“The only time to eat diet food is while you’re waiting for the steak to cook.” -Julia Child

I love Julia’s take of food and life.  Feeding ourselves can be such a sensual act. The whole concept of a diet is denial. But you can feed yourself and put the NO beast on a diet without limiting your choices. It’s all about balance.

Over the past few weeks we’ve seen how nitric oxide (NO) is an important chemical messenger in the human body. NO is used by cells to communicate to each other as well as serving an important role in the body’s immune response. Migraineurs who find relief when taking migraine abatement drugs, such as sumatriptan and indomethacin, are using the drug to block the uptake of NO by the blood vessels in the brain. This in turn allows the swelling of these blood vessels to stop, relieving pressure on the nerves and abating the migraine. Those that suffer from migraines are thought to be “supersensitive” to NO.

NO is produced in the body through a number of different ways. The primary pathway in cells is fueled by the amino acid arginine. We get plenty of arginine in a balanced diet. Yet when arginine is running low, the body can synthesise more from citrulline, found in high concentrations in watermelon, and citrulline can be synthesised from glutamate which can be found in MSG. More recently it has been found that nitrate and nitrite can be used by the same pathway to create NO.

This is once the products of digestion enter the bloodstream. NO production actually starts with your first bite of food. The saliva in your mouth processes nitrates and nitrites resulting in the release of NO high enough to trigger a migraine. Later in your intestines beneficial gut microbes do the same thing with nitrates and nitrites to produce NO.

The bottom line is NO is everywhere. It’s such an important chemical in our bodies that many redundant systems have evolved to ensure that there is plenty available. For most people this is not a problem. Unless of course for some reason you are “supersensitive” to NO.

There is a well studied group of people that are “supersensitive” to NO that we can learn a lot from, those with genital herpes. Genital herpes is just behind migraines in terms of the number of people affected annually. Sufferers are sensitive to excess NO because it is required for the virus to replicate. That same NO that the immune system makes to kill pathogens, this virus also eats up and uses it to reproduce. It hides in the nerves waiting for excess NO and then there’s a flair up of symptoms. As the virologist in the Brad Pitt movie World War Z so aptly put it:

“Mother nature is a serial killer….Sometimes the thing you thought was the most brutal aspect of the virus, turns out to be the chink in its armor. And she loves disguising her weaknesses as strengths. She’s a bitch.”

Not surprisingly researchers found that if you don’t feed the NO beast you can reduce the frequency and severity of herpes outbreaks. Starting in the late 1970’s with the discovery that if you increased the amount of the amino acid lysine you could reduce the severity of symptom outbreaks. It worked because lysine and arginine are taken up by cells using the same pathway. Effectively lysine caused a traffic jam and kept the arginine from getting into the cells to be processed into NO. By the 1980s not only were lysine supplements part of the treatment regime, a diet that was biased towards lysine and away from arginine was recommended to help manage outbreaks.

Unfortunately by the turn of the century the diet had gone out of favour because in the general population it was proving ineffective. I think that it proved ineffective because it was employed too early in our knowledge of how NO is made by the body. Significant discoveries have been made in the decade since the diet fell out of favour. It wasn’t until 2008 that there was enough research to prove that the body’s pathway uses arginine, nitrate and nitrites. Coupled with the 2015 discovery that nitrates and nitrites are converted in the gut to NO clearly demonstrates their importance as fuel for the NO beast. The failing of the diet is that it did not limit all the fuels such as artificial sources of nitrate, nitrite and the natural building blocks of arginine, citrulline and glutamine. I think the baby may have been thrown out with the bathwater.

Lucky for us there already exists a balanced diet that has undergone the rigors of scientific peer review and also acceptance by the medical community that is both high in lysine and low in arginine. With the simple additions of:

1. removing artificial sources of nitrates and nitrites in the form of preservatives and wine;
2. abstaining from the three foods naturally high in nitrates, nitrites and citrulline; and
3. avoiding added MSG in the form of yeast extract, flavour enhancer, hydrolysed vegetable protein, soy extract and malted flours;

we end up with a diet that keeps us healthy while reasonably limiting fuel for the NO beast.

This is why for the past three weeks my repeated message has been to remove the artificial sources of nitrates, nitrites and MSG from your diet. The fuel for the NO pathway is in everything we eat. Of course it is, NO is essential to life itself. Migraineur’s don’t need to be putting additional fuel on the fire of their “supersensitivity” to NO by consuming extra sources that are pervasive in highly processed foods.

The NO pathway evolved without these man-made fuels and your body will function just fine without them.

The bottom line is if you want to better manage the frequency and severity of your migraines, you are going to have to start reading food labels and making more things from scratch. That is the first step in reducing the excess fuel.

The second step is to shift to a diet skewed to lysine over arginine, or a herpes diet if you like. If you Google it you will find lots of tips. Like I said earlier, you will also find that it is no longer prescribed to help manage the frequency and severity of herpes outbreaks. I just want to be transparent about this.

A diet that is rich in lysine is a balanced diet that focuses on dairy and meat protein sources and limits nuts, cereals and grains. It doesn’t mean that you don’t eat nuts, cereals and grains; it means that when you do eat them you should balance them with a high lysine food. Cereals, nuts and grains have high nutritional value and should not be excluded from a diet unless under the care of a physician. For every yin there is a yang, arginine and lysine go hand and hand. Focus on the light, the lysine. Be prepared to embrace your inner carnivore.

Whole foods are complicated mixtures of nutritional goodness. If you are interested in finding out what the lysine to arginine ratio is for foods you eat try checking out this comprehensive list. I like to focus on foods that have a 1:1 ratio or better. We still eat foods that have less than a 1:1 ratio, just not as much of them or as frequently.

With a little forethought and planning you can feed yourself without feeding the beast. Next week we’ll start to learn how not to poke the beast.

As always, whenever making lifestyle changes be sure and consult your healthcare team. Under no circumstances should you stop or start taking medication or supplements without their consent.

Informed by science, cooked by you.