Many migraineurs have had the experience of the Beast visiting after they delay or miss a meal. But does hunger, or “low blood sugar,” actually trigger migraines? Or is there a hidden culprit?
In this episode, Dr. T reviews what happens in the body during fasting, including the surprising effect it has on migraines.
- The Migraine Miracle Resources
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- The Migraine Miracle Facebook Group
Howdy, folks. So in today’s episode, which is a Question of the Week episode, I’m going to be covering a topic that’s probably familiar to many of you, and that is the concept of hunger headaches, or migraines that come on when you’re hungry. I’m sure many of you had the experience where you’ve gotten really hungry, you couldn’t eat for whatever reason for a while, and then later on, you were visited by the beast.
So like I said, sometimes folks will refer to this as hunger headaches. This phenomenon has naturally led to the idea that these are headaches that are being triggered by not eating, or sometimes folks will attribute them to low blood sugar, assuming there that not eating has led to low blood sugar.
While it’s completely understandable why folks would reach that conclusion, I’m going to give you an alternative viewpoint on that today, as I think that this explanation for the phenomenon is typically wrong. The problem with it being wrong is that it oftentimes leads people to do things that either make the beast more likely to visit, or that will make him more intense when he does visit.
So in today’s episode, I’m going to be talking about this phenomenon of hunger headaches or hunger-related migraines and digging in to what I see as their root cause, as understanding them requires us to understand some fundamental concepts related to how we protect ourselves from the beast and also clearing up some misconceptions about blood sugar and about the effects of fasting on the body.
I think you’re going to be surprised to learn that all is not what it seems when it comes to this topic.
So this came, again, from a question that was submitted by one of our Migrai-Neverland members and for a recent Clinic Chat. For those of you who don’t know, the Clinic Chat is the weekly group coaching session we hold inside of Migrai-Neverland where our members submit questions in advance and then we gather for discussion around the topics they’ve proposed.
It’s one of my favorite things about the Migraine Miracle community as it allows us to dig deep into many topics that are highly relevant to the migraineur and for those who putting the Migraine Miracle plan into action.
So participation in those coaching sessions is one of the many benefits of Migrai-Neverland membership, and each week all of our members also receive the Chatter, which is the complete transcript of those group coaching conversations.
To learn more about that and all the resources that we offer inside of Migrai-Neverland, you can go to MyMigraineMiracle.com and just click on the Resources link on the top menu. Don’t forget that as a podcast listener you get a special discount, so enter the discount code MOMENT when you register, which will give you $30 off of your first six months as a thank you for being a podcast listener.
Also, our next 30-day challenge is our Keto Blast Challenge, which is our 30-day keto diet. It is beginning on August the 13th, so to learn more about it and to register you can go to KetoForMigraine.com. If you are listening past that start date, you will find the date for our next Keto Challenge.
Okay, so as I mentioned, this week’s episode is about a question I received as part of our recent Clinic Chat that came from one of our Migrai-Neverland members, Anne, and Anne wrote: “I have been reading a lot lately about longer-term fast for autophagy, cancer prevention, improving the gut microbiome, etc. The recommendations seem to be to water fast for four to five days to reap the benefits. I was tempted to try it after having fasted 36 hours for a starve and sink, but feared the longer duration might reawaken the beast.”
So this is a really good question. In the beginning, she mentions there that recently there has been more and more evidence emerging about the benefits of longer term fasts, so fasts that last anywhere from perhaps 3 to 10 days, and she mentions autophagy and cancer prevention as one of the key benefits. So autophagy refers to the clearing out of damaged or dead cells.
One of the issues with cancer is that the cells that become cancerous accumulate damaged or pre-cancerous changes over time and fasts are a way of allowing the body to identify and clear out those pre-cancerous cells. So that’s one of the potential benefits, and there are several others that are emerging.
So Anne here is wondering if she were to engage in one of those longer term fasts, could that be a problem in particular by bringing on the beast. So that’s a great question, and it will allow us to explore some facets of metabolism that can either increase or reduce our vulnerability to the beast.
She also mentions there that she has had success with what we refer to as the starve and sink approach, which is one of the 11 drug-free strategies for ending a migraine that I’ve written about previously and is my personal approach to ending a visit from the beast without drugs. If you want that guide to the 11 drug-free strategies, I will post a link to it in the show notes for this episode. You can find the show notes for this episode by going to MyMigraineMiracle.com/Moment.
So back to the starve and sink approach. So a couple of years ago when I was exploring the drug free strategies for migraine in-depth, I would induce a migraine to try to figure out which ones of these work the best. I won’t go into too much depth here, but one of those strategies was simply to fast or not eat until the beast was gone.
That’s the starve part of the starve and sink approach, the idea being to starve the beast or deprive it of energy, to not add any additional energy to the body that would support the perpetuation of migraine physiology in the brain. Then the second thing I would do whenever possible would just be to exercise, in particular, low intensity exercise like a light jog. So this is the sink part of the strategy where we’re trying to divert energy elsewhere away from the parts of the brain that are producing the migraine and to the muscles instead.
So my ultimate goal with this strategy is to accelerate the shift from burning sugar to burning fat for energy, which will create an unfavorable metabolic environment for migraines. This is a really important concept and one that is relevant to this discussion today, so I’ll come back to it in a minute. The initial motivation for trying all of these came from the observation that eating during a migraine, especially things that were higher in carbohydrate often amplified the pain considerably after about 30 minutes to an hour.
So the starve and sink has now become a favorite technique for many folks in our migraine miracle community, and it’s one for those who know about the phenomenon of hunger headaches seems to be really counterintuitive at first until they try it.
I think that after this discussion, it will no longer seem counterintuitive as to why this can work and why there can be such a thing as hunger headaches still. I think you’ll have a much better understanding of why this particular approach works so well.
I will be doing a podcast episode specifically about the starve and sink strategy in the future as we do get a lot of questions about it. But I can’t tell you the peace of mind that comes from knowing that I can end an attack from the beast without a drug and never have to risk going down the dreaded spiral into rebound headaches.
But, like I said, for most migraineurs, especially those who’ve experienced migraines when missing a meal or when they have perceived low blood sugar, this idea that fasting could be beneficial at all seems counterintuitive and it’s natural to think that if you were to engage in a prolonged fast like Anne talks about in the original question, that could be risky from a migraine standpoint.
But, like I said, here’s this approach, the starve and sink, that involves not eating, one that’s worked incredibly well for me and for many others in ending an attack from the beast, yet by the same token you may believe that missing meals and not eating is a trigger and that eating in those situations is the right thing to do.
So how can we reconcile all of these observations and put this together into something that makes sense? So to help us understand the relationship between food, hunger, energy and migraines, let’s revisit the topic of homeostasis or the maintenance of stable conditions inside the body.
This is a concept that is central to understanding why our modern environment has created an epidemic of migraine and how we can modify our environment to rid the beast from our lives.
So, as I said, homeostasis refers to maintaining stable conditions inside the body, and this includes things like body temperature, heart rate, respirations, mineral balance, fluid balance, and so on. The hypothalamus is the part of the brain that’s in charge or regulating all of these. So it’s what coordinates all the various activities in the body so that homeostasis is maintained.
Another domain of homeostasis is the maintenance of a stable amount of available energy circulating through us. So obviously this is a really critical thing as without energy we will die.
What’s also important to understand here is just as it is with body temperature or our heart rate or the concentration of potassium in the blood, and so on, we can either have too little or too much of a thing, and that includes energy. So there can be too little energy and there can also be too much. In other words, there’s an ideal range or window for everything including energy.
It’s the job of the hypothalamus to make sure that all of these things stay within their ideal range. The reason why this is so important for migraineurs, as I’ve talked about in the book and on this podcast, is that there is a lot of evidence that indicates that the hypothalamus is the place in the brain where migraines begin.
Furthermore, that the migraines begin during times when the hypothalamus Is under stress, when we’ve overwhelmed its capacity to maintain homeostasis. So the big migraine triggers, like poor sleep, stress, dehydration, all result in major homeostatic disruptions or major stress to our hypothalamus.
That includes disruptions in energy homeostasis. So now let’s talk about what’s happening in the domain of energy homeostasis for the typical modern human eating a typical high-carbohydrate diet, one that’s way higher in simple, easy to digest carbohydrates than that of our ancestors.
So a typical day for a modern human, especially in the west, will begin with a big dose of carbohydrates, usually in the form of bread and sugar, so the worst possible thing to eat first thing in the morning. Simple carbohydrates like this are poor in nutrients, but very high in energy.
So not only are they high in energy or energy-dense, but they’re also easily digested and absorbed, which means they will lead to a massive and rapid increase in the amount of energy that’s being added to the system. So with a typical high carb modern western diet, we’re constantly flooding the system with excess energy. Usually it’s far more than we’re able to utilize for our present needs.
Now, if everything is working okay still in the glucose regulation system, specifically if you aren’t pre-diabetic or diabetic, then that sugar will be rapidly cleared. That’s usually going to be associated with a rapid drop in glucose in the blood stream. We know that it’s these rapid drops in blood sugar that oftentimes lead to the feeling of ravenous hunger.
So that feeling is being generated directly by your hypothalamus because it thinks there’s an impending crisis of not having enough energy, so it’s telling you that you need to eat right now. Furthermore, that you-need-to-eat-right-now signal that the hypothalamus is giving you is a mistake. In this scenario, your body isn’t actually in jeopardy of running out of energy.
Typical human these days in the developed world has enough storage to supply energy for about two to three months without any food. The problem is our regulatory system for energy homeostasis didn’t evolve in a world where there are merely as many carbs, especially grains and sugars, which is precisely why it screws up our hunger and satiety cues.
So this is why we can be fooled into thinking we’re running out of energy which leads to this feeling of being really hungry. It’s during these dips that the beast usually visits, which has led to this concept of hunger headaches.
Now, if we go back to understanding migraines as the signal of a distressed hypothalamus, this makes sense because what we’ve done here is shocked our energy homeostatic system. First we’ve done it by spiking our sugar from a high carb meal and then second by rapidly clearing that sugar from the blood stream to prevent damage creating the perception in the brain that we’re running out of energy even though we’re not.
But to the hypothalamus, we’ve created a state of emergency. So the first really key point here is that the problem or the reason the beast has visited is not because we didn’t eat, it’s because we produced a major disruption in energy homeostasis.
Now, tragically, guess what typically happens next in this situation. So what do you typically want to do when you get ravenously hungry? Are you going to reach for a piece of celery or you’re going to reach for a box of crackers? Well, what’s going to give you the quickest hit of energy?
It’s going to be another hit of a simple carbohydrate. So the typical person in this scenario will reach for another food that’s high in simple carbohydrate, because, again, that will rapidly add energy to the system temporarily and quickly relieving hunger but starting this whole process all over again. Even worse, it will provide the beast with his favorite source of fuel, which is glucose, and migraines will intensify and the cycle will repeat over and over again.
But what most people end up concluding here is that the migraine came because they didn’t eat soon enough, even though eating, especially something high in carbohydrate, was probably the worst possible thing to do from a migraine standpoint. But remember, the problem was not that we had low blood sugar or that we were running out of energy, but rather it was the rapid drop in blood sugar, which was a direct consequence of eating an energy-dense, easily digestible nutrient poor carbohydrate meal.
If you’re eating a typical standard western diet, you’re doing this every day three times a day or more, and I think this is one of the central reasons why migraines are a disease of civilization only emerging in the context of modern diets and lifestyles.
When it comes to energy homeostasis, in particular, and the problems that we create in this area that lead to provoking the beast, the issue is virtually always going to be from putting too much energy into the system rather than too little energy.
So, as I mentioned, a 150-pound human with an optimal amount of body fat has enough stored energy to meet energy demands for about two to three months without any food. So that means that the typical person in the developed world is never even close throughout their entire lives to running out of energy or for too little energy to be a problem.
We’ve ended up developing some very peculiar ideas about how much we should eat that are partly cultural and partly because our modern diet screws with our energy homeostatic system so much, tricking our brain into the ways I described above into thinking we need to consume way more energy when, in fact, we have plenty of it stored away in our body.
While it is true that there are states or conditions that can lead to truly low blood sugar, these are from very specific medical conditions that would have their own treatment. So, in other words, this would only emerge under some type of pathology.
Okay, so now let’s get back to the question of fasting and review what happens to the body during a fast. So fasting has been part of human culture for a very long time. People have been engaging in regular fasts for either religious or health purposes, and our body is quite good at fasting.
Our wild human ancestors likely had to deal with extended periods of reduced food availability, particularly during times like winter, and so they probably thought very little of having to go without food for several days. They certainly didn’t adhere to a three meals a day every day routine, which is a recent cultural invention.
In the early 20th centuries, prolonged fasts typically for health purposes weren’t unusual and they were seen as a remedy for several conditions including chronic headaches. This was perhaps most famously reported in Sinclair Lewis’ book called The Fasting Cure, where he goes on and on about the many wonders of fasting, including how amazing it is that he no longer is suffering from chronic daily headaches.
Fasting was also used as a treatment for refractory seizures, so seizures that would come frequently. It was eventually hypothesized that maybe it was the ketone bodies coming during fasting that were causing the suppression of seizures. That’s what actually led to development of the ketogenic diet as a treatment for epilepsy.
So we’ve known for a long time that fasting and ketosis helped with various conditions, especially ones affecting the brain like epilepsy and like migraines. So to help us reconcile his observations that fasting can be a potent migraine remedy yet migraines tend to occur during times of intense hunger, let’s talk about what’s actually happening metabolically during a fast.
So if you recall, our body uses two primary sources of fuel. One is glucose or sugar and the other is fat or fatty acids. We know that the cells of the brain can also use ketones as a source of fuel. Overall, during a fast, what we’re doing from an energy standpoint is shifting away from burning sugar and towards fat.
So our body only stores a small amount of sugar, but it can store a very large amount of fat. So in the first 12 to 24 hours of a fast, we’re burning through our stores of sugar, which are in the form of glycogen in the liver and the muscles. So as our stores of sugar are being depleted, we are increasing the amount of fat that we’re mobilizing and burning for energy. The longer the fast goes, the more fat is being burned relative to sugar, and then the more ketones are being generated by the liver and being burned by the brain for energy.
Now, if we take a look at what’s happening from the standpoint of energy homeostasis or what the hypothalamus is having to manage in this scenario, during a fast, things are actually extremely stable. We’re not adding any energy into the system with food.
So the homeostatic system isn’t really being stressed at all and what we’re also doing is adding in the beneficial effect of ketone bodies in the brain. So we’re getting all the energy we need from the fat tissue and we’re not adding any extra energy to the system with food for the hypothalamus to have to regulate and figure out what to do with.
Now, if the fast were to go on long enough, of course, and we exhausted all of our stored supplies of energy, then things would become unstable again. But, like I said, it would take a couple of months of fasting for that to happen far longer than any of us fortunate enough to live in a place with a stable food supply are likely to ever encounter.
This is a recurring theme or a very consistent observation with migraines. So time and again we find that scenarios where the body is shifting away from carbohydrate metabolism or glucocentric metabolism and towards fat metabolism or adiposentric metabolism, that migraines go down. So this is well-documented in the weight loss literature, especially with gastric bypass.
So scenarios where you’re increasing their proportion of fat being burned for energy over sugar are associated with protection against migraines. We also see the same thing with the ketogenic diet. We also see the same thing in fasting.
Again, this makes sense when we understand things from the vantage point of energy homeostasis and how that’s impacted by the modern diet and how it’s impacted with an ancestral diet as well as with ketosis and fasting.
So two of the most protective things we can do from a migraine standpoint is, one, maintain stable energy in the system and the optimal way to do this is just to eat like a human, so eat whole foods, meats and vegetables and avoid processed and easily digestible carbohydrates, and to increase the proportion of fat to carbohydrates that are burned, both by establishing and maintaining metabolic flexibility and by minding our macronutrients or our proportion of carbohydrates, fats and proteins.
So now let’s get back to Anne’s original question where she asked about these more prolonged fasts that people are using these days and whether or not that would be risky from a migraine standpoint. Personally, for reasons that are hopefully clear, I don’t at all fear the onset of a migraine during a fast. That’s not to say that the beast won’t or can’t visit, but it won’t be because of the fast, because that is putting us in a state, of a metabolic state, where migraines are much less likely to occur.
Now, just as a caveat, this more prolonged fast that she’s referring to are typically on the order of 3 to 10 days. That’s where it seems that more of the benefits that can come from cancer prevention standpoint, which start to emerge. It’s generally recommended to do once of that duration under medical supervision, primarily to prevent certain rare complications that can arise with prolonged fasts, usually in the presence of specific medical conditions.
So, again, if you’re looking to do that sort of thing, it’s a good idea to consult with your doctor first. But that being said, fasting physiology starts to kick in at around the 16-hour mark, and so that’s when the benefits of it will begin to emerge.
All right, so just to summarize, number one, fasting is an amazing tool; one that I and many others now consider to be our ace in the hole if the beast does strike. Now, it’s the thing that gives me peace of mind that I know I can avoid ever going back into rebound hell. None of us is capable of fully eliminating illusionary mismatches from our lives, so the disparity between our modern lives and the lives of our wild ancestors.
There’s much we can do as I’ve talked about to minimize that mismatch, but we all live in the modern world and there are times when that mismatch is heightened and the beast might still strike.
So knowing that I have a tool that will not increase my risk of a subsequent visit from the beast gives me huge peace of mind. There are two key principles that help us to understand why fasting is so effective. One is that energy homeostasis becomes much easier to maintain the absence of food.
And, two, that our vulnerability to a migraine diminishes as the ratio of fat to carbohydrates that we’re burning for energy increases. That ratio is essentially as high as it can get when we’re fasting. So from a migraine standpoint, fasting puts the body in an extremely favorable metabolic state. But the good news is that we don’t have to fast to get those benefits as we can still behave and eat and live in ways that exploit those two key principles. Those are the three pillars of protection. Like I said, I do intend to do another episode on fasting, in particular the starve and sink strategy and the common questions that we get about it.
So a final question might be: “What should you actually do in this situation?” So what should you do if you haven’t eaten for a while and you’re starting to feel the beginnings of a headache? So how can you safely deal with this situation? As I said, the last thing we want to do is reach for easily digestible carbohydrate that will, again, spike our sugar and provide a nice source of fuel for the beast.
So what I’d advise in these situations is to eat something very low carbohydrate and typically a small serving and then wait. The reason for waiting there is to assess whether or not that bit of food that you’ve eaten is going to serve as fuel for the beast. What I would do is if I find that the headache escalates a little bit after eating that, then I would continue with the starve and sink strategy. If I felt like it improved, then I would go on and eat a regular meal.
If you’re at all skeptical about all this, try eating a regular high carbohydrate meal in this situation and see what happens in about 30 minutes to an hour. I can’t tell you how many times in my life I made this mistake where I would delay a meal, I would start getting really hungry, and then I’d reach for something high carb to satisfy that hunger and I would then get a massive migraine. My conclusion was always that, “Oh, I just waited too long to eat,” and I never realized that it was how I was responding to that hunger that was the thing that was bringing on the massive visit from the beast.
Okay, so that’s it for this episode of The Miracle Moment. Thanks to Anne for her great question. Hopefully this clears up some concepts about the relationship between fasting and migraines and hunger and energy homeostasis, and so on. If you have questions about these, please feel free to ask inside of our Migraine Miracle Facebook Group. Once again, you can find the transcript of these episodes in the show notes along with links mentioned by going to MyMigraineMiracle.com/Moment.
If you enjoyed The Miracle Moment, I would love it if you will leave a rating and review in iTunes. It really means a lot to me and it helps other people find out about this podcast. All right, thanks for listening. Now it’s time to go out and slay the beast.