The Dr. Hyman Show - The Functional Medicine Approach To Ending Migraine with Dr. Todd LePine

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. 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. Hey everyone, it's Dr. Mark. Well, the holiday season fast approaching, I'm already starting to plan some meals with family and close friends who are part of my quarantine bubble.

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Starting point is 00:04:32 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. 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.

Starting point is 00:04:59 But from a functional medicine perspective, they're probably the easiest things to treat. Wouldn't you say, Dr. Lapine? Absolutely. Yeah, Dr. Lapine? Absolutely. 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? The 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

Starting point is 00:05:32 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 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 know, they also call it a vascular headache. And I found it really is an interesting approach to know that each individual, their presentation for migraine is unique. The interesting thing is I would never treat two migraine patients the same because they all have different features.

Starting point is 00:06:08 So 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. You have a migraine that just describes people who have a certain type of headache with certain types of headache with certain types of symptoms like light sensitivity, noise sensitivity, maybe on one side, maybe visual pre-aura symptoms, nausea, vomiting. These are just the typical things.

Starting point is 00:06:37 Okay, you have a migraine. And then there's, 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 and exactly 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 yeah 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 uh at my uh advil or a leave or an excedrin uh you might take a trip tan uh you might take uh an opioid like imitrax or imitrax yeah imitrax exactly uh or opioids in

Starting point is 00:07:19 severe cases steroids in other cases so it's basically treated abortive therapy, which is when you get an attack, you treat that attack. And for people who get them more frequently, it's about trying preventive therapies. And they're all over the place. I found that actually quite interesting when I was looking at how do neurologists approach migraines, these headache neurology specialists.

Starting point is 00:07:43 And they use everything. They throw everything in there. They'll throw in beta blockers. They'll throw in calcium channel blockers. These are to prevent migraines. To prevent migraines, exactly. So the preventive role 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 migraines.

Starting point is 00:08:02 Debilitating. 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 gotta stay in bed and turn the lights off and just, you know, wait till the whole episode passes. And then other medications that are used

Starting point is 00:08:18 in mainstream medicine are anti-seizure medications. You know what I mean? You know, it's a- Antidepressants, seizure medications, blood pressure medications. Calcium, chanoblox, yeah yeah all the stuff that they're kind of throwing 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 you start just try this try that try this and I can't tell you

Starting point is 00:08:37 how many pages I've seen have been through the whole mill of these medications and it might help a little it might 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 so um 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 especially in women women are tend to have a little more i think uh in general women uh, I probably see more women with migraines as opposed to men. And then women also get menstrual migraines, which is another sort of flavor of migraines, which is another, probably related to estrogen detoxification. So it really is.

Starting point is 00:09:17 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. You know, 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. That's absolutely right. Because what, 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 you know neurological society

Starting point is 00:09:48 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 so difficult for people to get better oh yeah because they're not asking the right questions so in functional medicine we don't just name and blame which is what our mentor sydney 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 head hurts no that's not why your 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

Starting point is 00:10:34 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 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 what tell me what what are the things that you think of when you're coming to see these patients that could be driving the uh 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 when our body consumes food, we produce energy from that food in the form of ATP. And mitochondria are not really tested by

Starting point is 00:11:23 mainstream medicine. They are not really tested by mainstream medicine. They are not 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, to some degree, 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 uh mitochondria make energy in yourself so make energy yourselves in fact i've actually seen some patients interestingly who and i don't see uh i don't treat children but i've seen some uh 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.

Starting point is 00:12:14 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. Yes. Exactly. Right.

Starting point is 00:12:34 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 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.

Starting point is 00:12:55 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. 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. And when you look at some people who have migraine headaches, there are certain foods which can trigger a migraine.

Starting point is 00:13:30 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 are food and the brain. Yeah. I mean, it is. And it's such a big problem, Todd. You know, the amount of people with migraines there's 10 over 10 million people have migraines uh it costs about 17 billion

Starting point is 00:13:51 dollars a year to society and health care costs just direct health care costs that's medications emergency room visits hospitalizations doctor visits testing and then even managing the side effects and then and then the loss of productivity to employers because like you're saying is over 15 billion dollars 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 the mitochondria and let's just go to go down the

Starting point is 00:14:33 list of what are the the most common things because you know like there could be 29 things but there's a few that are really common stress stress stress okay tell us about stress and so so so so stress by itself does not cause any diseases but stress can turn the volume up on on all different kinds of conditions we see that in autoimmune conditions so how our bodies respond to stress and some people have um i would call it a genetic predisposition to be more stress resilient resilient and some people don't and some people are more prone to the effects of stress. And time after time, you know, you see these, these people who they'll go through a very stressful period and all of a

Starting point is 00:15:12 sudden they get a full blown migraine. Well, what, what is that? It's how, 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. Absolutely. And that's why, you know, beta blockers, which block adrenaline, which you get high levels of stress, makes a big difference. So things like yoga, meditation. Exactly.

Starting point is 00:15:32 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, you know, there are a lot of symptoms that people get

Starting point is 00:15:57 that could be related to leaky gut and food sensitivities, which seem to be a huge factor with migraines that are really undiagnosed. We know traditionally that, 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.

Starting point is 00:16:22 But it goes much deeper than that. There's like food sensitivities and gluten. So tell us about, you know, how that, 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 a there's definitely a two-way communication that's going on there and uh again you know uh sleep is another thing that plays a huge role so lack of sleep is is huge in migraines so when you look at uh 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

Starting point is 00:17:04 you know the what's 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. 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

Starting point is 00:17:25 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 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. Now, we found this on a food sensitivity test and that's not to say everybody's migraine is caused by eggs, but hers seem to be triggered by eggs.

Starting point is 00:18:02 She stopped the eggs and her migraines in a way. So I think everybody's different, like you said 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 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 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 uh with with um with migraines i mean i mean like exogenous chemicals like things like aspartame artificial sweeteners food additives sulfites for example

Starting point is 00:18:43 i would say that you know the those are basically excitotoxins there are certain types of foods which can uh cause excess activity like monosodium glutamate you get you know excess glutamine in the brain because glutamine gets converted into glutamate which is an excitotoxin so yeah definitely uh there are you know those those types of foods uh and even if you actually, if you give somebody glutamine, which we use a lot to help with patients. 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.

Starting point is 00:19:15 They'll get very agitated and get a headache. 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. I don't know if he's getting migraines, but he's giving everybody else a headache. But I think that you're right.

Starting point is 00:19:33 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 uh tyramine was in chocolate cheese these are really significant 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?

Starting point is 00:20:10 Oh, just by history. I mean, 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, our hormones tend to stay relatively stable. We are they go up in the morning and but they're pretty stable. Women's hormones, you know, they go up and down like the tides. And and that's normal. That's that's part of the the menstrual cycle. So when women are menstruating, they have these some women have great fluctuations in hormones. 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, one of the genes that's important in there is the catechol-O-methyltransferase or COMT gene. And typically that gene is oftentimes associated with increased sensitivity to pain. It's also associated with increased sensitivity to migraines, seizures, and headaches. So it's

Starting point is 00:21:16 definitely one of those pathways that you want to support for the detoxification or the methylation of- With B vitamins, like B6, B12. Magnesium. Magnesium. classification or the methylation of B vitamins like B6, B12, magnesium, magnesium, magnesium. And, you know, and often, you know, 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 cravings, irritability, breast tenderness, menstrual cramps, and they get heavy bleeding. And these are signs of sort of too much estrogen and not enough progesterone. Yep.

Starting point is 00:21:45 And 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, the company that made it. And I literally said, 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 over prescribe dietary

Starting point is 00:22:13 changes help with PMS he helps help detoxifying these hormones can be really helpful and also using 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 that worked for her was Xanax. Now, Xanax is a benzodiazepine, which is a tranquilizer. Yeah, like Valium, exactly. And it you know, a tranquilizer. Yeah. Like Valium.

Starting point is 00:22:51 Exactly. And it works on the GABA receptors. And guess what? 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 progesterone is women's natural Valium. 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, 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.

Starting point is 00:23:29 All those things can be managed easily with lifestyle and diet. 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, now this is also another thing

Starting point is 00:23:45 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.

Starting point is 00:24:00 It's a natural muscle relaxant. Yeah. It's actually, I remember, you know, when I was an ER doctor, it was one of the things we used. 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, you know, life-threatening ones like Torsade de Pointe and VTAC.

Starting point is 00:24:23 We also use it for status asthmaticus. Yeah. All right? You use it for preeclampsia. It's a very powerful element. It's a relaxant. And what you're saying is funny to me because I remember, you know, when you learn these ACLS courses, the advanced cardiac life support,

Starting point is 00:24:40 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? And then if someone's heart's not beating right, you give them magnesium and it fixes it. Or people are coming in in preterm labor or have this preeclampsia,

Starting point is 00:25:00 which is high blood pressure in pregnancy with seizures. They use IV magnesium. They use it as asthma, like you said, to relax relax the lungs they use iv 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 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

Starting point is 00:25:31 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 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 it 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?

Starting point is 00:25:58 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 said, that's not regular. She's like, it's regular for me. I go every week. You know, she's severely constipated, muscle cramps, headaches, insomnia, irritability,

Starting point is 00:26:11 anxiety, palpitations, sensitive and loud noises. These were 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 helpful because you mentioned mitochondria and there's

Starting point is 00:26:38 a couple of nutrients there that can really yeah i mean there's there's some, I think some of the key nutrients are vitamin B2. Riboflavin. Yeah, vitamin B6. And also CoQ10. 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 i had a patient uh who came in and his story was that he

Starting point is 00:27:11 first developed migraine starting around at the age of five which is interesting okay so so when you have a history of somebody who's having headaches i mean it's not normal for a five-year-old to have headaches that makes me sort of think okay this person may have a mitochondrial issue and that may be what's going on early on uh in their in their story um also interestingly the patient noticed in in uh in his in 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, it was a caffeine withdrawal headache. Right.

Starting point is 00:27:50 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, I'll never forget this,

Starting point is 00:28:07 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 withdrawal effect from the caffeine. So it was like a cat chasing a snail. That's not great because that's got talonidine. Well, it's great for the company because they keep selling it right

Starting point is 00:28:27 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 trigger a migraine so it's this sort of a double-edged sword uh in terms of uh the effect of caffeine but typically if i have somebody who's got migraines, I get them off of all alcohol, all caffeine, and give them some magnesium. You can shoot from the hip and just do that, and you can make a huge impact. So that was interesting with the patient. And this particular patient also had a history of developing an egg allergy at age 21,

Starting point is 00:29:05 which was interesting. Like, you know, what's going on? Why did Allison develop an egg allergy at age 21, which was interesting. Like, you know, what's going on? Why did Allison develop an egg allergy? In addition to that, the patient said that they would develop the itching with eggs and then also had itching with bananas. Oh, wow. Right. Which then sort of makes me think about, is there a problem with histamine and histamine detoxification?

Starting point is 00:29:22 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. 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 uh it is a 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 made by it's also made by gut bacteria. It's found in food.

Starting point is 00:30:08 It's it's made by the the white blood cells, specifically the mast cells. Exactly. And there are certain receptors for histamine. So there's I think there's like four receptors for histamine. And interestingly, when you block histamine what happens to you you fall asleep You ever to ever take Benadryl right? That's that Benadryl puts you to sleep So histamine actually activates the the body it wakes the body up So it's it's it's actually works as a neurotransmitter Also, it's involved in allergies and itching and things like that

Starting point is 00:30:40 So so histamine is it is it one of these things hives or things you get hives exactly Yeah, so histamine definitely plays. It things hives or things you can get hives exactly yeah so histamine definitely plays a it's one of the things that can play a role in in migraine headaches and uh with their how do you approach a patient with who's who's got histamine sensitivity well you you how do you diagnose it first yeah well you treat it his and 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.

Starting point is 00:31:21 Or certain bacteria will actually be making high levels of histamine, which in turn can affect the brain and your neurological system. Incredible. 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, histis, which is various supplements that help with modifying the histamine response,

Starting point is 00:31:50 and getting the diet low in histamine. People can really have radical transformations in their health, and it's not something most doctors think about or do. And it's tricky to do, but it can be really effective. Yeah. And this particular patient, when I did the testing on him, lo and behold, he had significant sensitivity to gluten, which he was totally unaware of. And it never really worked with a nutritionist. Sometimes, you know medicine can really look at the diet beyond just,

Starting point is 00:32:26 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 um had uh significant gluten sensitivity some leaky gut uh on on 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

Starting point is 00:33:10 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. I can sort of tell you what's going on below the scenes. And the thing about genetics of migraine is 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

Starting point is 00:33:54 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.

Starting point is 00:34:15 That stress was one of the big triggers for that particular patient. So, you know, stress management is huge for everything that we see in, in patients who walk through the door. I mean, we're all, everybody, everybody is affected by stress. 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.

Starting point is 00:34:34 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. 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, wasn't just the gut, it wasn't just histamine, it wasn't just this and that. It was a lot of different things. 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

Starting point is 00:35:08 one drug. Instead of saying, oh, where are all the imbalances in the system? Let me correct all those. 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.

Starting point is 00:35:23 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 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 Exactly. Right? Yeah. And so this is really what's so beautiful about our approach here at the Ultra Wellness Center, which, by the way, now during COVID, we're taking all virtual patients. We can see people from anywhere in the world.

Starting point is 00:35:54 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 to say but and we're still learning and we're still learning and it's just and you know you know that's the thing about functional medicine it's just it's constantly pushes you to discover and learn because yeah you're not just learning a rote approach to this diagnosis 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 everything and all they cared about was her

Starting point is 00:36:32 headache they didn't want to know about her constipation or her muscle cramps right or her 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 uh was one of the good fellas and and so it's really it's really important people to understand we're suffering out there from headaches and even regular headaches can respond to this as well uh 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 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

Starting point is 00:37:16 and be nauseous but like the room spins around like when you're on 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 uh severe bloating 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

Starting point is 00:37:57 magnesium and some other things and literally within a very short time, within six weeks, she 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 think in this comprehensive way with traditional medicine because so many people suffer unnecessarily. Yeah. It's interesting you talk about that because it reminds me,

Starting point is 00:38:28 I've actually, I think I've seen it in a couple of cases, is there are some patients who have H. pylori, which is a specific bacteria. And H. pylori, if you clear H. pylori in some migraine patients, their migraines go away, 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. So what are the kind of top tests that you might think you want to?

Starting point is 00:39:00 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. 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 an interesting, because there really is no one gene for migraines. The only thing I would tend to say is that if you,

Starting point is 00:39:41 if you're suspicious for mitochondrial issues, checking for mitochondrial function. that can be helpful that can be very hormonal testing yeah hormonal testing 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 uh 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 slam dunk this is easy you know and they're going to be so happy and make 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.

Starting point is 00:40:25 Personalized medicine. It's the epitome of personalized medicine because 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

Starting point is 00:40:48 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 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 meditation. Excuse me.

Starting point is 00:41:23 Relaxation. Relaxation. Exactly. Adding magnesium. use for uh uh excuse me uh relaxation relaxation exactly uh adding magnesium and then the simple dietary changes you know gluten sugar dairy those are the big three if you remove those from patient's diet it makes it can make a huge difference uh i think those are probably some of the key things that you can do yeah i 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, you know, the best thing to do is buy food that doesn't have labels on it, right? There you go.

Starting point is 00:41:58 Right, there you go. An avocado doesn't have a nutrition facts label or an ingredient list. It's just an avocado, right? Right, right. nutrition facts label or an ingredient list it's just an avocado right right uh i agree so you know that's something people can try an elimination diet you know we we have something called the 10-day reset which is really easy to do uh you can go to get pharmacy with 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 more you'll see a difference magnesium's super slam dunk easy thing to do yeah getting stress reduction

Starting point is 00:42:30 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 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 going to cure your migraines. This individual may be susceptible to having migraines for sure.

Starting point is 00:42:59 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, 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 00:43:13 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, 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?

Starting point is 00:43:38 Having a stroke, what's going on? 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 and for whatever reason it was i only had it once i had a migraine aura and i never did 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 you know it could have been maybe i was you know low in blood sugar i don't know stressed out 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

Starting point is 00:44:13 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 stress reduction certainly a place to start uh it is something that um has caused so much suffering i mean 10 million people have it probably collectively it costs

Starting point is 00:44:50 50 billion dollars a year to society it's a big deal and uh and some things are hard to deal with them you have certain cancers that's really tough uh 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 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.

Starting point is 00:45:15 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, thanks, Mark. Hey, everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast.

Starting point is 00:45:36 It's one of my favorite things to do and introducing you 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. 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.

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Starting point is 00:46:32 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

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The Dr. Hyman Show - The Functional Medicine Approach To Ending Migraine with Dr. Todd LePine

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