Tips

14 October 2025

Too Much Spinach?

It’s about time that we talked about oxalates.

The human body is incredibly complex. A full understanding of how it works and how it’s all balanced together is still far beyond the reach of modern science. And so there’s a lot to talk about.

Oxalates are natural chemicals in your body, and are also found in some foods, such as (you guessed it) spinach, almonds, peanuts, potatoes, chocolate, carrots and raspberries.

Oxalates have become a topic of conversation partly because of the popularity of the book Toxic Superfoods by Sally K. Norton. But the book has also been highly criticized as more health-hype than health-fact.

The fact of the matter is that oxalates have been a concern in the health field for more than a century. As early as 1933, migraine among other things was being connected with too much oxalate intake.

As with anything, there’s too much of a good thing. It’s not so much controversial that too many oxalates collecting in the body can cause problems (such as, most famously, kidney stones).

The controversy instead centres around just how common oxalate problems are, and just what kinds of health conditions they can cause. Some of the criticisms around Norton’s book, for example, are that she seems to associate almost every health condition and the fall of western civilization to eating too many oxalates.

I exaggerate, of course, and I think that some of these criticisms are a bit unfair as well. The fact is that our bodies are indeed complex, and doctors are often very hesitant to blame health issues on diet unless the connection is direct and obvious.

The nature of this controversy means that, if you’re interested in investigating it, you’ll need to do more than watch a couple of videos on YouTube. It will take some time to look at various sides of the issue, and to take a good look at what your body is telling you.

Norton is suggesting (among other things) that in many ways modern health crazes are pushing our bodies out of balance. To suddenly load up on spinach smoothies may indeed be too much of a good thing. And certain diets, in their effort to duplicate and feed our every craving, end up causing two problems as they solve one.

Even the question of which foods will cause problems with your oxalates can be complicated. But if you’re dealing with health issues and want to investigate diet solutions, I recommend looking into this question and making your own decision. Take a look at some of the foods commonly said to be high in oxalates. And do some serious reading of the research.

Norton’s book is one resource you can check out. But be warned that this is not a light, motivational self-help read. To understand her side of the issue, I strongly recommend you take the time needed to understand it. And she does address some of the concerns of her opponents – you can decide if her answers are helpful/satisfactory.

This issue raises some important general questions. Is it hopeless to try to improve our diets? Will the research of 2029 completely change diet recommendations for migraine and other similar conditions that we had in 2024? How can we make the best decisions now without being caught in fads that might not serve us well? Science is a moving target, and it should be, since it’s based on questioning and retesting. But we still want to make the best decisions we can by wisely interpreting the information we have today.

There are some rules that seem timeless, and moderation is one of them. And that may indeed be part of the issue with oxalates. But the human body is much more complex than a “just do this” diet can address. Your body changes as you get older. Rapid industrialization is changing the food that is available to us, meaning that the nutrients in common foods may not be what it was a hundred years ago. Migraine sufferers have specific needs that may not be addressed by “fad diets” anyway.

There are general rules that can be helpful. But in the world today, don’t expect a silver bullet that will solve all your health issues. It’s going to take some work. But we’re up for it!

21 October 2024

Oxford Report on the “Best” Medications – Takeaways…

James Discoveries & Stats, Medications, News, Tips 0

Led by researchers at the University of Oxford, and published in the British Medical Journal, a new study compares migraine medications to find out which is “best”.

Well, they would not phrase it that way. Really, they were trying to judge which medications had the best results in good clinical trials. This is important, because information like this can tell doctors which medication they might want to try with “person X”.

But, of course, there is no “person x”. When a specialist recommends a medication, they should be aware of your medical history, symptoms, and even family history. Study co-author Elena Ruiz de la Torre said it well – “Migraine is a very personal disease”. As also quoted at NewScientist, migraine expert Dr. Peter Goadsby adds that these studies “tell you about a population, but they’re very blunt instruments for trying to understand what’s going on at an individual level.”

With that warning in mind, it is still helpful to have these studies, and here’s what they found.

The now “older” migraine medications, the triptans, are still great tools. In fact, in these studies they are beating out the newer CGRP related medications such as lasmiditan, rimegepant, and ubrogepant.

So the report gave great marks especially to eletriptan, and after that rizatriptan, sumatriptan, and zolmitriptan. Interestingly enough, the humble ibuprofen also got high marks in this report.

In other words, these were the medications that had the best evidence for getting rid of pain and having few side effects.

Again, remember that the newer drugs are helping people that did not respond well to the triptans. And there may be medications and treatments that are better for treating certain people with certain symptoms.

The authors summarize their conclusion based on the studies they reviewed:

Results on both benefits and harms should inform shared clinical decision making, considering the preferences of patients, caregivers, and healthcare professionals. Our findings should help inform future guidelines and updates to recommendations to ensure that patients receive optimal care. Overall, the results of our network meta-analysis suggest that the best performing triptans should be considered the treatment of choice for migraine episodes owing to their capacity for inducing rapid and sustained pain freedom, which is of key importance for people with migraine. While the recent introduction of lasmiditan, rimegepant, and ubrogepant has expanded options for the acute treatment of migraine, the high cost of these newer drugs, along with the substantial adverse effects of lasmiditan, suggest their use as third line options, after the less expensive, similarly efficacious, second line options such as ibuprofen, acetylsalicylic acid, diclofenac potassium, almotriptan, and frovatriptan have been considered.
Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis

So the moral of the story? The general guidelines out there don’t seem to be far off, and this is no time to throw out the old just because we have the new. All things equal, if you’re thinking of trying a medication for migraine, talk to your doctor about the triptans. But be sure your doctor knows your situation. You are not “person x”.

Also see: Major study suggests best treatments for migraines

And from earlier this year: “Older” Migraine Meds on Trial: What Works?

And back to ibuprofen – NSAIDs – Which One Should I Take For Headache?

15 March 2024

Unexpected Micronutrient Deficiencies

James Information, Tips 0

Recently we talked about the vitamin and mineral deficiencies which may trigger more headache and migraine attacks in patients using certain heartburn medications. The truth is that nutritional deficiencies can be caused by a variety of things, and the consequences can be quite serious.

Curt Hendrix over at Akeso Health Sciences recently wrote about the admittedly extreme case of a teen boy who eventually went blind because of undetected micronutrient deficiencies. After finding a B12 deficiency, he was given injections and a recommended diet plan. But more information came out about three years later:

Upon further examining his eating habits, doctors learned that “since elementary school, [the boy] would not eat certain textures of food.” Subsisting only on a diet of chips, processed meats, white bread, and a daily portion of french fries. Doctors also found copper, selenium, zinc, and vitamin D deficiencies, as well as decreased bone density.
Your Body’s Language: Nutritional Deficiencies and Consequences

An extreme case – I hope so – but maybe not as unusual as we think. Hendrix quotes estimates that 2 billion people in the world have a nutritional deficiency. And lest you think that we’re talking about only the poorest countries, the Centers for Disease Control and Prevention estimates that almost 10% of the US population has at least one deficiency.

Certainly, these issues can be caused by genetics and many medications. But it is also surprisingly easy for us to fall into a diet that lacks variety and balance. One of the problems is that many of these tricky symptoms don’t show up right away – it may take years – and then, as in the case of this boy, the results may be irreversible. And even supplements may not be enough to correct the problem.

If you’re looking for one simple test for all deficiencies, you’re out of luck. But your doctor, or even certain home tests, can catch some of the major ones. You might want to consider testing, especially for iron, B2, B12, magnesium, and vitamin D. But certain symptoms may point to other deficiencies – your doctor can help you with that.

Sometimes, even with tests, it’s hard to nail down certain deficiencies. But what you can do is eat a balanced, nutrient-rich diet. Remember, just because you don’t have immediate problems because of what you ate yesterday doesn’t mean that you’re eating healthy.

After many years of migraine and headache research, I remain convinced that diet is one of the most powerful weapons you can use to fight migraine. Its importance is given lip service, but its true power is frequently underestimated.

To read more about this sad case and the danger of nutritional deficiencies in general, check out the full article here.

7 March 2024

More on [Avoiding] Heartburn Medications

James Tips 0

It’s been several years since we talked about headache and heartburn medications, but it’s such a big issue that we should probably revisit the question more often.

Woman with heartburn, headache, and gut problems.

As you probably don’t recall, we were talking about “Why Headache Patients Are Running from Esomeprazole (Nexium) and other “Heartburn” Drugs”. The main concern are proton-pump inhibitors (PPIs), and concerns seem to be rising rather than subsiding.

Back then we were talking about the link to headache, which may be especially linked to certain deficiencies that use and long-term use of medications such as Nexium, Prilosec, Dexilant, and others may cause.

Prompted by 2023 study, which once again linked PPIs with dementia risk, Dr. Alexander Mauskop at the New York Headache Center updates us with a few more years of experience on the topic.

First, he points out the specific link to migraine – “…one study found that past and current use of PPI increased the odds of migraine by 2.56-fold and 4.66-fold, respectively”. In other words, current use significantly increases risk, but even past use may increase migraine risk.

But most helpful were his tips on quitting PPIs:

Stopping a PPI can cause severe rebound acidity. This is why people get stuck taking them for years. The way to try is by replacing the PPI with an H2 blocker such as famotidine (Pepcid, Zantac 360) along with an antacid such as Rolaids (it’s better than Tums because it contains not only calcium but also magnesium) or Gaviscon. After a few weeks, people can often stop famotidine and after another few weeks, stop the antacid. Famotidine does not cause problems associated with PPIs.
Dr. Alexander Mauskop

There is also some advice for those who need to be on PPIs for certain conditions. You can read the whole post here: More on the dangers of PPIs such as Prilosec, Nexium, Dexilant, et al.

One thing to consider is whether or not you may have a vitamin deficiency or ongoing problems with your gut flora. It might not hurt to check your B vitamin levels, and magnesium levels. Also, remember to keep your gut healthy. You may want to try a probiotic such as Primal Defense Ultra. (I’m very picky about probiotics, because so many are not as advertised, and others don’t have the types of probiotics you need most.)

12 June 2023

Study: Moderate Aerobic Exercise for Migraine

James Discoveries & Stats, Tips 0

There are a whole host of lifestyle and exercise recommendations for fighting migraine. A fascinating study published this month in The Journal of Headache and Pain looked at how much solid evidence there is for various types of “therapeutic exercise”, and included studies of everything from high-intensity interval training to relaxation techniques.

Each type of exercise was given a grade from B to D. What will especially catch your eye are the specifics about aerobic exercise, so let’s take a closer look.

As I studied, I was surprised to discover that I was a little weak on the actual definition of “aerobic”. Citing The American College of Sports Medicine (ACSM), this article from the National Library of Medicine defines “aerobic exercise as any activity that uses large muscle groups, can be maintained continuously and is rhythmic in nature”. “Aerobic” refers to the use of oxygen, so think of anything that requires extra oxygen. But that’s not necessarily sprinting – it could be much less intensive, such as walking.

Other examples would include jogging, swimming, and stair climbing.

As you can tell, there is actually a wide range of aerobic activity. So what has the best evidence as a migraine-fighter? Several studies recommended aerobic exercise in general, and some specifically “moderate-intensity continuous aerobic exercise”. Low intensity did not seem to do as well as moderate intensity, but it still earned a “C” score on the evidence scale.

So basically, any aerobic exercise is a step in the right direction, with moderate-intensity having the most studied benefits. Moderate aerobics three times a week is the specific recommendation.

The benefits found in the studies included:

Decreased pain frequency
Decreased pain intensity
Decreased pain duration
Decreased disability
Increased quality of life

That may seem vague, but remember that these were studies specifically designed to measure improvement, so this is more than just “I seem to feel a little better”. This is a significant improvement.

For those with migraine, it seems to be wise to start slowly and gradually increase the intensity of your exercise, being sure to stay hydrated. The Cleveland Clinic has a great article introducing aerobic exercise here.

Also, the American College of Sports Medicine has a chart explaining “intensity” more specifically. Don’t get nervous – if you can add any kind of movement to your life, it should help your quality of life. These exercises don’t need to be intense – but you will need to push yourself a little. Here’s the chart: Tips for Monitoring Aerobic Exercise Intensity.