by Josh Turknett, MD
If you have migraines, listen up.
Why? Two reasons:
Reason #1: What I discuss here could very well have a major impact on your health both now and for the rest of your life, AND…
Reason #2: It’s very unlikely you’ll encounter it anywhere else. Meaning, if you miss it here, you probably won’t run across it anywhere else….at least not for a good while.
Some of you may know that eliminating gluten from the diet can pay powerful dividends for migraine prevention. But here I’ll be digging further into the connection between migraines, gluten, and gut health – to help explain why, for the migraineur, there are compelling reasons for avoiding gluten beyond the realm of migraine prevention.[NOTE: Long post below. As you may know, I share with you EXACTLY what I do as a neurologist and migraineur who happens to care a heck of a lot about both migraine prevention and the long term health of my brain.
So, if you care about such things, but don’t currently have the time or inclination to read it right now but still want the lowdown, skip to the summary box at the end. Either way, just make sure you don’t brush past it on your way to the next cat video :).]
“UBOs”: To Freak or Not to Freak?
If you have migraines, and you have had an MRI scan of your brain, there’s a reasonable chance that you were told you had them. Or you had them but your doctor, who didn’t know what to make of them and didn’t want to freak you out, didn’t mention them to you.
What were they? Unidentified Bright Objects (UBOs).
Also sometimes referred to as things like “bright spots,” “white matter abnormalities” (WMAs), “white matter spots,” “lesions,” or sometimes just plain ol’ “spots,” they’re basically parts of the brain that are brighter than they’re supposed to be on a particular kind of MRI scan. And they’re most often found in the deeper parts of the brain known as the “white matter.”
These spots in the migraine brain look virtually identical to the spots we see in other conditions like stroke and Multiple Sclerosis (which means we have to use other information to make those diagnoses).
Here’s what these guys look like:
For reference, here’s what a normal, UBO-free brain looks like:
Studies have revealed these type of abnormalities in the deep white matter are not only more common in migraineurs, but that the severity correlates with the frequency of attacks – i.e. the more migraines you have, the more likely you are to have more of them. 1
Like I said, nobody really knows what these things are, or what they mean. So the typical reaction is to shrug the shoulders and move on.
For example, in an October 2013 meta-analysis in the journal Neurology which revealed a link between migraines, white matter spots, and brain atrophy, the authors state in the conclusion that “patients with White Matter Abnormalities (WMAs) can be reassured.” 2
I’m not sure that’s the way to go.
For starters, I’m not crazy about junk in my brain that shouldn’t be there. Plus, there’s other evidence that indicates that WMAs SHOULD BE cause for concern.
Such as this: a 2010 study in the British Medical Journal analyzing 43 trials from 1966 to 2009 concluded that having these white matter spots on the brain “predict an increased risk of stroke, dementia, and death.” 3
You find that reassuring? Me neither!
I don’t know about you, but stroke, dementia, and death are the sorts of things I’m trying to avoid. And if there’s something I can do to avoid those things, I’d like to know!
In my opinion, UBOs are a sign of something potentially quite significant and, perhaps more importantly, I think they’re potentially preventable.
Maybe, just maybe, those bright spots are shining a light on something sinister happening in the body and brain of the migraineur, beckoning us to take notice and change our ways. Lemme explain…
Clue or Coincidence?
As I mentioned, these MRI findings in migraine can be virtually indistinguishable from MRI findings in Multiple Sclerosis, atherosclerosis (a.k.a hardening of the arteries), and stroke.
But we know that, in the case of migraine, these findings are not from Multiple Sclerosis or hardening of the arteries.
There is, however, another condition where we see these vexing spots. And in that condition as well, we don’t really understand what to make of them. What condition?
Celiac disease, also known as “gluten intolerance,” happens when the immune system attacks the intestines in response to gluten in the gut (specifically, the gliadin protein in gluten). In simple terms, consumption of gluten leads to inflammation in the intestines, leading to gastrointestinal distress, along with breakdown of the intestinal wall.
The scientific term for what happens here is “increased intestinal permeability.” The popular, and equally descriptive, term for it is a “leaky gut.” 6. When the gut is leaky, stuff that should stay outside the body gets inside the body.
When stuff gets in that should stay out, the body recognizes that it doesn’t belong, and the immune system (the body’s system for eradicating invaders) attacks it. This then leads to widespread inflammation in the body, along with an increased risk of all manner of autoimmune illness (in fact, there’s an emerging theory that a leaky gut is the root cause of all forms of autoimmune disease. 5).
Here’s a cartoon-ified rendering of a normal, healthy, leak-free gut:
And here’s how things look when the gut is leaky:
For our purposes here, the most important thing to remember is that, in those with Celiac disease, eating gluten causes a “leaky gut.” And a leaky gut, in this case caused mainly from gluten consumption, is behind all the other badness that then ensues with Celiac disease. Fortunately, by avoiding gluten, one can escape all that badness.
That badness includes a host of potential neurological effects, including a significant increase in the prevalence of white matter spots.
Here’s a brain MRI from a patient with Celiac disease:
What’s more alarming is that these abnormalities are primarily found in those who have both Celiac AND migraine.
Importantly, treatment of Celiac disease with a gluten-free diet, which heals the gut, greatly improves migraines in those with Celiac. In one study of 10 Celiac patients with white matter spots AND migraines with aura, a gluten-free diet led to the complete elimination of headaches in 7, and significant improvement in the other 2 (the 10th patient wouldn’t try the diet(!)). 7
Furthermore, in those who lapsed and went back to the gluten, the MRI findings worsened.
In other words, in Celiac disease, fixing a leaky gut fixes the migraines. Making the gut leaky again brings back the migraines and the spots in the brain.
So here we have strong evidence for at least one situation where a leaky gut causes both migraines and white spots on the brain.
Door Number 2
Now, we know that all the systemic effects of Celiac occur by way of the gut. Stuff gets into the body that shouldn’t be there, and all hell breaks loose.
But the brain is different. The brain is special. The brain is supposed to be walled off from the rest of the body through something known as the “blood brain barrier.”
Like the name implies, in the brain there’s a barrier between the blood and the brain. And stuff can’t get across that wall unless it’s carried across by special blood-brain ferries.
So, if we’ve opened a bad guy portal into the body inside the gut, those bad guys still don’t have a portal into brain, thanks to this wall. Even though those white spots look like a reaction to bad guys in the brain, the blood-brain barrier should keep that from happening.
Unless…there’s a leak in the wall.
Migraine and the [leaky] Blood-Brain Barrier
Recent evidence shows us that there are certain situations in which that wall becomes leaky. One such situation? Migraine.
Migraine is a many-armed beast, as you may know, meaning there’s a cornucopia of physiological changes occurring when the beast comes to town.
One of those arms involves what’s known as “neurovascular inflammation.” Nerves at the base of the brain that are activated during a migraine send a signal to the blood vessels they connect with to release inflammatory substances. The resulting inflammation then triggers breakdown in…the blood brain barrier. 4
And a leaky blood brain barrier means stuff can get inside the brain that shouldn’t be there.
What happens when stuff that doesn’t belong there gets inside the brain through a leaky blood-brain barrier? The same thing that happens when stuff that doesn’t belong inside the body gets inside through a leaky gut.
The immune system attacks it.
In this case, it’s the cellular guardians of the brain known as the microglia that do the attacking. The microglia attack as the first line of defense, then call for further reinforcements to finish the job, which ends up triggering more inflammation.
More inflammation means more breakdown of the blood brain barrier, allowing more invaders in, activating more microglia, causing more inflammation, and so on. It’s easy to see how the sinister combination of a leaky gut and migraine could lead to a state of chronic inflammation, and that our enigmatic spots are the MRI signature of such a process.
Gut Health for the Environmentally Sensitive
It’s widely accepted (and inherently obvious to the typical eggshell-walking migraineur) that the migraine brain is extra sensitive to the environment. And nowhere is this sensitivity more significant than in the food that we eat.
As such, the last thing anyone with migraines needs is a breakdown in his or her defenses against the external environment. From this point of view, it’s no wonder that behaviors that promote a healthy gut barrier (and the avoidance of foods that disrupt that barrier) protect against migraines.
In other words, a healthy gut means a life with less skull crushing head pain.
But the benefits of a healthy gut (of which gluten avoidance is a critical piece), as the above discussion suggests, may extend well beyond its head-pain protection properties. For the migraineur, a healthy gut may spell the difference between maintaining a solid wall of defense between the outside world and your brain, or rolling out the red carpet for all manner of badness to enter.
So, if we were to summarize all of the above in the form of an equation, it would be:
LEAKY GUT + MIGRAINE = CHRONIC INFLAMMATION/SPOTS ON MRI = INCREASED RISK OF MORE MIGRAINES, STROKE, DEMENTIA & DEATH
“That’s all a bit concerning. Are you sure about this?”
The above discussion is based on the assimilation of evidence from a few different areas. Is it possible that some of these links, compelling as they may be, are coincidental? Yes.
Is there enough here for me, as a neurologist and migraineur, to consider gut health as a fundamental component not only of migraine prevention, but of the prevention of other forms of unwanted brain disease? Absolutely.
And given that it will likely be many, many years until we have a definitive answer to these questions, I’m not comfortable with sitting around and waiting before I do anything about it.[RELATED: If you want to eat exactly the way I do to prevent migraines, leaky gut, freaky brain lesions, dementia, and death, click here to check out Primal Provisions, our weekly meal planning service.]
Now, to summarize everything, and for those of you who skipped ahead for the lowdown, here it is:
What are the cornerstones of maintaining a healthy gut? More on that soon. Subscribe to the Migraine Miracle email list below to ensure you don’t miss it:
1. Kruit MC, van Buchem MA, Hofman PA, Bakkers JT, Terwindt GM, Ferrari MD, Launer LJ. Migraine as a risk factor for subclinical brain lesions. JAMA. 2004 Jan 28;291(4):427-34.
2. Bashir A, Lipton RB, Ashina S, Ashina M. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013 Oct 1;81(14):1260-8.
3. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2010 Jul 26;341:c3666.
4. DosSantos MF, Holanda-Afonso RC, Lima RL, DaSilva AF, Moura-Neto V. The role of the blood-brain barrier in the development and treatment of migraine and other pain disorders. Front Cell Neurosci. 2014 Oct 8;8:302.
5. Visser J, Rozing J, Sapone A, Lammers K, Fasano A. Tight Junctions, Intestinal Permeability, and Autoimmunity Celiac Disease and Type 1 Diabetes Paradigms. Annals of the New York Academy of Sciences. 2009;1165:195-205.
6. Arrieta MC, Bistritz L, Meddings JB. Alterations in intestinal permeability. Gut. 2006;55(10):1512-1520.
7. Hadjivassiliou M, Grünewald RA, Lawden M, Davies-Jones GA, Powell T, Smith CM. Headache and CNS white matter abnormalities associated with gluten sensitivity. Neurology. 2001 Feb 13;56(3):385-8.