Dhru Purohit Show
Masterclass on the Root Causes of Migraines and A Four Pillar Plan to Tackle Them Head On with Dr. Elena Gross
Wed, 29 Jan 2025
This episode is brought to you by BiOptimizers, Fatty15, and Levels. Approximately 15% of the population suffers from migraines, many of which are debilitating and impact daily life, work, and relationships. For years, migraines were seen as something people had to endure or blamed on genetics. Today’s guest, a chronic migraine sufferer, shares her journey to uncover the root causes of migraines and how to prevent them from taking over her life. Today on The Dhru Purohit Show, Dhru sits down with Dr. Elena Gross to discuss migraines, their top root causes, and her Four-Pillar plan to address them. Dr. Gross highlights modern lifestyle practices that can increase the prevalence of migraines and the toxins that can trigger their onset. She also shares insights from epilepsy research that shifted her perspective on how to address migraines effectively. If you’re seeking answers on how to prevent and manage migraines, this episode is a must-listen! Dr. Elena Gross is a neuroscientist with a PhD in clinical research and a former chronic migraineur. Her personal struggle with migraines and the lack of effective treatments inspired her to pursue an MSc in Neuroscience at the University of Oxford and a PhD at the University of Basel, aiming to better understand this debilitating condition and improve clinical care. Passionate about the therapeutic potential of ketosis and nutritional interventions, Dr. Gross focuses on mitochondrial functioning, energy metabolism in brain health, and disease prevention to enhance health span. As the founder and CEO of KetoSwiss and MigraKet, and the inventor of four patents, her groundbreaking migraine research has been published in prestigious journals like Nature Neurology. In this episode, Dhru and Dr. Gross dive into: The number one disabler for women under the age of 50 (00:00:30) The top root causes of migraines (3:15) Dr. Gross’ journey with migraines (11:06) The modern lifestyle practices and how they drive the prevalence of migraines (18:21) Properly fueling your brain and lessons from epilepsy patients (28:16) Dr. Gross’ Four Pillar Plan for tackling migraines (35:51) Sources of toxins and how they can be triggering (47:11) Exogenous ketones (53:11) Dr. Gross’ Brain Ritual supplement (01:00:11) Nutrient deficiencies and triggers that can lead to migraines (01:03:11) Dr. Gross’ Community and sharing resources (1:11:22) Also mentioned in this episode: Brain Ritual Migraket: Use code DHRU30 for $30 off Dr. Georgia Ede’s Practitioner List For more on Dr. Gross, follow her on Instagram, Facebook, X/Twitter, LinkedIn, YouTube, her Website, and other platforms, such as Keto Swiss and Migraket. This episode is brought to you by Bioptimizers, Fatty15, and Levels. Go to bioptimizers.com/dhru now and enter promo code DHRU10 to get 10% off any order and up to 2 travel-size bottles of Magnesium Breakthrough for a limited time. Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Right now, Levels is offering my listeners an additional 2 FREE months of the Levels annual Membership when you use my link, levels.link/DHRU. Make moves on your metabolic health with Levels today. Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What are the root causes of migraines?
Hey, Ju, thanks so much for having me. Yeah, migraine is kind of the unwanted child of neurology. In a sense, it's so, so common. It's very debilitating, but it hasn't been very much studied or studied a lot. And not a lot of focus and research money has actually been going into it. Even though in women under 50, it's actually the number one disabler.
So it's the biggest disabling problem, actually, for women. And if you count men into it, it's still the second most disabled according to the WHO. So it really is a huge problem. What does it mean personally? What does it feel like? Well, first of all, anybody who's ever been a strong pain knows that pain is hard to ignore. Pain is a warning signal that is designed not to be ignored.
So if you have migraine, migraine is actually a spectrum disorder. And it can be very mild from like one or two attacks a year. all the way to being in pain every single day, all the time. And you cannot take painkillers on every single day because that's going to harm your liver. It's going to harm your whole body, right? You get medication overuse, medication overuse headache.
But firstly, it's really this... Very strong pain in the brain, typically half-sided, can be both-sided, and it comes with associated neurological symptoms such as light sensitivity, so light hurts, noises hurts, even smell can hurt. You get nausea, some people throw up.
Chapter 2: How did Dr. Gross' journey with migraines begin?
Movement makes it worse, so with a tension-type headache, you can go outside, you walk for a bit, you drink some water, it gets better.
migraine will wake you up in the night you can't sleep through it you can't walk that makes it worse and it really is moderate to severe mostly and in its worst form its chronic form it basically deprives you of life it's the presence of pain combined with the absence of life because you will miss important events of your kids you will miss all those school trips you will miss school itself work
Nobody really usually would take you seriously. I think it's changing, but it was also stigmatized a lot. So really what I want to do also with my work is that it's real. It's not a psychological issue, even though in some people it can. It's a real disorder. It's a real problem. It's painful and it means lack of life, even if you're not dying from it, at least not immediately.
Now, before we go into your story, just give us a little bit of a preview. Our audience has heard a lot about the role that lifestyle and diet can play when it comes to all sorts of brain conditions, Alzheimer's disease, all the way up to headaches. And even in this instance, now you're talking about migraines. What are some of the top root causes?
We're not going to go super deep, but give us a little bit of a preview. What are some of the top root causes that you found that significantly contribute to migraines?
This is really one thing that has changed my life and has the potential to change the life of many. If we stop thinking about very common civilization diseases, and I'm going to call anything a civilization disease that is more than a percent, because that really is not primarily a problem of genetics, most likely, but of lifestyle.
And lifestyle includes the way we're born, all the way to what we eat, drink, our friends, our sleeping behavior. All of that is kind of the environment, the lifestyle, right, that is changing the expression of these genes. So let's say anything that is very common is a civilization disease.
Now, what we're currently doing as a civilization or also as a field, a medical field, is that we say, oh, there's migraine, there's Alzheimer's, there's Parkinson's, and we treat all of these as if they were one disease with a single root cause. Now, one of the things I learned is that migraine has several different root causes.
and hence several different subgroups maybe that have a different root cause. And I think this could be actually true for a lot, if not all, common neuropsychiatric issues. And one of them, a very big culprit, let's say, in migraine, and also associated or related, as you said, neurological issues, can be metabolism and more malfunctioning metabolism.
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Chapter 3: What lifestyle practices contribute to migraines?
And the one that I have focused mostly for also selfish reasons is actually energy metabolism, which touches especially the brain because the brain is the most energy demanding organ. It requires energy whether we sleep or not, 20 to 25% of energy at all times, even though it only makes up 2% of our mass. It can't store energy very well because there's just no space in the skull, right?
There's no way to expand. There's just a physical barrier. And then it's protected, luckily, by something called the blood-brain barrier, which only lets through very small molecules and not, for example, big molecules such as proteins or big fats that other tissues can eat. So the brain is in a very vulnerable energy situation. It has a high demand and a limited supply and storage.
And that's, I think, one reason that this metabolism is so important for not just migraine, but almost any neuropsychiatric condition.
Well, let's go into your story a little bit, and then we're going to come back to some of these root causes and your recommendations, including your four-pillar plan and some of the top things. I think I saw a video of you recently that you made five things that people should absolutely avoid who are suffering from migraines, which I thought was fantastic.
But let's set the stage a little bit and let's talk about your story. I mentioned in the opening that since the age of 14, something was going on and you actually didn't even know what it was. Take us from there. January's here. Can you believe it? How are you doing with your New Year's intentions? As I like to say, one of my big intentions every single year is to focus on my well-being.
And we all know that the foundation of well-being is a good thing. Personally, if I had a list of a few things that would significantly improve my sleep or my friend's sleep and overall well-being, it's taking the number one mineral for that, which also helps me personally on so many levels that I can't even fully describe. Yes, I'm talking about magnesium.
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Chapter 4: What is Dr. Gross’ Four Pillar Plan for tackling migraines?
Yeah, so I started getting these debilitating headaches, right? I had no idea. My parents had no idea. Bless them. They thought I was being a difficult teenager. So my dad said, I should just get some more sleep, you know, and wake me up from sleep. And eventually we went to doctors and they were thinking, oh, maybe a brain tumor. You never know. So I went from scanning to psychologists.
It took about a year. And luckily, Dr. Google had just come around at that time to figure out that actually my grandma had these two, these debilitating headache. And then it could be migraine. And then that was the diagnosis was basically confirmed by a big, migraine clinic in Germany.
But just thinking about that this is something that affects a billion people, it takes a year to get a diagnosis, is already pretty crazy, right? It means there's not a lot of focus. And then I figured out later, much later, that there's only one hour of training from medical training of six years. There's one hour training on migraine.
That's insane, considering that every seventh person suffers from migraine. There's four hours on headache. 90% of people suffer from some form of headache. So that's just insane. So there's really also a lack of knowledge, which we have to change. But once I had the diagnosis, I was thinking, OK, that's a very common problem. Now, surely we can fix it.
But that couldn't have been further from the truth. So doctors were always very positive. We have this drug, we have this drug. They had a lot of side effects. This goes from anti-epileptic drugs over to anti-convulsant drug, you know, as a teenager. Didn't really work. So we wanted to try alternative things like acupuncture and Chinese herbal medicine. Nothing worked for the next decade.
It went from... like episodic, so occasional migraine to chronic migraine halfway through my bachelor's degree in psychology. I was even thinking I would fail the degree. I wouldn't know how to even pass my degree because I was either on drugs or in pain all the time. And this is when I then started to take tapiramate, which is a potent anti-epileptic drug. And epilepsy and migraine are related.
So what this drug does amongst others, it reduces the hyperexcitability in the brain. So the likelihood that neurons will fire which is relevant for migraine attack as well as epilepsy. What I didn't know at the time is it also improves the survival of our mitochondria, the powerhouses in our cells.
Now, there is a metabolic link to almost all drugs that are used in migraine, but we'll come back to that later. Anyway, I took that to pass my degree in Oxford then because I then went into neuroscience because I thought I could never lead a normal life or do a normal job anyway. And I was very lucky to be accepted and have a medical doctor there. take me under his care.
And I did both of my master's projects in migraine. The second one in neuroimaging and migraine. So I got to work with real chronic migraine patients like myself. And one day... The scanner broke down. So that poor migraine patient had to come back so we can repeat her scanning. And she walked in and I almost didn't recognize her. She was coming in. She was beaming. She was walking upright.
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Chapter 5: What role do toxins play in triggering migraines?
And now, I mean, I always like to apologize to these very early patients when I didn't have a clue what I was doing yet for not having an answer and even triggering their pain. When I finally was writing up my master's thesis and everything, I was procrastinating as usual. So it can be beneficial sometimes.
An epilepsy special that talked about the oldest treatment for epilepsy, which is a fasting mimicking diet. And it even talked about the pathways, potential mechanisms. And sitting there, like all the puzzle pieces fell together and everything started to make sense. It was the biggest and maybe only big aha moment in my life.
But this is where I knew migraine is an energy deficiency syndrome, but it's also a problem of glucose, sugar metabolism. So if it cannot use the primary fuel we give it all the time, How is it going to work? So that patient that was eating enough calories the whole time was still starving in the brain.
So the realization that calories doesn't equal fuel inside the cells was a big one that I hadn't come across. So she was fasting, but her brain was fueled for the first time ever since she was born, probably. So that was the, okay, this is what I want to do with my life. I need to study this. Now, Oxford is conservative. There was no data on this at the time that this could work.
So in the end, I had to make the hard decision and actually leave. And this is how I ended up in Basel, Switzerland, tiny Basel, because they said I could do a pilot project on looking at Ketosis in migraine prevention or in migraine management would be the regulatory correct version to say it.
And so we did the first ever clinical trial on exogenous ketone bodies in a patient population in tiny bars, Switzerland. I did my PhD there. Never regretted it. Now I have a startup working in that space. And I'm down to less than one migraine day a month, literally. It took a lot of trial and error to get there. It wasn't like I figured this out and then two days, two weeks later, I was fine.
It took me years to figure out all the things that you mentioned in the four migraine pillars and learning about metabolism. But when I learned about metabolism and really got my own brain back, I realized that Whether you get migraine or Parkinson's or Alzheimer's may be primarily genetic, but how to get out if you have a metabolic problem can actually be fairly similar.
And that all of these different conditions, while looking very different on the outside, if they have a metabolic root cause, then the keys or the path to getting better is actually fairly similar. Now, in the VC, in the vestibule, nobody would believe you, even the scientists will.
When you say that a metabolic Alzheimer patient and a metabolic migraine patient may have more in common than a hormonal migraine patient and a metabolic migraine patient, nobody's going to believe you, right? So that was the tricky bit 10 years ago. So I mostly talked about migraine.
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Chapter 6: How can nutritional deficiencies affect migraines?
Chapter 7: What are the benefits of exogenous ketones for migraine relief?
It took me years to figure out all the things that you mentioned in the four migraine pillars and learning about metabolism. But when I learned about metabolism and really got my own brain back, I realized that Whether you get migraine or Parkinson's or Alzheimer's may be primarily genetic, but how to get out if you have a metabolic problem can actually be fairly similar.
And that all of these different conditions, while looking very different on the outside, if they have a metabolic root cause, then the keys or the path to getting better is actually fairly similar. Now, in the VC, in the vestibule, nobody would believe you, even the scientists will.
When you say that a metabolic Alzheimer patient and a metabolic migraine patient may have more in common than a hormonal migraine patient and a metabolic migraine patient, nobody's going to believe you, right? So that was the tricky bit 10 years ago. So I mostly talked about migraine.
But honestly, I do believe that we need to identify metabolic subgroups or certain subgroups with a common root cause. And then these can be very similar across groups. civilization diseases, which means they're mostly lifestyle or environmental related.
Well, let's tease that out a little bit. Talk about our modern civilization that we all live in and that you grew up in. What do you feel specifically when you look at the way that we eat or move or actually don't move the substances that many of us have in our life on a
What are those things specifically doing, if you could identify some of them, that are contributing to this civilization disease? Because it's a major distinction.
I'm sure at some point in time early in your career, people were just telling you, or even when you were before you were at Oxford and then ended up in your current program that you were in, I'm sure people told you that, hey, migraines are just genetic. That's just what it is. Your grandmother had them, you had them. But you learn that that's not actually the case.
While there can be a genetic component that could be there, it's not primarily driven by genetics. So how is our modern lifestyle driving this so that 1 billion people are going through it? Walk us through some of those things. What are those things in our lifestyle doing that is causing this situation?
Absolutely. Yeah, you need to hit the nail on the head. And luckily, I studied psychology before, so I knew of twin studies that if you take identical twins, right, and you put them in different environments, and this could just be different families that feed them different things or that give them more or less love or whatever, they have a completely different outcome.
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Chapter 8: How can a personalized diet help manage migraines?
Now, they reduce hyperexcitability in the brain. Hyperexcitability plays a role in epilepsy, migraine, and some other conditions. So they have a lot of benefits to them when elevated. But when I say them, really the most potent or the molecule, the ketone body that has been studied the most is called beta-hydroxybutyrate. There's three forms of ketone bodies.
One is acetoacetate, and the last one is acetone. Acetone is that fruity smell. You might have smelled that before. Acetone is very volatile. It's gone fairly quickly. But beta-hydroxybutyrate is more like the storage and transport form, and that's really the most abundant ketone body anyway. Now, when it comes to exogenous ketone bodies, they're not all created equal.
I just want to give some information so people can make their own choices. And I try to be as unbiased as I can. Obviously, I do have my own startup. But there is first, there is when you have a molecule that has different functional groups, like my two hands, right? They have the same fingers, but different ones.
And no matter what I do, even though they have the same formula, I can never align them in space 100% because they have a different alignment in space, even though it's the same ingredients. You might remember this from chemical class way back. That's called enantiomerism, which means that molecules that have different ingredients have different orientations in space.
Now, when you chemically synthesize a molecule, you often get 50% of these two versions, but the body can only really well use one a lot of the times. Now, with ketone bodies, there's L and D. There may be benefits to both, but when it comes to primarily energy metabolism, the body prefers the D version, this version in space, let's say.
So when it comes to exogenous ketone bodies, and it's just the beta-hydroxybutyrate, I'm going to say BHP for short, bound to a mineral. That's how they're usually sold. So you have the minerals and that molecule attached. That's very natural. You have the choice between the mix, which is cheaper, and the pure D form that is primarily used for energy. So that's one thing.
That's one differentiation. Now, these are called beta hydroxybutyrate mineral salts, BHB salts. They're basically using the human identical, this BHB molecule, and they're binded to a mineral. So then you have this in sodium and potassium and magnesium form and calcium form. There's another way to make that molecule stable that has been used a lot that is called ketone ester.
You might have heard of that. Now, not all ketone esters are created equal, but a lot of ketone esters as a backbone that binds the BHP are using something called butanediol. Butanediol can also be bought on its own. Now, butanediol in a patient population can be very problematic. because it is an alcohol.
So a lot of these ketone esters have 50% butanediol, 50% alcohol, plus 50% of the BHB that we actually want. Now via synthesis and in the liver, it can be converted to this BHB molecule, but it's eating up a lot of good stuff. Some might know this NAD+, for example, a molecule that's reduced with aging. on the way, and it puts stress on the liver.
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