what supplements should migraineurs take, part 2

What Supplements Should Migraineurs Take (part 2)?

Are there any supplements that protect against migraine? In part 2 of this series on supplements for the migraineur, Dr. T reviews the evidence for therapeutic supplementation (click here for part 1).

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Hello, Beast Slayers. Welcome to another episode of the Migraine Miracle Moment podcast. Thank you for joining me. We are about to say goodbye to 2019 and we have a lot of exciting things coming in 2020, the first of which you will hear about this Saturday, an exciting announcement that will come also as an episode in this particular episode.

This is going to be part two of the series on what supplements migrants should take. So in the first episode, we talked about what supplements migrant workers should consider taking that would fall into the category of what I would consider true supplementation. So correcting for a potential deficiency and ones that would be particularly relevant for someone who is prone to migraines. So if you haven’t listened to that episode, you might want to go back and listen to it first. In this one, we are going to be talking about the other kind of supplementation, which you can think of as therapeutic supplementation. And I think it’s probably the case that many folks, perhaps even most who take a supplement, are actually doing so for this particular reason rather than to correct a deficiency. So rather than the true idea behind supplementation.

So in this case, with therapeutic supplementation, you’re trying rather than trying to correct a nutritional deficiency that we think exists for some reason we’re using a supplement essentially the same way we’d use a medication. So to achieve some kind of therapeutic benefit, thinking of the supplement as having some kind of medicinal value beyond just serving the basic needs that of human physiology.

And probably one reason so many people take supplements for this particular reason is because marketers have found it’s far easier to sell people something, something that they think will solve a particular problem rather than something they should do in the interest of their long term health, which is really the case with most supplementation. So just as a random example, people often take B12 and they do so to help with things like mental clarity or to well, to help with brain fog and someone who’s feeling tired and sluggish a lot will feel a lot more motivated to spend money on a B12 supplement if they think it will solve that problem. So in these cases, we’re essentially taking more than we need to meet our basic nutrient required requirements in hopes that it will achieve some particular goal. Yet there are very few instances where this is actually true. And most supplements that are marketed for things like this haven’t. We have never been shown to do the sorts of things they’re promoted as doing. Supplements are not under the same regulations as pharmaceuticals, which do have to produce research that backs their therapeutic claims and supplements do not. And this whole concept of therapeutic supplementation plays on our bias that more of something is better. So, for example, continuing with the B12 example, it is definitely true that a deficiency of vitamin B12 will cause cognitive impairments and low energy levels, but it is not true that taking extra amounts of it will give us extra cognitive powers or extra energy.

But it is this particular cognitive error that most supplement makers capitalize on this concept concept that more is better. Also, it’s worth pointing out here that no supplement or pill will ever hold a candle to what we can achieve with diet and lifestyle interventions. And it is naive of us to think otherwise. So the magnitude of their effect is going to be substantially less than those sorts of things or anything that we would do to strengthen the three pillars of protection against migraines. And furthermore, the benefits of any therapeutic supplement are likely to be magnified when the three pillars are already in order. And then these things like supplements, can be considered some of the final tweaks that you might make. And the reason I’m prefacing this discussion with these comments is because there’s actually only a very small fraction of the total body of supplements out there that are even worth considering as being possibly helpful. So I’m going to focus here on the ones that at least have some evidence of benefit for migraine prevention. And there are really just two that fall into that category. At one point, there were three that you might could say that about the third one being butterbeer. But because of issues that arose with liver toxicity, that one has been taken off as a recommended supplement for migraine prevention.

So that leaves two left. The first of those is riboflavin. And so riboflavin is one of the B vitamins. Specifically, it is vitamin B2 like most B vitamins. It has A has many different roles that it plays in the body. One of its most significant roles is in the production of energy at the level of the mitochondria. Now, it’s always nice when we think about taking something that we have some kind of biologically plausible. PRISM by which it could help. And in this case, there is evidence to think that that something like vitamin B2 could help with migraines. There is evidence that mitochondrial dysfunction plays a role in migraines. It’s still an area of early research, but there’s enough there to suggest that there that there could be a link. So riboflavin is an integral part of two COH enzymes S.A.T.’s and effin in Flavin adenine D-I nucleotide and flavin mono nucleotide that are part of the electron transport chain in the mitochondria. So this is the thing that essentially generates energy from food at the level of the cells. So it is necessary for energy production and defects in that process have been linked to migraines. So again, a reasonable link between taking vitamin B2 and improving migraines. So there are a handful of studies that have been done on riboflavin, as is the case with most supplements. There is not the same level of research that there is in pharmaceuticals since there is less money to be made from them.

But one randomized placebo study showed that fifty nine percent of subjects achieved greater than a 50 percent reduction in headache days, compared to 15 percent for those taking placebo. Additionally, there has been head to head studies against other pharmaceuticals that are used for Migrante prevention. There have been heads, a head to head studies with riboflavin compared to valproate or Depakote and propranolol or Inderal and those showed equivalency. So the same level of benefit is essentially seen with subjects getting either of those, and both of those are considered first line preventative treatments for migraines. Now, as you probably know, there is nothing available that has a major impact on migraine reduction. But at least we can say that based on the evidence that we have vitamin B to appears to be as good at preventing migraines as the best available pharmaceuticals that we have for doing so. Now, there does remain the possibility that vitamin B to exerts its influence through something known as the augmented placebo effect. And so this is something that I touched touched on a little bit in the book, The Migraine Miracle. So essentially the placebo effect occurs when the expectation that something you were doing or something you were taking, the expectation that it is going to help causes that thing to help. And we know that is a very well established phenomenon enough so that we have to control for it.

Anytime we’re testing a new drug, we know that there are going to be a percentage of people who will improve simply based on the placebo effect alone. Now, in clinical trials, the subjects and those conducting the trials are supposed to be blinded, meaning that the subjects and the researchers don’t know who is getting what drug. Yet one of the problems here is that if a drug has side effects, then the subjects may realize that they are actually taking the active form of the drug in most placebo trials, that placebos themselves are entirely inert. So they have no biological effects. So what this means is that if some of your subjects now recognize that they’ve actually gotten the active drug, that may boost the placebo effect even further. So if you look across all of the studies that have been done on migraine preventives, almost all of them have about the same benefit when compared to placebo. And all of them do have recognizable side effects. So it remains entirely possible that the augmented placebo effect, this effect of realizing that you’ve actually gotten the active drug and aren’t being given the placebo is accounting for that extra benefit. Now, it may occur to you that you could control for this by giving a placebo that did have some sort of side effect. So an active placebo, as it would be called. And this was actually done a few decades ago with the anti-depressants where it was speculated that perhaps some of the benefits being seen with antidepressant drugs over placebo was because of this augmented placebo effect, since those drugs had recognisable side effects.

And in fact, what they did show when they tested the available anti-depressants against active placebos was that in most cases the the effects of the antidepressants went away entirely. Now, unfortunately, since then, this has not been done, including in other trials where the augmented placebo effect may be playing a significant role. And this is a major limitation of many of the pharmaceutical studies. So what is the application here, dividing maybe two? Well, if any of you have taken vitamin B2, you know that it turns your urine a very bright yellow or orange color. And in fact, if you don’t realize that it’s doing that, it is very alarming at first. So even though these studies that have been done on vitamin. BE2 are supposedly blinded, meaning the subjects don’t know which medication they took. All they have to do is look in their urine to know whether they are getting the active form of the drug or not. So it remains entirely possible that with vitamin B too. As with all of the other migraine preventives, that the augmented placebo effect is at least accounting for some, if not most of the benefits of the above the placebo. Incidentally, this effect may also explain why the results in clinical trials of preventative medications always seem to exceed our real world experience.

So and why? The benefits always seem to be so great at the beginning when a drug is first released and when the hype is so high and then diminishes from that point in time, because as you’d expect, when there is a lot of hype, the expectations are at their greatest. And so you’re going to see the greatest placebo effects. We’re already starting to see this trend unfold with the new class of CGP medication. So I think every patient that I’ve had who went on one right from the start wanted to has reverted back to their baseline. So you can certainly make an argument that the augmented placebo effect accounts for a lot of what we see clinically. And so it may be no coincidence that the supplement that has arguably the best data on it also has a way that subjects can detect when they’re on it, when they’re supposedly in a double blinded clinical trial. But the upside is that there is minimal risk with taking vitamin B2 and the standard dose that has been recommended and testing tested is 400 milligrams per day. Also, it’s worth pointing out that our mismatched diets and lifestyles likely does lead to mitochondrial dysfunction in substantial numbers of people. So it could be that in some folks who are having mitochondrial dysfunction, taking vitamin B may mitigate that to some degree. So in that way, at least addressing one of the root causes here of an increased vulnerability to migraines.

And then the second supplement worth considering along the lines of therapeutic supplementation is magnesium. Magnesium is a mineral that is enormously important to human life. We can’t live without it. And it is involved in virtually every part of human physiology. And for several years now, we’ve known of some intriguing links between migraines and magnesium. And the studies that have been done appear to indicate that there are low levels of magnesium or ionized magnesium in the nervous system in migrant workers, or at least a subset of miners, including during a migraine attack and maybe specifically during that time. There’s also some evidence that giving high dose i.v magnesium is an effective abortive treatment, possibly by mitigating this particular effect. We rarely see it used in clinically like in the emergency department, in large part because there is no pharmaceutical companies to promote its use. Additionally, there is also evidence that supplementing with magnesium can help reduce migraine frequency. And again, the numbers that have that we see in trials are in line with what is seen with other preventives in the typical dose that’s been used is 400 milligrams per day. It’s worth noting that the form of magnesium that you take matters so you can’t take plain magnesium. It comes as a salt, meaning it’s bound up with another element and there are several to choose from here. They’re things like magnesium oxide, which which is poorly absorbed magnesium glycol 8 like an eight appropriate eight Malé.

The one that I’ve taken in that I typically recommend is Magnesium 3 and 8 because it has the best penetration into the nervous system, at least according to the studies that we have. The other good thing about the advantage of my magnesium is that it has minimal downsides. So we’re actually limited in how much we can absorb through the GI tract. So you can’t really overdose on it. The excess will be extra excreted and many of you may know that magnesium is also given as a laxative. So once you exceed the amount that can be absorbed, it works as a lacked laxative. So it’s essentially self-limiting in the amount that you can absorb at any one time. It’s also worth mentioning that when you are measuring magnesium on an bloodwork, what you’re getting is the extracellular magnesium and this does not reflect the amount that is stored in the body. So you can have an entirely normal result and still have insufficient stores of magnesium in the body. And in fact, magnesium deficiency is one of the most common deficiencies that people have these days on the standard Western diet. So it’s possible, I think, that there are two things going on with this link between migraines and magnesium, one being that the migraine process itself results. In reduced amounts of extracellular, magnesium in the nervous system, again, I mentioned that there are studies that show that there are reduced levels during a migraine attack and we know that there are massive shifts in the flux of ions in the brain during migraines, especially during the cortical spreading depression phase.

So it’s certainly plausible that the changes seen in magnesium during a mine migraine are a consequence of that flux and then helping the body to restore magnesium equilibrium with an I.V. infusion. Maybe why it’s helping in that circumstance. And then the other thing that may be going on with this link is that a deficiency of magnesium, which I said is pretty common these days, predisposes folks towards migraines. So in that case, correcting that deficiency by taking a supplement would improve that particular vulnerability. Now, it’s important to note here that this is still very much an evolving science. So the link between magnesium and migraines still hasn’t been definitively established, nor do we know with any precision the nature of this particular link in the interaction here. As with most things in biology, especially when we’re talking about the level of cellular and neuronal action interactions and ion fluxes and so forth, there’s still far more we don’t know than we do, but we can still make some reasonable decisions based on the things that we do know and the things that we can’t be fairly certain of. And so when it comes to magnesium, first and foremost is it’s best to ensure that you’re getting plenty of magnesium from the diet. Like I said, I suspect that when it is helpful as a supplement, it’s helpful because it is correcting for a deficiency.

So if you’re getting enough in the diet, you won’t have that deficiency to begin with. Some of the best places to get it in the diet are organ meats, leafy greens, though it is less bio available in plants than it is in animal foods. Some fish or high magnesium like salmon and halibut. And then nuts are also high in magnesium. Again, less bio available and sometimes a little bit problematic for the migrant or especially depending on what phase you’re in. On the timeline of migraines, freedom. So again, best to get from the diet, but if you want to hedge your bets and take a supplement, probably not an unreasonable thing to do as well. So getting back to our original question, is there any evidence that there is such a thing as a therapeutic supplement, at least with respect to migraines? In the answer there, maybe, maybe not. So like I mentioned, for vitamin B B2 taking amounts in excess of what you need to meet your normal requirements has been shown to be helpful against placebo. However, it’s entirely possible that that could be accounted for on the basis of the augmented placebo effect rather than a direct effect of the BE2 itself. And then with respect to magnesium, it’s entirely possible that in that case what we’re actually seeing is that magnesium is correcting for a deficiency. Given that we know that magnesium deficiency is very common these days and it’s not easy to test for.

So it’s not something you can just detect on a regular blood test. As I said, the benefits of vitamin B2 could conceivably be accounted for based on the augmented placebo effect alone because it turns your P orange and none of the trials required subjects to pee with blindfolds on. So we don’t know the answer to that question. So all in all, as I talked about in the beginning of this two part series, most important is going to be building the three pillars of protection against migraine. And I do know with certainty that you can move from phase one to phase four, which is our goal on the timeline of my reign, freedom without having to take any supplements of this nature and by simply building the three pillars of protection. And for me, the main scenario where I’m recommending people to take these particular things is in someone who is not willing to make diet and lifestyle changes that would build the three pillars. So the same scenarios where I would typically recommend a judicious use of a pharmaceutical. OK. That’s it for this episode. You will find links to the supplements that I mentioned, including the ones that I’ve taken myself and you typically recommend in the show notes as well as by going to the Web site and you’ll find the transcript of the this episode and all others by going to my migraine miracle dot com and clicking on the podcast tab on the top menu.

I hope everyone has a safe and wonderful New Year’s and I will be back with you soon this coming Saturday with a very exciting announcement. So don’t miss out on that. All right. Thanks so much for listening. Now it’s time to go out, slay the beast.

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LINKS MENTIONED: 

Riboflavin – Amazon link: https://amzn.to/39uAH1W

Magnesium Threonate  – Amazon link: https://amzn.to/2SJiW95

Migraine Miracle Facebook group (come take part in our month of gratitude!) : https://www.facebook.com/groups/899131986822364

The 9 Primary Migraine Miracle RESOURCESmymigrainemiracle.com/how-we-can-help/

MIGRAI-NEVERLAND, our premier resource for those who want to find their pill free path to migraine freedom (including the Beast Slayer Training Academy): mymigrainemiracle.com/endofmigraine

The Beast Slayer Training Academy

The 2019 Schedule of Migrai-Neverland Challenges: https://mymigrainemiracle.com/schedule

The book that started it all – The Migraine Miracle: https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Free-Inflammation/dp/1608828751