Monday, June 26, 2006

Caffeine & Diet: Heal Thyself!

I quit drinking coffee (both caffeinated and decaffeinated) at the end of 2004. Before that, I was only a cup-a-day coffee drinker, but I did drink an occasional Diet Coke, maybe 2-3 per month.

I had just read David Buchholz's book "Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain", which recommends a 60-90 day elimination diet to remove all possible food triggers. Buchholz is a neurologist at Johns Hopkins in Maryland, a rather esteemed medical establishment. I figured if he doesn't know headaches, no one does.

I learned a lot from this book, a lot of interesting theories anyway. Things like (i) tension-type (and sinus) headache has the same mechanism as migraine, (ii) my back/neck muscles aren't really tight; my aching brain is just telling me they are, and (iii) i can heal my headaches (supposedly).

His basic premise is in the 1-2-3 thing. Step 1 is to get off any OTC medications that might cause rebounding, things like Excedrin (with caffeine) and others. I didn't take many of these things anyway, but if you do, you wean yourself off the bad ones. Then Step 2 is to clean up your diet. He recommends a strict trigger-free elimination diet that removes all the usual bad-actors and a long list of others. The list includes foods containing: caffeine (coffee, tea, colas, possibly decaf coffee), chocolate, MSG, processed meats (aged, canned, cured, smoked, or preserved with nitrites/nitrates), most cheeses (unless fresh like ricotta or cottage or cream cheese) and some dairy products (yogourt, sour cream), nuts of all kinds, alcohol and vinegars (the ones that are fermented) especially red wine, beer, and condiments containing vinegar (mustard, mayonaise). Certain fruits and fruit juices like citrus fruits, bananas, raspberries, avocados, and so on aren't allowed either. Certain vegetables are also no-no's, including onions and certain beans (lentils, lima, etc.) as well as fresh-baked breads, aspartame, and possibly soy products. He gives an exhaustive list of chemicals which may be hidden sources of MSG (very helpful). Once the 60-90 day stint is over, you slowly re-introduce individual foods. And if that doesn't work, there is Step 3: Preventatives and Abortives: drugs like Elavil and the triptans.

I followed the diet religiously, saintly even, for 90 days. I ate a very pure diet and any processed foods were usually organic (the organic varieties had much shorter lists of chemicals and fewer of the bad actors). Many mainstream processed foods contained chemicals from his MSG list.

The diet was hard. I had to cook all the time, prepare snacks and lunches in advance, and never eat out (where I didn't know the ingredients). I discovered that every canned soup (except some varieties of tomato) has onion in it (onion is a no-no). I didn't eat vinegar (nor mayonaise nor mustard). No wasabi! I stopped drinking coffee, decaf coffee, and caffeinated soft drinks cold turkey. I didn't eat chocolate. I didn't eat soy products (no tofu dogs, no soy sauce!). No fresh bread. Nothing flavored with lemon/orange. No processed meats. Which was okay because sandwiches became virtually impossible without mayo or mustard. No nuts. No trail mix. No peanut butter! I cooked almost every night to supply lunches for the following days, and didn't have a social life. I reverted back to an almost-vegetarian diet. I was once a vegetarian (ovo-lacto for 12 years), so many clever meals came back to me. I ate a lot of permitted-fruits and veggies, rice and other grains, re-constituted dry beans (canning could mean preservatives) and rarely... minimally processed organic meat. I switched to teas (rooibos, herbals). I lost a few pounds and became painstakingly careful about labels. I slowly went mad.

Did a miracle happen? No. The diet didn't work. After 90 days, I saw no change in headache intensity nor duration nor frequency. Except for the first two weeks, when headaches worsened (likely due to the elimination of caffeine).

There were, however, some benefits: I kicked an arbitrary coffee habit, and completely lost my sweet tooth (my passion for chocolate has since returned, with a fury). I also learned that addiction to any foods (like chocolate and bread, in my case) is pure habit. Once certain foods were off my radar for a couple of months, I stopped wanting them.

Since then, I haven't drunk caffeinated coffee. Once in a blue moon, probably every 4-6 months, I have a decaf for nostaligia's sake. But it tastes awful to me now.

But on the diet-journey, I have made a fascinating new discovery, in the last year or so: Caffeine makes my headaches worse, always. It doesn't temporarily make them better, like all the evidence suggests. How do I know this? Every time I drink a decaf, my headache worsens almost immediately upon drinking it. In fact, my headaches take on a sickly, nauseating full-on migraine-like quality. How can this be? Decaf still contains caffeine (about 5mg compared to 150mg for a regular coffee) and my body seems highly tuned to it. But caffeine is a vaso-constrictor and is supposed to help your headache temporarily and only worsen it during rebound, when the caffeine wears off and your vessels re-dilate. But for me...having a decaf kills me. I feel like total crap and my head ache gets severe after having even a cup.

So what I want to say is...caffeine isn't always the god-turned-devil that causes retribution headaches after making you feel better briefly. For me, it isn't a god at all; it is pure demon from the get-go. So everyone's body must be different. You need to find your own fixes and failures.

And as for the "elimination diet" I hope it works for some people. All the rave reviews I read on Amazon say so. But my triggers are clearly non-food related, so while this is a great idea, it doesn't fix everyone. David Buccholz doesn't address non-food triggers very well, except for saying that they exist and if so, keep reading. So his book is great for food-issue folks, but it ain't magic and it didn't "heal my headaches" even though I was a perfect patient.

It did teach me a thing or two: like I need to pay attention, careful attention, to myself. It cued me to become aware of my other triggers, to keep a careful eye on things, to keep trigger diaries, to take as much responsibility as I can for reducing the triggers within my control. It helped fine-tune the way I look at my body. It helped me kick caffeine.

But it also insulted me. Healing thyself isn't as easy as following a diet and stopping eating meds like candy. The preponderance of books like these make us feel like lazy head-aching whiners who are clearly causing our own problems. They make it look like we can all "fix" ourselves. We can't. Which is why he covered his butt with Step 3: Drugs! Heal thyself (with the help of your pharmacist).



13 comments:

  1. i've heard of this book before; sounds like it didn't do you much good. i understand where you're coming from, wanting to try everything and anything that could 'fix' the problem. i'm the same way.

    i've got my fingers crossed for you, that you can have a low pain week! thanks for sharing the journey with me. :)

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  2. I admire you immensely for trying that elimination diet!!

    My gripe with "heal thyself" types is that it implies the pain is your fault, you could fix it if you really wanted to, and that one cure fits all.

    I think it's good to pay attention to possible triggers, because every little bit helps (like you & caffeine). I think I'd have to go to just air and water to find every trigger for everything that's wrong with me (and then, it would have to be pure filtered water LOL).

    Caffeine doesn't agree with me either, 1 excedrin could keep me up half the night (after I took it in the morning ROFL).

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  4. Great post! I particularly appreciate your last three paragraphs. :) It's good to hear your perspective on the topic -- and I agree with it wholeheartedly.

    Many people swear by this book, but, like everything else, some treatments work for some people and not for others. The presence of food triggers is way too generalized.

    The obsession about food triggers really bothers me. Sure, avoiding some foods may help some people, but so can eating a balanced diet, having a regular sleep schedule, etc. But food triggers are the "easy fix" -- and the one that the media are attached to. With a prevailing belief in food triggers, society expects headache sufferers to stop complaining and figure it out. As if.

    On the decaf coffee thing, I've discovered that it's the chemicals used to decaffeinate coffee that triggers my headaches, not caffeine. If I stick with Swiss Water Process decaf, I'm fine, but any chemically decaffeinated coffee kicks my butt.

    With as much coffee as I drink, this was a major discovery for me. Strangely, I wish that you drank more decaf coffee so you could see if the chemicals affected you, thus possibly reducing your headaches by not drinking it.

    I'm tired and not sure much of this makes sense, but I hope my point comes across!

    Take care of yourself.

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  5. In response to Kerrie's note...the point about chemicals used to decaffeinate coffee is very interesting. In fact, I'd just read her comment on this on The Daily Headache. That aspect of decaf hadn't even occured to me....that the chemicals used to decaffeinate the coffee could be causing me problems. I will investigate the various decaffeination processes and will give Swiss Water Decaf a try. I understand from what little I know on this topic, that in that method there are no chemicals in contact with the beans. Interesting finding. Thanks for the insights Kerrie.

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  6. I used to suffer from migraines that happened 6 or 8 times a year. Then a few years ago their frequency increased until I had daily debilitating migraines. I used to take a "cocktail" of over the counter drugs several times a day (oh my poor liver & kidneys) just to get the pain to a level soo that I could function at work.

    I read this book but was incapable of following the plan because it took more energy than the headaches allowed.

    Then one day I fell at work and broke my leg - someone took me to the ER where they also discovered that I had skyrocketing blood pressure. They thought I was going to have a heart attack and die right there before they ever got a cast on my leg. They kept asking me if I was having chest pain. No. Was I dizzy. No. Numbness in my arm. No. Difficulty breathing. No.

    I now take medication daily for the hypertension (no organic cause could be found - they chalk it up to "inherited from your mother"). The upside is, once I got the blood pressure under control the headaches went away.

    Now I urge every one who has headaches, to get their blodd pressure checked. Maybe this will help you.

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  7. Anonymous2:26 pm

    Hi,

    I have suffered from migraines for over 25 years, taken various preventative medications to no avail, except that they made me sick in other ways, and finally have come across the book by Dr. Buchholz. I have been following the diet religously for a year. It wasn't like night and day, as I knew a lot of dietary triggers beforehand, but it cut the severity and frequency by about half (from 4 or more to 2 per month) and eliminated the daily headaches. I only saw a real improvement after adding daily excercise and meditation. Now I have about one migraine per month which is hormonal. For me this book has made an unbelievable difference in my life, it actually has given me my social life back, I can go out with friends, go to a concert and don't have to assume I will be sick with another migraine. The diet is not easy. It involves a lot of cooking, it is difficult to go out for dinner and find something suitable, but it is so worth it. The book also clearly states that the diet might not do the trick for everybody, that you might still need preventive medicines, but that you might need only a lower dose and that means less side effects. Another thing the book definitely doesn't do, is suggest that if you just work on it, you will solve the problem and if not, it is your fault for suffering. I found the approach, that there is at least some part that I can deal with myself and improve my life very empowering. There is enough I cannot control like heat and humidity in summer, stress ... so doing the diet, exercise and meditate is like pampering myself, being good to myself and respecting myself.

    P.S.: In my exprience, diet is usually looked down upon by doctors, as something you can try if you have too much time, but they rather throw some medication at you.

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