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Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.

This episode is brought to you by our generous sponsor, Lundbeck.

Molly O’Brien: Hello, and welcome to Spotlight on Migraine. I’m your host, Molly O’Brien. I’m very excited to have our discussion today. We’re talking all about plant-based diet and migraine, how the two interact, how you can get started, all that kind of good stuff. So to join me today, I’m very excited to introduce our guest. She’s a board-certified psychiatrist and health and wellness coach, Dr. Ulka Agarwal. Thanks so much for joining us today.

Dr. Ulka Agarwal: Oh, thanks for having me.

Molly: I’m very excited to dive into this topic. I know I’ve really focused on plant-based eating myself throughout my entire life, and it seems like it’s becoming more popular and more mainstream. So I know a lot of folks out there have questions on plant-based eating, and you’ve done some research on this as well.

Dr. Agarwal: I have, yes.

Molly: So we’re excited to pick your brain. So let’s start off with the very, very basics. Plant-based diet almost seems jargon now, right, kind of a hype word. But can you explain to us what a plant-based diet is or what “plant-based eating” means?

Dr. Agarwal: Sure, and it’s just that — eating plants. And so a plant-based diet — nothing fancy about it. It’s helpful to think of it in terms of four plant food groups, so vegetables; fruits; and then whole grains, which are like rice, bread; and then legumes, so soy, nuts, seeds, lentils, and beans. So all plant foods, and don’t contain any animal products, so that would be no meat, chicken, fish, eggs, anything like that. And these diets are naturally low in fat because there are natural plant foods, very high in fiber, and packed with a lot of antioxidants, vitamins, and minerals.

So I like to think of plant-based diets — like you said, to sort of demystify the concept — a lot of plant-based foods, people are already eating, so a peanut butter and jelly sandwich, marinara sauce with vegetables and mushrooms and pasta. You can have a teriyaki tofu with vegetables over rice, even veggie fajitas. Guacamole’s vegan, rice, salsa, tortillas. So a lot of foods that people are already eating are plant-based.

Molly: And you’re making me hungry. I think that’s important to —

Dr. Agarwal: I know.

Molly: It’s important, like you said, to demystify, because a lot of things that we already eat actually may come from plants. So it’s not this hard, far-reaching thing, I don’t think.

Dr. Agarwal: Exactly, exactly.

Molly: OK, so let’s talk a little bit about — before we dive into the migraine aspect, overall, what are some — and you hit on some of these, high in fiber, that kind of thing, low fat. But what are some overall health benefits a person can get if they start out using a plant-based diet?

Dr. Agarwal: Absolutely. So one of the research topics that we looked at with plant-based diets was diabetes and type 2 diabetes, and what we found — and that most experts agree now — that plant-based diets are a great diet for preventing diabetes, improving it, and even in some cases reversing type 2 diabetes. So that means just from a diet, people can get off their medications.

Plant-based diets also help maintain a healthy weight and lower cholesterol, lower blood pressure, and these are also all risk factors for heart disease. So plant-based diets also reduce risk for heart attacks and strokes, and heart disease is the number one killer in the US, so a very powerful diet in terms of overall health and health risk. 

And there’s also other health benefits as well. So plant-based diets have been found to increase our life span, so we live longer when we eat more plants, and then reducing pain — like migraines, like we’re talking about today — and other sort of inflammatory-pain illnesses like fibromyalgia or rheumatoid arthritis, even premenstrual cramps. We did a study looking at plant-based diets and premenstrual cramps and saw that the pain does go down. We also know that about 40 percent of cancers may be related to diet. And so because of the powerful antioxidants in these diets, plant-based diets can reduce our risk for some cancers. So it’s nice to know we have some control over that. 

And you mentioned the high fiber with the plant-based diets. So we know that our guts and microbiomes really like fiber, and they really like plant-based foods. And the good bacteria feed on plant foods, so the good bacteria multiply. And we also have a more diverse microbiome or more diverse of gut — lots of good, different types of bacteria — and that all really helps with reducing inflammation, our body’s stress response, and even potentially improving mood.

Molly: Wow, it seems like there’s so many overall benefits, and it’s awesome that we’re getting research to back this all up, so it’s science-based evidence, which is awesome. And you talked a little bit about research in a couple of different areas, but you did do research on how migraine is impacted by a plant-based diet. Can you tell us a little bit about some of your findings?

Dr. Agarwal: Sure. So what we found was the participants in our study who adopted a low-fat plant-based diet had significantly greater reduction in the amount of migraine pain compared with the other participants in the study who stayed on their usual mixed diet, so with vegetables and animal products. Not only that, those who followed the plant-based diet had significantly less migraine intensity, so the pain was better and they were less intense. Those folks on a plant-based diet also lost more weight, which potentially could have been related to the migraine pain getting better, and they also saw their cholesterol go down.

And an interesting finding in that study as well was that it was a crossover study. So the first group of participants did the plant-based diet and then were supposed to go back to their usual diet, but many of them said, “I’m feeling so good, I’m not going back to my old diet. Yeah, I really like that my pain’s lower.” And they stayed on some form of a plant-heavy diet. And so that really spoke to us that it’s working and it’s an acceptable diet, that people feel like this is something they can do for the long run.

Molly: It’s so fascinating to learn this, again, and to have the research to back it up. And it seems like — while changing diet can be very difficult, it does seem like a simple thing we can do that doesn’t involve drugs to try to help reduce migraine pain. So it’s really exciting to be able to talk about this.

Dr. Agarwal: Right, and something that doesn’t have side effects.

Molly: One hundred percent no side effects. Yeah, that’s a great way to put it too. OK, so can you tell us what is it specifically about a plant-based diet that helps reduce migraine triggers in migraine?

Dr. Agarwal: Right, so many possibilities, but I think one of the main ones is that when you get animal foods off the plate, you’re naturally eliminating a lot of natural migraine triggers. Histamine and tyramine, they’re also found in plant foods, but they’re also found in smoked cured meats and aged cheeses. And so you’re just kind of wiping out that entire group of triggers. Animal products also have an omega-6 fatty acid called arachidonic acid — not important to remember, but just important to remember that that type of fat increases inflammation and that inflammation can trigger migraines. So you’re getting rid of an entire omega-6 fat and a potential migraine trigger.

And then with the dairy, getting dairy off the plate, we’re eliminating another pro-inflammatory potential migraine trigger called casein, and this is a dairy protein that is also commonly an allergen for a lot of people. And so lowering that kind of inflammation effect can also reduce that migraine trigger. And then as we mentioned before, plant-based diets are very high in antioxidants, and so they reduce oxidative stress all throughout the body, again reducing inflammation, boosting our immunity.

We also know that plant-based diets, when we look at the nutrient breakdown between people who follow a plant-based diet and those who don’t, that the plant-based folks are higher in a lot of different vitamins and minerals. And we know, for example, magnesium is important in migraines, and when the level is low, we get a migraine. And so spinach, legumes, nuts, these are all really high in magnesium. And so in that way, we can prevent some deficiencies that potentially could be triggers.

The high fiber in plant-based diets can help really balance blood sugar. And as a person who has migraines myself, and you can relate as well, between meals, if we go a little bit too long, our blood sugar is fluctuating, our moods are up and down, and that can really trigger a migraine. And so the fiber in plant-based foods can keep that nice and even, and that can really help a lot with the pain as well as keeping the inflammation down in our microbiome, in our gut, which can help our body’s stress response and potentially our mood.

And as a psychiatrist, I’ve really seen the connection between mood and migraine. And so when my patients have a worse mood, their migraine’s worse. When their migraine’s worse, of course they’re going to feel more depressed. And so if we can do anything to boost mood and promote mental health, I think that really helps with the migraine as well. 

And then kind of an interesting thing that I learned doing these studies was that when I was first learning about plant-based diets and guiding and coaching people through a plant-based diet, they would come up to me and say, “I’m going to the bathroom a lot. I’m peeing a lot. Is this normal?” And what we came to find was that, well, they’re a lot better hydrated because plant foods, if you look at fruits and vegetables, a lot of them are really full of water. And as we know, when we’re dehydrated, we get migraines, and so we can be better hydrated, and potentially that’s what’s helping as well with the migraines.

And then plant-based diets, like you had mentioned before, have so many health benefits, and many of them are symptoms or diseases that go along with migraine — obesity, for example, with the chronic inflammation, fluctuations in hormones. And so if estrogen is balanced, which we have found potentially plant-based foods can do — we know that soy has phytoestrogens that actually balance estrogen, that actually reduce risk for breast cancer. And so, potentially, we’re having fewer of those fluctuations around menstrual cycles, and that can potentially help with those menstrual migraines.

And then kind of a thing that I’ve noticed myself with plant-based foods and kind of coaching people with plant-based diets is that when you’re really thoughtful about what you eat three times a day, you’re building in a natural mindfulness in your day. You’re thinking about “How am I preparing that food? Where’s it coming from? What’s in it?” When you’re in the grocery store, you’re reading food labels. And this built-in mindfulness really gives us some space between feeling hungry and making a healthy choice. 

So we might know wine gives us a migraine or chocolate gives us a migraine, but when we have a little bit of space and thoughtfulness around it, we can kind of say, “I’m craving that, but you know what? I know that’s going to cause me pain.” And so I think that added mindfulness can help with our overall stress and mood and maybe also help lower the triggers for migraine.

Molly: Wow, it is pretty incredible when you lay it all out how many facts you have to link the two together on how a plant-based diet really can reduce migraine and migraine triggers. It’s amazing. It’s not just one thing; it’s multiple things linked together, which is really exciting, and I think really helpful to people who might be interested in either making a switch or just incorporating more plant-based meals into their diet as well.

Dr. Agarwal: Absolutely, yes.

Molly: I love the water part, right?

Dr. Agarwal: Isn’t that funny?

Molly: I love that. I wouldn’t think about being better hydrated by eating an apple and watermelon and lettuce and spinach, but it makes so much sense.

Dr. Agarwal: Yes, especially here in DC, we get really hot, humid summers, and it’s so important to stay hydrated because with those weather fluctuations, I know I always get a migraine, and I think dehydration is part of that.

Molly: Oh, my goodness, yes. So just another kind of fun thing that you might not think about, but it definitely makes sense, so another added bonus. 

I also found it interesting that you said people who have plant-based diets within this research study often had more nutrients and more vitamins than people who are eating animal products as well. I think there is a concern with some folks that they might be missing out on certain nutrients if they’re not eating animals or animal byproducts. Can you tell us, is there any knowledge out there that shows that eating a plant-based diet, you might be missing out on certain nutrients that could potentially impact migraine?

Dr. Agarwal: Yeah, great question. I think one of the things is if you are 100 percent plant-based, you do need to take a daily B12 vitamin. We don’t need a whole lot of it, just a touch of it. Any old multivitamin will do. And that’s because our B12 we historically got from the soil, but now with pesticides and how much we wash our fruits and veggies, we’re not getting that extra B12 from the soil. So we do need to get that from a supplement, and that potentially could be a deficiency for some people.

If you take it most days, three times a week, and you make sure that you’ve got the B12 that you need, you shouldn’t have any problems. But plant-based diets, what’s wonderful about them is it’s very intuitive eating. And so if you look at your plate and you do one-fourth veggies, one-fourth fruits, one-fourth whole grains, and one-fourth beans and lentils, and you make your plate as colorful as possible, all the colors of the rainbow, to make sure you’re getting all your antioxidants, vitamins, and minerals, you really don’t need to count, “Am I getting my omega-3, am I getting my protein, am I getting my potassium?” You’ll be getting all of those and more.

And the potassium, the increased potassium intake, is actually why plant-based diets reduce your blood pressure. And so there are some vitamins, minerals, electrolytes that we are getting with a plant-based diet that help improve some of these medical illnesses and symptoms. So one of the general rules is if you’re getting enough calories, you’re getting enough protein, and it’s really pretty unheard of to have low protein, especially here in the US. It’s pretty unheard of. And so if you’re eating enough calories and you try to make your plate as colorful as possible, we really don’t see that deficiency for people who eat plant-based. 

And people who eat plant-based also don’t have increased incidence of iron deficiency anemia, which is another concern that some people have. Dark-green leafy vegetables are full of folate, full of iron, nuts and seeds. And so there’s plenty of plant-based sources of all the essential vitamins and minerals.

Molly: And I think the more plant-based diets come to the forefront and more people are talking about them and actually learning what’s behind them, those sort of myths of not getting enough protein or not getting enough iron are there. But, of course, it does depend on what you’re eating. If you’re just eating white bread all day, sure. But that might not be the most nutrient-effective way to use a plant-based diet.

Dr. Agarwal: And that’s a really good point, because Diet Coke, potato chips, and Oreos are vegan. They are plant-based. So I think that’s a really great point, which is, plant-based or not, being really careful about what foods you choose. And that’s why I say whole grain, so opting for black rice or brown rice over white rice, opting for oats and whole grains, like you said, rye bread or wheat bread or pumpernickel bread over white bread. And so that way, you really are ensuring you’re getting nutritious plant-based foods.

Molly: Yeah, the Diet Coke, Oreos, and potato chips sounds delicious but also sounds like that would probably lead to migraine in some cases.

Dr. Agarwal: I agree.

Molly: Missing out on something there, some type of color.

Dr. Agarwal: Yeah, good point.

Molly: Right, exactly. Yeah, I always like to look at my plate and see if there’s enough colors. I had this conversation the other day. 

So you did give us some examples of things people can eat, some easy ways people can incorporate plant-based foods in their diet. But if someone’s a little bit nervous about starting out, but they really do want to get these benefits, what’s a good way to start out eating plant-based?

Dr. Agarwal: That’s a great question. I mean, I think depending on where you are, for example, if you’re somebody who just doesn’t really eat very many vegetables, you can start out by adding a vegetable side to your lunch and dinner, and you can add a fruit side to your breakfast, and then kind of just weave those in there. So sort of just start a habit that no matter what I’m eating, I’m going to have a little bit of whatever vegetable you like, whatever fruits you like, and start there. If you’re already eating fruits and vegetables, make it a bigger portion. So make it half your plate instead of a fourth of your plate.

And then some people kind of opt for “Well, I just want a full plant-based meal.” And so you could choose one meal out of the day that you decide to eat fully plant-based or one day out of the week, such as meatless Mondays. And meatless Mondays, there are some research studies around there that did show that there are benefits to eating plant-based even just one day a week.

Molly: And I was kind of curious about that. Do you have to totally change your diet 100 percent right away from the get-go to get these benefits, or do just incorporating more plant-based foods in your diet give you some type of benefit?

Dr. Agarwal: Yeah, absolutely, you will get some type of benefit. And I think the best thing is do what you can, what suits your taste, what suits your lifestyle, because that’s all we can really do at the end of the day. And really celebrate any small changes. However small you think they are, celebrate them that you’re trying something new and you’re doing something to take care of yourself, and that’s always to be celebrated, and that’s always wonderful. 

And you might notice that you’ve got more energy. You might notice you are better hydrated. You might notice your bowels are more regular because you’re eating more fiber. You might notice that you’re feeling fuller faster after each meal because you’re taking in more fiber and that you don’t feel as bloated or sluggish after you eat even a big meal at lunch that lunchtime and then till 2 or 3 pm. You might notice that that energy dip is not happening as intensely or happening at all. 

So there are certainly many immediate benefits even from just adding more plant foods here and there. And you might find that you like it, and you might gradually increase it more and more.

Molly: That’s a great way to look at it. I like the idea of you’re doing something good for yourself, so be proud of yourself and enjoy. I really like that. I like that mindset.

Dr. Agarwal: And that’s really what it is. It’s all about how you look at it, because it can be stressful and overwhelming to think, “Well, now I have to overhaul my whole life. I have to overhaul the way I eat.” And there might be some people who are motivated and want to do that, and that’s great. But for most of us, baby steps are a great way to go, and persistent and consistent but slow and steady. And there’s no rush to it. Make it a lifestyle, make it fun, experiment, and see what you like. You might be surprised.

Molly: And that’s actually a really great point, because I did want to mention changing your diet can be very stressful. Eliminating certain foods can be very stressful. Whether you’re at home or at the grocery store, you’re trying to go out to eat, that can be overwhelming if you’re trying to be regimented, and stress, as we know, can trigger a migraine. So I think it’s really important what you just said — take it slow and steady; you’re doing something good for yourself — and really trying to incorporate a positive message around so it’s not a stressful event.

Dr. Agarwal: Exactly. And anything new that we try is going to be hard because our brain is used to the status quo. We’re used to it. And so you’re going against the grain, and to celebrate how brave that is of you to try something new and different. And you might like it and you might not, but you’ll always learn something from it. And that’s great, is to just kind of figure out, “OK, well, what did I learn from this, and what’s working for me?” and really honoring your own pace. I think that’s really important.

Molly: That’s a beautiful way to put it. Well, Dr. Agarwal, thank you so much for joining us. As we kind of wrap up here, is there anything else that you think folks out there should know about starting a plant-based diet or using a plant-based diet to help with migraine?

Dr. Agarwal: Yes, I think go for it and don’t be worried about it. There’s so much information out there. You can google, you can go to pcrn.org — lots of free information. You can google “plant-based diet for beginners.” There’s lots of Facebook groups out there, lots of free, easy resources. I promise you, you won’t be alone. You might be surprised by how much you like it, how easy you think it is, and how much better you feel. So I say go for it.

Molly: Awesome, I love that. I love the positive encouragement too. It always makes a difference when you have someone on your side saying, “You can do it. You might even enjoy it.”

Dr. Agarwal: Absolutely.

Molly: All right, well, we’re wrapping up this episode of Spotlight on Migraine. I’d really like to thank our guest today, Dr. Ulka Agarwal. Thanks so much for joining us. You taught me a lot, and I really think people at home listening will get a lot from this as well.

Dr. Agarwal: That’s wonderful. Thank you so much. This was really fun. Thanks for having me.

Molly: Happy to have you. Well, thanks, everyone, so much for watching this episode of Spotlight on Migraine. I’m your host, Molly O’Brien. We’ll see you next time.

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Voice-over: Thank you for tuning in to Spotlight on Migraine. For more information on migraine disease, please visit MigraineDisorders.org.

*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.