New Migraine Research
Ask Dr. J: Omega-3 Oil Doses
In the Health News
Diet and Disease
Recipe of the Month: Potato/Bean/Tomato Casserole
A recent article suggested that cancer survivors are often
left with a poor quality of life from their experience with
the disease itself or from the treatments. However, this does
not have to be the case. Regardless of the disease or treatment
(and less toxic alternatives are often helpful), lifestyle
choices can lead to a vigorous, healthy, and rewarding life.
The power of positive feelings, a winning attitude, regular
exercise, and supportive nutrition and dietary supplements
can all combine to create enduring and enjoyable daily living.
The career of Lance Armstrong is an example of how a person
can survive the most intensive treatments and bounce back
with a rich, successful life. You don’t have to be in
the Tour de France to achieve the benefits of healthy lifestyles,
but you do have to take charge of your life and your health.
The recent study suggests that cancer survivors have lower
quality of life than age-matched controls who have never had
cancer. The survey shows that 31 percent of cancer survivors
report having fair or poor health, compared to only 18 percent
of the controls. Only 13 percent of the cancer survivors reported
having excellent health, but the researchers did not look
at how lifestyle and attitude relate to these results.
These healthier choices can clearly contribute to a positive
outcome. This is not to glibly pass off the physical and emotional
stress of having cancer, or the side effects of the treatments
with surgery, radiation, and chemotherapy, but some of my
healthiest cancer patients have been those who were determined
not to succumb to the emotional trauma of the diagnosis. In
Norman Cousins’ books, Anatomy of an Illness, The Healing
Heart, and Head First, he describes his own experiences with
healing—of himself from a debilitating and life-threatening
collagen disease and then heart disease, and of numerous cancer
patients in group sessions while he was on the faculty of
medicine at UCLA.
Cousins emphasized not only the power of laughter and positive
emotions, but the value of nutrition and dietary supplements
(he took huge doses of vitamin C orally and intravenously
during his first major illness, and unexpectedly recovered—at
least it was unexpected by the medical community). During
those group sessions, his experience with patients showed
him that the patients with cancer who did well were those
who accepted the diagnosis (they were not in denial) but did
not accept the negative prognosis. They mounted a vigorous
defense both emotionally and nutritionally, and survived far
longer than expected, with a superior quality of life.
The power of positive feelings, a winning attitude, and positive
actions to enhance one’s health may be immeasurable,
but it is clearly visible in those who choose to take charge
of their health.
Migraines can be debilitating headaches related to vascular
spasms followed by dilation of blood vessels. They are often
associated with initial warning symptoms (prodrome, or aura)
of blurry or double vision, or flashing, bright lights, or
localized vision loss prior to the headache and accompanied
by nausea, vomiting, irritability, mood changes, and severe
light sensitivitiy. Some people just get the visual auras
with no real headache, referred to as “optical migraines.”
Common migraines (as opposed to "classical") occur
without the prodrome.
These are not simple headaches, possibly lasting for hours
or days, and localized inflammation of tissues around the
brain can make the pain worse. Migraines can be triggered
by hormonal changes; weather patterns; bright, flashing, or
fluorescent lights; foods, such as chocolate, wine, cheese,
caffeine; aspartame; and specific food sensitivities. Abnormal
regulation of blood sugar (hypoglycemia) may also trigger
Dietary changes may make a considerable difference in migraines.
Avoiding refined sugar and eating five or six small meals
can help stabilize blood sugar levels and may reduce the frequency
of migraines. It is best if food selections are high in fiber,
which delays absorption of the naturally occuring sugars.
Also, avoid food additives.
A number of dietary supplements have been helpful in preventing
migraines, but it is much more difficult to treat them once
started. Magnesium doses of 300 to 600 mg daily can decrease
migraine attacks, especially those related to premenstrual
syndrome. Riboflavin (vitamin B2, 400 mg daily) significantly
lowers migraine incidence and the number of days of symptoms.
In a 1998 controlled study of 55 patients, 60 percent improved
on riboflavin compared to only 15 percent who were given a
Many people benefit from supplements of the herb, feverfew.
I recommend standardized extract containing 250 mcg of parthenolide,
one of the apparently active components of the herb, although
there may also be others. Feverfew has anti-inflammatory properties
and inhibits platelet aggregation. You may need to take feverfew
for a month or more to see the reduced frequency of migraines.
In addition to these supplements, 5-hydroxy tryptophan (5-HTP)
has been shown in a number of studies to reduce symptoms with
daily supplements of 200 to 600 mg. This is a derivative of
the amino acid tryptophan, and is a precursor of the neurotransmitter
serotonin. I and many colleagues have found supplements of
ginkgo biloba to help patients with migraines. Ginkgo may
help by reducing platelet activating factor, a suspected contributor
A recent small trial strongly suggested that supplements
of melatonin could reduce the frequency, duration, and intensity
of migraine headaches. Thirty-four patients were studied for
three months, and although the study was short and not double-blind,
the results were significant.
In a variety of migraine types, melatonin levels have been
found to be abnormal. In this study, the patients were given
3 mg of melatonin 30 minutes before bedtime. At the end of
the study, 25 patients had greater than 50 percent reduction
in the number of headaches, including eight with no headaches
and seven with 75 percent reduction. None of the subjects
had any increase in symptoms or side effects. Overall, duration
and intensity of the headaches was reduced and medication
use declined significantly.
Although most doctors and researchers will caution that this
research is not definitive, and may even recommend against
taking action based on it, I disagree. While this study was
small and not blinded, the value of melatonin as an antioxidant
for the brain and other tissues, its value in insomnia and
depression, and the lack of side effects make it worth trying.
Some preliminary open trials suggest that coenzyme Q10 can
help with migraines also. In a 2002 study, 32 migraine patients
were given 150 mg of coQ10 per day, and after three months,
the number of days with migraines and the frequency of headaches
were reduced by 60 percent.
Another recent study shows that patients have increased migraine
intensity if they have high levels of glutamate (not glutamine)
in their plasma, platelets, and cerebrospinal fluid. Glutamate
is found in MSG (monosodium glutamate), a common food additive
that may precipitate migraine headaches.
Coffee and other caffeinated beverages are ubiquitous, socially
accepted stimulants that are taken for granted among our cultural
habits. While the occasional consumption of caffeine is likely
to be relatively harmless, it is not without some potential
Caffeine is a stimulant and a diuretic causing calcium loss
in the urine and an increased risk of osteoporosis. It may
also cause acid indigestion. For those not habituated to it,
even one cup of coffee can cause anxiety, hyperactivity, rapid
heart rate, and arrhythmias. Evidence shows that this amount
can lead to signs of addiction, particularly the dependence
on the morning cup to prevent withdrawal symptoms of headaches,
fatigue, nervousness, irritability, and depression, and even
flu-like symptoms. (Even decaf can cause gastric irritation
and digestive upset.)
A literature review of over 60 studies, shows that withdrawal
was evident in 50 percent of subjects within 12-24 hours after
abstaining from caffeine. Symptoms were more severe with higher
consumption, but were evident even if subjects drank only
one cup of coffee daily (coffee contains 90-150 mg of caffeine;
green or black tea has about 30-50 mg, and sodas from 30-55
The peak of withdrawal symptoms occurs within one to two
days, and may last from two to nine days. Habitial coffee
consumption is related to a desire (conscious or not) to avoid
withdrawal symptoms. Coffee has some health value. It is full
of antioxidants and may reduce the risk of diabetes. However,
red bush tea (with no caffeine) and green tea (preferably
decaf) are even healthier and have fewer associated risks.
Q. What is the right dose of omega-3 oil,
either from fish or flaxseeds?.
—RL, Maryland, via email
The typical recommendation for flaxseed oil (containing alpha-linolenic
acid, or ALA) is from 1 to 2 teaspoons, up to 2 to 3 tablespoons,
depending on individual needs. I use it on salads and as a
garnish for steamed veggies, and I don’t measure it,
but as with any oil, it is high in calories. One recent study
suggests that although flaxseed oil does not increase the
risk of prostate cancer, ALA (from vegetable as well as milk
and meat sources) may be associated with more aggressive tumor
behavior in men who have those cancers. Most evidence shows
that flaxseed oil decreases prostate cancer risk, so I suspect
flaxseed oil may not be the cause.
Fish oil supplements have more anti-platelet and anti-inflammatory
effects than flaxseed oil, and the usual dose varies depending
on why it is being taken. Typical doses range from 2000 mg
twice a day, to 12,000 mg per day. Capsules contain varying
amounts of omega-3 oils, usually about 300 mg total of the
combination of EPA (180 mg) and DHA (120 mg). Some people
recommend larger proportions of the DHA, especially for children,
and such capsules are also available.
The larger doses are used for inflammation, such as arthritis
and auto-immune diseases, and for heart disease, strokes,
and asthma. One ounce of wild salmon contains about the same
amount of omega-3 oil as one typical capsule.
Click here to receive the Healthy Living newsletter free.
Yabroff KR, et al., Burden of illness in
cancer survivors: findings from a population-based national
sample. J Natl Cancer Inst 2004 Sep 1;96(17):1322-30.
Cousins N, Anatomy of an illness (as perceived
by the patient) N Engl J Med 1976 Dec 23;295:1458-1463.
Millichap JG, Yee MM, The diet factor in
pediatric and adolescent migraine. Pediatr Neurol 2003 Jan;28(1):9-15.
Lipton RB, et al., Aspartame as a dietary
trigger of headache. Headache 1989 Feb;29(2):90-2.
Bianchi A, Role of magnesium, coenzyme
Q10, riboflavin, and vitamin B12 in migraine prophylaxis.
Vitam Horm 2004;69:297-312.
Schoenen J, et al., Effectiveness of high-dose
riboflavin in migraine prophylaxis. A randomized controlled
trial. Neurology 1998 Feb;50(2):466-70.
Boehnke C, High-dose riboflavin treatment
is efficacious in migraine prophylaxis: an open study in a
tertiary care centre. Eur J Neurol 2004 Jul;11(7):475-7.
Peres MF, et al., Melatonin, 3 mg, is effective
for migraine prevention. Neurology 2004 Aug 24;63(4):757.
Rozen TD, et al., Open label trial of coenzyme
Q10 as a migraine preventive. Cephalalgia 2002 Mar;22(2):137-41.
Peres MF, et al., Cerebrospinal fluid glutamate
levels in chronic migraine. Cephalalgia 2004 Sep;24(9):735-9.
Juliano LM, Griffiths RR, A critical review
of caffeine withdrawal: empirical validation of symptoms and
signs, incidence, severity, and associated features. Psychopharmacology
(Berl) 2004 Sep 21.
Elta GH, et al., Comparison of coffee intake
and coffee-induced symptoms in patients with duodenal ulcer,
nonulcer dyspepsia, and normal controls. Am J Gastroenterol
Salazar-Martinez E, et al., Coffee consumption
and risk for type 2 diabetes mellitus. Ann Intern Med 2004
Siddiqui IA, et al., Antioxidants of the
beverage tea in promotion of human health. Antioxid Redox
Signal 2004 Jun;6(3):571-82.
Although antidepressants can relieve serious symptoms, they
can also lead to an increased risk of adolescent suicide.
The link has been played down by the FDA, accused of blocking
a congressional investigation (Reuters, September 9, 2004).
Another drug, Vioxx, a treatment for arthritic pain, is associated
with an increased risk of heart disease, and has just been
recalled by Merck, although they and the FDA knew as early
as 1999 about the associated risks (PRWEB Sept 1, 2004).
a. Curcumin, a component of turmeric, may prevent childhood
leukemia. A report by researchers in Chicago shows that this
spice inhibits the white blood cell effects of some of the
risk factors for leukemia, such as infections, radiation,
chemicals, pesticides, and viruses. In lab studies, this spice
blocks replication of leukemia cells and interferes with the
effects of cigarette smoke and processed foods. At the same
meeting, other researchers reported that eating oranges and
bananas helped protect children from leukemia. (Turmeric may
protect against leukemia-scientist. Reuters, Sep 9,2004)
b. Red meat consumption, and especially processed meats such
as hot dogs and bacon, is associated with a significant increased
risk of type 2 diabetes. Results from the Women’s Health
Study, evaluating 37,309 participants, showed that the highest
meat consumption was associated with a 28 percent increase
in diabetes risk, and 43 percent for processed meats (Song
Y, et al., A prospective study of red meat consumption and
type 2 diabetes...Diabetes Care. 2004 Sep;27(9):2108-15).
Cholesterol, animal protein, and meat-source (heme) iron were
also associated with greater risk.
Harvesting potatoes and tomatoes makes me think of the many
ways to use these versatile and tasty foods. Slice some potatoes
about 1/4 inch thick, and some tomatoes a bit more thickly,
and alternate several layers of each in a baking pan, with
a thin layer of cooked pinto beans in between. As you put
down each layer, sprinkle some crushed garlic; minced scallion
greens; fresh or dried basil, thyme, or chopped cilantro;
freshly ground pepper; chili powder; or other spices to taste
(this can also be made with a curry flavor), and if you like
you can spread a garnish of grated parmesan, feta cheese,
or crumbled tofu in one or two of the layers. You can use
a small amount of sea salt if you skip the cheese. Make several
layers, as it will cook down. Bake this in a preheated oven
at 400 degrees, for about 40 minutes, but test regularly to
see when the potatoes are soft.
Click here to receive the Healthy Living newsletter free.