Migraines, magnesium, and brown rice

Migraines, magnesium, and brown rice

Soon after I published Food As Medicine in 2011, I received an email from a reader, who wrote about her experience with migraines and magnesium. A long-time lacto-ovo vegetarian, she told me that she took supplemental magnesium each month to control her premenstrual migraines, and that it was the only thing that worked for her.

To be sure, it’s been known for years that magnesium can be helpful in the prevention of premenstrual migraines. Several studies have shown that low serum magnesium is an independent risk factor for migraine headaches, and that magnesium can be used therapeutically to both prevent and treat migraines, as well as a host of other disorders characterized by spasm.

She couldn’t understand why she might be magnesium-deficient, however, because she ate a lot of brown rice, and had been told that brown rice was high in magnesium. According to nutritiondata.com, rice indeed tops the list of all magnesium-containing foods, at 781 mg per 100 mg. Although this refers specifically to just the bran and not the whole grain cereal itself, brown rice still weighs in at a respectable 143 mg of magnesium per 100 g serving. Thus if she ate about three cups of cooked brown rice (about 550 g) on a daily basis, she should have been getting more than 780 mg of magnesium, which is a significant dose by any standard.

It was only after this woman read the sections in Food As Medicine that discuss the importance of fermenting cereals to enhance nutrient absorption, that she put two and two together. Following the instructions in the book (see below), she began to ferment her brown rice before cooking, and a few weeks later noticed that she didn’t experience the same intensity of premenstrual migraines. Inspired by her results, she continued to practice this technique for the next two months, reporting to me in her email that her migraine issues were apparently resolved. Any of my students enrolled in my Food As Medicine program won’t find this to be much of a surprise. One of the central tenets of my nutritional approach is that our issue with diet and its disease-causing potential is a direct result of industrial technologies supplanting traditional methods of food preparation.

All seeds (or more properly ‘fruits’), whether they be cereals, legumes, nuts, or what conventionally call “seeds”, contain a host of natural plant chemicals that serve to discourage predation by animals. This is done to ensure reproductive success, and while this strategy isn’t necessarily effective against all predators, such as insects and birds, it has been very successful against mammalian predators. The extensive grasslands found all over the world are a testament to just how effectively grass seed resists mammalian digestion, and how the grass actually uses these predators to spread it further afield. Such is the strategy of many plants, that sacrifice a part of themselves to ensure the distribution of their genetic material, hopefully dispersed intact, contained within a nutrient-dense clump of “fertilizer”.


Among mammals, however, humans are unique  for our relatively recent practice of consuming cereal and legume crops as staples. While a variety of seeds have long been a part of the human diet, the proportion consumed for pre-agrarian peoples was much lower when compared to the farming folk that began to emerge during the 9-10th millennia BCE. The archeological record shows that in every measurable way human health declined with this transition, with clear evidence of physical degeneration, including a loss of height and bone density, and a dramatic increase in dental and skeletal problems.

While this issue of diet and physical degeneration remains perennial throughout the history of human agriculture, the problem stabilizes and begins to reverse as early farming societies discovered the importance of using food preparation techniques such as fermentation, to increase digestibility and nutrient absorption. Since this time, traditional agricultural societies have maintained an unbroken practice of using such techniques to process cereals and legumes, and optimize health. Besides the traditional sourdough breads of Europe, examples of this can be seen all over the world, in traditional foods such as chocolate (from cacao, Central America), ogi (from sorghum, West Africa), injera (from teff, East Africa; pictured below), idli (from rice and urad, South India), and natto (from soy, Japan).


As I articulated earlier, the global exportation of industrial food technologies has meant that much of this knowledge is rapidly disappearing or has been lost entirely. In all of the regions I mention above, industry has either begun to or has entirely supplanted these traditions, as it has in Westernized, ‘First-world’ nations. As a result, we can see how Westernized patterns of disease have crept into these societies, to promote an increasing prevalence of digestive, cardiometabolic, and autoimmune disease. Billions and billions of research dollars are spent each year trying to find a cure for these diseases, when in many cases the cause is entirely related to a loss of traditional knowledge and practices. In 2011, I made the point in Food As Medicine that when wheat is properly fermented, it no longer elicits an immunological reaction in patients diagnosed with celiac disease. This demonstrates that the cause of celiac disease is directly related to a failure to maintain traditional food practices. In my opinion, this finding is just the tip of the iceberg in a huge range of digestive and inflammatory disorders that could otherwise be prevented.

Of course this epiphany for the most part continues to elude modern science, which due to monied interests and its myopic pursuit speculative, novel solutions, has little time for moldy old traditions like food fermentation. But in my clinical experience, and as demonstrated by this woman’s experience with brown rice, we continue to ignore traditional wisdom at the peril of chronic disease.

In Food As Medicine, I discuss two basic methods to ferment cereals and legumes. One way to prepare them is to half-cook them first, and then ferment them in a brine, using some leftover live-culture pickle juice as an inoculant. The last part of the following video (start at 4:47) describes the technique for fermenting cooked chickpeas:

While this makes for a very satisfying result, especially for making bean dishes like hummus, it does take several weeks before its ready. Another technique I mention is a pre-cooking fermentation method, that once you’ve got an inoculum going, only takes 24 hours to prepare. Here it is, taken from the book, Food As Medicine:

Fermentation is a key step in ensuring the digestibility of foods such as cereals, legumes, nuts and seeds all of which contain antinutrient factors (ANFs) such as phytic acid and trypsin inhibitors that impair digestion and inhibit the absorption of nutrients.  The procedure to ferment these foods begins with making a starter.  Soak the nut, seed, grain or legume in water for 24 hours at 86˚F/30˚C, in a ceramic or glass container.  If you don’t live in a tropical climate you will need to use something to keep the ferment warm enough, such as an electric heat mat used for sprouting and germinating seeds.  After 24 hours, drain off the liquid, but set aside one cup of the soaking water for later use.  Rinse the nut, seed, grain or legume, and prepare as normal. 


The cup of soaking liquid that you reserved is full of bacteria, and becomes an inoculum (bacterial culture) for the next batch. Repeat the same process with fresh ingredients, but add the inoculum to the soaking water, and let sit at 86˚F/30˚C for 24 hours.  After, drain the soaking water and cook as normal, but retain a cup of the soaking water for the next batch. If you keep doing this, by the fourth time you will have an inoculum that is capable of reducing ANFs such as phytic acid by 96%.[1]  While fermentation reduces ANFs, however, it does not remove components such as lectins,[1] and thus the nut, seed, grain or legume usually requires additional measures such as cooking.

Once you have created a viable inoculum, you can store it in a covered vessel the refrigerator for up to a week before it will die, but add a handful of brown rice to give it some food.

[1] Liang J, Han BZ, Nout MJR, Hamer RJ. 2008. Effects of soaking, germination and fermentation on phytic acid, total and in vitro soluble zinc in brown rice. Food Chemistry. 110(4): 821-828
[2] Sharma A, Sehgal s. 1992. Effect of processing and cooking on the antinutritional factors of faba bean (Vicia faba). Food Chemistry. 43(5):383-385  

So try it out… whether you ferment before or after cooking, doing so will go a long way to improve gut health, and diminish chronic inflammation.

Let them eat salt!

Let them eat salt!

If you have been keeping abreast of the news lately, you might have come across a news story that highlighted a recent study published in the New England Journal of Medicine (NEJM), which found that salt consumption wasn’t associated with an increase in systolic blood pressure in either men or women, after controlling for factors like age (1). Given that health authorities have been saying for years that salt increases the risk of hypertension, these recent findings are another wrench in works for low-salt proponents.

This is not to say that very high salt consumption is safe. There is good evidence that reducing salt intake from 9-12 g per day, in large part from eating junk food and prepackaged foods, to less than 7 g per day, does promote a significant fall in systolic blood pressure (2). The problem is getting a handle on what exactly this means, particularly when these same changes seem to have no effect on lipid levels, and the risk of dying from cardiovascular disease is at best weakly associated with high salt consumption (15% increase in risk). Once again, as I addressed in an earlier blog, we need to make sure that we don’t confuse our objectives, and remember that hypertension isn’t so much a disease as it is as diagnostic sign. Just because we can alter the findings of one diagnostic sign through various interventions, doesn’t necessarily mean that we have altered the course of the disease. It is really just another example of failing to see the forest for the trees.

Despite these rather unconvincing findings, authorities continue to suggest that we’re consuming too much salt, with the US Food as Drug Administration (FDA) suggesting that we consume less than 2.3 grams per day, and the American Heart Association (AHA) going even further by recommending that we consume no more than 1.5 grams. After all, if eating too much salt is a bad thing, dramatically reducing our consumption must therefore be a good thing – right?


In another recent study published by the NEJM (3), researchers compared the health outcomes of patients that followed the very low sodium diet recommended by the FDA and AHA, consuming less than 3 g per day, and found that they had a higher risk of death or cardiovascular than those who consumed more than 7 grams per day:


Shocked? You shouldn’t be, because it’s not the first time we’ve seen these kind of results. A study published in the Journal of the American Medical Association (JAMA) in 2011 found much the same thing, after following 3,681 people for almost a decade that were eating either a low, moderate, or high salt diet (4). And while researchers again found that excessive salt intake was associated with an increase in systolic high blood pressure, they found that a low-sodium diet was significantly associated with higher mortality from cardiovascular causes:

According to the USDA and Health Canada, the average North American consumes only about 3.4 g of salt on a daily basis, which according to the latest research, suggests that most of us are consuming salt at the low end of the spectrum. Personally, I found these results surprising, especially considering just how much prepared and packaged food we eat, which is notorious for containing the high levels of salt which appeals to our tastebuds, activates our appetite centre, and stimulates impulse purchases. But it seems that even with what is still perceived as relatively high salt consumption, most of us are eating salt within a range that is associated with the least risk. Besides which, we’re talking about very small differences in risk, regardless of how much salt we eat. There are far bigger fish to fry, for example, when we compare the effects of eating too much salt, to the consumption of a high carbohydrate diet, which increases the risk of diabetes by 44% and the risk of CVD by 25% (5).

In Āyurveda, salt is a flavor that is an essential part of the diet, and to help maintain good health. Salt stimulates the appetite, promotes the flow of glandular secretions, and assists with the assimilation and absorption of food. It is described as viṣyañdī, meaning that it promotes tissue secretion, and sūkṣma, because salt opens the channels and promotes the easy passage of the feces, making it helpful in constipation. Salty flavor is hot, heavy and wet in quality, and helps to reduce and balance vāta, the component of the humoral theory in Āyurveda that is most closely associated with function of the nervous system. Sodium accounts for almost half the osmolarity of the extracellular fluid, playing a key role in conducting electrical impulses throughout the body.  With excessive sweating or diarrhea, the loss of sodium and other electrolytes disrupts the function of the nervous system, leading to issues including nausea and vomiting, headache, mental dysfunction, fatigue, irritability, weakness, cramping, seizures, and loss of consciousness. Often people will think to drink water when they’re dehydrated, but without the addition of electrolytes such as sodium, the water will go right through them and the problem will likely get worse. Although medical organizations like to suggest oral rehydration packets loaded with sugar to restore electrolytes, research has shown that a traditional Āyurvedic salted rice soup (e.g. peya) is far more effective (6).

While I am an advocate for consuming salt, like anything, there is a down-side too. Apart from the overt effects of hypernatremia, which is almost impossible to achieve from dietary consumption, the excessive consumption of salt irritates the mucous membranes, and can lead to inflammation. In a similar fashion, excessive salt weakens digestion and promotes congestion, leading to a feeling of heaviness and lethargy. In this way, salt consumption is limited in kapha (congestive) and pitta (inflammatory) conditions in Āyurveda, but even with these contraindications, it is never eliminated entirely.

Perhaps the most important issue to consider when it comes to salt is the source. Most commercial sources of table salt are prepared from pure sodium chloride, to which various ingredients are added, including anti-caking agents (e.g. sodium aluminosilicate), and if the salt has been iodized, the addition of alkalis (e.g. sodium carbonate) and stabilizers (e.g. dextrose, sodium thiosulfate). I don’t recommend this salt for a number of reasons. Apart from the synthetic anti-caking agents and other additives, pure sodium chloride is a highly refined product, as pure NaCl doesn’t exist in nature. Typically derived from either marine sources (e.g. sea salt), or mined from prehistoric salt deposits (e.g. rock salt), natural salts contain a diversity of nutrients including calcium, magnesium and potassium, as well as a host of trace minerals. The net effect is that these natural salts moderate the direct influence of sodium in the body, and because salt craving can often be a sign of a mineral deficiency, helps to address the root cause of nutrient imbalances.

In Āyurveda, there are five basic groups of salt, called the pañca lavaṇa:

• saindhava lavaṇa
• sauvarcala lavaṇa
• viḍa lavaṇa
• sāmudra lavaṇa
• audbhida lavaṇa

Consumed not just as a flavor or condiment, the pañca lavaṇa are viewed as therapeutic agents, used singly or in combination, found in many different formulas used both internally and topically, such as Bhāskaralavaṇa cūrṇa and Saindhavādi taila.

Jamts Davs
Saindhava lavaṇa is considered to be the best among salts, mined for thousands of years at the feet of the Himalayas in the Sindh region of the subcontinent. It is derived from the ancient Tethys Sea that at one time separated the subcontinent from Asia. Also known as pink salt, sendha namak or Himlayan salt, saindhava is a light-colored rock salt with a mild taste and sweetish-salty flavor. Saindhava is stated to alleviate all three doṣāḥ (doshas), enkindle digestion, restore electrolytes, benefit the eyes, reduce burning sensations, and enhance fertility.

Sauvarcala lavaṇa is another type of rock salt mined in the Sindh regions and elsewhere, but contains significantly higher levels of iron sulfide, providing for its blackish-red color and characteristic sulfurous odor. Also known as black salt, kala namak, sonchal or sanchal, sauvarcala is considered best for digestion and to balance vāta.

Viḍa lavaṇa is an artificially-prepared salt, made by boiling the powders of saindhava, Āmalakī, Harītakī and sarjakṣāra (sodium carbonate) in water until it is completely evaporated. Naturally rich in ammonium chloride, viḍa is black in color, and possesses an alkaline, salty flavor. It is used to correct kapha and vāta, reducing heaviness in the chest and promoting good digestion, and the proper excretion of feces and gas. Viḍa lavaṇa is generally not used for dietary purposes.

Sāmudra lavaṇa is unrefined sea salt, prepared by evaporating off the moisture from seawater. It is made all over the world, and is differentiated from refined salt by containing a high density of trace minerals, giving it a greyish, rather than pure white appearance. It has a mildly warming energy, and acts to enhance digestion, reducing vāta and the expulsion of flatus, and is only slightly aggravating to pitta and kapha when consumed in larger amounts.

Audbhida lavaṇa is a type of salt that is collected and purified from the soil by calcination, and is rich in sodium bicarbonate. It has an alkaline taste and action, and is considered to be difficult to digest, greasy in quality, cold in energy and acts to reduce vāta. It is used therapeutically, but is generally not added to food.

The FODMAPS diet

The FODMAPS diet

Over the past couple years I have heard practitioners and patients refer to the FODMAP diet as a way to resolve chronic gut issues like irritable bowel syndrome (IBS). In a nut shell, the FODMAP diet refers to the reduction or elimination of foods that contain various long-chain sugars found in foods such as cereals, pulses, root vegetables, and fruits (see this list). Specifically, the term FODMAP is an acronym devised by researchers at Monash University in Australia, referring to foods that contain “Fermentable Oligo-saccharides, Disaccharides, Mono-saccharides and Polyols”.  According to proponents of the FODMAP restriction diet, as well as similar diets such as the Specific Carbohydrate and GAPS diet, many of these sugars aren’t properly digested. As a result, they are utilized instead by some of the bacteria that naturally inhabit our intestines, leading to their enhanced growth and fermentation, causing symptoms such as gas, bloating, colic, and diarrhea. Many people following a FODMAP or Specific Carbohydrate diet do indeed find that their symptoms diminish after some time. The problem, however, is that patients quickly find that the diversity and variety of foods in their diet begins to decline dramatically. With these and other restrictions, some may feel that they have painted themselves into a corner, finding that their intolerances and sensitivities actually worsen over time, or that they experience difficult problems such as chronic constipation.

The notion that indigestible sugars can cause gas and bloating isn’t anything new. More than 20 years ago when I began my training as a herbalist, I was taught that a whole foods vegetarian diet was a healthier option than a meat-based diet, and during the first couple years of my practice I encouraged many to make this switch. One of the more common issues I observed, however, was that with the displacement of meat for vegetarian sources of protein such as beans, nuts and seeds, as well as whole grains and root vegetables, patients very often presented with an increase in gas and bloating, and sometimes even experienced diarrhea. I learned to anticipate this, and explain that it was a natural result of adding more high-fiber foods to the diet, which in turn, altered the composition of the microflora in the gut. In many cases, the symptoms of gas and bloating that accompanied these changes were temporary, and usually the symptoms would begin to diminish within a few weeks. Often I would discuss ways to improve digestibility, such proper cooking techniques, and the use of culinary herbs, such as cooking legumes with ginger and garlic. In some patients however, their digestive symptoms didn’t get better, and it was this as well as other reasons, that I soon abandoned the idea that a vegetarian diet was necessarily good or well-suited to everybody. Nonetheless, I learned a great deal about how to deal with digestive issues attributable to a high fibre diet.

It is very clear that some people do note an improvement in their digestive symptoms when they avoid FODMAP-containing foods. But before we celebrate the success of this intervention, it is important to look at some potential problems. Firstly, the FODMAP diet seeks to remove many of the high fibre foods that researchers have linked to a reduction in the risk of hypertensionstrokeelevated LDL cholesterolischemic heart diseasediabetes, and colorectal cancer. Some of the FODMAPs have also been shown to benefit chronic digestive disorders such as GERD, ulcer, and hemorrhoid, as well as promote mineral absorptionmodulate immune functionresist infection, enhance mood and memory, and promote healthy aging. In this context, the fermentable, indigestible fibres described by the FODMAP system are also called ‘prebiotics’, meaning that they provide a substrate for the growth and development of probiotic bacteria such as Lactobacillus spp., Bifidobacterium spp. and Saccharomyces boulardii. It is well-established that these and related bacterial species promote a healthy gut, which in turn, conveys a benefit to immune and metabolic function. Further, some FODMAP foods such as onion and garlic contain powerful antitumor chemicals such as diallyl disulfide, S-allylcysteine, and ajoene, and when consumed regularly, are highly associated with a significant reduction in cancer risk. Given the weight of evidence in favor of consuming prebiotic foods, is the FODMAP-restricted diet a valid and safe approach for managing chronic digestive disease?

While it may be empirically true that in some cases a FODMAP-restricted diet promotes an improvement of symptoms, we need to ask if the benefits are only attributable to an avoidance of fermentable sugars. Upon review, many of the foods listed by researchers at Monash University as being high in FODMAPs, are also high in a plethora of other molecules that are well-established to cause problems in the gut. In my book Food As Medicine, I review the issue of antinutrient factors (ANFs) in high-fiber foods, which includes constituents such as phytic acid and polyphenols, which chelate minerals and directly inhibit digestive secretions. In the case of cereals and legumes in particular, these foods also contain toxic storage proteins such as gliadin and vicilin that promote inflammation, protease inhibitors that block the function of protein-digesting enzymes, and lectins that can induce gut inflammation and provoke autoimmune diseases. Thus it seems reasonable to challenge the conclusions made by FODMAP proponents that it is just fermentable sugars that are the problem, when in actual fact, the issue is a great deal more complicated. It is also difficult to have a great deal of faith in the FODMAP recommendations, when they state that spelt flour is low FODMAP and gluten-free, when in fact spelt is just a subspecies of wheat (Triticum aestivum subsp. spelta), and most definitely contains gluten. While there is some research showing that fermentation can reduce the gliadin content in sourdough bread, the procedure may require specific strains of bacteria (e.g. Lactobacillus sanfranciscensis) and must be fermented for up to 72 hours at 37°C, and currently, there are a serious dearth of commercial bakeries I know of that ferment their dough long enough to significantly reduce gluten. In other words, if you are following a FODMAP diet but actually have a gluten sensitivity, the recommended FODMAP diet won’t provide any benefit.

As a practitioner that has been studying global food traditions for 20 years, I am not overly impressed by the FODMAP diet and its conclusions. The meal plan is better than the Standard American Diet to be sure, but due to it’s myopic perspective I cannot consider it to be a sustainable diet. To be sure, some people have a very hard time digesting FODMAP foods. But is the solution one of simple avoidance? When we reach back into the history of our culinary traditions, it is very clear that humans have long worked out ways to deal with the digestive issues causes by FODMAPs, as they have been found in our staples for millennia. Beets for example, are a high FODMAP food, with high levels of fructans that can cause gas and bloating. When consumed irregularly, boiled or baked beets are helpful for occasional constipation, and have a laxative activity. When consumed as a staple however, the high levels of indigestible sugars in beets will eventually causes issues, and foment the creation of a gut filled with FODMAP-loving bacteria. Good news for the bacteria, but uncomfortable and bloaty for you.

The solution? Ferment the beets first. Make those same bacteria get the work done for you before you eat it. Surveying the majority of cookbooks, it appears to be a little known fact that a beet “borscht” was originally made with fermented beets – a tradition  kept alive by some Jewish families of Ukrainian origin as a dish called russel. Fermentation of the beets beforehand utilizes the same FODMAP-loving bacteria we don’t want to overpopulate our gut with, effectively breaking down indigestible sugars that just cooking cannot. Among poor Jewish farmers during the 20th century Ukraine, beets were very much a staple, but without fermentation it is likely that as a staple it would have resulted in severe malnutrition. Likewise, many different cultures employed fermentation to improve the nutrient bioavailability of their food, including dairy products (e.g. yogurt), cereals (e.g. idli), legumes (e.g. natto), and seeds (e.g. cacao). Perhaps the FODMAP diet should be renamed “The Fermented Food” diet, and then the confusion will cease to persist about which foods can and cannot be eaten. Then we can go back to using prebiotic foods such as garlic and apple, as well as medicinal herbs to modulate the gut, such as Astragalus and Slippery Elm. Generally, all that we need to know about them is that when given in larger doses, prebiotics tend to stimulate a colonic response by encouraging bacterial growth, helping with issues such as constipation. But when there’s gut irritation and diarrhea, indicating bacterial overgrowth, it is wise to use less prebiotics or even eliminate them altogether as a form of population control. It’s that simple. You are in charge of your bacteria by what controlling what you eat.

But what to do with the patient that has removed so many foods from their diet, that they can hardly eat anything at all? Is it a valid therapeutic goal to have someone stuck on a FODMAP diet forever? Or is there something missing? After considering the issue of food preparation, perhaps the answer is found within the process of digestion itself. Ideally, we should all be able to eat a broad variety of properly prepared, whole foods. Dietary ratios will differ for each, based on constitutional or disease factors, and for some there may always need to be a strict avoidance of a particular food – such as gluten. But humans have been consuming high fibre foods and herbs for a very long time, and there is no rational reason why we should not be able to now. Thus a blind adherence to FODMAP, Specific Carbohydrate, and GAPS, as beneficial as they might be to a patient at a certain point in time, misses the mark completely. It’s all about digestion. One major issue that needs to be accounted for, however, is the long term effect of systemic antibiotics on the human microbiome, creating ecological distortions within gut, promoting chronic inflammation and bowel dysfunction. Restoration of a healthy gut ecology is vital, and it could be that for some patients a fecal transplant from a healthy individual is the only answer (although there is some risk of autoimmune reactions). Otherwise, the focus needs to return to digestion, and how to improve it. In future blogs and webinars, I’ll explain this process further.