The Dr. Hyman Show - House Call Highlight: The Functional Medicine Approach To Ending Migraine with Dr. Todd LePine

Starting point is 00:00:00 Hi, I'm Kea Perowit, one of the producers of The Doctor's Pharmacy. If you or someone you love suffers from migraines, I don't need to tell you how debilitating they can be. In fact, they are one of the most common reasons people end up in the emergency room. When you're experiencing a migraine, your primary focus is on how to make it stop. But as migraines are usually a recurring issue, functional medicine really looks at what's causing the migraines in the first place. Dr. Hyman sat down to talk about this with Dr. Todd Lepine. This is one of our all-time most listened to episodes from the House Call series, and we're re-airing it today to help spread the word on ending migraines once and for all. Now, on to the episode. Hey everyone, it's Dr. Mark.

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Starting point is 00:03:40 with a Q&A or create an account at rupahealth.com. That's R-U-P-A health.com. Now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman. That's pharmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And if you ever, ever had a headache, you better listen up, especially if you had a migraine. Because today we're having a special episode of The Doctor's Pharmacy called House Call with my colleague and friend, Dr. Todd Lepine, here at the Ultra Wellness Center in Lenox, Massachusetts.

Starting point is 00:04:14 And we see so much migraines. Todd has been a colleague of mine for over 25 years, worked with me at Canyon Ranch, now at the Ultra Wellness Center for 10 years. And we've just been at the forefront of this whole movement of functional medicine. And I would say migraines are among the worst condition that people can suffer from. But from a functional medicine perspective, they're probably the easiest things to treat. Wouldn't you say, Dr. Lapine? Absolutely.

Starting point is 00:04:38 Yeah, exactly. So how do we think about this condition in traditional medicine? What is the normal approach to diagnosis and treatment and what's wrong with it? Interesting thing is when I look back, I can remember when I was practicing mainstream medicine, I always looked at migraine patients. And there were so many different things that were offered by mainstream medicine for migraines. And it sort of made me question, like, there's no such thing as one migraine. There's so many different flavors of migraine. You can have a patient who has periodic migraines. You can have someone who's got

Starting point is 00:05:15 menstrual migraines. So, to me, that was telling me that migraines, there's a lot of pathways to developing what we call a migraine or another, you they also call it a vascular headache and i found it really is an interesting uh approach to know that each individual their presentation for migraine is unique it's the interesting thing is i would never treat two migraine patients the same because they all have different features so that that's that speaks to a very central idea in functional medicine, which is this. Just because you know the name of your disease, it doesn't mean you know what's wrong with you, right? You have a migraine, that just describes people who have a certain type of headache with certain types of symptoms like light sensitivity, noise sensitivity, maybe on one side, maybe visual pre-aura symptoms, nausea, vomiting.

Starting point is 00:06:08 These are just the typical things. Okay, you have a migraine. And then we divide into classical migraine and this migraine, and they're all just different ways of describing the kind of migraine, but none of them tell you the cause. So functional medicine is about focusing on the cause, which is what you're talking about, these different flavors.

Starting point is 00:06:23 And there may be up to like 29 different factors that can drive a migraine. And traditional medicine just uses a one-size-fits-all approach. So what is the typical approach to treating migraines? Well, in mainstream medicine, it's really just basically abortive therapy. You know, you might take Advil or Aleve or an Excedrin you might take a triptan you might take an opioid in the tracks or in the tracks yeah in the tracks exactly or opioids in severe cases steroids in other cases so it's basically treated abortive therapy which is that when you get an attack you treat that attack and for people who get them more frequently it's about trying preventive

Starting point is 00:07:06 therapies and they're all over the place that was I found that actually quite interesting when I was looking at you know how do neurologists approach migraines you know these headache neurology specialists and they use everything they throw everything in there they'll throw in beta blockers they'll throw in calcium channel blockers to prevent migraines to prevent migraines exactly so it's a so the preventive role is is really important i think because when you look at someone who's suffering from migraines i mean people can lose a lot of work over over migraines

Starting point is 00:07:34 they're dilating oh it's absolutely and sometimes for some people it might be two three days or a whole week that's lost they're just like you know they got to stay in bed and uh turn uh turn the lights off and and just you know wait, wait till the whole episode passes. And then other medications that are used in mainstream medicine are anti-seizure medications. Yeah. I mean, you know, it's a- Antidepressants, seizure medications, blood pressure medications. Calcium chain of blood.

Starting point is 00:07:58 Yeah, all the stuff that they're kind of throwing at spaghetti against the wall. Antidepressants, tricyclic antidepressants, you name it. And there's no way to actually figure it out. You sort of like, it's like spaghetti on the wall. These doctors try this, try that, try this. And I can't tell you how many patients I've seen have been through the whole mill of these medications and it might help a little. It might.

Starting point is 00:08:14 Botox. They're using Botox now. They're using botulinum toxin. Yeah. Well, that's just to paralyze the muscles in the back of the head, right? Exactly. Yeah. Right.

Starting point is 00:08:22 So, and it's a terrible condition i've had people who had you know chronic daily migraines or you know 20 days a month and it's just so awful for people especially in women women are tend to have a little more i think in general women uh i'd probably see more women with migraines than as opposed to men and then women also get menstrual migraines which is another sort of flavor of migraines, which is another, I probably relate to estrogen detoxification. So it really is. And it's actually, it really keeps me on my toes in functional medicine when I see a migraine patient, because it's not like, oh, here's your problem, just do this and it's fine. I've got to like play detective. I've got to figure out what are the factors that are driving that person's unique presentation of their migraines.

Starting point is 00:09:09 That's absolutely right. Because what we do in traditional medicine is, okay, you have this type of headache and ask these questions and it meets this criteria for what a migraine headache is, according to the neurological society criteria. But once you make the diagnosis there's no more thinking involved it's like okay here's the cocktail of drugs i get to pick from yeah start with these try this that doesn't work we'll try this and it's just like it's kind of a yeah a merry-go-round of drugs and and it often is is so difficult for people to get better oh yeah because they're not asking the right question so in functional medicine we don't just name and blame, which is what our mentor Sidney Baker talks. We name it, blame it, and tame it. You name the disease and say, oh, you have a migraine. That's why your

Starting point is 00:09:54 head hurts. No, that's not why your head hurts. That's just the name of why your head hurts. And then we try to tame it with a drug instead of actually figuring out the cause. So let's talk a little bit from a functional medicine perspective about what the causes cause. So let's talk a little bit from a functional medicine perspective about what the causes are, and let's get into some cases, because I think we've both seen so many cases. It's one of the most satisfying things for me, as a doctor, to actually treat,

Starting point is 00:10:15 because it's so easy, usually, and people do so, so well with simple approaches that deal with the root causes. Yeah, absolutely, yeah. So tell me what are the things that you think of when you're coming to see these patients that could be driving the, the, the migraines? Well, one of the things that I think is missed by a lot of mainstream doctors, even neurologists, is to understand the role that mitochondria play in migraines. So interestingly, mitochondria, which are the powerhouses of the cell, they basically is where our, when our body consumes food, we produce energy from that food in the form of ATP. And mitochondria are not really tested by mainstream medicine. They are not

Starting point is 00:10:59 well understood. It's something that you learn about in medical school and then you forget about it. And the interesting thing is that people who have migraines also have a higher incidence of seizures. And that's why, uh, to some degrees anti-seizure medications can actually have efficacy in some patients who have migraines. Um, so there's a, there's a real important to realize that connection, uh, between mitochondrial dysfunction and migraines. The mitochondria make energy in your cells.

Starting point is 00:11:27 Make energy in your cells. In fact, I've actually seen some patients, interestingly, who, and I don't see, I don't treat children, but I've seen some adults, when I go into their history, they had a history of what is called cyclic vomiting syndrome. And so that's where a young kid is vomiting for no particular reason. And it turns out cyclic vomiting syndrome is actually a mitochondrial problem. And as a person gets older, they sort of outgrow that vomiting episodes, but they actually then present with migraines. And interestingly, the gut is connected to the brain. So a lot of people can have what we call abdominal migraines.

Starting point is 00:12:05 Yes. Exactly. Right. Right. Yeah. This reminds me, Todd, I had a patient who struggled with headaches and migraines and she had terrible SIBO, which is overgrowth of bad bugs in your small intestine that was causing all this fermentation and creates these toxic byproducts that were clearly creating

Starting point is 00:12:20 inflammation in the brain. And we treated her gut with antibiotics to cure migraine. But who would have thought of that as a neurologist, right? Exactly. Yeah. And it's also the other interesting thing, and we're going to talk about that in one of the upcoming episodes, is on histamine, the role of histamine.

Starting point is 00:12:35 And that's actually a very interesting thing when you look at histamine because people who have SIBO, they actually have bacteria that are producing toxins, like you're talking about. And one of the problems is excess amounts of histamine. So normally our bacteria will degrade histamine. And we have enzymes that do that. And there's all these different pathways.

Starting point is 00:12:54 And when you look at some people who have migraine headaches, there are certain foods which can trigger a migraine. So is it the food that's doing it or is it something in the food or it's how the food is actually being metabolized? So that's a really key important feature is that the connection between the gut, our food, and the brain. Yeah, I mean, it's such a big problem, Todd. You know, the amount of people with migraines, there's over 10 million people have migraines. It costs about $17 billion a year to society in health care costs, just direct health care costs. That's medications, emergency room visits, hospitalizations,

Starting point is 00:13:32 doctor visits, testing, and then even managing the side effects. And then the loss of productivity to employers, because like you were saying, it's $15 billion, about half that's a huge due to absenteeism and the other half is due to just people being on the job but not being at the job but not on the job you know they're just sort of there but not functioning absolutely and so you know over the years of functional medicine i i've seen so many patients and and like you said before there's so many different flavors uh tell us about some of the other flavors because we went through

Starting point is 00:14:04 the mitochondria and let's just go to go down the list about some of the other flavors. Because we went through the mitochondria. And let's just go down the list of what are the most common things. Because there could be 29 things. But there's a few that are really common. Stress. Stress. Okay. Tell us about stress and mitochondria.

Starting point is 00:14:15 So, stress by itself does not cause any diseases. But stress can turn the volume up on all different kinds of conditions. We see that in autoimmune conditions. So how our bodies respond to stress. And some people have, I would call it a genetic predisposition to be more stress resilient. And some people don't. And some people are more prone to the effects of stress.

Starting point is 00:14:39 And time after time, you know, you see these people who they'll go through a very stressful period. All of a sudden they get a full blown migraine. Well, what is that? You know, you see these people who they'll go through a very stressful period. All of a sudden, they get a full-blown migraine. Well, what is that? You know, what's going on there? And I think it is how that person perceives the world and how they detoxify their stress. Absolutely. And that's why, you know, beta blockers, which block adrenaline, which you get high levels of stress, makes a big difference.

Starting point is 00:15:02 So, things like yoga, meditation. Exactly. And then also sometimes when you have patients who have migraines and you measure their cortisol levels, they've got higher levels of cortisol. So that's telling you they're having some more chronic stress. And sometimes they'll be type A where they're sort of very, very driven, those kinds of things. So you mentioned gut issues a little bit earlier. And I think that's another big one. And not just SIBO, but there are a lot of symptoms that people get that could be related to leaky gut and food sensitivities, which seem to be a huge factor with migraines that are really

Starting point is 00:15:36 undiagnosed. We know traditionally that all people say, scientists and doctors say, stay away from tyramine foods, those things, cheeses, foods that contain certain chemicals like MSG or aspartame. So there are some recommendations, chocolate, caffeine. There are doctors who do say some of these things, and that can be helpful for some patients. But it goes much deeper than that. There's like food sensitivities and gluten.

Starting point is 00:15:59 So tell us about, you know, how that works. Yeah, well, I think that, you know, the connection between the gut and the brain is huge. And the, the leaky gut component, you oftentimes will see leaky gut in patients who have increased risk for, for migraines. It, it, there's a, there's definitely a two-way communication that's going on there. And again, you know, sleep is another thing that plays a huge role.

Starting point is 00:16:24 So lack of sleep is, is huge in migraines. So when you look at, when somebody comes to see me, you know, I ask them, how's your stress level? How are you sleeping? And what are you eating? And who are you feeding? Which is, you know, what's going on with the gut bugs? You have patients who will tell you that when they eat certain types of foods, like sugar, they'll trigger a migraine. Yeah.

Starting point is 00:16:46 It's huge. And I suspect that some of those foods are actually affecting the gut microbiome in a very rapid fashion that's causing migraines. Yeah. One of the biggest things I've seen, I'm sure you probably noticed this too, is that gluten tops the list when it comes to migraines. If anybody has a migraine the simplest thing to do is an elimination diet absolutely to get rid of the most common allergens gluten dairy

Starting point is 00:17:10 eggs and i've seen so many people i had one woman she was married to a mafia don and she had headaches for 40 years and was incapacitated in bed very often and it turned out that it was eggs yeah now we found this on a food sensitivity test and uh that's not to say everybody's migraine is caused by eggs but hers seem to be triggered by eggs she stopped the eggs and her migraines in a way yeah so i think you know everybody's different like you said we have to treat the person not the disease absolutely i think thomas uh i mean uh what is it um uh william ulcer said that you know we should treat the person not the disease absolutely i think thomas uh i mean uh what is it um uh william ulcer said that you know we should treat the person who has the disease not the disease that the person has and i think that's that's the mistake we make in medicine so doing elimination diet getting food sensitivity testing checking for gluten that's all important

Starting point is 00:18:00 um the chemical triggers you know we talked a little bit about that talk more a little bit about some of these chemical triggers that we notice with migraines. You mean like exogenous chemicals? Things like aspartame, artificial sweeteners, food additives, sulfites, for example. I would say that, you know, those are basically excitotoxins. There are certain types of foods which can cause excess activity, like monosodium glutamate. You get excess glutamine in the brain because glutamine gets converted into glutamate, which is an excitotoxin. So definitely those types of foods. And even if you actually give somebody glutamine, which we use a lot to help with patients.

Starting point is 00:18:40 I've had these patients who they'll metabolize their glutamine directly into glutamate. And you'll get, taking glutamine, it'll be just like taking MSG. They'll get very agitated and get a headache. And aspartame is bad. I've seen so many patients who- Oh, aspartame, yes. Swig back those diet sodas and they get- We have somebody in the White House who does about, I think about 10 a day.

Starting point is 00:18:58 I don't know if he's getting migraines, but he's giving everybody else a headache. But I think that you're right. I think we have to really look at these things. The nitrates that are in, for example, deli meats, sulfites that are commonly added to salad bars. I mean, just keep the vegetables fresh or the dried fruit and wine. Tyramine was in chocolate. Cheese. These are really significant.

Starting point is 00:19:23 So getting rid of all the processed food all those chemicals super important yep let's talk about about hormonal factors because these are really common yeah and and often uh you know women we see this whole phenomena of premenstrual migraines how do you know if this is an issue for you with your patients oh you just by history i mean just the history will tell you that. And I typically will see that those types of patients who have menstrual migraines tend to have problems with estrogen detoxification. Yeah. So, you know, as men, you know,

Starting point is 00:19:55 our hormones tend to stay relatively stable. They go up in the morning, but they're pretty stable. Women's hormones, you know, they go up and down like the tides. And that's normal. That's part of the menstrual cycle. So when women are menstruating, they have these, some women have great fluctuations in hormones.

Starting point is 00:20:12 And when the body is done with those hormones, unless you're pregnant, the body has to detoxify those hormones. And there are certain pathways that help with estrogen detoxification. And when women have problems with those pathways uh one of the one of the the the genes uh that's important in there is the catechol-ol-methyltransferase or comt gene yeah and typically that gene um is oftentimes associated with increased sensitivity to pain it's also associated with increased sensitivity to migraines, seizures, and headaches. So it's definitely one of those pathways that you want to support for the detoxification or the methylation of.

Starting point is 00:20:54 With B vitamins like B6, B12. Magnesium. Magnesium, yeah. Magnesium, yeah. And often the classic story that I've seen with these premenstrual migraines is is women get like pms symptoms so they get bloating food retention they get uh cravings irritability breast tenderness yep menstrual cramps and they get heavy bleeding these are signs of sort of too much estrogen and not enough progesterone yep uh and i remember i remember one patient who had a migraine literally in my office and i had a sample tube of topical progesterone that i had been given by the you know uh the company that made it and i literally said

Starting point is 00:21:31 well let's just try this and i took the progesterone i just put a little cream on her arm rubbed it in and her headache went away like right there in the office it was the most striking thing i'd ever seen and i think you know we often will prescribe topical progesterone or other things to help. We'll prescribe dietary changes, help with PMS. Detoxifying these hormones can be really helpful. And also using an overall strategy of diet and exercise and stress reduction to balance women's hormones. Because I think they're totally influenced by diet, even the microbiome. Well, it's interesting you say that because I remember distinctly when I had a patient when I was practicing mainstream medicine who had menstrual migraines and the only thing

Starting point is 00:22:11 that worked for her was Xanax. Now, Xanax is a benzodiazepine, which is a tranquilizer. Yeah, like Valium, exactly. And it works on the GABA receptors. And guess what? Progesterone is working on that system. That's why progesterone is working on that system right that's why that's why that's why progesterone is so powerful so just just to recap that what you're saying is basically

Starting point is 00:22:29 progesterone is women's natural value exactly and it works in the brain on these receptors called gaba that valium works on and makes you relax which is actually helps women sleep yeah calms their nervous system deals with some of this mood fluctuations that happen with high estrogen. And by the way, our whole lifestyle drives estrogen, right? Sugar, stress, lack of exercise, bad gut microbiome, environmental toxins. All these things will drive dairy, for example, drives excess hormone and estrogen production. It'll be overweight, sugar. All those things can be managed easily with lifestyle and diet. Okay, let's talk about some of the nutrients. being overweight sugar all those things can be managed easily with with lifestyle and diet yeah

Starting point is 00:23:05 okay let's talk about some of the nutrients because there are some key nutrients that are often low in people who have migraines absolutely what's the number one nutrient that you would be thinking i would say magnesium yeah magnesium now the interesting thing you know this is also another thing where you can sort of connect the dots here is magnesium which is such a powerful you know it's involved in like 500 enzyme pathways in the body, is magnesium, when you get to a high enough level, is actually a calcium channel blocker. And guess what doctors use to prevent migraines? Calcium channel blockers. It's a natural muscle relaxant. It's actually, I remember, you know, when I was an ER doctor,

Starting point is 00:23:37 it was one of the things we used. So, when none of the drugs worked, we would use IV or intravenous magnesium for migraine patients. Remember that? Absolutely. And not only that, but we use, in the ER, we use IV magnesium for heart arrhythmias, life-threatening ones like torsade de pointe and VTAC. We also use it for status asthmaticus. Yeah. All right? You use it for preeclampsia.

Starting point is 00:24:02 It's a very powerful element. It's a relaxant and and what you're saying is funny to me because i remember you know when you learn these these acls courses the advanced cardiac life support and how to run a code and bring people back from death when their heart's not working and they use all these drugs drug drug drug drug drug and the last thing if nothing else works they use magnesium why don't you use it first right and then like if someone's got hearts not beating right you give magnesium and it fixes it or people are coming in in preterm labor or have like this preeclampsia which is high blood pressure pregnancy with

Starting point is 00:24:34 seizures they use ib magnesium they use yeah it's an asthma like you said to relax the lungs they use ib magnesium uh it's pretty funny even for people who are constipated they give them milk of magnesia so it's kind of it's funny doctors don't really think about it and most of us about 40 percent of us are low or deficient in magnesium oh yeah and i remember this one patient i had who was a radiation oncology resident back when we were at canyon ranch and she was just debilitated with migraines she had the worst migraine she was on narcotics and zofran which is like a chemo drug that's used for nausea it was that severe she could barely work and she came to see me and i started asking her questions and this is how you find things out in functional medicine you try to connect the dots so usually

Starting point is 00:25:17 you can find out from a story if it's a premenstrual migraine if it's a food related migraine if it's a this is why you're saying we can actually figure this out as functional medicine doctors and and turned out you know i started asking her questions and she had muscle cramps. She had constipation. I said, how often do you go to the bathroom? Are you regular? She goes, yeah, I'm regular. I said, how often do you go? She goes, I go every week. I said, that's not regular. She says, regular for me, I go every week. You know, severely constipated, muscle cramps, headaches, insomnia, irritability, anxiety, palpitations, sensitive and loud noises.

Starting point is 00:25:47 These are all symptoms of low magnesium. And so it turned out she needed like normal doses 200, 400 milligrams. She needed like 2,000, 3,000 milligrams a day of magnesium and literally her migraines went away. Yeah. And that's sort of her constipation and all those other symptoms. So it's often really often very simple if you know what to do yeah absolutely yeah uh are there other nutrients that you would think of that might be

Starting point is 00:26:09 helpful because you mentioned mitochondria and there's a couple of nutrients there that can really yeah i mean there's there's some uh the one i think some of the key nutrients are vitamin uh vitamin b2 uh yeah vitamin b6 uh and also coq. Those are probably some of my key mitochondrial nutrients that really can have an impact along with magnesium. Yeah. So really, tell us about some of your cases that you've had experience with that have really kind of changed your thinking and have helped you understand. Well, I had a patient who came in and his story was that he first developed migraines starting around at the age of five which is interesting okay so so when you have a history of somebody who's having headaches and it's not normal for a five-year-old to have headaches that makes me sort of think okay

Starting point is 00:26:57 this person may have a mitochondrial issue and that may be what's going on early on in their story. Also, interestingly, the patient noticed when he was telling me his story that he would get the worst headaches on the weekends. And on further asking him, it turned out that on the weekends, he didn't drink coffee. So, what he was getting was a caffeine withdrawal headache. Right. Now, this is probably one of those things that because caffeine is a double edged sword. We actually use caffeine to treat migraines. And if patients take like over the counter medications like Excedrin migraine, guess what's one of the major ingredients in there is caffeine. In fact, I had a patient.

Starting point is 00:27:39 I'll never forget this. It was a woman who had refractory migraines. And it turned out that she actually was getting rebound headaches from daily use of excedrin migraine and so she would have to take the excedrin migraine to prevent the the withdrawal effect from the caffeine so it was like a cat chasing a snail so that's not great because that's got talent well it's great it's great for the company because they keep selling it right liver problems right yeah exactly yeah so so this this patient was caffeine sensitive so some of the treatments you can actually abort a migraine with uh caffeine but you can also

Starting point is 00:28:11 trigger a migraine so it's this sort of a double-edged sword uh in terms of uh the the effect of caffeine but typically if i have somebody who's got migraines i get them off of all alcohol all caffeine uh and give them some magnesium just that's that you can shoot from the hip and just do that and you know you can make a big a huge impact so that was an interesting uh with the patient and this particular patient also had a history of developing an egg allergy at age 21 which was interesting like why you know what's going on why did all of a sudden develop an egg allergy in addition to that uh the patient said that they would develop the itching with eggs and then also had itching with bananas.

Starting point is 00:28:48 Oh, wow. Right. Which then sort of makes me think about, is there a problem with histamine and histamine detoxification? There are specific genes in the body that have to do with histamine synthesis and also histamine detoxification. And you can do some esoteric testing on that to see, because histamine, I definitely think plays a big role in migraines.

Starting point is 00:29:10 So what is histamine, Todd? Well, histamine is the drug, or not the drug, it's the compound that is naturally found in the body. And it is actually a neurotransmitter. It's also involved in allergies so when we have uh you know uh spring allergies or uh allergic rhinitis we treat that with an antihistamine right all right now this is sort of interesting and i'll talk about this one it's made by your white blood cells it's right it's well it's yeah it's made but it's also made by gut bacteria it's found in food it's it's uh made by the uh the white blood cells, specifically the mast cells. And there are certain receptors for histamine. So there's, I think, there's like four receptors for histamine.

Starting point is 00:29:54 And interestingly, when you block histamine, what happens to you? You fall asleep. You ever take Benadryl, right? That Benadryl puts you to sleep. So histamine actually activates the body. It wakes the body up. So itamine actually activates the body. It wakes the body up. So it actually works as a neurotransmitter. Also, it's involved in allergies and itching and things like that. So histamine is one of these things.

Starting point is 00:30:15 You get hives or things like that. You get hives, exactly. Yeah. So histamine definitely plays, it's one of the things that can play a role in migraine headaches. How do you approach a patient who's got histamine sensitivity? Well, you- How do you diagnose it first? Yeah, well- How do you treat it?

Starting point is 00:30:34 Well, one of the things that you can do is put somebody on a low histamine diet, because a lot of the foods that we take in can be high in histamine. Normally, our body will just sort of deal with excess amounts of histamine. But when the gut bacteria is out, like if you have SIBO, you'll have problems with histamine breakdown or histamine degradation, or certain bacteria will actually be making high levels of histamine, which in turn can affect the brain and your neurological system. Incredible.

Starting point is 00:31:03 Yeah. Yeah, I've seen histamine treatment when you do it in the right patient by both dietary changes. Also, there's all kinds of supplements that can help, like quercetin, even medication like cromalin, and people can take orally, you know, histis, which is various supplements that help with modifying the histamine response and getting the diet low in histamine people can really have radical transformations in their health it's not something most doctors think about or do yeah and it's tricky to do but it can be really effective

Starting point is 00:31:32 yeah yeah and this in this particular patient when i did the testing on him lo and behold he had significant uh sensitivity to gluten which he was totally unaware of and it never really worked with a nutritionist sometimes you know they say well i worked with a nutritionist. Sometimes, you know, they'll say, well, I worked with a dietician. And, you know, a regular dietician is, I mean, they're not really all that helpful. Having a nutritionist who's trained in functional medicine can really look at the diet beyond just, you know, calories and the macronutrient proteins, fat, and carbohydrates is very, very important. So in this particular patient, the organic acid testing showed a higher need for the B vitamins, showed some evidence of dysbiosis, which is imbalances of the gut bacteria,

Starting point is 00:32:17 had significant gluten sensitivity, some leaky gut on testing testing had low normal magnesium was technically normal but it was on the low side of normal so these are all the different things that you can fix and then on a stress testing had high levels of cortisol interesting it was very very interesting um and then uh the other thing that i found on the patient i'm not really sure because i'm actually still working on that because i was going to deal with that later, is high levels of mercury, very high levels of inorganic mercury in this particular patient. And then the other thing, which is also really interesting, is I did genetic testing. I like to do genetic testing because it can really sort of, it's like lifting the hood on your car. It can sort of tell you what's going on below the scenes. And the thing about genetics of migraine is

Starting point is 00:33:04 there's not really one migraine gene, and we can test for these SNPs and variations, but this particular patient had a variation in the genetics, the polymorphisms of a G-coupled protein, which has to do with serotonin and stress resiliency. So this person's genetic makeup was such that he was more prone towards the effects of stress. It was a particular gene called HTR1A, which is on the testing that we do with a DNA mind test. And I found that really sort of interesting. Otherwise, the patient had good genes, they had like good detox genes, good COMT genes, et cetera, but had problems with stress. And the patient's history was consistent with that, that stress was one of the big triggers

Starting point is 00:33:49 for that particular patient. So, you know, stress management is huge for everything that we see in patients who walk through the door. I mean, we're all, everybody is affected by stress. You know, we just, you watch the news and you get stressed, right? That's why I don't have a television. Exactly. And so anything that we can do to help people to manage and modulate and detoxify the stress goes a long, long way. Huge, huge, huge. I think that's right.

Starting point is 00:34:18 But you know, this case brings up something really important about functional medicine because you listed a whole litany of things. It wasn't just magnesium. It wasn't just the gut. It it wasn't just histamine it wasn't just this and that it was a lot of different things exactly and and you know functional medicine is really about being a medical detective and looking for all the various factors because traditional medicine is okay you have this one disease that you treat with one drug instead of saying oh where are all the imbalances in the system? Let me correct all those.

Starting point is 00:34:46 Because if you correct two out of six, patient might get a little better, but not really. Right. You have to deal with all six. Exactly. And I think that's really the beauty of functional medicine. We're not treating the disease, we're treating the patient and all their unique variations in their story. And there are no two people who are the same.

Starting point is 00:35:03 So, when someone comes with a migraine, it's a blank slate. then i have to figure out what kind of migraine and what are the various factors and is it hormonal is it magnesium is it the gut is it the mitochondria is it is it uh food additives and is it histamine and i'm and maybe all of them exactly right yeah and so this is really what's so beautiful about our approach here at the ultra wellness center uh which by the way now during covid we're taking all virtual patients. We can see people from anywhere in the world. You don't have to schlep all the way here. And we have an incredible team of physicians here and physicians assistants, nutritionists. We've all been doing this for close to 30 years now, which is scary to say.

Starting point is 00:35:38 But we've been- And we're still learning. And we're still learning. And it's just, you know, that's the thing about functional medicine. It's just, it constantly pushes you to discover and learn because yeah you're not just learning a rote approach to this diagnosis like like that patient who had the migraine with all the magnesium deficiency and all those other symptoms she was at the Mayo Clinic she saw the top doctors there she went around all the headache clinics in the world she I mean she saw everybody did

Starting point is 00:36:02 everything and all they cared about was her headache. They didn't want to know about her constipation or her muscle cramps or irritability or insomnia or any of that. Or stress being married to a mafia don. Well, no, that was somebody else. That was, that was not the doctor. That was somebody else. It was one of the good fellas. And, and so it's really, it's really important to be able to understand we're suffering out there from headaches and even regular headaches can respond to this as well but you know migraines are the most severe and disabling kind of headaches and i just i just remember this patient i saw was a 24 year old young woman who was a nurse who wanted to become

Starting point is 00:36:39 a nurse practitioner brilliant young woman who was in bed because she had vestibular migraines which is a certain kind of migraine that makes you not only have a headache and be nauseous but like the room spins around like when you're in your beach and you spin around circles so you can't stand up anymore it's like that and she was just miserable now she got every treatment for the migraines every kind of headache drugs every neurologist nothing worked so i started asking her about like other stuff well she was very depressed. She was anxious. She had severe bloating.

Starting point is 00:37:09 She had acne. She had fluid retention. She had all these other symptoms. And it turned out she had really severe SIBO or bacterial overgrowth and severe food sensitivities as well as a bunch of other stuff and magnesium and this and that. And I literally just really focused on treating her gut and her food sensitivities and supporting her a little bit of magnesium and some other things and literally within a very short time within six weeks she

Starting point is 00:37:36 not only like had all her migraines go away yeah not only did she lose 20 pounds but her depression anxiety and everything else went away yeah and the gut can lead to all that stuff so it's so unfortunate that we don't we don't think in this comprehensive way with traditional medicine because so many people suffer unnecessarily yeah it's interesting to talk about that because it reminds me um i i've actually um i think i've seen it in a couple of cases is there are some patients who have h pylori which is specific bacteria and h pylori if you clear. pylori, which is specific bacteria. And H. pylori, if you clear H. pylori in some migraine patients, their migraines go away,

Starting point is 00:38:09 which is sort of very, very interesting. It doesn't happen in everyone. But if you do the testing for H. pylori and if you find it and a patient's got migraine, you go ahead and treat it and it can make a big difference. Yeah. So I just think you're right, Todd. I mean, it's really just spending the time to ask the right questions, to do the right kinds of tests.

Starting point is 00:38:28 So what are the kind of top tests that you might think you want to? Well, like we said, checking for magnesium and specifically red blood cell magnesium, because magnesium needs to be the intracellular form. So a lot of times patients are tested for regular magnesium. It was the RBC magnesium is what you really should check for. And then we'll do the testing for gluten sensitivity.

Starting point is 00:38:50 The Cyrex-3 is my favorite. And then we'll also do testing for increased intestinal permeability, organic acids, gut microbiome testing can be helpful. I mentioned genetic testing, but there really is the genetics play a smaller role. But it's interesting because there really is no one gene for migraines. The only thing I would tend to say is that if you if you're suspicious for mitochondrial issues, checking for mitochondrial function, that can be helpful. That can be very hormonal testing. Yeah, hormonal testing.

Starting point is 00:39:22 Exactly. So we have a lot of tricks and tests that you wouldn't necessarily see at a regular doctor's office to help us sort through what's going on cortisol testing exactly testing yeah yeah hormone testing nutritional testing absolutely food sensitivity testing i mean it's it's so it's so so important so i i feel like when i see a migraine patient i'm so happy yeah right because i'm like oh so i'm done this is easy you know and they're going to be so happy and if me look good but it really isn't it really isn't that we're that smart it's just that we're looking through a different lens that allows us to see the problem in a unique way that's individual to that patient exactly personalized medicine it's it's it's it's the

Starting point is 00:40:00 epitome of personalized medicine because uh there are probably no two migraine patients that I will treat the same. They're all unique. And I'll do a little, you know, there's a sort of a basket of things that you'll do. But you tweak that to that individual patient based upon their history, their testing, and everything else. And that's the fun part about it. So what's like if you're just saying to somebody who's listening and they're like, well, I don't really know any functional medicine doctors. I want to just try some stuff on my own. What would be like the top few things you would

Starting point is 00:40:26 tell a patient to try? Let's say, you know, your cousin had migraines and they didn't want to come in and see you. What would you tell them? Well, first thing is get good sleep. Most people are sleep deprived and actually because lack of sleep is a stressor. And we talked about stress being a big trigger for migraines. So getting into a good sleep-wake cycle, modulating and detoxifying stress, meditation, whatever different forms that you use for relaxation. Adding magnesium. And then the simple dietary changes, gluten, sugar, dairy. Those are the big three. If you remove those from a patient's diet, it makes it, it can make a huge difference.

Starting point is 00:41:12 I think those are probably some of the key things that you can do. Yeah, I agree. I think it's so simple. Just clean up your diet, gluten, dairy, sugar, processed food, all the additives, chemicals. Yeah, right. You're absolutely right. Because the excitotoxins, a lot of those things that are added to foods that you may not even be aware of, the best thing to do is buy food that doesn't have labels on it, right? There you go. There you go. An avocado doesn't have a nutrition facts label or an ingredient list.

Starting point is 00:41:34 It's just an avocado, right? Right. I agree. So that's something people can try, an elimination diet. We have something called the 10-Day Reset, which is really easy to do. You can go to GetPharm an f.com that is is a really simple approach to just cleaning up your diet for a week or 10 days and often you'll know very quickly yeah i mean if your migraines are two or three times a month you might have to do it longer but if you get regular migraines every week or

Starting point is 00:41:56 more you'll see a difference magnesium's super slam dunk easy thing to do yeah getting stress reduction and sleep so easy and ever and the other thing is is that oftentimes for pay for some people who have really bad migraines you don't i sometimes you know it's not as though they're never gonna have a migraine the rest of their life but when they if they do get a migraine it doesn't it's not disabling it might be very infrequently and if they get it again it's very mild and it may be triggered by something but it's really nowhere near as bad as when they first started right so it's not like i'm gonna cure your migraines that and it may be triggered by something, but it's really nowhere near as bad as when they first started. Right.

Starting point is 00:42:25 So it's not like I'm going to cure your migraines. This individual may be susceptible to having migraines. For sure. And when you make all these changes, their life is much better because they cannot function. And if they get a migraine, it's not disabling. It's mild. It's infrequent.

Starting point is 00:42:39 It's not a big deal. And then they learn what are the triggers for that. Absolutely. And they can avoid them. Yeah. Yeah. Interesting. Have you ever had a migraine?

Starting point is 00:42:45 I have not. I've had some headaches, but I've never had a migraine. Thank God. It's interesting. It's not fun, I can imagine. Yeah. I very rarely get a headache and I've never had a migraine. However, when I was working at Canyon Ranch, there was one time, it was right before lunch,

Starting point is 00:43:01 I all of a sudden had these jagged, sparkling lines in my field of vision. Yeah. And I'm like, where does this come from? Having a stroke. What's going on? Right. So, I was actually having, because migraines, you can have an aura with a migraine. An aura is like what you get before you get a migraine.

Starting point is 00:43:18 And for whatever reason, I only had it once. I had a migraine aura. And I didn't get a headache. But I knew exactly what it was. And I said, oh only had it once. I had a migraine aura and I never, I didn't get a headache, but I knew exactly what it was. And I said, oh, this is interesting. Now I know what the patients are experiencing before they get a migraine. And I had it once, didn't have a headache, never had it again. Don't ask me why I had it.

Starting point is 00:43:36 You know, it could have been, maybe I was, you know, low in blood sugar or I don't know, stressed out or I don't know what, but I was just sort of sitting there and I was in it. It was, it was, it was, it was a good experience because now i can understand what it's like for a person to uh you know have a migraine aura well if you've been listening this podcast and you've had headaches or migraines um don't fret because following these simple ideas can have a profound effect if you get stuck and you need more help we're here at the ultra wellness center to help you just go to ultra wellness center.com we can see you virtually and it really sometimes it's a bit of a detective job but uh simple things to try like we said diet elimination diets magnesium sleep

Starting point is 00:44:14 stress reduction certainly a place to start uh it is something that um it's caused so much suffering i mean 10 million people have it probably collectively it costs 50 billion dollars a year to society it's a big deal and costs $50 billion a year to society. It's a big deal. And some things are hard to deal with. If you have certain cancers, that's really tough. But migraines are easy slam dunk for functional medicine. So if you have a migraine, I hope you never have to have it again after listening to this.

Starting point is 00:44:39 And follow the instructions we gave. And if you love this podcast, we'd love you to share with your friends and family on social media. We love you to leave a comment, share your experiences about having migraines and what's worked for you and subscribe wherever you get your podcasts. And we'll see you next time on The Doctor's Pharmacy. All right. Thank you, Mark. Hey, everybody. It's Dr. Hyman.

Starting point is 00:45:03 Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter.

Starting point is 00:45:19 And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash PICS, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance

Starting point is 00:45:51 my health and get healthier and better and live younger longer. Now back to this week's episode. Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

The Dr. Hyman Show - House Call Highlight: The Functional Medicine Approach To Ending Migraine with Dr. Todd LePine

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