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What is an Elimination Diet?
Diet affects the frequency and severity of migraine symptoms in some people. The purpose of an elimination diet is to reduce your exposure to controllable triggers. I’m certain you know there are some common triggers that are unavoidable like hormones, weather, sensory stimulus and so on. Yet common food triggers can be avoided in an attempt to reduce our trigger load and to raise our migraine threshold resulting in better control over symptoms for some.
There are many elimination diets out there to choose from. Most members of Migraine Strong follow The Heal Your Headache Diet created by David Buchholz or The Charleston Diet (which is a bit more restrictive) created by Carol Foster.
When looking at elimination diets it’s important that you stick to just one. Don’t try to avoid every food listed on every foods to avoid list. Choose one diet that you are most likely to stick to and give just that one your all!
How Does an Elimination Diet Work?
All food triggers listed on the avoid list of the diet you choose should be strictly avoided for at least for months or until you see a reduction in frequency and severity of symptoms. Elimination diets are short term. You are not meant to exclude these foods forever. Once you reach baseline, plan to reintroduce foods slowly one by one.
Foods listed on the avoid list are there for a couple of reasons, 1) They have a high level of byproducts of food aging like red wine, yeast, yogurt, leftovers and aged cheese. 2) They contain chemicals similar to the neurotransmitters our brain uses and can excite brain cells & create cranky neurons when consumed for some people. A few examples are coffee, chocolate, MSG and nitrates. Elimination diets remove those known foods giving things like tyramine, histamine, glutamate, tannins and sulfites the boot. Removing them helps calm down hyper responsive migraine brains. I had chronic vestibular migraine with 24/7 dizziness so it was my goal in life to calm my dizzy brain down.
The Diet I Chose
With the help of my neurotologist, I chose to follow the Heal Your Headache diet which is detailed in this article by our dietitian, Danielle Aberman. It’s important to add that this was not my only treatment. I was dealing with chronic, intractable vestibular migraine. I was dizzy all day every day and housebound for many months. My migraine switch was literally turned on overnight and I needed a multi modal approach to turn it off. You can read more about what I was dealing with back then in my VM story here.
My HYH Process
The first thing I eliminated was coffee. Slowly weaning yourself off is best but, I quit cold turkey because I desperately needed to feel better. I’m happy to say that it wasn’t even a little bit tough. That in itself is sort of a miracle because if you knew me before VM, then you know I pretty much always had an iced mocha coffee in my hand. But, I was dizzy every minute of every day and I couldn’t stand it. Eliminating coffee immediately reduced the intensity of my dizziness. Yes, I was still dizzy but, that slight improvement was enough to not make me miss coffee even a little.
I did not give up sugar, wheat, dairy or gluten. Instead I stuck strictly to avoiding just foods on the HYH avoid list. I did give up nearly all processed food. Some processed foods are considered safe on HYH, but it took a while for me to get a handle on what ingredients were safe in premade foods and which ones were to be avoided. I felt so terrible in the beginning it was just easier to know that everything I was eating came from the safe foods list rather than scouring ingredient labels. I prepared every single thing I ate. My friends joked that I ate like it was 1900 and that’s a pretty accurate description. If I wanted a cookie or a muffin, I baked it myself with ingredients I knew were safe. Keep in mind, this was short term!
A couple of months into the diet, preparing everything I ate started to get harder. I was dying to have a little candy, a safe bowl of cereal and a cookie that I could eat right out of the box. That lead me to Ginger Snaps and an organic cereal with safe ingredients. I ate those ginger snaps nearly every day until I ran out. That’s when I noticed the daily feeling of rocking I was experiencing was gone. When I ate the cookies, the rocking came back. I wasn’t sure what was causing it, but gave up the cookies for good. Soon after I tried my fancy organic cereal and began feeling that rocking sensation again. I compared ingredients and realized that molasses was a trigger for me. When I ate them, I felt the rocking.
I believe following HYH allowed me to figure out difficult to pinpoint food triggers like molasses mentioned above. Before HYH I was feeling symptoms every day and when you’re feeling symptoms 24/7, it’s impossible to notice problematic foods.
In the end it took my brain waaaaay longer than four months to calm down from daily dizziness. I followed the HYH diet strictly for about a year before I began feeling good enough to trial adding foods back in. This isn’t uncommon for chronic VMers. I had many failed trials back then. Many foods provoked dizziness or head pain. The good news is I never gave up trying. Two years into the diet I gained so much control over my symptoms that I was able to successfully add back coffee (just one cup), nitrate free bacon, avocado and even chocolate.
Two years might sound crazy to you but, I was eating better than I ever had in my whole life. Fresh fruits and vegetables, organic and grass fed meats and eggs, wild salmon, fresh baked goods and very little processed food were my staples. I never found the diet to be that limiting except when it came to parties where most dishes are made with processed foods. When I attended gatherings, I always brought a dish I knew I could eat with me. When I went to restaurants I stuck with safe options like steak or fish with fresh vegetables on the side.
For me the longer I was on the diet, the more food triggers I was able to tolerate. I’m now three years into what I call a liberated Heal Your Headache diet. I still follow the general idea of it but, my avoid list is much smaller and more personalized as I’ve figured out my triggers. I can cheat occasionally (within reason) and eat whatever I want (except a handful of things like msg, yeast and yogurt) without repercussions. If the weather is bad or if I am close to my cycle an attack is possible and I can only do that here and there. If I eat common food triggers too many days in a row symptoms kick back in. It’s delightful to have occasional free days though.
There is a common misconception that food triggers will cause symptoms within an hour but, in fact, some effects will come immediately and some can come days later. So you can’t just avoid a few things on the list and expect to see if it’s a trigger for you. We call that an avoidance diet and that just doesn’t work. You need to go all in for at least four months and then slowly add foods back in one by one eating them every day for at least five days to see if symptoms arise for you.
Heal Your Headache did what it promised to do and helped me to reduce my trigger load and raise my migraine threshold. It now takes more trigger exposure to cause symptoms than it did early on. I believe this is why I can occasionally eat ALL the things.
In the end I identified my personal food triggers but, admittedly they’re a little complicated. I only have a few big guys. The rest seem to be little guys that I can eat for a bit. If I eat them too often or if I combine them with too many other little guys they become big. For example, I eat strawberries and spinach alone without issue but, if I combine them, I get symptoms every time.
The diet alone was not enough treatment for me to find relief. Along with diet I also exercise, take a variety of supplements recommended for migraine and take a daily preventative medication. A huge benefit of watching my dietary trigger intake is that I believe following the HYY diet has helped my preventative medication to be effective at a very low dose. I am not anti-medication but, because I still consider myself to be young, I’d like to keep my dose low for as long as I possibly can.
Everyone is different, and it may be that not every one of the foods that commonly cause symptoms are personal triggers for you. In fact, if you find that you have food triggers, you most likely only have a few. It’s also possible that your personal food triggers will not be listed on the elimination diet list you choose, like molasses for me. There is no question that finding out whether or not you have personal food triggers is tricky but, you just might be rewarded for your efforts with fewer attacks and more symptom free days. How will you know if an elimination diet will help you if you don’t try it?
I feel compelled to mention that elimination diets are not about blaming the patient. You don’t have migraine because of something you’re eating. Elimination diets are also not a cure. Your neurological disease is not going to magically go away by eliminating food triggers. However, many CAN gain control over symptoms and lessen attacks through dietary changes making them well worth trying in my book.
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