Low blood sugar and migraine

So I have once again fiddled with my diet. Now, on top of avoiding gluten, corn sugar, almonds, ginger and all the migraine causing things like: nitrates, msg, caffeine, aspartame, etc., I am also watching my sugar intake. Why, you may ask, would I want to eliminate or drastically curtail yet another food group? My reasons are threefold and all have to do with the high-glycemic value of most non-gluten containing grains.

1: I cannot get control of my weight since going gluten-free.

2: I have noticed a correspondence between low blood sugar episodes and my migraines.

3: I seem to get sugar “crashes” during exercise which makes problems No.1 and 2 worse.

I have known since high school that skipping meals, fasting, or waiting too long between meals is a sure recipe for a headache of any kind. So, for years I have made sure I eat something every 3-4 hours. The trouble is, as I have gotten older, I have noticed that this doesn't ensure I won't have a sugar “crash” which can and has brought on a headache. I even tried making sure I ate protein with my snacks, and it didn't seem to matter. 

Ten years ago, I gave up regular coffee at breakfast (which was a HUGE sacrifice for me) and noticed that the sugar crashes stopped. Great, I thought. Then a few years ago I noticed that if I had jam on my morning toast, I would have a sugar crash a couple hours later. After I gave up gluten, I started indulging in buckwheat frozen waffles for breakfast...with fruit and maple syrup (avoiding the corn syrup, of course). One day in May of 2007 I ate that for breakfast and had one of the worst sugar crashes of my life and as luck would have it, just as the weakness, lightheadedness and shaking started, I saw a bright light from the glare of sunlight reflecting off a window and — bam! Classic migraine (with aura). My day was shot. I took a triptan drug (Amerge) but it took 2 hours to work and I felt lousy the rest of the day.

Two weeks ago I had a ham sandwich on Tapioca Bread with lettuce, tomato and a few baby carrots and I grabbed a couple of potato chips off my husband's plate (!) and an hour and a half later in the middle of teaching our Naginata class, I had the mother of all sugar crashes. I had to stop practicing and since I hadn't thought to bring food with me, my only choice was to get orange juice out of the vending machine and chug it down while I sat on the bleachers waiting for the shaking to stop. Not good.

I had to find a way to eliminate refined carbs from my diet. Not easy when you have an egg allergy that you are not sure is a real allergy or just an intolerance and a moderate cow's milk allergy. I am a lifetime member of Weight Watchers and I had been struggling trying not to eat too many carbs. I looked on the WW forum under restricted diets and noticed that all the gluten intolerant and allergy sufferers were doing the “Core Program” which is based on real food, whole grains, etc. Sounds good, but I had avoided it because of the egg and milk problems I had. Same with South Beach Diet. Most breakfasts that are low carb seem to revolve around eggs.

I decided to try doing the Core program like the first phase of South Beach for 2 weeks and see if I could handle the eggs a little. At first it worked like a dream. I lost the sugar crashes and the sugar cravings and seemed to be ok with a little egg. Then on the third or fourth day I crashed big time. Could barely get out of bed I was so fatigued. I happened to be reading a book by Dr. Diana Schwarzbein about the importance of balancing carbs, protein and fat, especially if your adrenals are burned out...which I suspect mine are. Dr. Schwarzbein says that if you eliminate carbs altogether in that situation, you burn out your adrenals even more and will end up even more fatigued. So, I added some whole grains back in and things are going better now. I am not really missing the refined carbs now and they will taste even better when they are a rare treat instead of an everyday craving. Headaches have been fewer and really only resurfaced after I weakened and ate some chocolate the other day (!). Breakfasts are the most challenging, but I am rediscovering tofu as an egg substitute. Check out my lamb sausage tofu scramble. It's delicious and not too time consuming if you cut up the tofu ahead of time and refrigerate.

Lamb Sausage and Tofu Scramble

2 oz. loose lamb sausage (nitrite-free)

2 oz. firm tofu cut into small cubes

olive oil

1 green onion

1 T fresh mint, minced

1/4 cup or so cucumber, chopped

1/4 cup or so yellow squash, chopped

1 mushroom, chopped

1/4 cup tomato, chopped

salt and pepper to taste

pour a little olive oil in a non-stick skillet on medium heat

add lamb sausage and cook, breaking up with a wooden spoon

add tofu and cook until heated through

add squash, cucumber, mushroom and tomato and cook a minute or two

season with salt and pepper

add green onion and mint and cook another minute

makes one serving (5-6 WW points if you’re counting, depending on how much oil you use)

(note: lamb is pretty greasy, you won't need much oil, just enough for flavor)

Enjoy! You won't be hungry until lunch!

Karen, herself

Gluten-free Air Travel

Travel, particularly air travel, for those of us on a gluten-free diet is tricky. Adding migraine avoidance to the mix makes advance preparation absolutely essential for a pain-free travel day. With airlines no longer serving meals in coach and substituting boxes of junk food for purchase, bringing a healthy meal on board with you is key. You might be able to find something other than fresh fruit in the airport, but why chance it? Also, if you have a long day of cross country travel coming up, as I do tomorrow, a whole day eating nothing but fruit and water doesn't sound like much fun. The solution is to pack your own lunch and bring it with you. 

Whenever I travel I make sure I have gluten-free and migraine trigger free food with me. This time I am taking Real Foods Multigrain Corn Thins in a zip-loc bag, a few EnviroKidz Organic Crispy Rice Bars, some cut up celery and some apples for snacks. (You never know when you might get hungry, especially if your flight gets delayed. Better to bring extra things to tide you over). For breakfast I am taking gluten-free lemon poppyseed muffins I baked a couple weeks ago and froze and for lunch a smoked salmon and wild rice salad with blueberries. I made the salad this morning and have it cooling in the fridge. Tomorrow morning I will take it out and put it in a thermal lunch box with an ice pack so that it stays nice and cold until I am ready for it. I'll make sure I grab a plastic fork from a concession in the airport and buy a bottle of water and I'm set to go!

Smoked Salmon Wild Rice Salad with Blueberries

1 package (4 oz) smoked salmon (preservative-free)

1/2 cup or so fresh blueberries

1 cup sautéed vegetables (I used asparagus, yellow squash, zucchini and wax beans sautéed in 1 tsp. lemon-infused olive oil (O & Co) with a little minced garlic, salt and pepper)

1  1/2 cups cooked wild rice

2 tsp. basil vinaigrette (see recipe below)

salt and pepper to taste

(makes 2 servings) (6 Weight Watcher points per serving)

Slice salmon into slivers. In a medium bowl mix salmon, rice, vegetables and basil vinaigrette. Toss. Adjust seasoning. Add blueberries and gently mix. Divide into travel containers and refrigerate. Pack in a thermal lunch sack with a cold pack.

Basil Vinaigrette (from most recent AARP Magazine)

1/4 cup Dijon mustard

1/2 T finely minced shallots

1/4 tsp salt

1/4 cup champagne vinegar

juice of half a lemon

1/4 cup extra-virgin olive oil

1/4 cup fresh basil, chopped

In a medium bowl, combine the mustard, shallots and salt. Slowly whisk in the vinegar, lemon juice, and oil until the mixture is emulsified. Add the basil and chill for 30 minutes.

Note to Migraine sufferers: None of the above ingredients cause any problems for me. Even the mustard and vinegar are ok in small amounts. Your triggers may be different from mine. Substitute where necessary.

Try packing a gluten-free lunch on your next trip and see how much better you feel—physically and emotionally. Not to mention that those sitting around you will be jealous!

Bon voyage!

Karen, herself

Brown Rice and Black Bean Salad

Some people balk at leftovers. I embrace them. My favorite lunches have leftover chicken or pork tenderloin as a major component. This particular lunch was easy to put together with leftover brown rice and canned black beans and tuna. I added a bit of broccoli that I steamed in the microwave and some fresh tomato, shredded red cabbage, then tossed it in a bit of homemade vinaigrette and—lunch! Healthy, gluten-free, full of fiber and very satisfying.

People often say they have no time to make healthy meals, especially lunches, but with a little advanced planning and some imagination, you can eat well without spending all day in the kitchen. The day I made this salad I had a busy morning, so I put brown rice in the rice cooker, pushed the “on” button and off I went on my errands. When I came back a few hours later, it was lunch time and my rice was ready for me. Then a couple minutes to steam a cup of broccoli in the microwave, slice off a bit of previously washed cabbage and tomato, open a couple cans—you get the picture. Pretty quick.

These days I work at home and my lunches are leftovers from the previous night’s dinner or a big salad with leftover meat or fish. When that fails, I steam some vegetables, add rice or not and maybe open a can of tuna or salmon or add some tofu. I never spend more than 15 minutes making lunch and my salad dressings are all homemade, stored in recycled jelly jars. So  my advice is to think positive and invest in a good salad spinner and a rice cooker. Buy some good olive oil and start experimenting. 

За ваше здоровье!

Karen, herself

Beet and Peach Salad

I love pairing fruit with vegetables in the summer. I especially like fruit and cheese added to summer salads. My typical lunch is a big salad with leftover meat or fish from the previous night’s dinner. The most common fruit I use on salads is apple, but in summer I lover the addition of stone fruits—peaches, plums, nectarines and apricots. The other day I used leftover roasted beets (you can also use canned) and fresh peaches to a salad with pork tenderloin. I topped it off with mild fresh goat cheese (Chavrie is my favorite brand) and a homemade olive oil and champagne vinegar dressing. The natural sweetness of the beets is enhanced by roasting with a bit of olive oil and the sweet/savory mix of the beet and peach with the cheese is heavenly, I think. If you don't like goat cheese, feta also works well here. I suppose blue cheese would also be good, if you like it. For me, more aged cheeses can be problematic and cause headaches. I happen to be allergic to blue cheese, so that is reason enough for me to avoid it.

In addition to being naturally gluten free, this kind of salad has the added benefit of being great for those watching their waistline. As a lifetime member of Weight Watchers I weigh my meat or fish to be added to the salad. Two ounces of  pork or beef or three ounces of chicken or fish are pretty standard for lunch salads and are quite enough if you are adding fruit and cheese. The Chavrie cheese is only 1 Weight Watcher point per 2T so it is ideal for adding to salads and pasta. I rarely use more than 1T at a time so it only adds a half a point to my meal. I also measure out my salad dressing to keep the points and calories low. If you are a migraineur who cannot eat vinegar or citrus, the Chavrie is soft enough to dress your salad without a typical dressing. I use it to stretch out my vinaigrette and make it creamy. Just toss the salad well—as the French say: “Fatiguer la salade”. It is an idiom that just means to dress the salad, but it makes me smile, because I think of it as mixing it well to tire it out!

With Farmers’ markets in full swing now that is my choice for keeping the cost down on organic salad greens. I am also fortunate to have friends who give me vegetables from their gardens and I even ventured into growing my own this year. No harvest yet, but things are growing and looking good. Much great eating in sight down the road.

Karen

How to keep it simple on an elimination diet

One of my favorite blogs is The Daily Headache, which has a migraine forum. Recently, someone in the forum was asking for help following an elimination diet. She had read my blog but apparently not found an answer to her question: “What can one actually eat while on an elimination diet?” Good question, especially if you haven’t ever tried one.

The thing is, I have long suspected that migraineurs (those who suffer from migraine) who complain about elimination diets and avoidance of common triggers have either never really tried to do it properly or have not suffered enough to be willing to give up foods that they love in order to buy a little pain-free time. I say this last part with sincere sympathy for my fellow migraineurs, as I was, until recently, in that category. I was that person who proclaimed I would NEVER give up coffee or chocolate. Well, never say never. I have given both up, at least with rare exceptions, and I can honestly say that it is quite possible to live without them. Abstaining from caffeine actually gives you energy, especially if you also abstain from alcohol most of the time. 

Having said that, elimination diets can look bleak. I have read about studies done in England in the 1980’s where the subjects ate nothing but rice and lamb or chicken for five days. Their headaches disappeared at that point and they then started to reintroduce foods to see which ones brought them back. I think when some people read about these diets that this is the point where they take things a bit too literally. I think it is safe to say that the subjects of the group probably seasoned the rice and chicken and lamb (with at least salt and pepper). I think they probably used cooking oils of some kind. I do not think one needs to go on a prison ration in order to try an elimination diet. But I could be wrong. It is just my opinion.

I began eliminating food gradually. Four years ago on the advice of my neurologist, I gave up regular coffee and tea, diet soft drinks and other diet foods with aspartame in them, msg, and nitrites. I cut back on the chocolate and almost entirely eliminated alcohol. It didn't really lessen my headaches, but I thought it was a good idea, especially since I am over 40 and caffeine and alcohol drain your adrenals and can leave you feeling exhausted. 18 Months ago I learned that my adrenal hormones were low, that I was gluten intolerant and had mild allergies to a lot of foods, many of which are considered major headache triggers: aged cheeses, yogurt, certain nuts, beans and spices and corn sugar. I decided to eliminate all of them for 9 months to two years while I strengthened my adrenals to see if I would outgrow the sensitivity. This actually did produce some positive results. 

While I was doing that,  I tried a yeast elimination diet for one month. I found the diet in a book by Steven F. Hotze, M.D. called Hormones, Health, and Happiness (page 236). Basically you eliminate all sugar and sugar substitutes except xylitol, all vinegars, alcohol, dairy, grains and for the first two weeks, all fruit and butter. What can you eat? All meats, fish, vegetables (go easy on the starchy ones) dried beans, eggs, avocados, black olives, olive oil, lemons and limes, herbal teas. For someone like me who loves good food and loves to cook, I found this challenging at first. But, I discovered some interesting things along the way. Lemon and lime juice and olive oil are all you really need to make a salad dressing. Add some garlic and voila! Water and tomatoes and chicken broth go along way in any dish. Have a recipe that calls for vinegar or wine? Try substituting water and herbs or broth or tomato paste and water. You really do not need the wine/vinegar. Experiment with herbs, especially fresh ones. Also try Bragg’s Aminos instead of soy sauce. It is not fermented, so better for avoiding headache.

The hardest part of the yeast elimination diet was breakfast. I was used to having cereal of some sort or toast (gluten-free of course). On this diet I ate all sorts of things. One morning I had sauteed filet of sole and vegetables! Guess what else? I dropped 5 lbs without really trying. I did have dreams of eating potatoes again (not allowed on the diet) and dairy. But in the end, I didn't go back to dairy right away. I found out I was mildly allergic to cow’s milk so I avoided dairy completely for six months and milk for one year. I now quite enjoy soy milk. I also found I had fewer headaches while following this diet.

So I guess my message is that elimination diets do not have to be bleak. I managed to retool most of my standard recipes to fit into the yeast elimination diet. Afterwards, as I reintroduced foods back into my diet, it was easier to see what I reacted negatively to. (I should mention that I keep a food diary.) When reintroducing, you need to do one food every four days. Takes awhile, but it is worth the wait. The yeast elimination diet showed me that any elimination diet is do-able. Last Fall I tackled eliminating all migraine triggers for two months and then gradually reintroduced them. I discovered that most of them did not effect me, but the ones that do were a surprise (i.e. red onion). I do not think I would have found them if I hadn’t followed an elimination routine. By the way, I still do not drink regular coffee or tea or diet soft drinks and now I am steering clear of chocolate except for rare occasions. I have a glass of wine once in awhile, but not every week and certainly not every day. I feel much better and that is more important to me. I have my life back. I can work most days. This is huge for me.

If you still have questions about what to eat on elimination diets, look at my recipes. If they seem to have things in them that are not on your diet, think about what a reasonable work around would be. Then look at other recipes. See how you could adapt them. It is really not as hard as you may think. Good luck and good eating.

Karen, herself

Allergy-free Grilled Shrimp, Tofu and Mango Salad

We had a few days of hot weather a few weeks ago and in my excitement over the heat I adapted a recipe I found in a recent Martha Stewart Living to suit my allergy-wracked body and the contents of my pantry. It called for grilling extra firm tofu and that appealed to me as I had never tried it before. It also called for ginger, which I am seriously sensitive to. I left that out. It also called for mint and pineapple, which I didn't have. I  found substitutes. It was still very tasty and very refreshing on a rare hot Seattle day. I served it over cooked quinoa as the recipe suggested.

Grilled Shrimp, Tofu and Mango Salad

1 pkg. extra firm tofu, quartered lengthwise

1 pound medium shrimp, deveined

1/4 cup unseasoned rice vinegar

2 T honey

2 T Sweet Thai Chili Sauce

1 clove garlic

1 T cilantro, minced

juice of 1/2 lime

1 large mango, peeled and cubed

2 tsps. olive oil

1/4 coarse salt

freshly ground pepper

3 medium carrots, julienned

1/2 English cucumber, quartered lengthwise and chopped 1/4" thick

1 medium jicama, peeled and julienned

(dressing)

1/4 cup unseasoned rice vinegar

2 T sugar

1 tsp. coarse salt

1/2 tsp. freshly ground pepper

If you use the extra firm tofu, there is no need to drain it. If you have any moisture in yours, place it between paper towels and weight it with a plate or something to drain out the excess.

Then slice it as directed. Place shrimp in a bowl. Whisk together the garlic, vinegar, honey, chili sauce and cilantro and pour over the shrimp. Cover and refrigerate 1 hour.

Preheat grill or grill pan to medium. Brush tofu with oil and grill until brown, 2-3 minutes per side.  Cut into cubes. Combine shrimp with mango, tofu, carrots, cucumber and jicama in a bowl.

Make the dressing by whisking ingredients in a bowl. Pour over salad and toss well.

Feeds 4

(Weight watcher note: you can lower the points value of this dish by using sugar substitute. The original recipe in Martha Stewart Living (6 points per serving) had pineapple instead of the mango and chili paste instead of chili sauce, but the sauce I used is only 30 cal. per T and no fat. so I think the points are the same.)

Some advance prep (I made the marinade in the morning and put it in the fridge until an hour before dinner) makes this a quick dinner even during the week. Try it the next time the temperature reaches 90 degrees.

Karen

Flank Steak with Bell Peppers and Mango

I made flank steak with peppers and mango the other night. It is my husband’s favorite of my invented recipes and one of mine too now that I have perfected my workarounds to avoid gluten, ginger and corn syrup. I started making this dish a few years ago in an attempt to recreate a dish my husband used to make for me when we were dating. The original recipe was from the Time-Life series on Chinese Cooking, published sometime in the 1970’s ( I know I am really dating myself here).

Anyway, being the lazy sort of person that I am sometimes, I didn’t feel like digging out the book and I thought I remembered the marinade well enough to wing it. This was before I knew I was gluten intolerant, so I used regular soy sauce, rice vinegar, Mirin, corn starch and ginger. I like red bell pepper better than green (which was in the original recipe) so I used those as well as shallots (which were always in the recipe). It came out pretty well and I continued to make it, eventually adding a jar marinade (Thai Chili Roasted Garlic Dipping Sauce from Wild Thymes) that brought some heat to it and I tossed in some red wine at the end. One summer I added sliced nectarines and the result was heavenly.

My first few attempts to make it sans gluten and ginger were pitiful. I could substitute sake for the Mirin and wheat-free soy for the regular, but substituting the ginger was really hard. I was afraid to use the Wild Thymes dipping sauce because it had unidentified “spices” in it and I am allergic to chili powder. I experimented with different spice combinations and discovered that allspice, cinnamon, paprika, red pepper flakes and cayenne worked pretty well. It tasted good, but not particularly Asian. The nectarines were still great and in the summer I would alternate with peaches. In the Fall I tried Fuyu persimmons and then I hit on the mango version. All of them are great and allow me to make the dish in any season. I recently discovered that adding a bit more soy, rice vinegar and sake near the end of the cooking process brings a bit more Asian flavor to it and gives the sauce that extra sweetness I used to get with the red wine—without the headache! I serve it over Japanese style white rice cooked in a rice cooker.

Flank Steak with Red Pepper and Mango

1 lb. flank steak, cut lengthwise into 4 or 5 strips, then cut crosswise into bite size pieces.

2 red or orange bell peppers, cut into 1" squares

1 large shallot, peeled and roughly sliced

1 mango, peeled and cut into large dice

1 T peanut oil

a few drops of sesame oil

marinade:

4 tsp. wheat-free soy sauce

2 tsp. corn starch

1 tsp. sake or corn syrup-free Mirin

1 tsp. rice vinegar

a few drops of sesame oil

1/4 tsp. allspice

1/4 tsp. paprika

1/8 tsp. cinnamon

dash of cayenne

1/2 tsp. red pepper flakes

Japanese style rice

feeds 4

Start rice (if using a rice cooker, it should finish right on time).

Cut steak. Add marinade ingredients to meat. Toss to coat.

Chop vegetables and mango.

Heat peanut oil in wok (use medium heat if using non-stick pan). Add shallots and saute until slightly soft. Add bell peppers and mango and cook slightly. Remove from wok with slotted spoon. Add marinated steak to wok (add more oil if necessary). Use a slotted spoon or tongs to add meat. Do not pour in rest of marinade. Trust me. The steak will boil in it and end up tough. Brown the meat well on all sides. Let it form a crust before turning. Add the vegetables and mango back in. Cook, stirring all until the meat is done to your taste and the vegetables are still a bit crunchy. Taste and adjust seasonings. Add a bit more soy, rice vinegar and sake. Cook a minute more and taste, making any adjustments necessary. You should have a lovely sauce by then. Serve over rice. Sigh with happiness.

Karen, herself