Introduction
Dr. Eric Westman: I am pleased to be here with Dr. Angela Stanton. I’ve wanted to talk to Dr. Stanton for a while now, and you’ll see why. I’ve referred many of my patients, maybe even you, to her book, and I received a lot of great feedback. I always wanted to know how it got started. So thank you for being with me today.
Dr. Angela Stanton: Thank you very much. I’ve been looking at your podcast for several months, and I enjoy what you’re doing.
Migraine and how it all started
Dr. Eric Westman: You’re my go-to person for migraines, for things that people are asking me in the clinic all the time. I’m using a low-carb keto diet for weight loss mainly, and diabetes reversal. People come in spontaneously telling me their heartburn and irritable bowel syndrome are gone, and many say their migraines are gone. I didn’t formally diagnose them with migraines, but they’ll just tell me their headaches are better, and that’s interesting. There’s a low-carb or keto overlap with your program. Before we get to that, how did you get into this in the first place? I seem to glean that it was from your own problem with migraines.
Dr. Angela Stanton: I’ve been a migraineur from very early on. I was in my early teens, I would say maybe 11 when I started getting migraines. My migraines presented differently. The kind of migraine that I had at that time was what I now call a child’s presentation of migraine, which is different from the standard migraine. Around my late 20s, when I was officially experiencing my first real migraine that you would associate with a migraine with a headache and everything that goes with it, I was diagnosed shortly after that with migraine. I’m 71 now, so we’re talking about over 50 years of struggling with migraines. I was in academia teaching at the university, working in the field of neuroscience and economics. It’s called the neuroeconomics field. I said that’s it. I can’t teach. I would have to lie down on two chairs pulled together in my office between classes. University classes have 300-plus students. You’re talking about a big lecture hall, lots of work, and you have to pay attention. It’s not that simple. I said I couldn’t do this because, in between classes, I would be sleeping, taking a triptan, or some other medication, and I didn’t consider myself to be a fair teacher as a result, and I couldn’t focus. So I quit all that. I quit teaching, quit everything associated with academia, and decided to focus 100% on migraine. That’s how I got connected to migraine – my own experience. Then it evolved into something completely different, which is where we are now.
Tertiary education
Dr. Eric Westman: Where was this? Where were you as a university professor?
Dr. Angela Stanton: I was teaching at Berkeley at first, and then at Chapman University, and then I moved to Germany, to the Max Planck Institute. I was working for Max Planck as a visiting scholar and doing some research. I got my Ph.D. at a later stage in my life because I had children, and I wanted to have them grow up a little bit before I returned to education. I started my education from the bottom. I was 35, I got my Ph.D. when I was, I think, 54. It was a late start and a late finish. I don’t have that historically long academic career that a lot of people do because I haven’t been in academia that long. Most of my work was in clinical trials and research.
What initiated the research
Dr. Eric Westman: You say your personal experience. You were trying to solve a problem that you had. I assume you went to the traditional treatment centers, and what have you learned along the way?
Dr. Angela Stanton: A couple of things. First of all, it’s very difficult to diagnose migraine because everybody thinks of migraine as a headache. A migraine is not a headache. A person who has migraines may or may not have a headache associated with that migraine. Going to the doctor will automatically be assumed to be a migraine sufferer with migraine headaches. The treatments are treating the headache. But assuming you are on medication for your headache, and maybe your headache is even gone as a result of the medication, your migraine is still there because the headache is just a symptom, and so this is just a symptom treatment.
I didn’t find the medications working as a result, even if they worked, and triptans were the most commonly used and prescribed at a time, talking about 20 years to 30 years ago. They would work about 50% of the time, and so that’s the other question: how come they aren’t working the other 50% of the time? Some of the medications that were available at that time were for other diseases; they would be for depression, heart disease, or other conditions, and not for migraines. Some were for epileptic seizures and that’s getting closer to migraines, but still not it.
I thought that there was a huge distance between what I had and what science thought I had. This was the one that initiated my research into digging up what it is that science is missing, that what is it that medicine is missing. What is a migraine to start with? When I quit university teaching and became a scientist, you work as a researcher. So I was researching, and I would hit all the books, and all the academic articles, because I have a very unusual educational background. Most people go to their undergrad university, get their bachelor’s, and then you know what you want, and you pursue that degree. My case was very different. I was going to become a PhD in mathematics, which is very different, but this also gave me a mathematical mind to research things.
My looking at medicine came from math and physics; it did not come from medicine. I didn’t look at it the same way as doctors or researchers look at it. I started to discover things that, wait, this isn’t even mentioned. This is not even near. The literature that I was looking at was not just medical literature and not just migraine, but I would look at the literature on electricity, on physiology from the perspectives of physics, not from biology, and looking through all the non-biological kinds of cells and looking at the different stops within the human pathology. If you’re looking at, for example, our brain, we have neurons, we have (inaudible) but what do these do, and how do these work? You can’t understand that looking only at medicine or biology; you need to look at physics, chemistry, engineering, and mathematics. You have to understand all the things that are associated with the atomic nature, basically.
Most common manifestations of a migraine
Dr. Eric Westman: What are the most common forms of a migraine, if it is more than a headache, and what are the most common manifestations?
Dr. Angela Stanton: The most common manifestations would be, before a migraine, a person would urinate excessively, and it’s very clear. It has no toxins in it. It’s just pure water, so it’s an electrolyte balanced by your kidneys. Second, most migraine sufferers get a little bit dizzy and a little bit nauseous. Some of them vomit. Some get vertigo, so they can’t even sit up or stand up. They will fall over. Many start slurring, they may not recognize their spouses or children. They have a lack of consciousness or understanding of the world around them. They may not remember where they are or what they’re doing.
Like me, one of my common things is that I tend to increase my speech volume, but at the same time become very sensitive to others talking to me. If my husband is talking to me, suddenly his voice appears to be louder even though he didn’t speak louder. That would be a symptom for me. That’s a prodrome, and so you will have a lot of symptoms and prodromes that have absolutely nothing to do with the migraine, and the aura, which is very well understood by a majority.
Aura associated with a migraine
Dr. Eric Westman: What does an aura feel like if you have one?
Dr. Angela Stanton: There are two things that I should tell you about the aura. One is that everybody thinks of the aura as beautiful and colorful, or black and white zigzag lines, but any kind of visual disturbance can happen, and those are all auras, even if they are called something else like scintillating scotomas or something similar. Those are all visual disturbances presenting the same thing, just different ways of representing it. They feel scary. Some of them are beautiful, and some of them are scary.
I sleep and suddenly I get a huge visual. Think of a reflector from the back of your brain shining onto your eye. It’s not coming from here, in the front. You can see it coming from the back, but you don’t know what that huge light is. It’s like lightning. It’s just on and off. You will wake up from that and won’t know what it was. Oftentimes they look to see if there was a storm with lightning, but it’s within the brain. There are many manifestations.
Further manifestations of an aura and the role of electricity in the brain
Dr. Eric Westman: You might think those were like transient ischemic attacks, mini-strokes almost.
Dr. Angela Stanton: Then a lot of yawning. That’s an essential need for oxygen, and being out of it. I have people who, for example, tell me, I felt so good I cleaned the kitchen from tip to toe at 10 p.m. last night. Is it normal to clean the kitchen at 10 p.m. from floor to ceiling? It’s not. That too is a sign that a migraine is about to hit. There are a lot of different things and it’s very difficult to discover that you have it.
Dr. Eric Westman: Did you find that the literature you were looking at had answers for this for you?
Dr. Angela Stanton: No, not at all. For the aura, they did, but it’s really interesting that the very science that is looking at the aura and looking at the processes in the brain, understanding what they are, is not able to connect the two. It’s amazing for a mathematical brain person to see that on the one hand, we have what is called the cortical spreading depression. Let me explain a little bit about that so that you know what it is. The cortical spreading depression is actually the visualization, the aura. It is a visualization of the cortical spreading depression. The cortical spreading depression is, before you have a migraine, your brain has a built-in CPR, so to speak. It can start or initiate what is called depolarization. Depolarization, in terms of brain talk, is basically the sending of active sodium across the brain. It starts at one point and goes through every single neuron in one hemisphere of the brain from beginning to end. Where it starts may vary; that I don’t know, and we also do not know the duration. It touches every single neuron in the process. I explain it as, “Hello, are you there? Are you awake? Keep on going. Are you awake? Keep on going.” It’s checking and passing on the sodium to find the place or places in that one hemisphere where the electrolyte voltage gate or channels are not working.
This is a huge wave of electricity. Think of it as an ocean wave. It’s very similar to a seizure. In the case of a seizure, you have the exact same thing happening, but it’s like a giant bomb taking off in one place and it’s activating the neurons in all directions at once. It’s a huge hyperpolarization. In the case of a migraine, it’s the exact same thing, but rather than going off in one place to all directions at once, it behaves like a wave touching every single neuron, but it’s the same hyperpolarization but in a different fashion.
Depending on the size of the brain, the typical speed is about two and a half millimeters, I believe, per minute. It takes about 30 to 45 minutes for this period to go through. For those who see the aura, this wave is heading through the brain at an angle that hits the occipital cortex in such a way that it is assumed to be a signal coming from the eyes. The aura is just translating into something that the person could be watching and sort of trying to make sense of. Hence, the forms, the symptoms, and the kinds of shapes that we can see are always associated with the area of the brain, the neurons specifically, where the electricity is traveling.
This is why the scintillating scotoma sometimes can appear as little lines and dots, sometimes there’s a blind spot in the middle. That would be the part of the brain that is not working where the attempt is to read.
Dr. Eric Westman: Scotoma is seeing something like a speck in the eye, or a floater.
Dr. Angela Stanton: It’s not a floater because it moves differently. So if you’ve ever had a floater, you know that you blink, the floater kind of drops and then goes back up again.
Dr. Eric Westman: Or it keeps going away.
Dr. Angela Stanton: Exactly, and it also changes shape. It can be smaller or bigger, and it can be moving. You can, if you look and you don’t move your eyes, you can see it sink. That would be a simple floater.
When you’re looking at spots, for example, that may appear to be floating, and you think are floaters but they’re part of this cortical spreading depression or auras, they aren’t floating away. They stay stationary, and if you move your eyes, they aren’t moving; they’re moving exactly with your eyes. So everything remains totally the same, and they’re moving with your eyes. It’s a very different way of looking at it.
The connection between sodium, potassium and magnesium
Dr. Eric Westman: I was going to say there are a couple of connections I’d like people to make. One is the connection between sodium and electricity. The depolarization is part of the electrical activity that’s going on. Sodium is integral, a huge part of translating the chemicals into electrical energy. Many people are not aware of that. How could salt or sodium be important in the brain? That’s the connection there.
The other keto connection, of course, is the use of a keto diet to influence children who have epilepsy. A subset of all child epilepsy can actually be reversed. Many get better, but some could be reversed because of the lack of a glucose receptor. I just want people to make the connection that, yes, a keto diet, we know it can affect the brain, the epilepsy reversal, and then the electrolytes turn into electrical energy. Think of sodium, potassium, and magnesium as things that are important for electrical activity.
Dr. Angela Stanton: I’m glad that you brought up the epileptic children and the ketogenic diet connection. If I’m looking at epilepsy, which is just more than one seizure we’re talking about seizures. If you’re looking at seizures and migraines, I noted earlier that they’re pretty much the same, but the manifestation differs. You can get an aura even with epileptic seizures. It doesn’t change. You can get an aura with a traumatic brain injury, with just about any kind of brain tumor. It’s not specific to migraine. Even though we think it is, it actually isn’t.
What you have described in terms of the ketogenic or ketosis diet, the important connection to sodium is that one sentence that is in the medical manual that seems to be completely ignored: as glucose enters the cell, sodium leaves that cell. Sodium and water both experience an efflux. If somebody has ingested a tremendous amount of salt and gets into danger and they call an ambulance and take them to the hospital, what do they give them to reduce the hypernatremia, the excess sodium? They give them sugar because the sugar is going to remove the salt from the cells. This capacity of sugar is the connection to the brain in those so predisposed that they can’t use glucose for whatever reason. That part of it’s genetic, that they can’t use glucose properly by the brain, and this, over time, of course, is edited in the case of migraine.
You can see that children aren’t necessarily born with migraine, but they evolve with migraine over time. The brain evolves a bigger and bigger carbohydrate intolerance as a result of the sodium leaving when eating glucose. In the case of migraine, there is a genetic connection in addition to this. If you go to the human genome website, which is genecards.org, and I peruse that website very much because you can type in migraine, and you get all the SNPs, the variants, genetic variants associated with migraine, and they’re ordered according to the importance of frequency of how it affects migraine.
For the past six or seven years I’ve been following the Human Genome Project. The first three or four are all sodium voltage-gated sodium channels, voltage-gated potassium channels, and the most important is the voltage-gated sodium-potassium ATPase channel. This channel is the one that balances every single cell or neuron’s membrane potential to return to normal. In the brain of the migraineur, these three are variants; these are the most important variants. Even if the migraineur were not carbohydrate intolerant – which the migraineur is – but if she weren’t, she would still have a difficult time resetting the electrolytes because of these variants. So it’s a combination of these two.
Salt
Dr. Eric Westman: Very interesting. How did you come across the path of helping yourself through this?
Dr. Angela Stanton: I went straight to the electricity because that is so important in the brain. I said, “Okay, let me try. What happens if I add salt? Is that going to help me?” Just simply taking more salt, because of the idea of salt reduction, everything is reduced salt, foods reduce salt everywhere, salt is not recommended. But I said, “Okay, so what if I don’t reduce the salt?” I started to, rather than increasing salt in my food because I don’t like the taste of salt, I added a little bit of salt to my tongue and swallowed with a little water first thing in the morning when I woke up. I would wake with a migraine nearly every single morning and to my surprise, it would take away the migraine. Not permanently, but it would help, much better than triptans. The success rate was nearly 100%. I said, “There’s something to this.”
Dr. Eric Westman: How much salt was it at the time?
Dr. Angela Stanton: It was a little pinch. Pinches vary between people. It can be very tiny to very big. So my pinch is about an eighth of a teaspoon. I know because I measured it, so it’s not a big amount, but it was uncomfortably big to swallow it. After a while, it became uncomfortable, so I switched to capsules later on. I did this for a couple of years before I was able to move past it and continue in other territories because I didn’t yet understand the connection. I understood that it was helping with my migraine, and I understood that it had something to do with the electricity, but I didn’t yet understand the full scope because, at that time, I was not involved in nutrition at all. I was in neuroscience.
I’m partly in neuroscience, not a full-fledged one, but part of my Ph.D., half of it was neuroscience. I wanted to understand neurology, but just like everybody else, I went down the rabbit hole of symptom cure at the beginning. It was just taking salt to reduce the symptoms or make the symptoms disappear, but it was not yet understood how and why that happened. It took me a couple of years.
I have a Facebook group that I created, which is now 10 years old, and in the first year of the migraine group, we still ate bread, potatoes, and starches because I didn’t yet understand any of the connections. It took me a long time to even qualify the salt because it’s not clear. Just because you eat salt, it doesn’t mean it’s going to end up in your brain. There’s no direct connection, right? It took me some time to be able to prove to myself that it did and explain how it did it. Once I explained that and again, being a mathematician means you have to prove it. There’s just no alternative, so you have to come up with a logical explanation that cannot fail. It took years for me to get there.
I had some friends who joined me in taking salt. I was lucky because my mother was ill at the time, and we had a nurse who came in and stayed with us every day for a couple of hours. She was a migraineur as well, and I asked her to take it, so she was taking salt, and her migraines also disappeared. I said this was not by chance. Then I wrote my first book, which is no longer sold. It was basically, “This is what I did,” and a lot of people started to read it and joined my migraine group at that time. It appeared that it worked for other people, and that’s when the whole work started of what is actually happening and how to make this a permanent fixture of our lives.
The diet
Dr. Eric Westman: How did the diet get into this equation?
Dr. Angela Stanton: It came into the equation quite accidentally. I still didn’t see any connection whatsoever to nutrition at that time. I have a condition called POTS, which is postural orthostatic tachycardia syndrome, which is very common for migraineurs, and I was taking medication for that. It was a heart medication, a beta blocker, very specifically to reduce the heartbeat speed, not the blood pressure. Unbeknownst to me, this medication has a huge interaction with ketosis. I didn’t notice, and I went on ketosis just to see what it was. I did it the right way. I went to Kaiser. I belong to Kaiser, a medical company, and I said, “Please teach me ketosis.” They said, “We only have ketosis for children.” I said, “That’s fine, just send me through the rabbit hole. I want to understand what ketosis is.” They took me as if I were a child. They said, “Okay,” and they put me on MAD, which is a modified Atkins diet, 4:1, which means you’re eating four times as much fat in calories as you do in protein or carbohydrates. They said, “This is what you do, and keep on checking with us so that you know what you’re doing. This is how you measure your ketones.” That was a urine measure at the time.
I started it, being on that heart medication, and I had no idea. I ended up with such a struggle with my heart from that tachycardia to bradycardia. It was really bad. It took three doctors to figure out the connection of what actually happened. That was my first time when I said, if that can do this to my medication and my heart, what else can nutrition do? What’s with the connection?
This was the connection, and this was also the start of my understanding that there is much more to the ketogenic diet than just eating that way. It is a huge biological change that can change how medication works. This was the first time I realized the connection with food and started experimenting on my own. Everything started with me. That led me to see what I could do and what I shouldn’t do. By that time, I had, I would say, maybe about 2,000 people in my migraine group. Currently, it’s almost 17,000, and I would tell them, “I did this, and this is what’s happening. If any of you try it, what happens to you?” This was more of a give-and-take in the Facebook group of understanding how other people react and if there was a difference if they were similar.
It was interesting to see how all of the migraineurs who at the time were in the group were like topsy-twins. It was interesting how we all reacted the same way to the same things. It was rare to see somebody have a different reaction. It was fascinating, and so this allowed me to further understand the connections and also to be able to generalize to other people a little bit more freely than before. I had run a lot of surveys in the group. “I have this, do you have this?” One of the biggest signs of a migraine prodrome is one eye becoming smaller than the other. It’s really fascinating.
Dr. Eric Westman: The pupil size?
Dr. Angela Stanton: Yes, the pupil. It’s a complete ptosis. You can barely open your eyes. Also, under the eyes, the puffiness, or the unevenness. It’s not an even look.
Dr. Eric Westman: Ptosis is the name for it?
Dr. Angela Stanton: It’s a dip, but it’s temporary, unlike, where you have it permanently in the condition, this is just temporary, and it’s down. I didn’t notice, but my husband would tell me. I’ve been married for 50 years; we’re celebrating this year, so he’s very familiar with my face, and he was telling me, “You have a migraine face.” I said, “What is a migraine face?” He said, “I don’t know, but your face changed. You have a migraine face.” It took us a few years to discover that this was the biggest difference, and of course, everything was a little bit droopy, but that was the one thing that you could see changed significantly.
The importance of magnesium
Dr. Eric Westman: I like the fact that many people start with fixing themselves or, improving themselves and then starting a group where you’ve learned a lot from the group that’s been getting larger and larger over time. It’s one thing to read a book by someone who fixed themselves; there are diet books like that. It’s quite a different thing to have someone who wrote a book that’s based not only on yourself but on thousands of people. It doesn’t tell us if it will work for everyone, but it tells us that it will work for at least this many people, and that’s a lot of people.
When did magnesium become important along this journey?
Dr. Angela Stanton: Probably around the second year or third year of the group’s existence. Once I understood the electrical part, I started to get into the biology part. Then I discovered that magnesium has a role in feeding the ATP to these channels, the voltage-gated channels, that open and close. If I need sodium to open the voltage gate, but I don’t have enough magnesium, I’m still stuck. I said, okay, magnesium is equally important.
Potassium is not important, by the way, because potassium is important in terms of the closure. There are some conditions where the gates don’t close because there isn’t enough potassium, but that was not a problem for migraine sufferers. It was more focused on sodium and magnesium. But there’s a caveat with the magnesium, which I later discovered, is that because magnesium is the ones that take the ATP to these voltage-gated channels to open the door, if you take your magnesium at the wrong time, then your channels are going to open, open, open, open. That, again, is a bad thing. I did not realize the connection until I discovered that migraineurs taking magnesium at night, like many people take magnesium at night to get better sleep, migraineurs get nightmares from taking magnesium at night. So there is another connection, again, to the voltage-gated channels, very specifically, is that we can’t sleep from magnesium. It keeps us awake, so it’s the complete opposite of how it works for other people. It took me a couple of years to understand how that worked, why it worked, when to take the magnesium, and how much magnesium to take.
It took me some time to – not as long as the discovery of the salt importance – but it took quite a bit of time to understand that a simple magnesium supplement that everybody always just supplements has a very important function in our brain and why migraineurs really have to supplement even if they’re eating magnesium day in and day out. It’s just something they need to do. As to how much is needed, some migraineurs have more magnesium than they want from their diet, and they feel overwhelmed by the magnesium, so they reduce or even stop it. That’s fine; you just have to make sure you have enough.
Publishing the 1st book, 2nd book and Facebook
Dr. Eric Westman: When was your first book published?
Dr. Angela Stanton: 2014, so 10 years ago.
Dr. Eric Westman: You are growing. How many people are in your Facebook group now?
Dr. Angela Stanton: In 2017, I had a second book published, that’s what started to open the floodgates because the first book was just me. It didn’t contain anything from anybody else, but the second book had a lot of migraineurs and their experiences. I ran many surveys and learned so many things, and I also included a lot of quotations from my migraineurs with their permission in that book to help me explain what it was. It was not just me but thousands of other people. In 2017, I published that second book, which I called a complete guide because it had everything in it that I knew up to that point. The book is over 600 pages. It’s a very big book.
Dr. Eric Westman: There’s also another interesting thing about folks who develop programs from their own experience. I’m thinking about a doctor who had type one diabetes himself and is now in his 80s, Dr. Richard Bernstein. I don’t know if you’ve come across his work, but the method he has in his book is very comprehensive. It’s kind of off-putting for a lot of people that it’s too much to do. How do you look at the most important elements of what to do, and whether it’s electrolytes, diet, or both? It sounds like having the salt was the highest and was effective even when you were eating carbohydrates. Is that the most important thing?
Dr. Angela Stanton: That is the most important element. As we went on, I discovered that there are caveats there too, because, for example, if you eat a high-carbohydrate diet and you feel you’re about to get a migraine, if you take salt with water, you’re going to get a bigger migraine. You need to take salt without water because now that I understand that glucose removes water and sodium from the cell. You have plenty of water, but it’s all in edema, and migraineurs get edema all the time. That’s one of our symptoms. So if you take salt without water, your edema is gone. If you take salt with water, you’re going to get a bigger migraine, so it’s not straightforward.
If I had to choose between salt and anything else, I would choose salt because that is the primary purpose of migraine. There is one study that I have found from 1951 that shows that, on top of everything, migraineurs are salt wasters, so we urinate the salt out much more than other people do, and that is another problem. We don’t recycle the sodium, and so the combination of all these, I would say that if there’s one thing you can do, then add salt just with water or without water, even if you don’t change what you eat. That is going to solve, I would say, about 50 to 70% of your problems, not all, because we still have other issues with carbohydrates. If you eat a lot, you’re still going to get edema; you’re still going to get issues, so you need to manipulate and manage how you do that.
We also have a hormonal influence because estrogen recycles sodium and progesterone dumps sodium, so these are the most cycle connections. Then we have the barometric pressure connections where increased pressure is a vasoconstriction effect, and a reduced barometric pressure is a vasodilation effect. These all affect your electrolytes. We have a huge template now of what to do and when to do it and how to do it. We don’t know how long it takes for somebody to be able to reset their body to the start. By this, I mean I am not at that point at the start for several years where I can go out and eat an ice cream and not get a migraine. Last summer, I spent the whole summer experimenting with how many carbohydrates I could eat and get away with it. I ate watermelon all summer long … which was terrible because I’m addicted to watermelon, but that’s what I was doing to experiment. So you reach a point where none of these will bother you, but I don’t yet know for how long before everything is going to return to being bad again. So that’s another thing: you can reach a point where if you do everything just right for your body, it might just be the salt you need. You may not need to change your diet, but how long will that last? Change is a self-detective, or rather, major detective. You have to modify who you are, what you do, and how you live.
If you’re an athlete – I work with a lot of athletes – it’s fascinating. I have marathon runners and weightlifters in my group as well as competitive runners. That means they also have issues, but they’re very different from other people who don’t. My work now is past just a simple migraine; it’s more specialized into these little nooks and crannies of specialties where it is very difficult. For some people, we have cases where they have completely recovered within two weeks, with no more migraines. And then there are people, like just yesterday, I got a testimonial from someone for whom it took four years to become migraine-free.
Dr. Eric Westman: You have a Facebook group now with tens of thousands, or 17,000. The book has been out there for 10 years. I remember in training some years ago, working with headache specialists, they were using this drug and that drug, and when that drug didn’t work, they would go to another drug. They even talked about rebound headaches from drugs causing more issues. Have you been approached by any academic or non-headache specialists about this?
Dr. Angela Stanton: Yes, many of them. Many of them understand what I’m saying and would like to put it to good use, but they can’t because, obviously, the Board of Medicine and the anti-salt stance make it just impossible.
Dr. Eric Westman: You would start with a small study first. Have there been any studies done with the method that you have?
Dr. Angela Stanton: No.
Surveys and collaborating
Dr. Eric Westman: Has anyone helped you take the surveys of your followers? We did that with a group of people with type 1 diabetes. We surveyed them, and it led to a publication in the literature. It was the most popular article in the journal Pediatrics that year. It was a collaboration with the Harvard group, so there was Duke, there was Harvard, and then this Facebook group.
Would you have any interest in collaborating that way?
Dr. Angela Stanton: Absolutely. I don’t know if you’re aware, but I had an article accepted. It’s not yet published because I’m looking at the proofs that I have to review. It’s called, “Specifically Formulated Ketogenic, Low-Carbohydrate, and Carnivore Diets Can Prevent Migraine: A Perspective.” I’m seeing it because it’s open on my desk, and it’s a long title. I’m the only author.
Ketogenic textbook
Dr. Eric Westman: It’s just one author: Stanton, Angela, and it will be in Frontiers in Nutrition. That’s fantastic. You also contributed to the textbook called Ketogenic.
Dr. Angela Stanton: Correct.
Dr. Eric Westman: What did you do for the Ketogenic textbook?
Dr. Angela Stanton: For that, I derived a section on migraine for professionals. I think it’s about two and a half pages. I left some space in the book. It’s not a big part, but it includes a graph that shows the progression of what a migraine is and at what point the healthcare provider could get involved and do something. I also have several lectures at the Nutrition Network. I think I have five lectures, and the last one that I created, is a very big 90-minute full lecture on neuroscience in general and the health and degenerative diseases of the brain. I cover migraines as well. That’s not the focus, but all the degenerative brain activities and why they happen. I have a lot of things going on, and I have some other companies where there are lectures for professional credit for healthcare professionals.
There are a couple of articles that I have published. Unfortunately, at the time when I did that, I was not yet familiar with the industry papers; I was only familiar with papers within economics. These two went to pirate papers, which I didn’t know at the time. Nevertheless, they are being cited interestingly in other literature.
So, I have some contributions, and of course, with the current two migraine groups that I now have. I’m hoping that we can talk a little bit about the different kinds of nutrition forms because my main migraine group is not ketogenic, while the other group is ketogenic.
Two different migraine groups
Dr. Eric Westman: Explain that a little bit.
Dr. Angela Stanton: The main migraine group does not allow ketosis, period. We measure the blood ketones. I followed Dr. Bernstein’s procedures and also Dr. Kraft’s test, but I modified it. It’s a 5-hour test, but every half hour, instead of using insulin, I’m using ketones as a proxy. So, I’m using blood glucose and blood ketones. For the protocol group members should not have blood ketones higher than 0.4 or 0.5; that’s the max. It can’t be ketosis because they’re taking medications. Remember my experience: I don’t know which medications will interact, but we don’t want any interaction.
We can’t even really explain the interaction other than that ketosis causes a little bit of acidity in the blood, more so than without ketones. Nobody’s talking about whether it’s changing the clearance of the medication or whether it is changing the half-life of the medications. We don’t know what is happening, but it’s not clearing the observed clinical trial way. As long as people are taking any medication, they can take Tylenol; that’s okay. If they have standard medication, that’s fine. Hormone replacement therapy is fine, but if they’re taking medication that crosses the blood-brain barrier, that’s a no-go. They have to sign a waiver. I have a medicinal waiver of interaction for medicines in my group. Everybody who’s taking medication must sign it; they need to know that there is a potential for interaction.
We have over 17,000 people right now in the group, but overall, in the past 10 years, if I add the people back who left because they returned to work and left the group, we’re talking 25,000 or more. People all had to be aware and sign; they even had to sign a supplemental waiver if they were taking supplements that we don’t recommend because supplements are just unregulated medicines. It’s a very serious group; it’s not your typical everyday Facebook group. It’s a serious working group.
The other group is ketogenic and keto carnivore. The main group is low-carb, and carnivore, and we set these two at a high protein level so that nobody can get into ketosis because the protein level is too high. In the ketogenic group, they start with keto with a 4:1 or 4:2 ratio and can continue the keto carnivore diet if they wish. I created keto carnivore macros, and they can follow that. I also created hypercarnivore, which is a very high-protein, non-ketogenic diet with high enough fat and a little bit of carbs. They can have, say, a pickle with their burger or something like that.
The different levels are organized such that as long as somebody still has migraines and may need medication for them, they can’t be in ketosis. Period. As good as the ketogenic diet is at the beginning, if the person doesn’t know what they’re doing, they can end up with killer migraines. It’s not recommended to start with that. The reason is that when we talk about insulin resistance, if people have insulin resistance or diabetes and switch to the ketogenic diet, they do fantastic very quickly. But because they don’t have a migraine brain, water and sodium are lost from the system as a result of the dropping insulin, which is a benefit to them. However, knowing how important salt is, a drop in sodium and water is not a benefit to a migraineur. If you move the migraineur straight to a diet where insulin is reversed very quickly and we don’t replace the lost sodium and lost water right away (and most people on ketogenic diets don’t do that), they will end up with very serious migraines.
Dr. Eric Westman: That’s interesting. There are so many different versions of a ketogenic diet today. Even “Internet keto” is a term we use for what they teach out there. The main point is to be with someone who is teaching you a legitimate way of doing a keto diet. I think my approach is, to me, like a harsh hammer, compared to if someone comes to me, I don’t take this care to worry, but it’ll certainly make them pay more attention. Most of the time, people come back and tell me that their migraines, in whatever form, are better. I don’t tell people not to do ketosis. It would be interesting to do a study comparing these different approaches. That’s the first time I’ve ever heard of a test where you measured glucose and ketones over time. That’s pretty neat. The idea is to not be in ketosis.
Dr. Angela Stanton: Exactly. Many people disagree with me, but I am very firm on my ground because I have so many people. Many of the people who are not in my group, when I talk to them on X (formerly Twitter) or anywhere else, tell me, “Well, the migraines have been reduced.” Reduced migraines are certainly welcome, but it’s not elimination. I go for the elimination, so I have a different purpose in mind.
Book recommendation
Dr. Eric Westman: Absolutely. When people come to me, they want it to work the first time, every time. They don’t want to mess around with approaches that may not work. There’s so much that could be assessed, analyzed, and even taken to a clinical center on migraines. It would be so neat. Right now, I’m thinking that a research fellow who has a project could help with a survey of the people who are following this approach to learn so much.
When the type 1 diabetes paper was published, the rebuttal was that it was just a Facebook group. Even though they had better results than we ever get in our clinic. I think a Facebook group is quite legitimate as a place to start. I’m so impressed with your knowledge and the following of people that you’ve had. Even the clinic experience in my clinic, handing out your book, has been of such great value to my patients and, I hope, to other migraineurs.
Tell me again the book you would recommend for someone to start with.
Dr. Angela Stanton: The book title is Fighting the Migraine Epidemic: Complete Guide How to Prevent Migraines Without Medicine. The title is longer than I remember, but it’s the only book sold by that title. It’s a big white book, over 600 pages, it is available on Amazon, both in paperback and ebook. Fighting the Migraine Epidemic – that’s the only thing they need to remember. I’m working on the third edition. I give some updates because the group is so busy.
Many of your patients have come to me with questions in the group about how they heard about us. They tell me “Dr. Westman.” There are a lot of doctors in the group and other well-known doctors send their migraineurs to me. The title is going to remain the same. In the group, I have about every single country represented on the planet. Some surprising places, like Mongolia, where you wouldn’t expect internet access.
Dr. Eric Westman: Where do you live, Angela?
Dr. Angela Stanton: I live in Southern California.
Dr. Eric Westman: Do you have a clinic where someone can visit you personally?
Dr. Angela Stanton: No, I’m not a medical doctor; I’m a scientist. I don’t have a clinic, so I don’t do any diagnostic work or prescribe anything. What I do is all theory. It’s all free, there’s no charge for any of this, and people can come and go as they wish and do as they please. Fascinatingly, there is about 80% – 90% true following and adherence. We still find people in the group who have been with us for 10 years and say, “What group is this?” They haven’t paid any attention.
We had a few turbulent years when people came in and said, “What? Salt? Really?” There were some bad starts, as you know, you have a lot of industry after you. Some nasty things happened in the past, but that’s kind of stopped now. Now, people coming into the group are like, “Okay, where do I start?” They start their reading, and we have what they call the Stanton University, because of the amount of literature they need to follow. It can take a good six months to read everything, understand, and ask a lot of questions. So, we are very, very busy.
Back to the survey: I do have surveys, and they can run statistical analysis. The problem is that I don’t have the time. The second problem I face, and I even faced during the publication of this one article that is now going to be published from one of the reviewers, is that migraine is considered to be a medicine deficiency. You’re familiar with this.
Dr. Eric Westman: Diabetes, right?
Dr. Angela Stanton: Exactly. Migraine is so connected to metabolic disease. We know that it is considered to be a medicine deficiency, so it’s simply just swept off.
Dr. Eric Westman: Time passes, it took 15 years for this recent paper on low-carb diets for irritable bowel syndrome that just came out. Our paper was published in 2009, 15 years ago. I bet there’ll be a doctor, especially one who got into the migraine field because of his or her migraines, who’ll come around. Hang on, always be optimistic. I just want to thank you for what you’ve done. It’s based on your own experience and then spreading the word through simple tools like books and food and nutrition. It’s amazing and unbelievable that people don’t believe it.
Where are you from originally?
Dr. Angela Stanton: I’m from Hungary.
Dr. Eric Westman: When you were at the initial universities?
Dr. Angela Stanton: I started at UCLA.
Dr. Eric Westman: Then you were in Germany?
Dr. Angela Stanton: After my PhD, I went to Germany. I was teaching at Chapman University locally and I was very unhappy with my teaching there. I quit and went to Max Planck in Germany to the Institute. I was not there as a postdoc but working on research at the time. My research was in neuroscience—the hormonal response to the environment. I would make people sniff oxytocin, for example. That was one of my clinical trials, and vasopressin was another one. I would see how their decisions were changing.
The connection of oxytocin to generosity, which is often called “the love hormone,” was part of my investigation. After this, I went to Germany. Vasopressin is fascinating. We give people vasopressin because of urinary issues. But vasopressin makes people stingy – really stingy. It’s really fascinating. It’s part of my dissertation. It has to be real stuff. It has to be refrigerated and kept in such a way that it retains its potency because both vasopressin and oxytocin very quickly lose their strength.
Magnetism and magnetic fields
Dr. Eric Westman: The video is over, but this fits into magnetism and magnetic fields doesn’t it?
Dr. Angela Stanton: Yes. I’m trying to tell people not to be scared of the electromagnetic fields of telephones and all these kinds of things. It really fascinates me.
Dr. Eric Westman: Does the transcranial magnetic stimulation, kind of “dumb-down” ECT?
Dr. Angela Stanton: It does temporarily. Depending on the kind of electricity you put through, you can create a type of electricity that can initiate electrical activity in your brain. In fact, in depression, there was a study—and there’s only one, and I don’t remember the title—but in that study, there were, I think, four people who volunteered for the experiment with clinical depression. They literally opened their brains and inserted electrodes. At the time, I was with Berkey, looking at animals where we put single electrodes into the brain and observed single neurons’ responses to certain stimuli from the outside that would make them want more or less or be generous or otherwise.
These people had a single electrode pushed deep inside and stimulated, and their depression disappeared for the period that they were stimulated. You can create electricity that can cause a lot of things, but you can also stop the brain from working. Some of the things that people fear today are not meaningful.
Dr. Eric Westman: I had a family member who had ECT for depression, and it was night and day. The thought is that it might be the chemical, neuronal, or hormonal release. I thought about it and read about it, and it might even be the magnetic field generated by that electricity.
Dr. Angela Stanton: You’re familiar with the device (inaudible). I don’t know if I’m pronouncing that properly. It’s a device that people put on for migraines, and basically, it’s magnetic and sends a current through the brain. It does stop migraines, but when you take it off, it stops working. The fact is that our brain is just pure electricity. Now I understand depression to be a problem of electricity. Whether salt can help a lot or not is not a question because there’s no way to put salt into the migraine treatment. If the avenue is broken, there’s nothing you can do. But clearly, by stimulating the electricity in the brain, in the amygdala, and that was not ECT but just a single electrode, ECT is the same. It can also be damaging because if you don’t have that problem, it can cause major harm as well.
Dr. Eric Westman: The first half of my career was working with a neuroscientist who was into nicotine. He is the inventor of the nicotine patch. He’s in Durham. Although I don’t work for him anymore we still talk together every few months.
Dr. Angela Stanton: A lot of smoking affects migraines, the nicotine itself. That was a clever guy with the nicotine patch. That’s a fantastic innovation.
Dr. Eric Westman: Thank you so much.
You can watch the full video here.
