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Dietary Ups & Downs

I promised myself my next post would be about something other than the diet. But diet is all I think about right now. It is exhausting. You’d think whittling down my food selection would be a reprieve, except that I’m either in a migraine, recovering from a migraine, or planning the next food I’m going to try that will likely start the cycle over again.

It took six days to recover from cheating on the diet, then I triggered another migraine Thursday night with iceberg lettuce. When I recovered Friday, I cooked up some chicken and rice. To add flavor, I poached the chicken, then boiled the poaching liquid for 30 minutes to reduce it and added the liquid to the mix. Apparently, that was long enough to develop sufficient amines to trigger a migraine.

If I read this on another person’s blog, I’d probably think they were being paranoid and attributing too much to foods as migraine triggers. That was my attitude toward food triggers until eight weeks ago. Here’s the thing: I know my body and I know what my migraines and headaches feel like — I know these things better than I know anything else in the world. On my “baseline” days, which are migraine-free and the headache is of low to moderate pain, my head feels different — better — than it has in a decade.  I still have a headache all the time, but the pain is higher on my skull and it has a different quality than usual, though I haven’t found the words to describe it. I’m also very aware of how my body responds to triggers. Now that my diet is so simple and the headache pain has changed, I can tell when a migraine is triggered by food. I’m more than willing to stick to chicken and rice if it means I can stay at my baseline.

For a couple more days, at least. I see a dietician Thursday and hope she can provide me with good direction and advice. I know what I’m eating is not nutritious and not a long-term solution. But I hope there’s a way to get adequate nutrition and stick with the diet long enough to sort out what my food triggers are.

Because much of the RPAH/Failsafe diet information is anecdotal, I don’t know how much stock to put in this, but there are a couple factors that make me think I just need to keep at it. Some people report being on the diet six months to a year before they can test foods without exacerbating their symptoms. No one uses this word, but I think of it as a detox — it takes a certain amount of time to reduce the buildup of food chemicals in the body enough to introduce them again without causing a flareup. Also, some people, especially those with chronic fatigue symptoms or chronic pain according to the Failsafe WordPress blog, are “super-responders” and have to eliminate all vegetables. Though migraine and headaches are my primary symptom, fatigue has actually been more limiting in the last year.

From your comments and emails, I know many of you find this useful. I hope I’m not boring the rest of you to tears. Maybe my next post will be about something other than diet. I’d certainly appreciate thinking about something else.

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RPAH/Failsafe Diet for Migraine & Headache

The low histamine and salicylate diet that seems to be helping me is referred to as either the RPAH diet or the Failsafe diet. Originally developed by the allergy unit of Royal Prince Alfred Hospital in Australia (that’s the RPAH part), the diet was popularized under the name Failsafe by a woman whose daughter was helped by RPAH. The name Failsafe comes from the diet being free of additives and low in salicylates, amines (including histamine and tyramine) and flavor enhancers.

Calling the diet “flavor-free” sounds snarky, but it’s an easy and accurate summary. Naturally occurring food chemicals are responsible for the flavor in foods. Without them and without artificial flavors and chemicals, the diet is pretty bland. However, it is not a permanent dietary change. The idea is to cut out all these possible food chemicals for two to four weeks, then slowly add them back in, testing to see which ones are problematic for you.

This diet was developed for treating behavior problems in children. You’ll find people online saying the diet has helped them with a wide variety of health issues, from eczema to migraine and headache to heart palpitations. All the evidence is anecdotal, but if you’re really sick and no conventional or alternative treatment seems to help, it is worth a try.

The diet is drastic: check out this two-page list of allowed foods (PDF). This list, which I printed and keep on my coffee table, includes common pitfalls and mentions other chemicals in allowed foods. Even though potatoes are allowed, I discovered this week that I react to them, perhaps because they have naturally occurring nitrates. Working with a nutritionist is the best way to maintain proper nutrition without losing your mind.

Where to learn more:

Failsafe WordPress Blog: This blog is a superb resource and is where the aforementioned two-page list comes from. It is really all you need to get started on the diet.

RPAH on Food Intolerance: The original source, which doesn’t have a ton of information online, but the overview is particularly helpful. You can order the diet handbook from them for about $80 (including shipping from Australia), but it doesn’t seem necessary.

Food Intolerance Network: This website is run by the woman who coined the name Failsafe. The amount of information is a bit overwhelming, but the site answers a lot of questions. Check the US shopping list (PDF) for specific allowed foods.

Allergy Friendly Food: I ordered this book used from Amazon (much less expensive than ordering it directly from RPAH) and reference it a lot. This and the Failsafe WordPress blog are my go-to resournces.

The Failsafe Cookbook is good if you’re looking to get the most flavor possible while on the diet. I bought this book, but haven’t used it because many of the foods (like nuts and dairy) are ones I’m avoiding for other migraine-related reasons.

Keep in mind that I haven’t started the “challenges” yet. Once I begin testing which foods/food chemicals I can tolerate, my list of recommended resources may change. Also, most of the information is from Australia, so product information isn’t always relevant and you may need to do some translating.

After writing this all up, I’m struck by the fact that I’m not following the RPAH/Failsafe diet, although it was my starting point. Because of a stomach virus, the results of an ELISA food allergy test, and foods I’m pretty sure are migraine triggers for me, I’ve eaten mostly chicken and rice for the past week. My head feels better than it has in a decade, but this is not a healthy diet for the long-term. I’m definitely scheduling an appointment with a nutritionist.

P.S. In your reading about the diet, you’ll see toiletries mentioned. Many body and beauty products contain salicylates and histamine and it is recommended that you avoid those as well. I’m working on another post about that.