To Your Health

What is the best alternative to an elimination and challenge diet in determining dietary factors with migraines?

Q. I have two children, a demanding job, and migraine headaches. My doctor thinks something I eat is triggering these headaches and wants me to do some experimenting with my diet to see if I can find out what it is, but I just don't have the time or the motivation to do what he describes. Are there easy ways to find out which foods could be giving me such misery?

A. I assume that your doctor is advising you to try an "elimination and challenge" diet. This diet is the best way in deciding whether a specific food is implicated in your headaches, but it is a lengthy process and may take two to three months to achieve clear results. It involves strict elimination of the most common foods in your diet for several weeks, in addition to avoiding foods with additives and preservatives (see "To Your Health," Feb. 20, 2004). It is not an easy diet since it requires eating virtually all of your meals at home with food you have prepared from fresh ingredients.

The best alternative to an elimination-andchallenge diet, though far from ideal, is a blood test to detect antibodies to specific foods. This can now be done easily at home and is relatively inexpensive, less than $160 to test 12 common foods. The blood is collected from a finger prick, mailed by regular surface mail to the laboratory, and results are available in a couple of weeks. This service is available from Direct Laboratory Services Inc. (800/908-0000) without physician's orders. If you need Medicare or other medical insurance coverage, you will need a physician's orders for the test.

The results are easy to interpret: The foods with the highest antibody levels are the foods you suspect most. Once you have this list of suspect foods, you have two options on how to proceed. One option is to eliminate the most suspect foods for a week then add back one of these foods each day to see if it produces a headache. This is a lot like the elimination-and-challenge diet, except that it is not necessary to eliminate all common foods, so it is much easier to manage. Be prepared to do without one or more of your favorite foods for a long time because often the foods we eat regularly are the culprits. The silver lining is that problem foods can often be reintroduced into your menu in a few months as long as you have them only occasionally.

The second option is appropriate if you find that one of the foods you need to eliminate is present in just about everything you eat. Foods like wheat, milk, corn, and some others are routinely used in many foods and are extremely difficult to avoid. If you have elevated antibodies to one of these foods and can't manage a meticulous elimination diet, digestive enzymes can help you break down this food into smaller particles that your body will no longer react to. You will probably find a wide variety of digestive enzymes at local health-food stores. Vegetarian enzymes are available, but a multiple digestive enzyme with pancreatin (not vegetarian) as one of its major ingredients is a good first choice. You may find that a tablespoon of acidic liquid (lemon juice or apple cider vinegar) before your meal also helps some people with digestion.

Removing even some of the foods that have a negative impact on your health will reduce your total stress burden and could get rid of your migraine headaches.

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