Transcription
All right, so let's move into, uh, to Dr. Pickman's metabolic laboratory classroom. Yeah, yeah. Great. I love this part. Thank you, guys. Uh, thanks for the time, uh, Jack and and Carly and Rich. And, and I hope this can drive some helpful discussion for a bit. So, neurological disorders, of course, encompasses a very broad class of of disorders that that that where the where in the brain is uniquely affected. And among all of those neurological disorders, migraines are about the most common you have. And of course, as most people know, I, I don't know firsthand, much to my relief, a migraine headache is a very severe headache, um, debilitating to the point that it could can compromise someone's vision acutely, or their hearing, or their, their, uh, their balance. And they can have a sense of vertigo, uh, where, uh, and to the point that they have to take a full day off and just dim all the lights and stay in kind of a quiet, dark space. In fact, having said all that, do either of you guys ever experience migraines? And if so, did I explain it moderately well?
I've never had migraines, but my son Parker has had migraines before. And and you described, uh, it very accurately. I think in his situation. Yeah. Those seem to be the most common for everybody. They're different for everybody. Okay. Yeah. Yeah. Uh, so everyone who's had them would think that is not something I want to do again. It's not a ride you want to get on again. Uh, and thus the encouragement to look for a better understanding of what is causing it, because it is generally a very poorly understood problem, unfortunately, as so many neurological disorders are.
So, with regards to migraine headaches, it is, it is so fascinating to look at this, uh, most common neurological disorder, and then, uh, view it in the context of the most common metabolic disorder, namely, of course, insulin resistance. And the one study that we shared, uh, really highlights this in remarkable simplicity. It is simple in that the test, what they did with these subjects, these patients who had, they had three groups of people: people who frequently experience migraine headaches, people who who occasionally experience non-migraine headaches, so other headaches, and then healthy people who rarely experience any headache of any kind. And then they simply did this analysis of looking at their fasting glucose and insulin. Then they gave them a glucose tolerance test. And then over the course of this oral glucose tolerance test, or what's called often abbreviated as an OGTT, at minutes zero, so right when they, right before they consumed it, then 30, 60, 90, they looked at their insulin curve and their glucose curves.
So the first data, and it really is simple, but the first data that's compelling is looking at what is in table two. And I'll just kind of briefly explain it, but this is where we can see the fasting differences. And and essentially, the thing that stood out was that the fasting glucose across the two groups that frequently had headaches, migraines and others, was significantly higher than the glucose level of the people of the healthy controls. And these people were balanced with regards to age, sex, and weight. And so they're eliminating some of those confounding variables. Interestingly, we see a similar differential or or, uh, disparity when it with regards to fasting insulin. Where the fasting insulin in the other headaches and the healthy controls was six. It was right around six micro units per ML, which is what I consider to be a good number. Uh, the fasting insulin in the migraine people, experience migraines, or the migraineurs, they had a fasting insulin of 10. So, you know, a solid, all not quite double, I shouldn't say double, but but significant. It was significantly elevated. And I would argue that is a meaningful difference from six to ten. It might seem modest, but that is a real difference that I think is is worth highlighting.
Now, beyond the fasting numbers, that's when they then introduce this glucose load. And so they drink this sugary solution, and then they measure the glucose and the insulin response. And in figure one, they measured the glucose response. And the both headache groups had a significantly higher glucose response than the non-headache control group. Where in the non-headache control group, at 30 minutes, their peak glucose got to only 114 milligrams per deciliter. Whereas the headache groups, both of the migraines or other headaches, they got to a peak at 30 minutes of over 140. So about about 30 milligrams per deciliter points higher at the peak of the glucose curve.
Then we looked at insulin. If we move then to look at insulin, I should say, and that's figure two. This is very compelling because now we only see a difference in the migraine group. The peak of insulin was almost exactly the same in the other headache group and the healthy control group at 30 minutes. They both peaked at about 47 micro units per mil, and then immediately started to come down. Although the other headache group stayed higher a little longer, took them a little longer to start to descend, but it was very, very similar. No, no real difference. However, the migraine group, their peak, now remember the non-migraine groups, both of them, they got to a peak of about 47. The migraine group got to a peak insulin of 86 micro units per mil. So almost double their insulin response compared to the other two groups. So clearly, clearly an incredible difference when when we were challenging this body to start metabolizing glucose. Where the the the the glucose difference was real, it took them a little longer to clear the glucose, and they needed almost twice the amount of insulin to actually do it. So very good evidence of of insulin resistance in these people.
So those are the, those are the findings in this one human study. And then I would, I believe there are two mechanisms that can explain how insulin resistance can be be eliciting or lighting the fuse, be causing the mechanism mediating migraines, insofar as it may be happening at all. And there's this is speculation, of course. One could be that the insulin resistance is, once again, compromising, like we talked about with Alzheimer's disease last week, it's compromising the ability of the brain to get glucose. And so the brain starts to get a little hungry. That it's one explanation that people have heard before.
The second explanation is a little more novel. And this is an instance of where the brain may be overloaded with blood. It's basically like brain, brain circulation or brain blood flow has gone too high. And this is a bit, this is a bit, um, tricky to explain, but I'm going to take a crack at it. So when insulin is working well, it will flow through the blood vessels anywhere in the body and produce a molecule called nitric oxide. And nitric oxide will then make the blood vessels dilate and relax. So indeed, if someone's having a heart attack, they're having chest pain, the reason they'll put a little nitroglycerin tablet or something like that in their mouth is because that nitroglycerin will get rapidly metabolized into nitric oxide, which will basically open up the blood vessels throughout the body, including on the heart. And then the heart pain will start to go away. So nitric oxide is a key mediator of vasodilation, this opening and relaxation of blood vessels, pushing more blood through the blood vessels as a consequence.
Now, with insulin resistance, the body is of course experiencing hyperinsulinemia. So it's very possible that the blood vessels in the brain are responding to this elevated, not the brain itself, which may be insulin resistant in in getting less glucose, but the blood vessels may be insulin sensitive still. They've maintained their insulin sensitivity, but so but they're responding to the elevated insulin too much. This excess insulin is resulting in an excess production of nitric oxide in the brain blood vessels, flooding the brain with blood, increasing pressure in the brain. And that could be causing the symptoms, the severe headaches, the vision problems, the balance problems, the hearing problems, once again, all a result of the excess insulin that is the other side of the coin that we call insulin resistance. So those are, those are the two mechanisms, mechanisms whereby I believe insulin resistance is connected to migraines.
Now, having said that, anyone listening to this would say, well, great, Ben, thanks. I'm going to dim the lights and turn down your irritating, nasally voice in the midst of my migraine because you didn't give me any advice. Here's the advice. And it is that there is evidence to suggest that the good news is that there's evidence to suggest that a diet intervention that improves insulin sensitivity can improve migraine experience or people, the migraine frequency and severity. This is, there are numerous studies to support this, and they utilize low carbohydrate diets. And there, there's many. I will sort of rattle off. There is a case report, um, that was published in the journal Cephalalgia. And this was just a handful of years ago, where this physician actually writes this letter. It's sort of a personal case study where he details the frequency and severity of the migraines that his wife would experience. And she had adopted a low carbohydrate diet in order to not, with no thought on improving migraines, it was exclusively to control weight. And the migraines stopped. And that seems novel, but it's not at all. We have known that a low carbohydrate diet can resolve many migraines in many people, not all, but many, from as far back as 1928. So in 1928, the first paper was published on this topic. Another paper was published in 1930. And these were fairly large studies, you know, about 15 or so people or more in the second one. But they found, in fact, that the 1928 study is remarkable because this physician, I would love to have known how he stumbled onto this, but he took these 12 or 15 people who experienced migraines, put them onto a low carbohydrate diet, and then he details person by person what their response is to the diet. And the theme of this response is throughout all of them. It was something like, at the initiation of the diet, migraines stopped completely. Or at the initiation of the diet, the patient experienced two more migraines and has not experienced another, you know, in three years follow-up or something like that. So very, very compelling data.
Even independent of of adopting a low carbohydrate diet, which I am most certainly the strongest advocate of, there are some supplements that have been shown to improve, um, migraine headaches. And they are thought to improve it because of the improvements in insulin sensitivity. One like alpha-lipoic acid, for example. Now, one interesting experience for me is my colleague about five doors down. He would have debilitating migraines about one to two a week that would severely compromise his his life and his professional, um, goals or just profession, I should say. And he overheard me talking, or was a talk I gave to the department, um, on our findings that I've published earlier this year with regards to ketones and mitochondrial function. And I mentioned the benefits of low carbohydrate, even ketogenic diets, and migraines. And on a whim, he just thought, almost desperation, I guess, he tried it. And then it was months later, I saw him and I commented, you are really getting lean. I mean, he was not fat, but he was a little chubby, he would admit that. And I said, you're really getting lean. What's up? Because I'm always curious how people lose weight. And he said, well, actually, when I heard you talk, I wanted to try this low carb diet, um, because you'd mentioned migraines. And he said, I got to tell you, I used to have one to two every every week, and now I have had one in the past six months. Talk about a turnaround. The life-changing transition for someone who would be experiencing something hopelessly, in their mind, I'm sure, thinking there's nothing I can do. These come on, and I don't know how to control it. Imagine this is one more instance of when you can, when you can find a metabolic origin of whatever the problem is that's that's plaguing you, that's something you can address. And in so doing, imagine the power, how liberated the person feels, uh, in learning that they can control this when they previously thought they couldn't. Yeah.
So that's the connection. Uh, ins, the two supposed, what I believe, my suspected mechanisms whereby insulin resistance is connected or causal to migraines. And then the evidence that when you address insulin resistance, in many, many instances, or addressing insulin and fuel use, then you start to resolve the problem. You know, you mentioned Dr. Pickman, this, you, you kind of referred to this idea of hopelessness. And I, you know, I've met a lot of people who suffer from migraine headaches, and that does seem to kind of be the feeling is that it feels so out of their control. Like they've tried severe pain medications that make them nauseous. They feel like they're on pins and needles, just waiting because they know the next one is coming. Yeah. And this is the hope. It's the gospel of metabolism, right? The good news. Yeah. I would say anyone who's, um, contemplating trying this to control migraines, I don't think there's any migraine treatment out there that isn't just trying to control the pain and the symptoms. There's nothing that's, um, you know, searching towards the core of the problem here. And like Dr. Pickman just said, this could be, um, kind of doing that, getting to the core of the problem. Yeah.
Well, spread the good news. Uh, if you know people, and and we all know people that suffer from migraine headaches, if they want to to consider, um, you know, reversing insulin resistance as a as a potential remedy for migraines, have them go and take our little preview course at insuliniq.com. Because so many people just don't understand this space, and this is just a great overview for them and an opportunity for them to really, you know, look into remedies for migraines. Hey, Jack. Hey, Ben. Yesterday, Dr. Barry and I talked about diabetes. And and he talks about the American, you know, the American Diabetes Association being like a big ship, and it takes miles and miles and miles, I think, to turn. Are we seeing anything in the migraine community, at least medically, that they're starting to promote this kind of, uh, dietary change?
No, no, no. Not a whisper. Nary a whisper. It is certainly the case in the American Diabetes Association to the point that its most recent guidelines published for 2020 do actually include explicitly the use of low carbohydrate diets as a possible dietary intervention. So that ship is moving in. And Steve Berry is right in describing it that way. Um, but I have not heard of any discussion of the efficacy of low-carb diets in the context of migraine headaches. Yeah.
Well, we can spread the word. And by the way, we, a couple of years ago, Dr. Pickman, you wrote a blog post on our on our website. I'm going to have our team share that again in the chat. Um, it's a, it's a nice short read and has many of the references that you also refer to today. So we'll share that with our with our viewers.