For anonymity throughout this case study, we’ll refer to our patient as Mrs Smith. We’ll explain the symptoms that she presented to us, our process for getting to the root cause of her health concerns and the functional medicine treatment plan that we put in place to answer her question; ‘How can I improve my gut health and reduce my headaches?’.
How Our Nutrition & Functional Medicine Clinic Helped Mrs Smith Improve Her Gut Health.
Mrs Smith is a 37-year-old lady that presented to the clinic with migraines and daily headaches. She has suffered from migraines since adolescence, but the frequency of her migraines tripled in the past year, causing her to experience headaches almost daily.
Having tried a variety of medications without much relief, Mrs Smith decided to contact our team for a discovery call. Following her triage, she was consulted by Alina Tierney who has been supporting people with their health and wellness for over 10 years.
Symptoms That Impact Everyday Life
Mrs Smith reported that the migraines were impacting every aspect of her life, and stated that they had ‘become a third person in her relationship’ and that she ‘hated having to tell her children to be quiet because her head was hurting again’.
Throughout we’ll explore the functional medicine approach used to assess this client’s chronic migraines and headaches, aiming to identify the underlying causes contributing to her symptoms.
Exploring symptoms in the initial consultation
Mrs Smith reported that her migraines and headaches worsened after she’d stopped breastfeeding her child. During the breastfeeding period, Mrs Smith did not experience any migraines.
Breastfeeding is known to suppress oestrogen production due to high prolactin, the hormone responsible for milk production, inhibiting oestrogen and progesterone production.
The migraines seemed to have a regular pattern around her menstrual cycle. She was given the combined pill in the past, but this resulted in 3 weeks of daily headaches and migraines every other day.
We know that the contraceptive pill leads to low levels of endogenous hormones as it can suppress the body’s natural production of hormones.
It seemed to Mrs Smith that her headaches began to occur a day before menstruation and continued on alternate days until day six of the menstrual cycle. Appearing again in the middle of her cycle.
During a healthy menstrual cycle, oestrogen levels generally fluctuate throughout, but oestrogen levels are typically low in the days just before the onset of menstruation and in the first few days of the menstrual cycle.
Mrs Smith also complained of an inability to lose weight despite exercising and reduced calorie intake. In addition, she’d mentioned digestive issues, including loose stools, stomach upsets/ cramps, bloating, heartburn and indigestion.
Finding The Root Cause With Reliable Functional Testing
We’re fortunate at the London Clinic of Nutrition as we’ve access to a range of tests and techniques to help get to the bottom of health concerns. Often tests via the NHS can be limited and considering the client’s health history and presentation, the following tests were recommended:
This test measures hormonal patterns throughout the menstrual cycle rather than one measurement of hormones. As such, it can provide insight into menstrual cycle-related symptoms, like migraines.
Measuring thyroid function and thyroid antibodies. Individuals with low thyroid function can have a slow metabolism, making it more difficult to lose weight, even with diet and exercise. In addition, there is also a potential link between thyroid function and migraines, with research showing that individuals with hypothyroidism are more likely to experience migraines than those without thyroid disorders.
To assess gut function and gut microbiome in light of her symptoms of gut discomfort. In addition, studies have shown that changes in the gut microbiome may be associated with migraines.
Initial Findings and Naturopathic Treatment Recommendations
Mrs Smith suspected that high histamine foods are potential dietary triggers for her; thus, she was advised to eliminate high histamine and tyramine foods for 3-4 weeks and then to reintroduce the foods monitoring her symptoms gradually.
Histamine and tyramine are two types of biogenic amines naturally present in certain foods. Biogenic amines are special chemicals that are found in our bodies and in certain foods we eat, like cheese, chocolate, and fermented foods. They help our body do different things like regulating our mood, keeping our heart beating, and even helping us digest our food!
However, some people may be more sensitive to certain biogenic amines than others, and eating foods high in these chemicals can sometimes cause negative reactions like headaches, and nausea, or even make them feel a little bit sick.
We also advised her to increase the intake of cruciferous vegetables, like broccoli, kale, cabbage, etc, as these provide compounds which can help with the healthy metabolism of hormones.
In addition, Mrs Smith was advised to supplement with riboflavin 400 mg which we know is effective in reducing the frequency and severity of migraines. Whilst switching to magnesium glycinate instead of magnesium citrate, as the latter might have been contributing to the loose stools. She was also recommended zinc, which can get depleted with the contraceptive pill and a liver support formula to support the healthy metabolism of hormones.
First Follow-up Visit at 6 Weeks
Mrs Smith implemented all the dietary and nutritional recommendations and although she felt the diet helped to identify potential triggers of her gastrointestinal symptoms, there were no changes in her migraine frequency.
During this consultation, we discussed the results of the thyroid function test and comprehensive stool test. The results of the hormone mapping were not yet available.
The Thyroid function test showed some abnormalities and was positive for antibodies. A small percentage of the population can have positive thyroid antibodies without impacting thyroid function. Since the abnormalities were within a ‘normal’ range, a referral to her GP was not warranted this time, but Mrs Smith was advised to keep monitoring thyroid function, as she can still be at increased risk of developing thyroid diseases in the future.
A low level of Folate was flagged in test results, which was likely due to inadequate dietary intake as Mrs Smith’s diet was initially low in green leafy vegetables. Folate, also known as vitamin B9, is an essential nutrient that plays a key role in many biological processes, including the production of DNA, red blood cells and neurotransmitters. There is some evidence to suggest that folate may be linked to migraines and may also have an impact on thyroid function.
We also discovered that Mrs Smith’s pancreatic elastase was below the expected level. This is important because it’s an enzyme produced by the pancreas that plays a role in the digestion of protein, thus indicating poor digestive capacity. Alongside this, her Secretory IgA, a marker of gut immunity, was low, which can make an individual more susceptible to gut infections.
We also suspected that previous use of antibiotics and corticosteroids has led to Mrs Smith having low levels of some of the beneficial bacteria that promote good gut health (Lactobacillus and Bifidobacterium).
Additional Functional Medicine Recommendations To ‘Improve My Gut Health’
As such and considering the limited improvements to this point some additional recommendations were made to help improve gut health and reduce the frequency of migraines being experienced.
A gut support programme
This included digestive enzymes to support digestion and probiotics and prebiotics to support gut microbiome and gut immunity was initiated.
Support with Thyroid hormone production
Although thyroid function was normal, a nutraceutical with compounds that support thyroid hormone production was recommended.
Nutraceuticals are essentially foods that have added health benefits beyond just providing basic nutrition. They’re foods that have similar benefits to modern medicine, without the side effects and could help boost your immune system or improve your focus. They can be a helpful addition to your diet if you’re looking to improve your overall health and well-being and include foods like Blueberries, Turmeric & ProBiotic Yoghurt.
A B complex (a mix of B vitamins that help with converting food to energy and a healthy immune system among other things). We included good amounts of folate to support an improvement in the depleted folate levels.
Mrs Smith was also recommended to continue with riboflavin 400 mg, magnesium and zinc until the next consultation to assess whether these reduce the migraine frequency. Whilst being advised to stop the liver nutrient supplement recommended in the initial consultation once supplies were finished.
Further dietary recommendations
From a functional medicine diet perspective, Mrs Smith was encouraged to gradually reintroduce the previously excluded foods back into her diet, whilst monitoring her symptoms.
It was suggested to continue to add green leafy vegetables and cruciferous vegetables to her meals as a source of folate.
Finally, Mrs Smith was advised to monitor her gluten intake as there is some evidence to suggest that gluten may contribute to the development of thyroid antibodies in some individuals.
Second Clinic Follow-up Visit at 12 Weeks
Mrs Smith reported that she had thoroughly followed the dietary and supplement recommendations and that she had lost 11 lbs since starting the new supplement protocol. She also reported that her gut symptoms had significantly improved and that she no longer experienced any reflux, indigestion, heartburn or diarrhoea.
However, there was still no change in her migraines and headaches frequency. Whilst this was not ideal it was clear that our functional medicine-led approach led to her reporting that it had helped to “improve my gut health”.
We discussed the results of the DUTCH cycle mapping, which showed lower than expected oestrogen levels in the first 5-6 days of the menstrual cycle and from day 16 of the luteal phase, corresponding to the migraine episodes. This could also be explained by her levels of Progesterone being lower than expected throughout the menstrual cycle.
Client Feedback: “My Gut Health Has Improved”
Since the DUTCH cycle mapping showed a correlation between the migraine patterns and inadequate levels of sex hormones, a referral was made to a hormone specialist doctor for further assessment and to discuss potential hormonal therapy.
Mrs Smith was also advised to slowly discontinue the use of supplements in light of the improvement of her symptoms and to continue to optimise her diet based on her needs.
As a result of our work together, the following statement was made by the client:
“I would highly recommend LCON (The London Clinic of Nutrition). Though I suffer with migraines, what I appreciated was the overall approach taken at the clinic. They don’t dismiss or focus on just one area but look at the big picture. Thanks to my practitioner Alina, my thyroid is being supported, I’ve lost weight for the first time in three years, and my digestive and gut health has been radically improved. Last but not least Alina found the missing piece of the puzzle for why my migraines have tripled in the last two years. Well worth the phone call! A fantastic place with thoughtful caring people ready to listen”
Do you also think ‘How can I improve my gut health’?
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