Why are some people more likely to get migraines?

Genetic and environmental factors that increase the risk of migraine headaches

Anyone can have a migraine headache, however, some people just have a higher risk compared to others. The reason why some people are more likely to get migraines is based on a combination of genetic and environmental factors. A simple way I explain it is by describing everyone’s risk to having a migraine based on different sizes drinking cups. The larger the cup, the more it takes to fill the cup and thus the harder it is to get a migraine.

The cup size is determined by genetic factors. It is well known that migraine headaches have a very strong genetic component. Such that, 70% of people who have migraine headaches have a 1st-degree relative who also suffers from migraine headaches. This genetic predisposition is believed to be due to a mitochondrial dysfunction that results in a hyper-excitable or sensitive brain. Thus, in people who have a family history, it does not require as many triggers to cause them to have a migraine. Or with the cup analogy, they have a smaller cup, to begin with, thus they do not need as many triggers to push them over to the point of having a migraine.

The thing that ‘fills your cup’ is the environmental risk factors or triggers. Common triggers include hormonal changes, stress, changes in sleep patterns, certain foods (MSG, red wine, sulfates), strong odors, certain medication, and changes in weather patterns. Typically it requires a combination of these triggers, or enough to fill the cup to cause a migraine.

Unfortunately, what I am seeing, as a headache specialist, is that more people are experiencing more frequent headaches. They describe it to me as if they always feel on the edge of having a migraine, and things that typically would not trigger a migraine now are. I like to describe this as ‘the cup is already half full’ so it takes less ‘water’ or triggers to fill the cup and cause a migraine. I believe this is due to increased inflammation in our bodies.

Things that increase inflammation in our bodies are very similar to what triggers a migraine in the first place along with some that you would not expect to see. Common causes of this increase inflammation include chronic stress, obesity, narcotic pain medications, food allergies and sensitivities (gluten, dairy, eggs), processed foods, sugars, refined carbohydrates, and omega 6 fatty acids in vegetable oils. Exposures to any of these factors over time can cause an increase in the inflammation in the brain that then results in more frequent migraines.

So to decrease your risk for migraine headaches you need to limit the triggers and things that can cause inflammation. I typically make these recommendations to my patients.

  1. Decrease stress, if unable to decrease stress than at least find healthy ways to deal with it such as regular exercise.
  2. Get off processed foods, and stop using artificial sweetener,
  3. Stop using vegetable oils and use more olive oils and coconut oils to cook with
  4. Consider eating a low carbohydrate, high fat ketogenic diet.

If you would like information on how to start a ketogenic diet, fill out the contact form below.

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Inflammation, ketones and depression

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New theories on how inflammation may be a cause of depression, and how the ketogenic diet may be a novel treatment option

Depression is the most commonly diagnosed neuropsychiatric disorder, (Chen, 2017) characterized by persistent feeling of sadness, loss of interest and hopelessness. Is it estimated that >16 million people in US have suffered from a depressive episode in the past year, which represents 6.7% of all American adults.

The cause of depression has typically been blamed on a chemical imbalance in the brain, specifically a decrease in the monoamine neurotransmitters (serotonin, noradrenaline and dopamine). Most of the anti-depressant medications work by increasing the levels of these monoamines neurotransmitters. It is estimated that a third of depressed patients treated with these anti-depressant medications however, do not improve. (Miller, 2016) (Yamanashi, 2017) So maybe the pathophysiology of depression is not that simple.

Scientific evidence now suggests that inflammation plays a role in the pathophysiology of depression.

Psychosocial stress is a very common risk factor for the development of depression. Studies have shown that stress, especially early life-trauma, is associated with an increase risk for developing depression. (Miller, 2016) Stress has been shown to cause many pathological changes in the body including increased inflammation. When the body is stressed, the NLRP3 inflammasome is activated. When activated the NLRP3 inflammasome causes the release of the pro-inflammatory cytokines (interleukin 1 beta, interleukin -6 and tumor necrosis factor alpha). These pro-inflammatory cytokines, which are markers for inflammation, have been noted to be significantly higher in the brains of patients with depression and in people who have committed suicide. The amount of inflammatory present correlates to the amount of life stressors that one experiences. This then directly correlates to a higher risk of developing depression. (Miller, 2016)

It is this increased amount of inflammation in the brain that is believed to be the underlying cause of depression. (Yamanashi, 2017) Inflammation may cause depression thru several different mechanisms. First of all, studies have indicated that the inflammatory in the brain causes a decrease in the amount of the anti-depressant monoamines neurotransmitters. Next, high level of inflammatory also results in the increase the amount of glutamate in the brain. Elevated glutamate level in the brain has also been correlated with causing depressive symptoms. (Miller, 2016) Not only does having increased inflammation increase depressive symptoms but also may limit the antidepressant medications from working as well. (Miller, 2016)

So does decreasing the levels of this inflammation result in improvement in the depression symptoms?

The answer is yes. Studies have indeed shown that blocking the release of these inflammatory cytokines can reverse the depressive behaviors induced by stress and the levels of inflammation in the brain. (Yamanashi, 2017) (Miller, 2016) Since the NLRP3 inflammasome is such a critical factor in the development of this inflammation, blocking of this inflammasome is a potential target. Ketones, specifically Beta-hydroxybutyrate (BHB) has been shown to have to exert an anti-inflammatory effect via inhibition of the NLRP3 inflammasome. (Yamanashi, 2017) Ketones are the break down products of fats. They are produced naturally in your liver during times of starvation or while on a ketogenic diet. The ketogenic diet has been used since the 1920s as treatment for neurological disorders such as hard to treat seizures. Many believe that is the benefits of the ketogenic diet are due to the neuro-protective and anti-inflammatory properties of ketones.

To date the benefits of ketones or a ketogenic diet in depression have only been studied in animal models. The first study showed that rats that were pretreated with a ketogenic diet showed less depressive activities compared to the rats on a standard diet. (Murphy, 2004) In 2017, two studies were published using ketone supplementation in animal models of depression. One study by Chen showed that exogenous BHB improved depressive behaviors in mouse models. This improvement was similar to the benefits seen with treatment of the anti-depressant medication imipramine. (Chen, 2017) Another study, using rat models of stress, looked the anti- inflammatory and antidepressant effects of ketone supplementation with BHB. They found that the rats that were pretreated with BHB had less depressive and anxiety behaviors than would typically be seen with stress. Also the amount of inflammation in the brains of the stressed rats was decreased in the BHB treated rats. (Yamanashi, 2017)

Ketones have also been shown to have other benefits that may also help with depression symptoms. The ketone BHB has been shown to increase the levels of brain derived neurotrophic factor (BDNF), which has been shown to be decreased in psychiatric diseases including depression. (Chen, 2017) Additionally, BHB has been shown to decrease the excitatory neurotransmitter glutamate and increase the levels of the calming neurotransmitter GABA. This increased ratio of GABA to glutamate also reduces anxiety. (Ari, 2016)

These animal studies and research suggest that the ketone, beta-hydroxybutyrate, may have an antidepressant effect. So can something as simple as changing your diet, or using a ketone supplement* improve depression? That question in humans has not been formally studied. However wouldn’t it be worth a try? If you would like to give it a try, I will be happy to help.

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Bibliography

Ari, C. (2016). Exogneous Ketone Supplements Reduces Anxiety-Related Behaviors in Sprague-Dawley and Wistar Albino Glaxo/Rijswijk Rats. Frontiers in Molecular Neuroscience, 9, 1-10.

Chen, L. (2017). Beta-hydroxybutyrate alleviates depressive behaviors in micepossibly by increaseing the histone3-lysine9-Beta-hydroxybutyrylation. Biochemical and Biophysical Research Communications, 490, 117-122.

Miller, A. H. (2016). The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nature, 16, 22-34.

Murphy, P. (2004). The Antidepressant Properties of the Ketogenic Diet. Biological Psychiatry, 56, 981-983.

Yamanashi, T. (2017). Beta-hydroxybutyrate, an endogenic NLRP3 inflammasome inhibitor, attenuates stress-induced behavioral and inflammatory responses. Nature, 7, 1-10.

The medical information on this site is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.

These statements have not been evaluated by the Food and Drug Administration.  This products is not intended to are not intended to diagnose prevent treat or cure any disease

 

 

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Inflammation And Your Brain

 What is INFLAMMATION and what it is doing to your Brain?

Inflammation is a vital process for the body.  The body uses inflammation to heal itself against something that it thinks is harmful.  You can recognize inflammation as the redness and swelling that occurs when you get a cut or sprain your ankle.  Inflammation also occurs internally when you are sick and the body needs to fight off the infection.  The problem occurs when the inflammation process is in excess to what is needed or becomes chronic meaning that it lasts for a longer time than it should.

It is easy to understand how chronic inflammation can be linked to conditions such as arthritis and autoimmune disorders since typically the treatment is an anti-inflammatory medication.  Chronic inflammation, however, is also linked to many chronic conditions that you might not think of including: coronary artery disease, stroke, cancer, diabetes, epilepsy, Alzheimer’s dementia, multiple sclerosis, along with chronic pain syndromes such as migraines and fibromyalgia.

Chronic inflammation is not just confined to a particular tissue but involves different organs in the body including the brain.  Some signs that you have inflammation in your body are obvious such as joint pain and redness.  The problem, however, is when inflammation occurs throughout your body, the signs of inflammation may not be as obvious. Your body can have chronic inflammation occurring and you don’t even realize it.  Some of the symptoms that have been associated with chronic inflammation include:  fatigue or lethargy, somnolence, brain fog, weakness, anxiety, depression, irritability and headaches.

Why does inflammation cause damage?  Inflammation is a complex biological reaction. Basically, when the body is injured, white blood cells, which are the body’s first responders to a problem, are recruited to the site of damage.  They release chemicals, which are pro-inflammatory including histamines, cytokines (interleuking-6, interleukin-1B and tumor necrosis factor), prostaglandins, and leukotrienes.  These chemicals then cause an activation of pathways that leads to increased free radical production.  When there is an increased free radical production with decreased levels of antioxidants, it leads to oxidation stress.  Oxidative stress causes damage to the cells and proteins.  This damage causes more inflammation, which causes more free radicals and the cycle continues.  Since oxidative tissues and cells do not function normally, this leads to organ dysfunction and chronic health problems.

Causes of Inflammation

  1. Stress
  2. Trauma/injury
  3. Infections
  4. Pollution/toxins such as tobacco smoke
  5. Chemicals including some drugs and artificial sweeteners
  6. Obesity and adipose tissue (especially central fat)
  7. Food allergies and sensitivities (gluten, soy, nuts, shellfish, dairy, egg)
  8. Processed grains and refined carbs i.e. carbohydrates with relatively high glycemic index
  9. Trans-fatty acids and vegetable oils which contain omega 6 polyunsaturated fatty acids

So what can we do to prevent or decrease inflammation?

First is to remove any of the things listed above that can be a contribution to inflammation.   This includes removing processed foods, artificial sweeteners, vegetable oils, high GI carbs along with any food from your diet to which that you are sensitive.   You should also commit to decreasing stress, stop smoking and losing weight (decreasing body fat).

There are foods that have been reported to have natural anti-inflammatory properties including:

  1. Spices Turmeric, Garlic, Cayenne, Cinnamon and Ginger
  2. Foods that are high in fiber such as fruits and vegetables
  3. Food that are high in Omega 3 such as salmon, anchovies, flax seed, walnuts, chia seed and sachi inchi
  4. Food that is high in magnesium including dark greens and quinoa (for other good sources of magnesium click here)
  5. Super foods such as Ashwagandha, reishi mushroom, and holy basil

Ketones or Ketone bodies, specifically B- hydroxybutyrate, have been shown to decrease inflammation in your body.  Ketones including B- hydroxybutyrate are a naturally occurring by-product of burning fat when the body is low in carbohydrates or proteins. Ketosis or the production of ketone bodies occurs if you eat a very low carbohydrate diet such as the ketogenic diet or during times of starvation.   Up until recently this was the only way to feel the benefits of ketones, an alternative fuel source for the body.  Just in the last year a supplement became available that contains the ketone body, B- hydroxybutyrate.  When the supplement is taken, it will put your body into a state of ketosis in just 60 minutes, no matter how many carbohydrates you have eaten.

Exercise is also a great way to decrease inflammation. Exercise can  decrease stress and obesity which then can decrease inflammation.  Additionally, exercise directly lowers inflammatory cytokines. Population studies have shown that people who preform more frequent physical activity have lower levels of inflammatory cytokines, even after adjusting for obesity (BMI).  Lastly, there is also positive data from randomized controlled trials showing that increasing aerobic physical activity is effective in decreasing chronic inflammation.

In summary, if we don’t want inflammation and all the consequences of inflammation, we have to be more committed to more healthy living.  Including watching what we eat and what we should not eat, along with starting a regular exercise program. You and your brain deserve it.

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Bibliography

Beavers, K. M. (2010). Effect of exercise training on chronic inflammation. Clinica Chimica Acta , 411, 785-793.

Gabay, C. M. (1999). Acute-Phase Proteins and other Systemic Responses to Inflammation. New England Journal of Medicine , 340 (6), 448-454.

Galland, L. M. (2010). Diet and Inflammation. Nutrition in Clinical Practice , 35 (6), 634-640.

Hunt, K. J. (2010). Inflammation in Aging Part 1: Physiology and Immunological Mechanisms. Biological Research for Nursing , 11 (3), 245-252.

Lucas, S.-M. e. (2006). The role of inflammation in CNS injury and disease. British Journal of Pharmacology , 147, S232-240.

Morgillo, F. e. (2007). Chronic inflammation and oxidative stress in human carcinogensis. Internation Journal of Cancer , 121 (11), 2381-2386.

Youm, Yun-Hee. (2015). Ketone body β-hydroxybutyrate blocks the NLRP3 inflammasome-mediated inflammatory disease. Nature Medicine, 21 (3), 263-269.

This site is purely informative and should not be considered medical advice. It is not intended to be used to diagnosis or treat any disease.  Please consult your physician before starting any fitness program or new supplement.