by Amy Richter, MS, RDN, LD, CLT | Jan 11, 2019
We use the term “functional nutrition” a lot around here, so you might be wondering what it’s all about.
Maybe you’ve heard it used by dietitians, but you have absolutely no idea what it means.
Or maybe you ARE a dietitian, and you’ve heard about functional nutrition, but you don’t fully understand how to implement it.
If so, then keep reading!
We’ll define functional nutrition, explain the philosophies behind it, and provide examples of how a dietitian might use it in practice.
Overview of Functional Nutrition
The term “functional nutrition” is actually a component of a concept known as “functional medicine.”
Functional medicine is a model or framework that some doctors use to address the root cause of disease.
Before we can truly understand functional nutrition, we’ll have to take a closer look at functional medicine.
What Is Functional Medicine?
The concept of functional medicine was created by a biochemist named Jeffrey Bland in 1990 (1).
Bland was familiar with integrative medicine, a kind of healthcare that focuses on the patient as a whole person (mind, spirit, body) and uses both conventional and alternative treatments (2).
But being a biochemist, he saw the value of molecular medicine, which seeks to understand and treat disease based on the causes and mechanisms at a molecular level (3, 4).
So, he decided to combine integrative medicine with molecular medicine to form a framework called “functional medicine” (5).
In 1991, the Institute for Functional Medicine (IFM) was founded as a way to promote functional medicine and provide education to healthcare practitioners.
In a nutshell, functional medicine is a model that allows patients and practitioners to work together to address the underlying causes of disease by evaluating biological systems (6).
Functional medicine may look a little different depending on who’s using it, but in general, it can be summed up by these characteristics:
Characteristics of Functional Medicine
1. It is patient-centered rather than disease-centered, with the goal of promoting health that extends beyond the absence of disease (7).
2. The practitioner evaluates clinical imbalances within biological systems and identifies points of connection that reveal the underlying cause of disease or dysfunction (5, 8).
3. The aim is to treat the root cause of disease to promote healing, instead of treating symptoms to provide temporary relief (6).
4. Lifestyle changes are heavily emphasized in the prevention and treatment of chronic diseases (7).
5. Through a therapeutic partnership, the practitioner and the patient work together to achieve goals (6).
How Functional Medicine Differs from Conventional Medicine
In practice, the functional medicine approach looks very different from conventional medicine.
For example, let’s say a patient presents with eczema, an inflammatory condition characterized by itchy, scaly skin.
If this patient sees a doctor who practices conventional medicine, they’ll most likely be prescribed several drugs and ointments that suppress the immune system and lower inflammation in order to relieve symptoms (9, 10).
But a functional medicine doctor will ask the question, “WHY is the immune system reacting this way?”
Maybe they have food allergies, sensitivities, imbalanced gut bacteria, or high stress levels that are triggering their eczema (11, 12, 13).
So their treatment will include further investigation into possible root causes, plus diet and lifestyle interventions to address them.
The real difference is that the functional approach aims to provide true healing from the bottom up, while the conventional approach to many chronic illnesses is often like a band-aid.
In acute care (emergency situations), conventional medicine works beautifully, using drugs and surgery to save lives.
But when it comes to chronic diseases, which are often diet and lifestyle-related, many drugs only MASK symptoms, leaving the root causes unresolved.
Doctors who practice functional medicine believe it is a better model for addressing chronic disease, because of its focus on prevention through lifestyle changes such as diet, exercise, and stress management.
Because nutrition plays such an important role in functional medicine, doctors often refer patients to dietitians and nutritionists who practice functional nutrition.
What Is Functional Nutrition?
The IFM defines functional nutrition as an approach that “emphasizes the importance of high-quality foods and phytonutrient diversity to address clinical imbalances and move people to the highest expression of health” (14).
My dietitian friends may be thinking, “Well, that doesn’t sound any different than what I learned in school!”
In some ways, you’re absolutely right.
Just like traditional dietetics, functional nutrition also uses the nutrition care process and personalized dietary interventions to improve health (7).
The main difference is that functional nutrition requires dietitians to take a closer look at the patient as a whole person (mind, body, spirit) and base nutrition and lifestyle recommendations on the underlying causes of disease or dysfunction.
For example, let’s say you’re evaluating a patient who has been diagnosed with diarrhea-prominent irritable bowel syndrome (IBS-D).
The non-functional approach might include advising the patient on the low-FODMAP diet, how to identify and avoid trigger foods, and nutrition education to prevent diarrhea-related dehydration.
A functional approach, on the other hand, would involve functional testing for underlying causes, like SIBO, gut dysbiosis, parasites, food sensitivities, allergies, or intolerances and a thorough evaluation of lifestyle and health history (15, 16). The root causes would then guide the interventions.
Because this approach requires in-depth knowledge and critical thinking skills, many dietitians who want to practice functional nutrition find it helpful to obtain additional certifications or training.
Using Functional Nutrition in Practice
The concept of functional nutrition isn’t too difficult to understand, but if you’re a dietitian you may be wondering how to actually APPLY it to your practice.
Thankfully, there are tools to help guide you as you begin to implement the functional nutrition framework.
Two of the most widely used are the functional medicine matrix and the 5-R protocol. Let’s explore these below!
1. The Functional Medicine Matrix
Functional medicine practitioners use tools to organize information, analyze that information, and guide treatment decisions while still allowing for flexibility and personalized care.
They prefer using systems and models that allow them to focus on a patient’s unique clinical picture, rather than “cookie cutter” formulas or templates.
And that’s where the functional medicine matrix comes in!
Basically, the matrix is a reminder to put on your detective hat and consider ALL of the patient’s potential causes of dysfunction so that you can prescribe nutrition interventions that address these root causes.
It was designed to be used by doctors, but it works for dietitians and nutritionists as well.
The actual functional medicine matrix is copyrighted by IFM, so we are not including the image in this article, but will summarize the main points below. You can find a digital copy of the matrix here.
Section 1: The 7 Core Imbalances
The functional medicine matrix contains a box in the center that prompts the practitioner to organize the patient’s clinical presentation based on what the IFM considers to be the “seven potential core imbalances” that may underlie any disease state (17).
These include:
- Assimilation includes digestion, absorption, respiration, and the gut microbiome.
- Defense & repair refers to immunity, inflammation, and infection.
- Energy deals with energy regulation and mitochondrial function.
- Biotransformation & elimination involves toxicity and detoxification.
- Transport describes the cardiovascular and lymphatic systems.
- Communication is comprised of neurotransmitters, endocrine, and immune messengers.
- Structural integrity encompasses everything from subcellular membranes to musculoskeletal structure.
Section 2: The Patient’s Story
The column on the left side of the matrix (“retelling the patient’s story”) is a way to organize the patient’s disease pathogenesis into “antecedents, triggers, and mediators” (18).
- Antecedents are any factors that predispose the patient to illness. These could be genetic or environmental (nutrition, physical fitness, etc.).
- Triggers are any factors that provoke the signs and symptoms of illness. Some examples are infection, trauma, environmental toxins, or foods that the patient is allergic or sensitive to.
- Mediators are any factors that contribute to pathological changes and dysfunctional responses. These mediators can include biochemical factors like cytokines and hormones, or they might be psychosocial factors, like the patient’s thoughts and beliefs.
Section 3: Lifestyle Factors
Finally, the bottom row organizes the patient’s modifiable lifestyle factors into five categories: sleep & relaxation, exercise & movement, nutrition, stress, and relationships.
Functional nutrition practitioners are equipped to address all of these lifestyle factors to some degree, but their area of special expertise and focus is nutrition.
2. The 5-R Protocol
Many functional dietitians and nutritionists also use a modified version of the IFM’s “5-R protocol” to address gastrointestinal issues in patients with chronic conditions:
The 5-R protocol is as follows:
1. Remove: Remove any foods from the diet that you are allergic, sensitive, or intolerant to, as well as any pathogens in the digestive tract.
2. Replace: Replace anything you are deficient in, such as vitamins, minerals, fatty acids, digestive enzymes, bile, etc.
3. Repopulate: Repopulate your gut with the right balance of gut bacteria, as needed, using probiotics & fermented foods.
4. Repair: Repair damage to the gut as needed, with supplements to support the process.
5. Rebalance: Examine your current lifestyle & look for places in which it is unbalanced. Things to examine include sleep quality, stress levels, work-life balance, social support, and stress-relieving activities.
The 5-R protocol is a helpful tool because it provides a framework for addressing complex issues that require multiple nutrition interventions.
The steps can be done in order or as a simultaneous multi-pronged approach.
Additional Resources
If you’re reading this and thinking, “Wow, all of this sounds great! Where can I learn more?”, then these resources are for you:
1. The Functional Nutrition Library
Interested in learning more about functional nutrition on your own time and at an affordable price point?
Then you’ll love the Functional Nutrition Library!
It’s our membership site for dietitians and other wellness professionals to use as an educational/reference tool in their practices.
It includes functional nutrition recommendations for a variety of conditions, plus information on special diets and supplements, tips for lab interpretation, and more!
The notes are updated weekly in order to make the content more comprehensive and helpful for you. It’s really the perfect online reference for functional dietitians!
2. Integrative & Functional Nutrition Academy
If you’re ready to take your knowledge game to the next level, then you MUST check out the Integrative & Functional Nutrition Academy.
It is an online training and credentialing program offered by dietitians Kathie Swift and Sheila Dean.
Enroll in your choice of online training courses to complete at your own pace. Do them all, and you’re eligible for the IFNCP credential, which is recognized by CDR!
PS – IFNA also offers a FREE listserv that is open to ALL dietitians (even if you are not an IFNA student) 🙂 Just email info@ifnacademy.com to request an invite.
Already an IFNA student or alumnus? Email us at erica@functionalnutritionlibrary.com for an exclusive 50% discount to The Functional Nutrition Library.
3. Dietitians in Integrative and Functional Medicine
If you’re a registered dietitian in the US, you may be familiar with the Dietitians in Integrative and Functional Medicine (DIFM) dietetic practice group within the Academy of Nutrition and Dietetics.
DIFM provides continuing education, newsletters, webinars, and a free subscription to the Natural Medicines Comprehensive Database for its members.
This is an excellent resource for any dietitian who is part of AND and interested in practicing functional nutrition.
Final Thoughts
At its core, functional nutrition is a philosophy that promotes the use of food as medicine to prevent and alleviate diet and lifestyle-related disease.
By addressing the root cause of disease or dysfunction, functional nutrition practitioners are able to promote healing instead of simply masking symptoms.
If you are a patient looking for a dietitian who practices functional nutrition, you can search for one here or here.
If you are a dietitian who wants to learn more about functional nutrition training and resources, consider joining our Functional Nutrition Library!
Amy is a registered dietitian nutritionist and certified LEAP therapist. Her passion is finding ways to communicate nutrition research in an interesting and easy-to-understand way. She has an undying love for food, especially homemade almond butter, steamed asparagus, and fresh summer cherries.
by Amy Richter, MS, RDN, LD, CLT | Oct 10, 2018
Did you know that roughly 1 out of every 6 Americans suffers from migraines (1)?
Migraines are severe headaches that are often accompanied by symptoms such as nausea, vomiting, sensitivity to light or sound, and vision disturbances.
Unfortunately, there is no definitive cure for migraines (though many have had success with food sensitivity testing), so treatment is usually focused on reducing the number of attacks and managing symptoms.
Medications, such as over-the-counter painkillers and prescription drugs, are often used to treat and prevent migraines, but natural remedies are becoming more popular.
One promising option for those seeking natural migraine relief is to try magnesium supplements.
In this article, we’ll explain the link between magnesium and migraines and tell you which magnesium supplement is best for preventing migraines.
What Is Magnesium?
Magnesium is an essential mineral, meaning that it can’t be made by the body, so instead, we have to get it from food.
This often overlooked mineral is involved in over 300 biochemical reactions in the body (2).
It plays important roles in energy production, muscle contraction, DNA synthesis, neurological function, and bone structure.
The Recommended Dietary Allowance (RDA) for magnesium is 400 mg per day for males and 310 mg per day for females. After age 30, this increases to 420 mg and 320 mg, respectively (2).
The Standard American Diet, which consists mostly of meat, processed carbohydrates, and vegetable oils, usually does NOT provide enough magnesium. In fact, nearly half of Americans fail to meet their magnesium needs, typically falling short of the RDA by 100-200 mg (3, 4).
Even people taking multivitamins may fall short since magnesium is a large mineral that is hard to fit into a daily multivitamin-mineral supplement. It is often included only in small quantities (<100 mg) or excluded entirely.
Magnesium Deficiency
Symptomatic magnesium deficiency is rare, especially in people who don’t have any diseases (5).
This is because magnesium is an important electrolyte, and the consequences of not having enough in the bloodstream can be very severe.
To avoid these complications, the body tightly regulates levels of magnesium in the blood and will pull from body stores to avoid low levels.
However, it’s still possible to have inadequate magnesium even if you don’t have an obvious deficiency.
This is called a “subclinical deficiency,” which means that you might not have obvious symptoms, but your body is not functioning optimally and may suffer long-term negative consequences.
It is thought that subclinical magnesium deficiency is VERY common, affecting 10-30% of people (5). It may even be one of the leading causes of heart disease worldwide (6).
Some signs and symptoms of overt magnesium deficiency include (7):
- Loss of appetite
- Nausea and vomiting
- Fatigue
- Muscle weakness
- Numbness and tingling
- Leg and foot cramps
- Tremors
- Seizures
- Personality changes
- Depression
- Irregular heart rhythms
Of course, if you have a subclinical deficiency, you might not experience any of these symptoms, so it can be helpful to test your magnesium levels.
Testing Magnesium Levels
The most common and inexpensive way to check magnesium levels is to test serum (blood) magnesium.
Unfortunately, this isn’t a very accurate picture of magnesium status because only 2% of the magnesium in the body is found in the blood. The majority (67%) is found in bone, and 31% is found inside cells (8).
This means that your serum will be the LAST place to show a deficiency since levels won’t become low until you’ve exhausted your body’s available stores.
There are more accurate ways to test for low magnesium or subclinical deficiency, such as looking at the amount of magnesium in your red blood cells, white blood cells, or tissues, but these tests are usually more time-consuming and expensive to do (6, 9, 10).
Magnesium deficiency may increase your risk for certain diseases. A long list of conditions has been linked with low magnesium levels, including high blood pressure, heart disease, arrhythmias, osteoporosis, diabetes, and premenstrual syndrome (2, 11).
Because of magnesium’s role in brain function, it is also thought that the deficiency of this nutrient may be one of the causes of migraines (12).
What Is the Link Between Magnesium and Migraines?
Studies have found that up to 50% of migraine sufferers have low magnesium levels (13, 14, 15, 16).
They have also shown that daily magnesium supplements can reduce the frequency and severity of migraines (17, 18, 19, 20)
One study even found that magnesium supplementation was more effective and fast-acting than a common drug used for the treatment of acute migraines (21).
Still, other research has found no benefit from magnesium supplementation, but this may be because the dose was not high enough (22).
Also, because magnesium status is so difficult to test, it’s possible that some studies’ results are thrown off by including both magnesium-deficient and non-magnesium-deficient patients.
How Does It Work?
Researchers aren’t sure exactly how magnesium works to prevent migraines, but they do have some theories.
First, let’s review the mechanisms that cause migraines. Scientists believe it goes something like this (12):
- A trigger causes brain cells to release neurotransmitters (chemical messengers), such as calcitonin gene-related peptide (CGRP) and substance P.
- These chemical messengers cause increased blood flow, swelling, and inflammation in the brain.
- Nerve cells transmit messages to other parts of the brain, where pain is perceived.
Human and animal studies have shown that treatment with magnesium can decrease CGRP levels and block pain receptors, which may explain its therapeutic effects (23, 24).
However, these are likely just a couple of the ways that magnesium affects migraines, and there are probably other mechanisms we are not yet aware of.
What’s the Official Recommendation?
According to the American Academy of Neurology and the American Headache Society guidelines, magnesium supplementation is probably effective for migraine prevention, but no recommended dosage or form has been established (25).
Even though there is no formally recommended dosage for migraine prevention, most studies have used between 400 and 600 mg of magnesium per day (12, 26).
Magnesium supplements can be taken with food to reduce stomach upset and increase absorption. However, they should be taken away from calcium supplements and high-phytate foods, since these can interfere with absorption (27, 99, 100).
What Types of Magnesium Are Available?
Because magnesium is unstable by itself, it likes to be combined with other minerals to form what is called a “salt.”
Magnesium can also be combined with organic acids to form magnesium acid complexes or with amino acids (the building blocks of protein) to form magnesium chelates.
Depending on what chemical is combined with magnesium, the “bioavailability” might change.
Bioavailability basically means the amount of a substance that is absorbed by the body. So, if a supplement has HIGH bioavailability, then most of it is absorbed.
There are MANY types of magnesium available to choose from, so we’ve broken down some of the most common forms below.
{Please note that this post contains affiliate links. As an Amazon Associate I earn from qualifying purchases.}
1. Magnesium Ascorbate (Poor Choice)
Magnesium ascorbate is the salt of magnesium and ascorbic acid, the synthetic form of vitamin C.
Since it contains more vitamin C than magnesium, it is typically used as a source of vitamin C, not magnesium.
For this reason, it is probably not the best choice for migraine prevention.
2. Magnesium Aspartate (Poor Choice)
Magnesium aspartate is formed by bonding (chelating) magnesium with the amino acid aspartate.
Chelated forms of magnesium, like magnesium aspartate, are more bioavailable than magnesium salts since they are absorbed as proteins, rather than via passive diffusion (28).
According to one study using rat intestines, magnesium chelates were nearly twice as bioavailable as magnesium citrate (28).
While magnesium aspartate is well absorbed, it may not be the best choice for people with migraines. This is because the amino acid aspartate is an excitatory neurotransmitter that may worsen migraines (29, 30).
3. Magnesium Carbonate (Poor Choice)
Magnesium carbonate is a form of magnesium usually used as an antacid to treat heartburn and upset stomach (31).
This is because the carbonate in the supplement acts as a base and neutralizes excess stomach acid.
Magnesium carbonate is an inorganic salt and is not very soluble in the gut. Because of its low bioavailability, magnesium carbonate is not the best choice for migraine prevention (32).
Ironically, diarrhea and upset stomach are common side effects of this supplement due to its poor absorption.
4. Magnesium Citrate (Good Choice)
Magnesium citrate is one of the most commonly used magnesium supplements. It considered an organic salt and is made by combining magnesium with citrate.
It is relatively cheap and has a higher bioavailability than inorganic magnesium salts, like magnesium oxide (33, 34).
This form of magnesium has been widely studied and is recommended for migraine prevention by several organizations, including the American Headache Society (25, 35).
However, citrate is typically produced via corn dextrose fermentation, so it may need to be avoided by people with corn sensitivities. (If you are not sure whether the citrate in your supplement is made from corn, you can always call the manufacturer and ask.)
Our favorite brands of magnesium citrate can be found here in capsule form and here in powdered form.
5. Magnesium Gluconate (Poor Choice)
Magnesium gluconate is made by combining magnesium with gluconic acid, a tart-tasting organic acid that naturally occurs in fruit, honey, wine and other foods (36).
Compared to nine other magnesium supplements, magnesium gluconate was found to have the highest bioavailability (67%) in one study performed on rats (32).
Because it is well-absorbed, it also tends to cause less diarrhea than other magnesium supplements (37).
However, magnesium gluconate pills tend to contain a smaller amount of magnesium per serving, so may not be a practical way to get the dosage needed for migraine prevention.
6. Magnesium Glutamate (Poor Choice)
Magnesium glutamate is formed by bonding (chelating) magnesium with the amino acid glutamate.
Like other chelated forms of magnesium, magnesium glutamate has good bioavailability.
However, glutamate is an excitatory neurotransmitter and may worsen, rather than improve, migraines (38, 39, 40).
For this reason, magnesium glutamate is probably not a good choice for people with migraines.
7. Magnesium Glycinate (Good Choice)
Magnesium glycinate (also called magnesium bisgylcinate) is a chelate of magnesium and the amino acid glycine.
The bioavailability of magnesium glycinate is relatively high (23.5%), and it tends to be well-tolerated (41).
It has been studied most in the treatment of depression, but no studies on migraines have been conducted (42). The glycine in magnesium glycinate can also have other benefits, including improved sleep (43).
Many practitioners recommend this form of magnesium, especially for people with GI upset, since it is less likely to cause diarrhea than other less-absorbed forms of magnesium.
Our favorite brands can be found here in tablet form and here in powdered form.
A similar product, magnesium glycinate/lysinate is also available. It contains 1 molecule of magnesium bonded to 1 glycine and 1 lysine (rather than 2 glycines in magnesium glycinate).
8. Magnesium Hydroxide (Poor Choice)
Also known as “Milk of Magnesia,” magnesium hydroxide is an antacid that is commonly used as a laxative. It has a lower bioavailability (15%) than other forms of magnesium (44).
Because of its laxative effect, this is definitely NOT the type of magnesium you want to use to prevent migraines.
9. Magnesium Lactate (Good Choice)
Magnesium lactate is an organic salt of magnesium and lactic acid.
It has relatively good bioavailability in humans, much better than inorganic salts like magnesium oxide (45).
It has been shown to effectively raise red blood cell magnesium levels in humans, so could be a good choice for correcting magnesium deficiency, but has not been studied for migraines specifically (46).
Magnesium lactate is not as popular as other types of magnesium salts but is available from a few reputable companies, including this one.
10. Magnesium L-Threonate (Good Choice)
In recent years, a new form of magnesium, called magnesium L-threonate, has become available.
Studies have found that this form of magnesium can cross the blood-brain barrier and enter the brain better than other forms, which may be especially beneficial for learning and memory (47).
In fact, magnesium threonate has been shown to improve memory and enhance learning in both rodents and humans, although more research is needed (48, 49, 50).
These effects may be due to the synergism between magnesium and threonate, improving neuroplasticity (the ability of the brain to form new connections) and increasing the availability of magnesium within the brain (51).
No research has investigated whether magnesium threonate is effective for migraines, but the fact that it easily enters the brain is promising.
Our favorite brand of magnesium l-threonate can be found here.
11. Magnesium Malate (Good Choice)
Magnesium malate is the salt of magnesium and malic acid – a naturally occurring organic acid that is responsible for the tart flavor of many fruits (52, 53).
Magnesium malate has been studied as a possible treatment for fibromyalgia, but other than that, there isn’t much research about this supplement (54, 55).
One recent study on rats found that this form of magnesium was more bioavailable than magnesium citrate, so it might be a good choice (56).
Our favorite brand of magnesium malate is this one.
12. Magnesium Orotate (Poor Choice)
Magnesium orotate is magnesium combined with orotic acid, which is a chemical that helps create energy in the muscle of the heart (57).
This combination has been studied for its potential beneficial effects in heart failure and cardiovascular disease, but no research has been done on migraines (58, 59, 60).
It also doesn’t seem to cause as much diarrhea as other forms of magnesium, which could be a benefit for people with already loose stools (61).
However, magnesium orotate contains far less magnesium per serving than other types of magnesium, so it is probably not the best option for people with migraines.
13. Magnesium Oxide (Poor Choice)
Of all the forms of magnesium that have been studied, magnesium oxide consistently shows the lowest bioavailability at 4-5% (34, 45).
It is typically used to treat constipation because it has a strong laxative effect (62). For this reason, it’s not a great choice to increase magnesium levels.
Magnesium oxide is one of the most frequently used forms to prevent migraines, but that doesn’t mean it’s the best.
14. Magnesium Taurate (Good Choice)
Magnesium taurate is another chelated form of magnesium, made by bonding magnesium with the amino acid taurine.
This form of magnesium is believed to be especially helpful for the prevention and treatment of migraines.
This is because it provides magnesium AND taurine, which can help dampen neuronal hyperactivity in the brain and reduce the likelihood of developing a migraine (63).
More research is needed, but magnesium taurate appears to be a good option for migraine headaches.
Our favorite brand of magnesium taurate is this one.
15. Sucrosomial Magnesium (?)
One of the newest forms of supplemental magnesium is called sucrosomial magnesium, and is available from companies like Pure Encapsulations.
In this form, the magnesium ions are encapsulated inside a membrane with sugars. This combination increases the permeability of the gut, allowing more magnesium to cross into the bloodstream (64).
However, it is debatable whether increasing gut permeability to boost magnesium absorption is actually a good thing since increased gut permeability has been linked to lots of negative health outcomes (65).
One small human study found that sucrosomial magnesium is more effective at raising magnesium levels than magnesium citrate, oxide, or bisglycinate (64). However, more human research is needed.
16. Liquid Magnesium (Good Option)
Magnesium can also be taken in a liquid form, which is typically made by dissolving magnesium chloride or magnesium citrate in water.
Magnesium chloride has been shown to have good bioavailability, but it has not been studied specifically for migraines (45).
Liquid magnesium is very concentrated and can be taken in very small quantities (no more than a few teaspoons). It is a good option for people who do not tolerate pills.
One of the most popular liquid magnesium supplements is this one.
17. Intravenous (IV) Magnesium (Not for Home Use)
People whose migraines are accompanied by auras (visual disturbances) and women who experience menstrual migraines may be more likely to benefit from intravenous magnesium sulfate (12).
This form of magnesium is given through an IV in large doses (1 gram) and is usually administered only in hospitals.
18. Topical Magnesium (?)
Magnesium oil and bath salts (Epsom salts) are gaining popularity as magnesium sources and can be used in several different ways:
- Magnesium oil is actually not an oil – it’s made from magnesium chloride flakes and water. It can be applied directly to the skin and can be used during massages or added to baths.
- Magnesium oil spray can be sprayed on the skin after showering. Most people use just enough spray to lightly coat the skin, then rub it in.
- Magnesium lotion is made from magnesium oil and works great for dry skin.
- Epsom salts are made from magnesium sulfate and can be used for foot soaks or baths.
The idea is that magnesium can be absorbed through the skin and enter the bloodstream without the unwanted side effects that can come with oral magnesium supplements.
No high-quality research has been conducted on this topic, but the studies that do exist report mixed results (66, 67, 68).
It appears that magnesium is absorbed through the skin, but it is unclear in what amounts. Therefore the optimal dosage of magnesium cream/oil/salts for boosting magnesium levels is not known.
There haven’t been any studies to test whether topical forms of magnesium are able to prevent migraines, but some people anecdotally report that it helps.
Which Form of Magnesium Is Best?
The majority of studies have used magnesium oxide or magnesium citrate to prevent migraines (17, 26).
The American Headache Society officially recommends magnesium citrate since it is well studied, affordable, readily available, and has a relatively high bioavailability.
But, just because some forms of magnesium haven’t been studied specifically for the treatment of migraines doesn’t mean they aren’t effective.
Many practitioners recommend other forms, like magnesium glycinate, lactate, or malate since they are also well absorbed can have other health benefits.
Some formulations, like magnesium taurate or threonate are especially promising for migraines due to their beneficial effects on the brain, but more research is needed.
The forms that should probably be avoided for migraines are magnesium ascorbate, aspartate, carbonate, gluconate, glutamate, hydroxide, orotate, and oxide.
If you find that you can’t tolerate any of the oral magnesium supplements, it might be worth trying magnesium lotion, spray, or Epsom salt baths.
At the end of the day, the best supplement is the one you will actually use! If you can’t tolerate one brand or variety, you can always try another.
Safety and Side Effects
The most common side effect from magnesium supplementation is mild diarrhea which tends to get worse with higher doses (2).
This is because unabsorbed magnesium functions as an osmotic laxative, pulling extra water into your digestive tract and softening your stool (69).
To avoid diarrhea, the tolerable upper intake level (UL) (the largest amount that can be taken each day without causing negative side effects) for magnesium is 350 mg per day for adults (2).
However, diarrhea seems to be the only potential adverse effect from taking more than this amount.
No evidence has shown any negative effects from magnesium supplementation during pregnancy and breastfeeding, so the UL is the same for pregnant women (2).
There is a higher risk of toxicity for those with impaired kidney function, so it is important to consult your doctor before deciding to take supplements (2).
Overall, taking magnesium supplements carries a very low risk for most people.
Magnesium in Food
Typically, the best and most natural way to consume nutrients is through food.
If you find that you can’t tolerate magnesium supplements, or you would like to avoid having another pill to take, consuming food sources high in magnesium is an option.
In fact, some researchers even recommend getting your magnesium from food as a BETTER alternative to supplements (70).
Here are some foods with the highest amounts of magnesium:
- Amaranth: 160 mg (40% DV) per cup, cooked (71)
- Spinach: 155 mg (38% DV) per cup, cooked (72)
- Pumpkin seeds (pepitas): 150 mg (38% DV) per ounce (73)
- Swiss chard: 150 mg (38% DV) per cup, cooked (74)
- Tofu: 146 mg (36% DV) per cup, raw (75)
- Black beans: 120 mg (30% DV) per cup, cooked (76)
- Adzuki beans: 120 mg (30% DV) per cup, cooked (77)
- Quinoa: 118 mg (30% DV) per cup, cooked (78)
- White beans: 113 mg (28% DV) per cup, cooked (79)
- Pink beans: 110 mg (27% DV) per cup, cooked (80)
- Brazil nuts: 105 mg (26% DV) per ounce (81)
- Coconut milk: 104 mg (26% DV) per cup (82)
- Edamame: 99 mg (25% DV) per cup, cooked (83)
- Mung beans: 97 mg (24% DV) per cup, cooked (84)
- Navy beans: 96 mg (24% DV) per cup, cooked (85)
- Spelt: 95 mg (24% DV) per cup, cooked (86)
- Black eyed peas: 91 mg (23% DV) per cup, cooked (87)
- Cranberry beans: 88 mg (22% DV) per cup, cooked (88)
- Acorn squash: 88 mg (22% DV) per cup, cooked (89)
- Prickly pear: 87 mg (22% DV) per fruit (90)
- Buckwheat: 85 mg (21% DV) per cup, cooked (91)
- Pinto beans: 85 mg (21% DV) per cup, cooked (92)
- Brown rice: 85 mg (21% DV) per cup, cooked (93)
- Caviar: 84 mg (21% DV) per ounce (94)
- King crab: 84 mg (21% DV) per leg (95)
- White potato: 83 mg (21% DV) per large, with skin (96)
- Lima beans: 80 mg (20% DV) per cup, cooked (97)
- Almonds: 80 mg (20% DV) per ounce (98)
About 50% of dietary magnesium is absorbed, which is MUCH better bioavailability than most of the supplements mentioned above (2).
If you don’t mind making some lifestyle changes, dietary magnesium is a great alternative to supplementation.
Final Thoughts
For people who suffer from migraines, magnesium supplements may be a safe and affordable alternative to medications.
Magnesium oxide is the most commonly used magnesium for migraine prevention, but it isn’t well-absorbed and causes diarrhea in many people.
A better option is to take 400-600 mg of magnesium citrate, glycinate, taurate, or threonate each day.
Undesirable side effects like diarrhea can be avoided by taking several, smaller doses (200-300 mg each) throughout the day.
But supplements aren’t the only answer. If you’re willing to make changes to your diet, getting your magnesium through food can also be effective.
It’s important to remember that magnesium is just one possible treatment for migraines. Typically, migraines have more than just one cause, so it’s unlikely that one single treatment will completely eliminate your symptoms.
{Want to learn more about migraines? Join The Functional Nutrition Library to learn about other causes and treatment options.}
Amy is a registered dietitian nutritionist and certified LEAP therapist. Her passion is finding ways to communicate nutrition research in an interesting and easy-to-understand way. She has an undying love for food, especially homemade almond butter, steamed asparagus, and fresh summer cherries.
by Amy Richter, MS, RDN, LD, CLT | Sep 7, 2018
Are you suffering from histamine intolerance?
Have you been instructed to follow a low-histamine diet, but are feeling a little confused about what that means?
We get it! There are so many things to think about.
Which foods contain histamine? What foods might provoke histamine release? What supplements might worsen your symptoms?
This comprehensive article will explain the science behind histamine intolerance and help you understand the best diet and supplements for managing your symptoms.
What Is Histamine?
Histamine is a chemical that is naturally found in some foods and also produced by the body.
Histamine In Food
Histamine forms when certain bacteria or yeasts transform the amino acid histidine into histamine (1).
This means that any food containing protein can form histamine under the right conditions.
Generally speaking, aged and fermented foods or beverages contain the highest levels of histamine, while fresh foods contain almost none.
Histamine In the Body
Our bodies also naturally produce histamine.
It is released by our immune cells during allergic and inflammatory reactions that occur when our immune system detects a threat.
When released, it causes stomach cramps and diarrhea, low blood pressure, mucus secretion in the nasal passages and GI tract, and many other physiologic effects that are intended to fight off invaders (2).
Once the perceived threat is over, histamine levels are reduced back to normal, and symptoms subside.
Histamine Breakdown
The body has two enzymes that are capable of degrading histamine: N-methyltransferase (HNMT) and diamine oxidase (DAO) (2).
HNMT exists only in the cytoplasm, so it is responsible for breaking down any histamine found inside of cells.
The highest concentrations of HNMT have been found in the kidney and liver but it also exists in many other tissues.
DAO, on the other hand, is produced and stored by epithelial cells (cells that line our organs and blood vessels).
When stimulated, it is secreted into the bloodstream and gut where it picks up and degrades any histamine that might be floating around.
DAO is produced in large amounts within the intestines, but also by the placenta during pregnancy.
However, in some people histamine degradation doesn’t work the way it should, causing a condition known as histamine intolerance.
What Is Histamine Intolerance?
Histamine intolerance occurs when more histamine accumulates in the body than we are able to break down effectively.
This build-up eventually causes symptoms that are very similar to an allergic reaction.
It is estimated that 1% of the population has histamine intolerance, and most of those are middle-aged women (2, 3).
It’s unclear why women are more often affected than men, but one theory is that an imbalance of female sex hormones may cause the body to produce more histamine than it normally should.
Studies have shown that estrogen activates histamine release from mast cells (cells that exist in the lining of our tissues), while progesterone inhibits it (4, 5, 6).
So, if the amount of estrogen being produced is higher than the amount of progesterone, more histamine is released.
Signs and Symptoms of Histamine Intolerance
Symptoms of histamine intolerance can vary depending on the person and the amount of histamine that has accumulated.
The following are some of the most common signs and symptoms of histamine intolerance (2, 7):
- Itching, redness, hives and/or swelling of the lips, tongue, or skin
- Sneezing and nasal congestion
- Asthma
- Low blood pressure
- Heart arrhythmia
- Diarrhea
- Headache
- Dizziness
- Sleep disturbances
- Menstrual irregularity
- Chronic fatigue
- Anxiety
- Depression
These symptoms are very general, so experiencing them is not enough to confirm a diagnosis of histamine intolerance. Further investigation is usually needed.
What Causes Histamine Intolerance?
Histamine intolerance may occur for several reasons:
1. The body has produced too much histamine (due to immune reactions or a condition like mastocytosis, in which the body has too many mast cells that release histamine).
2. Too much histamine is ingested (through food or alcohol).
3. The degradation of histamine is impaired (due to genetics, medications, or other medical conditions).
It is thought that the main cause is the impaired breakdown of histamine due to alterations in DAO activity.
Many studies have shown lower serum DAO activity in those with symptoms of histamine intolerance compared to healthy controls (8, 9, 10, 11).
Genetic Causes
While the exact causes of DAO deficiency are unknown, there may be a genetic component that explains why some people experience insufficient DAO activity.
If the DAO gene (known as ABP1) contains certain single-nucleotide polymorphisms (SNPs), this may increase the risk of developing histamine intolerance (12, 13, 14).
In this case, the most relevant SNPs are rs10156191 Thr16Met, rs1049742 Ser332Phe, and rs1049793 His645Asp (15).
With genetic testing, it is possible to determine if you have some of these SNPs, but simply having a SNP does not necessarily mean that you will experience histamine intolerance.
Gastrointestinal Causes
Poor gut health caused by stress or infection may also be a trigger for histamine intolerance (2, 16).
Gastrointestinal diseases, such as Crohn’s disease, have been associated with impaired DAO activity. This is caused by a decrease in DAO production when intestinal cells become inflamed (17, 18).
In many cases, it may be possible to reverse histamine intolerance by healing the gut or removing whatever is inhibiting DAO activity (2).
When Is a Low-Histamine Diet Helpful?
A low-histamine diet can be helpful in both the diagnosis and treatment of histamine intolerance.
Histamine intolerance should be considered in people who have the signs and symptoms but test negative for allergies and other disorders.
The gold standard for diagnosis is a double-blind placebo-controlled oral challenge after a histamine-free diet. This requires following a very strict low-histamine diet for 4 weeks and then reintroducing a few high histamine foods to see if symptoms develop (2).
Other than the oral challenge, there are no reliable tests to diagnose histamine intolerance.
One study found that a histamine skin prick test that measures the rate of reaction resolution showed 79% sensitivity and 81% specificity in diagnosing histamine intolerance, but this test is still considered experimental and is not commonly used (19).
Another test sometimes used for diagnosis is serum DAO activity. In those with histamine intolerance, serum DAO activity is lower than that of healthy controls (8, 9).
{Want to learn more about testing DAO activity? Join The Functional Nutrition Library to learn about our favorite lab options.}
No test is perfect, so trying a low-histamine diet is often the simplest and most effective option!
Foods to Avoid on a Low Histamine Diet
On a low-histamine diet, it is important to avoid foods that contain high amounts of histamine.
In severe cases, it may also be helpful to try cutting back on histamine-releasing and DAO-blocking foods (see below).
High-Histamine Foods
The longer a food has been aged, the more amino acids have been converted to histamine. So, fermented foods have the highest levels (2).
Keep in mind that histamine levels in a food can vary significantly depending on aging, storage time, and how it is processed (20).
In general, aged and fermented items are much higher in histamine than fresh foods.
Foods that are generally high in histamine include:
- Aged cheeses
- Alcohol of any kind
- Avocado
- Dried fruits
- Eggplant
- Fermented/aged meats (salami, sausages, pepperoni, lunch meat, hot dogs, canned meats/fish)
- Fermented beverages (kombucha)
- Fermented dairy (yogurt, kefir, sour cream, buttermilk, cottage & ricotta cheese)
- Fermented vegetables (kimchi, sauerkraut, pickles, miso, natto)
- Fish and seafood, especially if leftover, smoked, salted, or canned
- Ketchup
- Pineapple
- Soy sauce, tamari, coconut aminos, liquid aminos
- Spinach
- Spoiled food/old leftovers
- Tea (black/green/white)
- Tomatoes
- Vinegars
- Yeast products
*Note that measured histamine levels can vary widely from study to study, even for the same foods. This can make it very difficult to pinpoint which foods might be problematic.
Following a structured elimination diet under the care of a registered dietitian or other nutrition professional who is knowledgeable about adverse food reactions can help immensely.
Histamine Releasers
Some foods are also thought to be “histamine releasers.”
These foods are actually low in histamine but may cause mast cells to release histamine (2, 7).
This is a hypothesis based on old in vitro and animal studies, but there are no randomized controlled trials confirming their findings (21, 22, 23, 24, 25).
Currently, there is not enough scientific support for histamine-releasing foods, so more research is needed before limiting these foods can be recommended routinely (26).
Foods that may be histamine releasers include:
- Additives
- Alcohol
- Bananas
- Chocolate/cocoa
- Citrus fruits (lemon, lime, grapefruit)
- Egg whites
- Fish
- Legumes
- Licorice
- Nuts
- Papaya
- Peanuts
- Pineapple
- Pork
- Shellfish
- Some spices
- Spinach
- Strawberries
- Tomatoes
DAO Blockers
There are other foods that are called “DAO blockers” because they inhibit the activity of DAO.
These include:
Since alcohol is both high in histamine AND slows its breakdown, it should definitely be avoided by people with histamine intolerance.
Foods to Enjoy on a Low-Histamine Diet
Low-Histamine Foods
Generally, fresh foods have the lowest amounts of histamine.
Some low-histamine foods to try include:
- Fruits: apples, apricots, blackberries, blueberries, cherries, coconut, melons, peaches, plums, pomegranate, and raspberries, among others.
- Vegetables: arugula, asparagus, bell peppers, beets, bok choy, broccoli, brussels sprouts, cabbage, carrots, cauliflower, garlic, greens, leeks, lettuce, onions, rhubarb, rutabaga, shallot, summer squash, sweet potato, turnip, watercress, winter squash, and zucchini, among others.
- Grains: gluten-free options like amaranth, corn, millet, quinoa, rice, teff are less likely to exacerbate an irritated gut than gluten-containing grains.
- Fresh herbs
- Olive oil
- Fresh animal proteins: chicken, beef, lamb, goat
Please note that just because a food is low in histamine does not mean that it will be tolerated well by your body.
Other types of adverse food reactions like allergies, sensitivities, and intolerances are always possible. Listen to your body first!
Food Purchasing and Preparation Tips
Since histamine forms as food ages and ferments, there are some tips for keeping food fresh and reducing the amount of histamine produced.
1. Purchasing Proteins
When purchasing animal-based proteins, the fresher the better. Check the “packaged on” date when shopping for meat, and choose the freshest.
Also look for meat that has been butchered and frozen quickly. Check with local meat suppliers for the best options.
Additionally, whole cuts may be better than ground meats, since the grinding process spreads bacteria throughout the meat, increasing their ability to create histamine.
If buying fish, look for the “frozen-at-sea” (FAS) label.
When shopping, select your animal proteins at the end of your grocery shopping trip and keep in a cooler on your way home.
2. Freezing
Freezing food prevents or slows down the development of histamine (27).
Buying fresh meat or other foods and freezing in individual portions allows for quick thawing and minimal histamine accumulation.
Of course, this doesn’t work for ALL foods, because some are not freezer-friendly.
3. Cooking Method
There’s also some evidence that the histamine level in a food can change based on how it is cooked.
Frying and grilling tend to increase histamine levels, while boiling can maintain or decrease levels, but the difference is relatively small (28).
Other strategies include cooking with a pressure cooker, using quick thaw methods for frozen foods, freezing individual meals, and avoiding slow-cooked foods.
Supplements to Try
While limiting histamine-containing foods is the most effective way to find relief from symptoms of histamine intolerance, low-histamine diets are definitely not easy to follow, and total avoidance of histamine is impossible.
To help reduce symptoms even further, certain medications and supplements can help support the degradation of histamine:
1. Antihistamines
Antihistamines are sometimes used by those with histamine intolerance to block the action of histamine and quell symptoms.
However, antihistamines just mask symptoms and do not address the root cause.
They may provide temporary symptom relief, but it is expensive to routinely take antihistamines and they can cause side effects like excessive drowsiness.
Additionally, antihistamines do nothing to boost DAO activity, which is typically at the root of histamine intolerance.
2. Supplemental DAO
Another option is to take supplemental DAO enzymes orally.
These enzymes will enter the gut and help degrade histamine in food, much like the DAO naturally produced in your gut would.
However, it is important to note that DAO taken orally is NOT absorbed into the bloodstream, and will do nothing to reduce systemic histamine levels.
DAO supplements can be helpful for breaking down histamine from food, reducing the amount of histamine that gets absorbed, but that’s about it.
There has not been a lot of research on the effectiveness of these supplements, but they do have a good amount of anecdotal support.
A couple of small studies testing the effect of DAO supplements on symptoms of histamine intolerance are conflicted about its efficacy (29, 30).
3. Vitamins to Support Histamine Breakdown
There is also some evidence that vitamin B6, vitamin C, and copper increase the activity of DAO and aid in the breakdown of histamine; however, no randomized controlled studies have been conducted to confirm this (31, 32, 33, 34, 35).
Several studies have shown that vitamin B6 deficiency is linked with lowered serum DAO activity, suggesting that status of this nutrient may influence serum DAO activity (31, 36).
Another study found that vitamin C administered by IV significantly decreased serum histamine concentrations in patients with allergies (32). The theory behind this is that vitamin C is actually able to degrade histamine (37).
The effect of copper on histamine has only been studied in vitro (in test tubes); researchers found that a copper solution inhibited the release of histamine from mast cells in a dose-dependent relationship (35).
It’s best to consume foods rich in vitamin B6, vitamin C, and copper rather than rely on supplements, unless you have been diagnosed with a deficiency in one of these nutrients.
{Want to learn more about our favorite brands? Join The Functional Nutrition Library to learn about our favorite supplement options.}
4. Mast Cell Stabilizers
Those suffering from gastrointestinal symptoms may benefit from supplementing with mast cell stabilizers (2).
Mast cell stabilizers inhibit the release of mediators (including histamine) from mast cells in order to reduce their inflammatory effects (36).
The most popular mast cell stabilizer is disodium cromoglycate (DSCG), also known as cromolyn sodium.
It is available by prescription-only as an oral solution under the brand name Gastrocrom and over-the counter as a nasal spray (NasalCrom) or eye drop (Opticrom).
5. Histamine Degrading Probiotics
Optimizing gut bacteria is vital for overall health and disease prevention (37, 38). Unfortunately, that’s not easy to do for those with histamine intolerance because probiotic foods (yogurt, kefir, kombucha, etc.) are high in histamine and should be avoided.
Another option is to use probiotic supplements, but it’s important to choose probiotic supplements containing bacteria that do not produce histamine.
The following strains may be helpful because they have been found to break down or reduce the formation of histamine:
- Lactobacillus plantarum (39)
- Lactobacillus rhamnosus (40, 41)
- Bifidobacterium infantis (42)
- Bifidobacterium lactis (43)
- Bifidobacterium longum (42)
These strains should be avoided because they produce histamine in the GI tract:
- Lactobacillus brevis (44)
- Lactobacillus casei (45, 46)
- Lactobacillus delbrueckii (45)
- Lactobacillus fermentum (47)
- Lactobacillus helveticus (47)
- Lactobacillus hilgardii (44)
- Lactobacillus lactis (47)
- Enterococcus faecium (47)
- Streptococcus thermophilus (48, 49)
These lists are not comprehensive, because this is still a new area of research, but they can be used to guide decisions about which probiotic supplements to purchase.
{Looking for the best probiotic for histamine intolerance? Join The Functional Nutrition Library to learn about our favorite one.}
Final Thoughts
Most people with histamine intolerance find relief after just a few days of following a low-histamine diet (7).
A generalized low-histamine diet should not be followed long-term, because it may be over-restrictive, increase the risk of malnutrition, and take some of the pleasure out of eating.
Instead, it is better to use the diet as a tool to determine an individual’s histamine tolerance, and craft a customized diet from there (50).
Start by following a low-histamine diet for 2 weeks, and then slowly reintroduce higher histamine foods while documenting symptoms. A tolerance threshold can be determined, which will help guide long-term dietary changes.
Supplements can also be considered to help manage symptoms but should be taken under the guidance of a physician or other healthcare professional familiar with your unique health history.
{Are you a healthcare practitioner who often works with histamine intolerance? Join The Functional Nutrition Library to stay up to date with current research.}
Amy is a registered dietitian nutritionist and certified LEAP therapist. Her passion is finding ways to communicate nutrition research in an interesting and easy-to-understand way. She has an undying love for food, especially homemade almond butter, steamed asparagus, and fresh summer cherries.
