Preventing Migraine by Healing the Gut

By Tom Staverosky

Is it possible that the best way to prevent migraine is to improve digestive function? This creative approach has its roots in the growing field of neurogastroenterology and is showing exciting results in the work of ForeverWell, a nutritional supplement company with a unique concept.

The debate has continued for a long time. Is migraine a vascular/circulatory disease or is it a neurological disease? While there is no conclusion as to the root cause of the problem, the research increasingly leans in the direction of a neurological disorder.

Medical research is a slow methodical process. The occasional news stories offering us hope in the treatment of chronic medical conditions are a mere tip of the iceberg. The detail of most research never reaches us and if it does it seems so obscure and unrelated to our current health needs as to seem to be a waste of time and money. Fortunately, some of this esoteric work opens doors of possibility and windows of opportunity.

Such is the case with the developing work in the field of neurogastroenterology, or more simply put the brain in our gut. In an attempt to alert us all to the possibilities and opportunities of this work Michael D. Gershon, MD, the recognized father of neruogastroenterology, has published a fascinating book, The Second Brain. The subtitle, Your Gut Has a Mind of Its Own, begins to suggest some of the implications of this evolving field. Some of the more intriguing facts of this enteric nervous system, extracted from Dr. Gershon's preface to his book, include:

• 95% of the body's serotonin is made in the bowel.
• There are more than a hundred million nerve cells in the human small intestine, a number roughly equal to the number of nerve cells in the spinal cord. Add on the nerve cells of the esophagus, stomach, and large intestine and you find we have more nerve cells in our digestive system than in our spine.
• The enteric nervous system is a vast chemical warehouse within which is represented every one of the classes of neurotransmitter found in the brain.
• The multiplicity of neurotransmitters in the bowel suggests that the language spoken by the cells of the enteric nervous system is rich and brain-like in its complexity.

The History of the Gut Brain

Our nervous system is divided into two general categories, the skeletal, or voluntary, which is under our conscious control and the autonomic, or involuntary, which runs the body's systems on a subconscious level. A search of a medical school text book on the autonomic nervous system as recently as five years ago will reveal just two components to the autonomic nervous system, the sympathetic, and the parasympathetic with no mention of the enteric system. This is particularly surprising when you read Gershon's history of the gut brain and realize it was discovered 100 years ago.

Neurogastroenterology really started with Bayliss and Starling, two investigators who worked in nineteenth century England. They were the first to observe "the law of the intestine", now known as the peristaltic reflex. They correctly attributed peristalsis (the muscular movements that propel the contents of the intestine in a startling one-way direction) to nervous system function. The discovery that most surprised Bayliss and Starling was that when they cut all central nervous system connection to the animal guts they were studying the peristaltic reflex continued. They knew that if they were to cut all the nerves to limbs or other organs all reflex would be lost. Reflex behavior anywhere but the gut always involves the participation of the brain or spinal cord.

Simply put, if eliminating any possibility that the central nervous system was responsible for "the law of the intestine", Bayliss and Starling concluded it was controlled by the "local nervous system" of the gut.

A couple decades later, in 1917, UlrichTrendelenburg, a German scientist, suspended a guinea pig's intestine on a hollow J-shaped tube in an organ bath. This nutritive solution, supplied with oxygen, allowed the intestine to survive for several hours. When Trendelenburg blew into the J-shaped tube the gut blew back, which indicated the same reflex behavior that Bayliss and Starling had observed in an intact dog. In Trendelenburg's laboratory, the brain, spinal cord, and sensory ganglia had all been discarded with the rest of the guinea pig. His experiment was revolutionary because he had demonstrated that the local nervous system of the gut actually had properties that are like those of the brain and the spinal cord.

Texts at the turn of the century considered three aspects of the autonomic nervous system, the sympathetic, the parasympathetic and the enteric. Gershon's history suggests that the enteric system fell by the wayside as the neurotransmitters for first the parasympathetic, acetylcholine and then sympathetic, norepinephrine were discovered and embraced. It seems that this neat package of two systems and two signaling chemicals fit the logical scientific thinking in a way that resulted in the disappearance of the enteric nervous system.

The Rediscovery of the Enteric Nervous System

Enter Dr. Gershon and his work, which began in the 1960's and reached a critical moment in 1981. He was convinced that the enteric nervous system was largely independent of the central nervous system and functioned with a new neurotransmitter, serotonin. At the meeting of the Society of Neuroscience in Cincinnati in November of 1981 Dr. Gershon presented his work opposite his principal critic. Imagine his surprise when his opponent rose to present his most recent research confirming that Dr. Gershon was correct, serotonin is indeed an enteric nervous system neurotransmitter.

Thus began in earnest the acceptance of the second brain in the gut. The research has expanded by leaps and bounds and while much has been learned as is true with a lot of medical research, the more that is learned the more we realize how little we know. Some of the more intriguing bits of new knowledge include:

• The same type of tissue damage that is found in the brain of patients with Parkinson's disease has also been found in their enteric nervous system.
• The enteric nervous system has more in common, both chemically and structurally, with the brain than with the remainder of the peripheral nervous system. It looks as if it were a brain gone south. As a result, it is to be anticipated that illnesses of various types that occur in the brain will also involve the enteric nervous system.
• New studies demonstrate that the mucosal release of serotonin is important not only in signaling within the bowel to initiate peristaltic reflex and sensory reflexes but also in sending messages from the gut to the brain.
• Serotonin regulation in the gut and brain is accomplished by cells that reuptake excess serotonin when its job is complete. The drugs developed to treat depression such as Prozac inhibit the reuptake of serotonin. While it is not clear why this lifts depression, the drugs exert a similar effect on the reuptake of serotonin in the gut, which seems to be responsible for the gastrointestinal disturbance suffered by many who use anti-depressants.
• The digestive system works with a complex array of balancing and counterbalancing mechanisms designed to create the environment needed to digest and absorb various necessary nutrients. While we understand these mechanisms in general there is much to learn about the specifics of their actions and interactions.

Implications For Migraine Sufferers

How does all this relate to the prevention of migraine? One possibility is being pursued by our company ForeverWell. Considering the similarities of the brain and the enteric nervous system, and realizing that some brain centered medical problems had manifestation in the gut we wondered what impact we could have on migraine disease by improving the relative health of the digestive system.

We designed targeted nutritional supplements to support improved function of the gut and its principal supportive organ, the liver. We conducted an open label outcome based study utilizing the Migraine Specific Quality (MSQ)of Life Questionnaire (version 2.1, copyrighted 1992, 1996, 1998 by Glaxo Wellcome, Inc. Research Triangle Park, North Carolina). You can link to a copy of the study as it was published in the peer-reviewed journal Alternative Medicine Review at our web site
www.foreverwell.com .

The bottom line of our efforts is that by the end of the 90-day study, 60% of the 40 participants were no longer getting headaches, 20% experienced a reduction in duration and frequency and 20% saw no improvement.

Based on Dr. Gershon's book we can suggest several possible reasons for this improvement. Perhaps within an improved digestive system the production and balance of various neurotransmitters essential in nerve stimulated biological response is improved. Is it possible that enhanced digestion allows the body to function more smoothly, that underlying dysfunction is mitigated when the body is getting what it needs? These are just two explanations to consider. I will leave it to the research community to continue to open the doors of possibilities.

On a broader scale one cannot read The Second Brain without getting the picture that the body is a vast array of interconnected mechanisms that allow the human organism to survive and thrive. The exciting aspect of this vision of the body is that everything that happens within one aspect of the organism has repercussions in some other area of the organism. In other words, everything effects every other thing. In a medical system that is increasingly compartmentalized into specialties, there is little acknowledgment of this interconnection. For example, the neurologist rarely considers what the gastroenterologist knows to be of value to his work and vice versa. A system evolving to recognize and benefit from a vision of the interconnected body will serve us all well.

Clearly, the work we are doing at ForeverWell is an example of the value of understanding the body as an interconnected organism. The bottom line for any migraine sufferer is to eliminate the headaches. This new approach to a nutritional preventive is certainly an option to consider.

For more information visit our web site www.foreverwell.com .