Elimination Diet

Hi All,

I used to post on the old forum many years ago, but this is my first post on this forum.

My migraines have increased greatly in the past year- to the point where many would go on for several weeks at a time.
I just went to a new migraine specialist who proposed an "elimination diet" where I would have to eliminate most possible trigger foods and food groups.
It eliminates gluten, dairy, caffeine, and many other things. After 6-8 weeks of this, I think I'm supposed to gradually introduce different foods back into my diet.

As much as I want to get to the root of what is causing my migraines, rather than keep putting a "band aid" on them by taking preventatives- this type of diet is so strict- I'm a bit overwhelmed just thinking about it.   I will need to go to the health food store to buy many of these products, since they are not what you would probably find in the regular grocery store.

Has anyone done an elimination diet? If so, do you feel you learned anything about your food triggers? Was it worth it? I've heard/read various things about food triggers from it's overplayed to it's responsible for 50% of migraine episodes in most people.

Any help/advice will be greatly appreciated.

Being a food sensitive migrainer myself (100% proven in myself and my cousins), I believe that most doctors simply do not know squat about migraine food triggers. There is so much crap out there that it is pathetic. Migraines are not caused by allergies, nor by foods that people are typically (or even atypically) allergic to. Gluten intolerance diagnoses are all the rage in medical circles and simply way over diagnosed. Less than 1 in 100 are actually gluten intolerant. I believe in the value of an elimination diet (I found an allergy to beef using them), but a lot of the foods that I have seen listed on many of them may also trigger migraines, like tofu and lamb. The opposite is also true, and many foods that are considered M triggers are actually not, or not for the reasons though to be. Fresh non-aged dairy foods do not trigger my M's, and in fact they bind with tannins and help to reduce them.

My M food triggers are a collection of tyramine, tannins and MSG. Also opiate Rx drugs. Tannins are not considered by most as M triggers, but many new studies and a few web sites implicate them. They are found in a lot of foods that are considered M triggers. Typically nitrates are blamed for causing M's in smoked meats, but I have found that its the tannins in the wood smoke that cause them and not the nitrates, nitrites, or sulfites. Similar to caffeine, but tannins are almost always high in coffee, tea, and chocolate. Caffeine is actually a common ingredient in M meds like Bayer aspirin for Migraines (that stuff does nothing for my M's though).

So where do you start? I would certainly not favor the health food store, as M triggers are just as common in foods there as anyplace else (if not more). [Note that foods listed here in red are guaranteed M's for me] I would eliminate all foods high in tyramine, including aged meats and cheeses, eggplant, red plums, tofu, soy sauce, liver and pate, pickles, buttermilk, sour cream, and yogurt, lima and green snap beans and peas, figs, black eyed peas/beans, all nuts and many seeds, ripe bananas and avocados, chocolate, and limit the amount of citrus. Cut back on tomatoes. I would also eliminate foods high in tannins, including tea (herb teas as well), coffee, chocolate (double trigger), all nuts (double trigger), red raisins, olives, red plums (double trigger) and grapes, blueberries, pickles (double trigger), malt, malted barley and barley, cranberries, peaches, red pears, super fresh bread, anything smoked or with smoke flavor added, wild rice, red and black beans, many red and some white wines, gold tequila, scotch and brandy, and all nuts (double triggers). Avoid MSG, including a lot of flavored potato and tortilla chips (read the labels!), ranch dressing, bratwurst, and most canned tuna (any with veggie broth or natural flavor added, which is really MSG). There is MSG in a lot of processed foods, and you have to learn to read the labels and find the hidden alternate names for it. Also avoid all dried food snacks, like trail mix, Chex mix, etc. Also avoid dried and fresh papaya, pineapple, red grapes and anything with red and yellow dyes in them. Onions are another item to avoid, other than a small amount to season food with. Green onions are better though. Fresh or frozen foods are better than old, stale or canned.

The other alternative is to start with a restricted diet like mine, that includes: Triscuts and Wheat Thins, plain or low sodium Frito corn chips, plain potato and corn chips, white rice, cottage, American and ricotta cheese, fresh mozzarella cheese, tortillas (corn or flour), oats and oatmeal, simple breads, fresh chicken (eat all meat before it gets 'old' as the tyramine builds up long before the bacteria make it go bad, before and after it is cooked), lamb (you can also eat beef, but I am allergic to it), turkey, fresh fish and seafood (cod, salmon, lobster, crab, clams and mussels), pasta, milk, cream, butter, canola oil, olive oil, Granny Smith apples, white raisins, ketchup, Worsteshire sauce, celery, carrots, potatoes, broccoli, zucchini and crookneck squash, mushrooms (white and crimini), German lager beer (but not ale; the Germans consider tannins in lager beer a flaw and filter them out), all citrus (but avoid too much as they may contain tyramine and some orange juice drinks that have red or orange coloring added, as that is almost always tannin based), cantaloupe, water melon, lettuce, cabbage, mayonnaise, eggs, honey, maple syrup, wheat and corn flour, corn on the cob or in just about any other form, and onion and garlic (cooked and in very small amounts).

Vinegar is a wild card, and some vinegars are far worse than others. Basalmic vinegar is to be avoided, as is apple cider vinegar. Plain and rice vinegar do not seem to trigger M's for me though. Apples are another variable. About half the apple varieties have high tannins and are used in making cider. Avoid those. The way to test them is to cut them open. If they turn brown fast, that is a sign that tannins are forming and they are high in tannins. If they stay white, they are OK. Granny Smiths are good low tannin apples. Pork is another variable, and some pork is high in tyramine. Avoid all bacon and sausages as they are almost always smoked. I buy fresh meat and freeze what I cannot eat in a day. Freezing halts the conversion of proteins into tyramine. I buy ground turkey in 2 pound blocks and freeze 1/2  pound chunks and thaw them as needed. I buy whole chickens and split them and roast half and freeze the other half. You can do the same with ground beef or various cuts of meat. I eat a lot of raspberries that I grow in my yard, and for whatever reason no amount of them give me M's. I eat them right off the vine though. They are on everyone's do not eat for M's list. I also grow blueberries, and they give me M's if I eat more than a handful. Sadly, I have 8 huge blueberry bushes here and I love them, but I let the birds eat them now.

Tannin diet information is here (but note that some foods listed as safe for tannins are high in tyramine, like pineapple and yogurt):

http://www.widomaker.com/~jnavia/tannins/tanngood.htm

A low tyramine diet is listed here (but some items are high in tannins):

http://www.headaches.org/pdf/Diet.pdf

Hope this helps. I am 56 and I am still trying to wade through all the Migraine trigger diet bombs, but I am getting far fewer migraines these days.

I did Dr. David Buchnolz's elimination diet, which you can probably find online. It's very comprehensive. I got a marked improvement in my migraines for a few months, but then they came back as bad as ever.

IMO, this is your best plan to avoid food triggers:
1. Avoid MSG at all costs. MSG can trigger headaches even in non-migraineurs. MSG is used VERY WIDELY in packaged and prepared foods - for example, if you see "natural flavoring" as an ingredient, there's a good chance it's MSG.
2. Avoid alcohol especially red wine
3. Avoid aged cheese (which is most, excepting American, Provolone, etc.)
4. Avoid nuts
-chocolate, citrus fruits, bananas, and onions are triggers for SOME migraineurs. You can easily determine if they are triggers for you.

-Platy

I have kind of a funny story about this. I don't think I've ever told this story before. When I was about 10 I was put on an elimination diet. I had to eat white skinless chicken and green beans for a period of time and then add one food a week. Well I broke down at some point and snuck a secret stash of food under my bed. And of course I kept getting migraines. I probably would have anyway but I tried to hide the fact that I had migraines because I thought it was my fault for eating things I wasn't supposed to. So then the doctor thought I had this huge improvement and it happened that she was pioneering this cause and was writing a book on this topic (this was the 80s). She then announced one day that she was going to feature me as a subject in her book. Only it still hadn't been completely decided because it was down to me or another girl. In the end the other girl was chosen so I was never faced with what I was going to have to do in that situation.

It makes me a bit dubious of things I read in books. Just goes to show.. the miracle case featured in some book actually might be a kid suffering migraines with a bunch of food stashed under their bed. Ha.

You know Fullon that anyone can write anything they want, but it means nothing in scientific terms, unless it is backed up by facts and figures, which could prove the point they are trying to make.

This is why any proper scientific research needs extensive trials, which involve as many people as possible and this must be stated clearly, when  the results are published. It does not matter if the book is written by the Dr, but Dr also must substantiate their facts by credible argument based on some decent research otherwise they cannot be taken seriously.

WE as patients need to be aware of this, and learn how to read such books and to look for proper figures, so we can check the facts with other sources so we can make up our minds what suns credible, and who is not.

Any research which, like you describe, is based on the experiences of just one person is only a hearsay, and therefore  cannot be taken  too seriously, anyway.

So, as long as we know that, we can read books and articles and by using common sense we can decide what sounds like a convincing research,  or what sounds like a waste of time.

At least this is what I find helpful when reading about matters connected with health issues.

Hi Everyone,

Thank you so much for all your replies!

Zomigman- congrats on being able to find your food triggers- it sounds like you have really done your homework when it comes to your diet.
I agree with you on gluten intolerance probably being over diagnosed. I went to an allergist for the first time for an unrelated issue, and had the usual allergy "scratch tests" done. While I was there I asked the Dr. about the blood test for celiac disease- he laughed and said almost every patient is now asking for that and he rarely finds it to be the case.
This Dr. (a neuro) thinks that you can be "sensitive" to gluten without actually having celiac disease. I don't know- I guess anything is possible, right?

I have gone to the Whole foods store, and bought some new foods to enable me to do this diet, and it's going OK- I still haven't given up my morning cup of coffee yet though- I have had that since I'm a teenager and I'm now in my 50's. Plus, I'm dreading the caffeine withdrawal headache that I know I will get. It's funny because the instructions specifically say that giving up caffeine is such an important part of the elimination diet- yet it's the one part that I'm struggling with the most.

I agree that it *is* so confusing- I've read some elimination diets for migraines eliminate bananas, and beans yet mine does not- so there is a lot of contradiction.

Platypus - Yes, I've read that MSG is a pretty big trigger for migraines- so that's a good one to avoid. I was disappointed to find nuts on my list of foods to avoid since I love them - and I love nut butters, so giving them up is hard to do.

Fullon- Thanks for sharing that cute story! It does go to show that you can't believe everything you read!

Mini- Thanks for the good advice when it comes to reading books about health advice!

I wanted to add that I found artificial food colorings made my migraines significantly worse (red #40, artificial color, color added, etc). I don't think anyone else mentioned that yet. Not sure how common it is for those to worsen migraines but it's worth mentioning.

Nuts contain tyramine which is a known migraine trigger and bananas are a trigger for a lot of migraineurs. The point of the elimination diet is not to eliminate everything on it forever. You start with the "pure" diet and see if you get improvement. If no improvement, chuck the whole thing, you have no food triggers!

If you do have improvement, you still can go ahead and add foods back into your diet one at a time to see if they are triggers. Naturally you start w/ things you suspect are not triggers. Bananas, onions, nuts and citrus are good things to try adding back in. They're healthy foods and only triggers for a subset of migraineurs. But they are common triggers so don't be surprised if you can't tolerate a couple of those.

Mini wrote:You know Fullon that anyone can write anything they want, but it means nothing in scientific terms, unless it is backed up by facts and figures, which could prove the point they are trying to make.

This is why any proper scientific research needs extensive trials, which involve as many people as possible and this must be stated clearly, when  the results are published. It does not matter if the book is written by the Dr, but Dr also must substantiate their facts by credible argument based on some decent research otherwise they cannot be taken seriously.

Any research which, like you describe, is based on the experiences of just one person  is only a hearsay, and therefore cannot be taken  too seriously, anyway.

No, haha she was going to profile a FEW people for her book. It wasn't going to be Sybil style about the experience of just one person. As far as results are concerned scientific studies are strictly formatted and analyzed and submitted to scholarly and scientific journals for peer review. I'm not sure what the normal course is when writing a book but I'm not sure it's the same. She was a serious MD though and maybe she did have research she wanted to use and it's possible she just wanted personal stories to compliment her research, I'm not sure.

I'm not saying it's all bunk. Just that my story would have been.

I actually felt pretty bad about this until years later when I finally realized that asking a kid to eat skinless chicken three times a day was a little much.

Thank you for explaining it more Fullon.

Occasional examples are great and often interesting to read, but they are best used when supporting a good body of evidence.
I was just trying to make a general point that we all need to be careful when reading any books which concern medical conditions, no matter how important and well qualified the author is.
We must never forget to use commons sense and try to be aware of  what consists  a good, credible  research, or what is just hearsay. I think we certainly agree on that.

Hi,

Just wanted to post my 2 cents having just found the trigger for my migraines---wheat.

Along with migraines, particularly triggered by exercise and hot, humid weather, I have also experienced hot head/ red face, asthma, and non-itchy skin rash which have all vanished. I did not test positive for a true wheat allergy but I don't care what any test says...I am biking 10 miles+ per day.

I thought it was silly...How can a simple grain that our ancestors have subsisted on for generations be causing such damage? But I'm convinced now! Give it a try.

-Corinne