This is the second post in a series about migraines. Start with the first post, about hormonal triggers.
Migraines from gut barrier dysfunction
This and this review show the correlation between migraines and gut disease, such as irritable bowel syndrome, h.pylori infection, inflammatory bowel disease, celiac, gastroparesis, and colic, among others.
There are many ways that gut disease can trigger a migraine. However, all have one common mechanism at play. . .
A permeable (leaky) gut barrier
You may have heard the term “leaky gut.” Actually, it’s a real thing, called intestinal permeability in medical terms. In a nutshell, the cells that make up the lining of your intestines have tight junctions so that nothing undesirable passes through. This lining is thin, just one cell in depth, so that you can easily absorb nutrients. You need tightly controlled junctions between these cells, in order to discern between desirable nutrients and things to keep out. Leaky gut is when these junctions are loose.
What leaks through that shouldn’t?
→ Food protein molecules that are not completely broken down. Your immune system tags these as antigens, or invaders, and creates antibodies against them in defense. In the process, you can also create antibodies against your own body tissue, which is an auto-immune attack. This creates a systemic inflammatory response, which can trigger a migraine. If you have migraines WITH food intolerances or an autoimmune disease, it’s likely you have leaky gut.
→ Toxic bacterial byproducts called LPS (lipopolysaccharide) endotoxins (toxins produced from bacteria in your gut). When LPS endotoxins leak through, they cause widespread inflammation, as well as pain. If you have migraines WITH unresolved pain such as fibromyalgia, chances are high that you have leaky gut.
Dysbiosis is the primary cause of leaky gut
Dysbiosis is an imbalance of gut microbes. This could be an overgrowth of inflammatory bacteria, yeast, or parasites, or not enough beneficial bacteria. Dysbiosis affects your gut lining in many ways:
- Beneficial bacteria secretions build your healthy mucosal lining! So lack of beneficials = impaired mucosal barrier.
- Dysbiosis makes your lining irritated, inflamed, damaged, and permeable.
- When you restrict carbohydrate and fiber too much, bacteria can feed on your own protective mucosal gut lining, which is damaging.
- Fungal overgrowth can embed into your gut lining, and provide houses (vacuoles) for bacteria and viruses.
- Beneficial bacteria make short-chain fatty acids (butyrate is THE crucial one) that are natural lining anti-inflammatories.
- Certain types of beneficial bacteria that make up your lining also knock down invasive pathogenic bacteria, yeast and parasites, and keep dysbiosis in check.
- Your gut immune system (GALT) provides important immunoglobulins that fight pathogens. Dysbiosis lowers these immunoglobulins.
There’s another way dysbiosis can cause migraines. You can have an overgrowth of bacteria that turn nitrates into nitric oxide, a headache trigger. In fact this study showed that nitric oxide was higher in the bloodstream of migraine sufferers.
Other causes of leaky gut
- Alcohol: Alcohol damages your gut lining, and allows endotoxins to leak through. Measurements of LPS endotoxins are higher with alcohol disease damage.
- Medications: The most common are:
- Antibiotics, which significantly change your gut microbiome for the long term.
- Nonsteroidal anti-inflammatories (NSAIDS) like aspirin, ibuprofen, and prescriptions like meloxicam all damage your gut lining.
- Antacids, H2 blockers and proton pump inhibitors that block reflux. Actually, these medications are meant to be used to short-term, no more than two weeks, while you fix your reflux. Beyond that, you lose protective stomach acid that breaks down your proteins and kills incoming microbes. Also these medications cause malabsorption of nutrients and change the pH of the food that enters your small intestine. Without proper pH, you’ll miss the signals to secrete your own enzymes from your pancreas, and bile from your liver/gallbladder. Interfering with pH in your stomach will interfere with your pH, and digestive secretions, throughout your whole GI tract.
- Gluten: In all people, gluten increases a protein called Zonulin, which signals a loosening of your intestinal cell tight junctions (TJs). People with robust immunity can handle this, but anyone with gluten intolerance cannot handle this without gluten proteins leaking through and wreaking havoc.
- Other inflammatory foods for you, determined on a case-by-case basis.
- Stress: There is a myriad of explanations and studies as to how stress affects gut permeability.
- Constipation: This is likely due in part to microbiome imbalances. This new 2017 study is the first that shows how treating constipation improves leaky gut.
What to do for leaky gut?
Get a comprehensive assessment for food intolerances, dysbiosis, and intestinal permeability. I have seen time and time again many migraine sufferers lesson or resolve their migraines by cleaning up gut issues. Work with a functional medicine practitioner, this is too complex to assess and treat on your own. Fortunately, there are excellent tests that influence individual treatment, such as the GI Map, the SIBO breath test, and food intolerance tests like the FIT.
After an assessment, your practitioner will apply the four “Rs” of gut treatment:
- Remove food irritants and microbial overgrowths
- Reseal your gut lining
- Reinoculate beneficial bacteria through food, prebiotics, and specific strains of probiotics
- Restore functional digestion
Migraines from brain barrier dysfunction
Your blood brain barrier (BBB) is similar in structure to your gut barrier. Both are composed of endothelial cells with tight junctions. In addition both are regulated by signaling proteins such as zonulin (remember this is activated by gluten) and occludin.
When your blood-brain barrier is disrupted, then the same gunk that leaks through your gut lining can leak into your brain and cause inflammation. This includes LPS endotoxins, inflammatory molecules, and nitric oxide. Brain inflammation can trigger migraines.
Scientists used to think migraines were either neurological (nerves) or vascular (vessels), but now they realize migraines have both components. The BBB is a complex neurovascular unit which separates blood vessels from your brain. Tight junctions should seal the endothelial cells of the BBB.
When your BBB is leaky, all kinds of neurological symptoms can occur, including migraines, dizziness, brain fog, sleep disturbances, fatigue, anxiety, and depression. Over time, neurological autoimmunity and degeneration can occur, including cognitive impairment and dementia.
Causes of leaky brain
- Alcohol, gluten, food intolerances, microbial endotoxins, and stress can trigger permeability in both your gut and brain barriers.
- Nerve pain from injuries, neuropathy, sciatica, rheumatoid arthritis, multiple sclerosis (and more) increases enzymes called matrix metalloproteinases (MMPs). MMPs are really important in the development and flexibility of your nervous system. However, nerve pain can raise MMP levels too much, which then causes a disruption in your blood-brain barrier. The latest research shows higher MMP levels in migraineurs.
A side note is MMP levels are higher in those with chronic inflammatory response syndrome (CIRS) from biotoxin illness like mold and Lyme.
- Blood sugar imbalances including high or low blood sugar disrupt the integrity of your BBB.
- Systemic infection and/or inflammation disrupt your BBB through many pathways (cytokines, prostaglandins, NF-kB, MMPs, and more). This recent 2017 study outlines all of these pathways.
- Traumatic brain injury (TBI) is shown to disrupt the BBB.
- Oxidative stress (think rusting)disrupts the BBB and causes neurodegeneration.
What to do to seal your blood brain barrier
First of all, strengthen your gut barrier. Your gut and brain barrier control mechanisms are the same. Therefore when you improve your gut barrier you will improve your brain barrier.
Next, assess brain inflammation and oxidative stress with the organic acids test. Work with a functional medicine practitioner to improve these markers.
Lastly, apply approaches to seal your BBB. Some of my favorite research-based blood-brain barrier sealers include turmeric, resveratrol, ashwagandha, and rhodiola.
It’s worth mentioning that glutathione is an important antioxidant for the brain. Also, a good brand of CBD can cross your blood-brain barrier to reduce inflammation.
Check out the next post in this series, about migraines and sensitivities.