Trigger foods can play key role in causing migraines


Rhonda Cadle loves pepperoni, but she has given it up for good.

Pamela Yeager used to savor the veal paprikash served at a local restaurant but now avoids it at all costs.

These women gave up foods they loved not because of calories, cholesterol or fat. Instead, they gave up foods that they realized, after some detective work, were almost sure to trigger headaches.

Certain foods and substances, such as caffeine and MSG, are common migraine triggers, but not all trigger foods prompt headaches among all migraine sufferers. This is because headache food triggers vary among individuals, and also because other factors, such as stress, hormone and weather changes, fatigue and hunger, can also raise the threshold that might trip a migraine. Because there can be so many contributing factors, doctors can find headaches notoriously difficult to treat.

“Migraines are generally not prompted by a single food or other environmental element, but doctors often underestimate foods as a risk factor,” said Dr. Roger Cady, vice president of the National Headache Foundation and director of the Headache Care Center in Springfield, Mo.

Finding the Connection

Further, many people don’t connect what they eat and drink with their pounding headaches.

“It would be logical to think that a trigger food would cause a headache every time you ate or drank it, but that’s not the case,” said Dr. David Buchholz, associate professor of neurology at Johns Hopkins and author of “Heal Your Headache.” “There are also many potent nondietary triggers, including stress, weather and hormonal changes, hunger and fatigue, that pile on the layers that lead to migraine. If the total trigger level is low, you’ve got a wider margin of error with your diet.”

To help patients figure out just what is causing their migraines, both Cady and Buchholz encourage their patients to keep a headache diary. Cadle, who is Cady’s patient as well as the research coordinator in his clinic, did just that.

“The migraines were running my life,” said Cadle, 42, a registered nurse who used to get migraines about twice a week, each of which could last for up to three days.

Cadle used her diary to track her activities and food intake for the previous 24 hours, noting what she ate, her stress level, odors she may have been exposed to, the weather and her hormonal cycle. She also noted what medication she took for the headaches.

Lowering the Risk

It took a few months to see the pattern, but eventually Cadle realized that her risk factors included many nonfood triggers, including changes in weather, stress levels and hormonal fluctuations. Because many of her triggers were unavoidable, Cadle tried to keep her overall headache threshold level low by drinking enough water, getting enough sleep and avoiding the foods and food additives that could prompt headaches, such as MSG and onions. She also learned to take headache relief medication at the first signal of an impending headache for maximum relief. Since taking these steps, Cadle has cut her migraine rate by about half, to roughly four per month.

Yeager’s relief has been even more dramatic. When she began tracking her headaches carefully, Yeager identified several risk factors, including certain perfumes, flashing or fluorescent bulbs and extreme hunger. But her biggest triggers were hormonal changes and foods, including red wine, smoked cheeses and meats, red dyes and dark chocolate, plus MSG.

From more than 100 migraines a year, Yeager, 43, now gets only about four. She’s given up on Cajun food but won’t give up Chinese and only goes to restaurants where she is sure that MSG won’t be hiding in her food.

Buchholz is not surprised by the women’s success. He believes that nearly all migraine sufferers can benefit by first cutting as many known headache trigger foods from their diets as possible and then adding them in one at a time until the problem foods are identified.

The Cold Turkey Approach

Buchholz recommends cutting them all at once, as opposed to one at a time, because food triggers are also inconsistent, leading many people to deny the food-headache connection.

“Headache sufferers often convince themselves that some of the foods they love don’t contribute to their headaches, either because the foods don’t always trigger a headache or because the headache comes a day after the food was eaten, when they assume it would have been immediate,” he said.

In fact, a headache may not erupt until a full 24 hours after eating a problem substance.

Buchholz believes that caffeine might be the top dietary headache trigger, yet people are fooled into thinking it’s a help, not a hindrance.

“Caffeine helps temporarily to relieve headaches because it constricts the blood vessels, but the rebound effect of those blood vessels expanding again contributes to more headaches in the long run,” he said. “When people get withdrawal headaches from stopping caffeine, they may think their headaches are caused by caffeine deprivation, and that reinforces the wrong idea.”

Painful as it is for our caffeine-addicted culture, Buchholz recommends that chronic headache sufferers quit caffeine completely, either by going cold turkey (and toughing out the withdrawal headaches that may follow) or cutting it down and then out within two weeks. This includes eliminating headache medications containing caffeine, such as Excedrin.

After caffeine, Buchholz’s list of the most potent headache trigger foods are dark chocolate (milk chocolate isn’t as bad since it has less cocoa, and white is OK), MSG (which can be hidden by other names, including hydrogenated vegetable protein and “seasonings”), processed meats and fish, cheese and other dairy products, nuts and nut butters, alcohol (especially red wine) and most vinegars, citrus and dried fruits, though even bananas are triggers for some people.

The artificial sweetener aspartame, which goes by the brand name Nutrasweet, is often a trigger for children, as well as adults. Last on the list are vegetables such as pea pods, lentils and other beans and brown onions. Sauerkraut can also be a trigger.

Buchholz acknowledges that it is unclear why certain foods will trip the migraine switch in headache sufferers, but that trigger foods, when added to other nondietary triggers, stack the deck, and migraines can result. He also acknowledges that the list of potential trigger foods is daunting, and that nobody can avoid every one.

But it’s not a life sentence, either.

“Eliminating these foods is a golden opportunity to learn to control and heal your headaches,” he said. “And after slowly adding foods back in, most people will end up with a small, manageable list of foods to avoid. This can potentially lower the dietary trigger by 90 percent.”

And that means a lot fewer headaches and a lot of life restored to migraine sufferers.

As Cadle observed: “The best thing you can do about migraines is to learn to prevent them. That way, you take charge of them instead of them taking charge of you.”

Judy Gruen’s latest book is “The Women’s Daily Irony Supplement.” She has written for the Los Angeles Times, Ladies’ Home Journal, Family Circle and Natural Solutions, where this article first appeared. Read more of her work on www.judygruen.com.

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White Dies, But Cause Lives On


The living room grew more crowded by the minute as relatives and friends of the White family continued to arrive on this cold, overcast September morning in Cheviot Hills. More than two dozen people clutched siddurs and faced east, davening Shacharit at a few minutes past 7 a.m.

Like many tales of mourning, this story was not supposed to end this way — or to end this soon. Judah White, the young doctor whose battle with cancer became a clarion call for adult stem cell donations, died this month at 39. White, an intensely private person, allowed his suffering to enter the public domain so people could realize that there is no moral controversy attached to adult stem cells, that adult stem cell donation is relatively painless and that these donations are desperately needed to save lives.

White’s case now also stands out as an example of the unavoidable imperfection of medical treatments. He died despite getting an adult stem cell transfusion that doctors hoped would help save him.

“We thought he was really going to beat it,” said his mother, Martha White, who spearheaded the public outreach both on behalf of her son and to raise awareness among potential donors. In each case, she hoped to address the acute shortage of Jewish donors.

As a result of her work and her son’s own generosity, Judah White was profiled in a July 1 Jewish Journal cover story on the acute shortage of adult stem cell donors. He underwent a stem cell transplant at City of Hope in June, and the initial prognosis was good. Doctors suspect it was scarring on his lungs from cancer treatments that ultimately led to his decline and death.

During the traditional gathering at Martha White’s house on that damp, unseasonably chilly morning, some mourners wore tefillin and tallit, while others eschewed a kippah altogether. What united them all was sorrow, but there also was a tinge of hope about the cause that Judah White and his mother took on.

“We think adult stem cells work,” Martha White said. After the stem-cell transplant, “Judah had good white blood cell counts.”

A graduate of Tel Aviv University’s Sackler Medical School, Judah White was a resident in internal medicine at Huntington Memorial Hospital in Pasadena when he was diagnosed with Hodgkin’s lymphoma in February 2003.

In 2004, doctors tried to rebuild White’s blood system with his own stem cells, which had been extracted and set aside before he underwent chemotherapy. But that procedure didn’t work. His cancer came back later that year, just after Rosh Hashanah.

A shortage of Jewish adult stem cell donors was also working against him, so the White family held a stem cell donor drive earlier this year in hope of finding a good match. More than 200 people turned out, which inspired Martha White to consider expanding donor-screening efforts locally.

None of the donors screened at the Whites’ home were suitable matches, but the Florida-based Gift of Life Bone Marrow Foundation found an anonymous donor whose stem cells were considered good enough to try the transplant. The goal was to boost White’s immune system so that he’d be strong enough to recover from cancer treatments. Adult stem cells can begin the work of rebuilding a patient’s immune system by creating new bone marrow and white blood cells.

At first the transplant seemed to be working. White quickly progressed to eating solid food and taking limited trips outside of his ward. But by the end of July, his condition began deteriorating.

“His lungs were getting rigid because of the scarring [from chemotherapy and radiation] and he couldn’t get enough air,” Martha White said.

“It was never in my consciousness that he wouldn’t make it,” said Tamar Tamler, Judah White’s former girlfriend.

Judah White died Saturday, Sept. 3.

His story touched many outside the family. More than 450 attended his funeral at Mount Sinai Memorial Parks and Mortuaries in Simi Valley, where Martha White works as marketing and sales director.

On Judah White’s blog (judahdaniel.blogspot.com), people from around the world continue to post thoughts and feelings in the very space where his family provided daily updates on his condition.

Martha White is still grieving, but her belief in the therapeutic potential of adult stem cells is unshaken. She plans to continue promoting the registration of Jewish donors.

“We’re trying to put together the structure for a drive,” she said. “It’s going to be more than local. One of the things I’d like to do is hold a weeklong countrywide donor drive.”

To contact Martha White about her adult stem cell initiative, e-mail ccjsla@aol.com. To send donations, please mail to CCJS, 2779 Forrester Drive, Los Angeles, CA 90064.

 

A Bigger Sunday


At the risk of sounding like a cranky old-timer, the Jewish festivals of yore — the ’70s and ’80s — had a distinctive communitywide feel to them. The festival that was once held in Rancho Park drew thousands of people from across the communal spectrum — young, old, Orthodox, Reform, Israeli, American, rich, poor.

Part of the celebration was a morning march through the city, the marchers waving flags and accruing donations for Israeli charities for each mile they walked. The booths reflected the entire spectrum of Jewish involvement, and the entertainment — David Broza, Theodore Bikel — had a multigenerational, cross-cultural appeal.

“It was amazing,” said Temple Aliyah’s Rabbi Stuart Vogel of the Rancho Park Jewish Festival — affirming my nostalgia. “The whole Jewish community turned out.”

“We’d start at 8 a.m., walking,” recalled Rabbi Daniel Bouskila of Sephardic Temple Tifereth Israel. “Everyone was there for the cause. You grew up in your little enclave — your synagogue, community center — then you all came to this. It was a very unifying event.”

That was clearly not the case Sunday, May 15, at the Israel Festival in Woodley Park in Van Nuys.

To be fair, by most measures, the Woodley Park gathering was a success. Putting together any Jewish event on that scale is like herding cats in a hurry, and the organizers did a praiseworthy job, pulling off a well-run, well-attended event.

At least 30,000 turned out on the hottest Sunday afternoon of the year. I wandered around, taking in the humanity: the anti-Gaza-withdrawal group in their bright orange T-shirts placed with something like black humor next to the booth of Americans for Peace Now, their political nemeses. The black-clad Chabadniks offering passersby the chance to lay tefillin, as Israeli beauties wearing barely anything paraded close by. Everyone pausing to look skyward as a parachute team swirled down from the sky trailing American and Israeli flags. The Latino servers at the Cafe Tel Aviv serving ex-pat Israelis their cafe hafooks, almost just like in the old country.

If you were there, chances are you would have enjoyed yourself.

But, chances are, you weren’t there.

The crowd was largely Israeli, by some estimates 90 percent. On a day when the entire Jewish community could have been represented, most weren’t. I spotted just a couple of rabbis there. The community activists and organizations heads who attended showed up primarily to work — they couldn’t not be there. The El Cab crowd, the Hillcrest crowd, the masses of non-Israelis who used to swarm Rancho Park, they just didn’t show. (If you were one of the few present from those communities, go ahead and write your rebuttal, but you were the exception.)

Many organizations and synagogues even scheduled competing events. Chief among them was Big Sunday. Big Sunday, a wildly successful mitzvah day-for-the-masses, was founded by David Levinson as a volunteer program of Temple Israel of Hollywood. It has now grown to include dozens of synagogues and non-Jewish institutions. Last Sunday its 7,000-plus volunteers fanned out across the city to do everything from cleaning the L.A. River to singing for seniors. Last year I did a Big Sunday project in the morning and the Israel Festival in the afternoon. This year I could only do one.

The truth is, most people who pick choose one or the other, limiting the reach of either. For all the bigness of Big Sunday and the Israel Festival, in terms of drawing the entire spectrum of the Jewish community, both could be bigger.

Part of the reality is that the L.A. Jewish community has changed drastically since the Rancho Park days. Back then, the Persian, Israeli, Russian and Orthodox Jewish communities were smaller. Now each can sustain its own festival.

The community of yore was also more cohesive. Partly this was demographics: A more homogenous L.A. Jewish world remained largely unified around a core of temples and service organizations as well as a shared post-World War II perspective of how things were and ought to be.

I wonder, too, if the idea of marching with the Israeli flag began to be less dreamy and more politically freighted in the years following Israel’s incursion into Lebanon War and the Palestinian intifadas. Now Jewish and non-Jewish protesters would swarm over such a march like June bugs on an unscreened porch.

The result is an Israel Festival that has supplanted the annual communitywide Jewish festival without really substituting for it. The Jewish Federation/Valley Alliance joined forces with the Israel Festival this year in hopes of blending the disparate communities, but clearly more work and time is needed for that to happen.

“I really feel sort of split about the festival,” said Bouskila, who grew up in West Hollywood but served in the Israel Defense Forces. “The Israeli side of me felt very at home. The American Jewish side of me felt, ‘Where is the American Jewish community?’

“Are they not part of this? Why can’t the entire Jewish community be there?”

The long-term effects of this seem obvious — a declining sense of attachment to Israel on the one hand, and a declining sense of belonging to a broader local Jewish community on the other.

But the optimist in me wants to believe this, too, will pass. If, for now, groups of us are separating out, more comfortable apart than together, perhaps the next generation will realize the value of a larger unified community and come together.

I noticed in this paper a report that Israel Television is launching its own version of the popular American reality show, “The Bachelor,” in which 15 single Israeli women will compete for the heart of an eligible Jewish American male.

Maybe that’s just where we’re at, we Israeli and American Jews — not married, not divorced, yet still interested in dating.

 

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