescued:

[9] Bad News From Alabama and Malaysia: From an Alabama teacher:

I am a 6th grade school teacher, and I am appalled at what we are feeding our children every day in the lunchroom.  Yesterday our students had pizza, corn, wheat bread, and rice krispie treats.  They could also buy slushies full of sugar and food coloring.  Also available was tea sweetened with splenda.  It is unbelievable that people with degrees in nutrition are planning these meals!  It is no wonder that we have such a problem with childhood obesity and that our schools are full of students that have ADHD, behavior problems, and learning problems.

From another reader:

In Malaysia (Sarawak), I was served a local dessert made with Sago and coconut milk and sugar.  Wonderful!  I asked about the sago and was told it was a starch made from trees!  The next day for lunch I had the sago (in hardened form) with some type of local fish marinated in spicy oil.  I asked if they eat the sago often and sadly I heard this story:  Sago is a local food that they have made and eaten for centuries BUT now everyone in Malaysia realizes that coconut oil and coconut milk have saturated fat so they should not eat it very often and because the sago is primarily associated with these ‘fattening’ and ‘bad for you’ foods, that the sago is going out of style. Truly sad.

Sago is, of course, one of the safe starches recommended in our book; and you know we like coconut oil and coconut milk.

C.H. Spurgeon said that a lie can get around the world before the truth gets its boots on. A lie has conquered Alabama schools and reached Malaysia. Does the truth have its boots on yet?

[10] Candy eating good?: Epidemiology is hard to interpret, but this was interesting. Compared to adults who ate no candy, candy-eaters had lower body weight, 5% slimmer waists, lower blood pressure, and higher HDL – despite eating more total calories and more saturated fat.

I doubt this is supporting evidence for 30 bananas a day. Two more plausible explanations:

  • Adults who eat candy pay no attention to the health advice propagated by authorities, and follow their taste buds (which evolved to help them) toward meats and fats and away from grains.
  • When adults develop poor health, they start avoiding candy.

Nevertheless, if I do review Gary Taubes this week, this paper might deserve a mention. It counts against both the “carbs make you fat” and the “gluttony makes you fat” theories!

Source: O’Neil CE et al. Candy consumption was not associated with body weight measures, risk factors for cardiovascular disease, or metabolic syndrome in US adults: NHANES 1999-2004. Nutr Res. 2011 Feb;31(2):122-30. http://pmid.us/21419316.

(Via John J. Ray, Food & Health Skeptic.)

[11] Addendum to last week: Speaking of John J. Ray, he has a nice cartoon that I wish I’d used in last Saturday’s #11 on increasing morbidity among the elderly:

[12] Second addendum to last week: I noted last Saturday (#8) a study claiming that “displays of power” led to increased testosterone with positive health effects.

But can displaying a “We Rule” t-shirt transform milquetoast economists into dominant athletes? They actually studied this question at Stanford:

(Via John B Taylor)

[13] Aerobic Exercise Not as Healthy as Candy: Fight Aging! notes that while lower metabolic rates extend lifespan, aerobic exercise doesn’t lower metabolic rate (despite lowering pulse rates). Moreover, higher 24-hour energy expenditure shortens lifespan – so “chronic cardio” may shorten lifespan! It may not be a coincidence that centenarians rarely exercise intensely. They are active but rarely fitness freaks.

One topic I’ve gotten a bit interested in is the effect of obesity on lifespan, which is not large. If obesity induces a lifelong reduction in metabolic rate, it may tend to extend lifespan even as it impairs health. Perhaps this has something to do with the fact that obesity rates are rising and lifespan is lengthening even as morbidity is increasing.

[14] Evil Plot Uncovered: For weeks Richard Nikoley has been claiming to have evil plots underway. I love an evil plot, so I investigated. I haven’t felt as cheated since I flew business class to Tokyo booked as a vegan, and had to eat seaweed while everyone else got filet mignon.

Turns out his evil plots were to inspire vigorous discussion in his comment section and improve the health of young children.

At first I thought I had been duped: Clark Kent was pretending to be Lex Luthor, and I got suckered. But then I realized it was rather like the Cretan Paradox. If only the evil lie, and he had lied, then he must be evil. And evildoers plot. So he really must have an evil plot – even though he said he did, which would make him honest – unless he had lied about the nature of his plot. But what could his real evil plot be?

It so happened I recently installed a Firefox add-on that displays site meta tags. What do you think is high on Richard’s list? Not the first tag – his reachout to the porn community (“food porn”). This: “vegan / vegetarian.”

This can only mean one thing. Richard Nikoley is attempting a hostile takeover of the vegan community. He’s trying to replace T. Colin Campbell as their leader. His upcoming book? The New Evolutionary Vegan Diet Solution.  Its premise: vegans are so brain-addled from lack of B12, they won’t notice their new diet is 90% beef.

Yes, I know he won’t admit it. No evil plotter ever admits his plans. Just remember – when it happens, you heard it here first.

[15] Hot pinup girl!: Yes, inspired by Richard’s “porn” tag I’m trolling for Google hits:

(via Rantburg)

[16] Video of the week: Hike the Appalachian Trail in 4 minutes:

Green Tunnel from Kevin Gallagher on Vimeo.

(Via Craig Newmark.)

A Cure for Migraines?:

Posted by on March 29, 2011 104 comments

The weekend was happy for us, because a number of readers left word of health improvements.

Raynaud’s Syndrome, Constipation, and Other Problems Relieved

Becky reported that her Raynaud’s was better:

Hat tip and thank you: After I started reading your blog, and adding in “safe starches”, my Reynaud’s largely cleared up with temperatures over 20F. This wasn’t the intention, but a wonderful side-effect. Last month, when the sun came out and the temps got over 25, I enjoyed a successful 2-mile snow hike for the first time in three years. =)

Kate reported the same:

I too have had Raynaud’s all my life … In the past two months, I have modified my diet in line with Paul’s suggestions for Migraine. I now eat 200 calories worth of safe starch, all the recommended supplements, and as much coconut oil as I can stomach. I am also doing the 16/8 fast. My Raynaud’s has further improved, as measured by the fact I sometimes forget to turn the heat up in the morning, and cold extremities don’t always alert me to my forgetfulness!

Bill, who last October reported a variety of health complaints which persisted after he adopted a Primal Diet in May 2009, has experienced a big improvement:

I definitely feel 100% better with a more appropriate caloric intake and some starch.

Betty reported her constipation was gone:

You have blessed my life. I had one final symptom that was chronic all my life. Constipation. I e-mailed you last week and you offered up some suggestions. PRAISE THE LORD! I have had NO IBS, or constipation since following your advice. I am, and will be forever grateful.

I’ll discuss my constipation advice in Thursday’s post. Today I want to discuss migraines.

Migraines

You may recall that reader Rob Sacks cured his migraines through ketogenic dieting. I asked Kate if her migraines had responded. Here was her reply:

Thanks for asking about the Migraines. They are in fact vastly improved, which I attribute solely to your recommendations. I can say that, because I have tried virtually everything else in the past.

Kate sent me a full account of her experiences by email. It is fascinating and she has given me permission to share it. The next section was written entirely by Kate.

Kate’s Story

Thanks for asking about the migraines.  They are in fact vastly improved!  Since they have been so intractable in the past, I guess I was waiting to make sure the effect was stable before I reported my results. But clearly something remarkable is happening, thanks to your recommendations!

A little history.  I started getting these headaches in my late 30s.  (I am now 52).  In the beginning I thought I had the stomach flu, because in addition to the headache I would always throw up or have dry heaves.  The worst headaches would keep me immobilized in bed for up to two days.  My brother-in-law, a neurologist, convinced me they were migraines. I finally consulted a doctor, who put me on midrin, which did not help, and a few months later I started on imitrex, which did help, at least at first.  Eventually, my headache pattern evolved, and I had at least a mild headache every day, punctuated by the occasional doozy.  Apparently, this is a pretty common progression, especially with women my age.  I always suspected there was something wrong with my lifestyle or diet, and over the years I have tried numerous experiments, but nothing ever worked.  Here is a summary of what I have tried, more or less in order. Unless noted, these were all for three months.

What I tried The inspiration The results
Chelated Magnesium and riboflavin Mauskop’s book What Your Doctor May Not Tell Your about Migraines nada
Expensive German butterbur preparation Magnum website (www.migraine.org) nada
Forever Well Gut Brain Therapy (a mix of probiotics, peptides, and a state of the art supplement to support the organs of elimination) Magnum website I think I slept a little better.  No help with headaches.  Was surprised that the president of the company called me to see if the supplements were helping
Amitriptyline, a tricyclic anti depressant—my first foray into pharmaceutical prophylactics My doctor insisted I consult a neurologist Tried for 4 months. Slept like a zombie, and acted like one.  No help with headaches.
45 minutes of low intensity aerobics 6 days a week Inspired by Crowley and Lodge’s Younger Next Year—Never mind I had been exercising regularly all my life. Got a heart rate monitor and got after it.  No help for headaches.
No caffeine, alcohol, triptans, or over the counter analgesics Buchholz  Heal Your Headache. I love my coffee, so this was a big step for me. Did this for four months.  Very sleepy for first few days.  Did NOT help with headaches.  However, I felt I could rule out medicine overuse headaches.
Cerapamil—A calcium channel blocker My primary care manager thought it would be worth a try. Tried for four months, and upped dose after a few weeks.  Extreme constipation and painful cramps.  No help with headaches.
Low carb diet Found a reference to a german website of someone who had cured his headaches with a low carb diet.  I had always though low carb diets were ridiculous, but decided to give it a try Immediate improvement within a few days!  Also cured insomnia and acid stomach within a week. Headaches were less severe by about 50%.  Frequency was unchanged however.  Remained on low carb diet and manipulated the variables, but did not find further headache improvement.
Vitex Always felt there was a hormonal connection nada
Natural progesterone cream Same Didn’t help my headaches, but did weird things to my period
Nortriptyline–another tricyclic antidepressant My brother-in-law, a neurologist thought I should try it. Did seem to help a little.  Had to stop in less than a month because it gave me high blood pressure.
Birth Control-Yaz PCM sent me to gynecologist for heavy menstrual bleeding.  Benign fibroids found.  Doc was sure Yaz (without placebo pills) would help heavy bleeding and headaches.  I didn’t care about the bleeding, but I rose to the headache relief bait. Tried for five months. Spotted every day, but got no headache relief.
Inderal-a beta blocker Neurologist Seemed to help, but my blood pressure went too low.
Fish oil, vitamin D, coenzyme Q10, and various other supplements Grasping at straws Tried these at various times. No noticeable effects
Acupuncture same No noticeable effects, but I didn’t really believe
Self analysis, meditation Sarno The Mind Body Prescription I think there is something to this, but no headache relief for me.  Do feel more at peace with myself.
Topamax-epilepsy drug Neurologist Low dose did not help.  Worked up to 100mg over four months. Did not help headaches.  Gave me extreme anxiety about driving on limited access roads.  I didn’t notice the connection, but my college age daughter did.  I immediately tapered off.

Got off the Topamax last summer, and forswore further pharmaceutical prophylactics at that point.  In the meantime I stumbled upon the profusion of “primal” material that is now out.  I had not read any low carb stuff for a couple years, and I enjoyed reading Sisson, Wolf, Cordain, et al.  I started eating more saturated fat. I also read Fallon’s Nourishing Traditions, and started eating liver again, which I had loved as a child.  Her book inspired me to order some kelp tablets for iodine, and I took one here and there when I thought of it.  In January, in my blog travels, I stumbled on your site.  I ordered the book and was intrigued by your and Shou-Ching’s ideas about disease and chronic conditions.  I was already familiar with the idea of a ketogenic diet for epilepsy, so I was immediately interested in trying a more ketogenic diet for myself.

I ordered all your basic supplements, and immediately upped my kelp to two capsules.  I had been using coconut oil for curries, so I started using it habitually.  Started eating 200 calories of starches that you recommended—this was a little scary, after studiously avoiding them for four years!  I was afraid I they might keep me awake at night, but I am sleeping like a log. Started fasting 16/8, which was easy once you absolved me for having cream in my morning coffee!

Within a week of starting this regimen my chronic headache started to disappear! Some days I would only have a headache for part of the day, and occasionally I would have no headache at all!  I read somewhere on your site that NAC is good on a ketogenic diet, so I ordered it too.  I had never heard of this supplement before.  It seems to have made a further positive difference.  I have started taking it twice a day.  Once before bed, and once in the late afternoon, when the headache sometimes starts coming back.  Since I added NAC, I have been nearly headache free.

Another amazing development concerns anxiety.  Over the years I have become somewhat anxious when I drive on highways. I grip the steering wheel tightly, sit forward in the seat, and am generally hyper vigilant. I always chided myself for my lack of nerves, but that didn’t help.  As mentioned above, this was magnified by the Topomax.  I never had this issue when I was younger; indeed I used to fly helicopters in the army.  Two weeks ago I drove up to New Jersey to pick up my daughter, a 3.5 hour trip from where I live in Northern Virginia.  I stopped two hours into the trip to make a pit stop, and I suddenly realized I was totally relaxed, and had been for the entire trip!  The PHD is strong brain medicine indeed!

Thanks for all your research, insights, and ideas.  I think the Perfect Health Diet is going to be a game changer for many people.  Hopefully it is the start of a sea change at how we approach the chronic maladies of our times.

Mechanisms

Thank you, Kate! That’s a fantastic chronicle of your history.

This is already a long blog post, so I won’t go into an analysis of why and how the ketogenic variant of the Perfect Health Diet can cure migraines, reduce anxiety, and improve sleep. I’ll only add a few things.

First, there is a case report in the literature of a ketogenic diet helping migraines. [1]

Second, the diet helps in part by getting around mitochondrial dysfunction. Some other nutritional supplements that support mitochondrial function have a chance to help:

  • carnitine [2]
  • riboflavin [3,5]
  • CoQ10 [4,5]
  • alpha lipoic acid [4]
  • magnesium [4, 5]

I realize that you’ve already tried those, Kate, and didn’t notice an effect, but you may notice a benefit now that your diet is better. If in the past they reduced headache severity from 100% to 99%, you wouldn’t have noticed a change. If now they reduce severity from 2% to 1%, or 1% to 0%, the improvement might be obvious. So you might re-consider them now.

Finally, in the interests of full disclosure I should note that some doctors expect improvements from diet and nutrition to be short-lived: “high-dose vitamin and cofactor treatment and, where applicable, high-fat diet, are well tolerated and possibly effective in the short term, but ineffective in the longer term” against mitochondrial disorders. [6]

I believe that fading benefits are likely a result of eating the wrong diet, and that on the ketogenic version of the Perfect Health Diet the good effects will prove permanent. But time will tell.

Conclusion

We believe that diseases are generally caused by food toxins, malnutrition, and pathogens. The Four Steps of the Perfect Health Diet eliminate food toxins, optimize nutrition, and enhance immunity; therefore they remove most of the causes of disease and should render most diseases curable.

But we had no idea, last October when our book was released, which cures would appear first.

It’s interesting that migraines are appearing so early as a curable disease. I think this says a lot about the discipline, and eagerness for a cure, of Rob and Kate. Rob was willing to fast for 30 days (!); Kate read the book in January and was able immediately to make substantial diet, lifestyle, and supplement changes.

It seems that a painful but non-debilitating disease will create the most dedicated, venturesome patients.

I’m very grateful to Kate for trying the diet and sharing her story. Hopefully we can bring the good news to others, and gather more evidence to prove that diet is the best therapy – for migraines, and for many other diseases as well.

References

[1] Strahlman RS. Can ketosis help migraine sufferers? A case report. Headache. 2006 Jan;46(1):182. http://pmid.us/16412174.

[2] Kabbouche MA et al. Carnitine palmityltransferase II (CPT2) deficiency and migraine headache: two case reports. Headache. 2003 May;43(5):490-5. http://pmid.us/12752755.

[3] Triggs WJ et al. Neuropsychiatric manifestations of defect in mitochondrial beta oxidation response to riboflavin. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):209-11. http://pmid.us/1564483.

[4] Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. http://pmid.us/19454881.

[5] Taylor FR. Nutraceuticals and headache: the biological basis. Headache. 2011 Mar;51(3):484-501. http://pmid.us/21352223.

[6] Panetta J et al. Effect of high-dose vitamins, coenzyme Q and high-fat diet in paediatric patients with mitochondrial diseases. J Inherit Metab Dis. 2004;27(4):487-98. http://pmid.us/15303006.