Weight Gain in Migraine Patients

Jul 20, 2023
Introduction to Weight Loss

Weight Loss Tips 


The author assumes that if you are reading this, you are either struggling to lose weight, have tried and failed in the past, and/or you are looking for a more aggressive approach to weight loss.  Many people have no issues with losing weight: They add on some morning jogging for 20 minutes, 3 times a week, and the weight just falls off. 

These folks likely don’t need any advice on weight loss.  The following is not for those who lose weight easily, but rather for the ‘metabolically stubborn.’  Folks, who have tried and failed, and tried and tried again, only to fail again. 

This discussion is not exhaustive, but touches on key points regarding weight loss physiology. 

The advice we often hear, “eat less, move more” works well on paper. However, when placed into practice in real life, it simply does not last for more than a few days or few weeks before failure sets in. 

We will discuss several ways to lose weight, but first it is important to understand how you got where you are. 


  1. How did I become overweight? 

We are the descendants of people who did not have food in plentiful quantity much of the time. In fact, there were many stressors on our ancestors, including famines, ice ages, etc. In this environment, nonetheless our species survived, but those individuals who were able to pack on extra fuel in the form of fat, were able to make it through those lean times, whereas those of us who were more scrawny, did not. 

We obviously get our DNA from the survivors:  From those ancestors that made it through those challenging times. This means then, that we have genes that enable us to efficiently extract calories from any food source that we find.  

Although this may have been a good feature when we were having to hunt our food by running through the forest and chasing it down, or gathering berries from the wild, this does not serve us well today. 

We now live in an environment that is promoting easy access to food all the time, and it is quite easy to eat an excess of calories, with little effort. 

All that said, the reason you are overweight is that you have simply consumed too many calories for your necessary requirements. 

Your body requires a certain number of calories per day, and there is a specific way to determine this (see below). If you routinely intake more calories than you need, your body will store it in the form of fat. 

If you take in less calories than you need, then you will tend to lose weight by burning fat. 

It is that simple. And yet, it is not that simple.   


How many calories do I need per day? 


Go to www.shapesense.com or other comparable sites, to determine your Daily Caloric Expenditure (the amount of calories you need daily to ‘run’ your body, for one day). 

Let’s use the example of a 180 lb female who wants to lose about 50 or 60 lbs.  She’s 60 years old and isn’t physically active. Input this data into the Shapesense calculator, and it will produce a number:  1808 calories per day. 

This means that just living life, going through one’s daily routine, this person will burn 1800 calories per day.  To maintain her weight, she will need to consume 1800 calories per day.  More than this, and she’ll gain fat.  Less than that, and she’ll lose fat. 


 Set Point 


There is a concept that is talked about, and should be considered, specifically, one’s Set Point.  Although not clearly elucidated, it appears that the human body seeks to return to a previous point in terms of bodyweight.  For example, let's say you have been stuck at 180lbs and you are trying to lose weight.  You muster your will power, buckle down, and lose 15 lbs over, say 6 weeks.  But then, it seems as if your body is fighting you more and more, and your efforts become less effective.  In time, you creep back up to 180 lbs and you are back where you started. 

In this case, your body has ‘decided’ that its set point is 180, and it will stay there.  Even gaining 10 lbs, getting up to 190, you will find it is rather easy to drop back to 180, because that is where your body thinks it should be. 

Our strategy is to break through this Set Point and re-establish a new Set Point that is lower.  To do this, you must reach your goal weight, and stay there long enough to convince your brain that the new lower weight is in fact where you should be. 

How long does this take?  It is unclear, and it is probably different for everyone.  I have heard estimates of around 3 months or so, but it is an academic question. 

Regardless of whether Set Point theory is a thing or not, we do know that it gets more difficult to lose weight as time goes by, and as the pounds drop. 

You must use all the tools at your disposal to be successful. And, when you DO achieve your goal, you must be vigilant to maintain this weight, and have a plan in place for when your weight might tend to stray upward. 

Even if there is no such thing as an actual Set Point, it is still useful to think in terms of trying to defeat a Set Point, because it helps us with our expectations.  We must be aggressive in our weight loss efforts, which means being consistent, using a plan, sticking to the plan, and not beating ourselves up when we fall off the wagon. 


 A Word on Insulin.   


Dr. Jason Fung describes obesity as a hormone driven disease, and I think he is correct on this.  For far too long, we have ignored the function of hormones such as insulin, glucagon, ghrelin, etc. and their role in causing weight fluctuations. 

Without being too exhaustive, when insulin is secreted into our digestive tract, triggered by eating, its function is to signal our tissues that we have calories coming in, and that we should preserve any stored fuel.  In short, when we eat, insulin gets released.  When insulin is low, as in the fasted state (e.g. on awakening), then you DO have access to stored fat.  Elevated insulin levels have a function of preventing us burning fat from stored adipocytes (fat cells), so we need to be aware that when insulin is high, fat will not be burned.  But, if insulin is low, then we can burn fat more easily. 

Insulin release varies by the type of food we eat:  Carbs elicit a large insulin response, that is, they cause insulin to be released into the bloodstream.  Eating Protein produces a small insulin response, and fat (by itself) elicits no insulin to be released. 

Carbohydrates, especially simple carbs like sugars, tend to spike our insulin levels very effectively.  Not all carbs have the same ‘spiking power.’  E.g., wheat is remarkably like table sugar in its ability to elicit insulin response, whereas other grains are less so. 

Protein is less likely to stimulate insulin release, but it can depend on the type of protein.  (E.g., Casein may be less insulinogenic than whey protein.)  Also, the amount of protein ingested seems to affect the amplitude of the insulin release.  A rule of thumb is to keep lean protein intake equal to or under 4 ounces to avoid significant insulin rise. 

Fat does not cause any measurable insulin release.  BY ITSELF. However, when it is mixed with other foods, and you get an insulin spike from the other constituent elements, then beware. 

E.g., eating bacon on it’s own results in low/no insulin response.  But putting it into a BLT sandwich on wheat bread, defeats the purpose of avoiding insulin release. 



In Defense Of Artificial Sweeteners 




Weight loss methods. 


There have been numerous ways to lose weight, and none are perfect.  Also, NONE ARE EASY.  If someone tells you of an easy way to lose weight, then he/she is likely mistaken, or selling something.  Be careful and be skeptical of all rapid weight loss claims. 

Even getting the Gastric Sleeve procedure takes work on the part of the patient.  You must first prove to the surgeon that you have the staying power to decrease your caloric intake. 

I typically advise my patients to avoid surgery, if possible.  But, if all else fails, then I would recommend considering it.  If you can get your weight down, and improve your health, then it doesn’t really matter the path you took, as long as you got there. 

The weight loss methods further described are nonsurgical approaches.  You have heard of most of not all of these. 

You may only need to focus on one.  Or you may need to combine two or more of them.  None are perfect, but you may be able to find a combination that works better. 

Also, for consideration, not to be discounted is exercise.  Increasing metabolic rate will often tip the balance of the caloric scale more in favor of weight loss. Not to mention the numerous other benefits of exercise, including increased longevity, lifespan, and healthspan. 


Weight loss diets.   


There are lots of these, but we’ll focus on 3 commonly used diet plans. 


These include 1) low calorie, AKA “eat less move more,” 2) low carbohydrate/ketogenic, 3) intermittent fasting/limited eating window. 

We will look briefly at these and try to offer some comments/tips for success. 


Low Calorie Diet.  “Eat less, move more.”  AKA, low fat dieting. 


Its sounds so easy.  Figure out how many calories it takes to run your body for one day, and then aim for a lower number. 

Works on paper.   Harder to put into practice.  Yes, you can go with just 500 calories per day for 1 week.  Yes, you will lose a fair amount of weight, but you will also tend to be hungry.  You will need enormous amounts of will power to achieve this for a sustained length of time.  Oftentimes, people who do this, will gain the weight right back in short order. 

These diets were heavily promoted in a time when it was thought that carbohydrates were ‘good’ and fat was considered ‘bad.’  This is of course, nonsense.   But, at the time because it was realized that a gram of fat holds 9 calories of energy, versus 4 calories per gram for both protein and carbohydrates, then it seemed to make sense to slash the amount of fat in the food we ate.  And thus began the whole ‘Low Fat’ trend of the 70s 80s and 90s.  Even though this advice has failed repeatedly, the Low Fat thinking is still deeply ingrained in our thinking. 

Pros:  Low calorie diets are effective at losing fat WHEN THEY ARE ACTUALLY FOLLOWED. 

Cons:  Difficult to stay on this diet long term because of hunger, depressed mood.   Results are usually impressive at first, but short lived, as the weight comes right back, when you inevitably go back to normal eating. 

See https://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment 





Low Carbohydrate diet, AKA Ketogenic Diet.   


This gained popularity in the early 1990s even though the diet has been around for far longer.  It focusses not so much on calorie restriction, as it does on avoiding carbohydrates.  Fat/protein ingestion tends to cause far less of an insulin surge as detailed above. 

The allowance and encouragement of high fat in the diet also promotes release of cholecystokinin, a hormone which signals the satiety center in our brains.  This tells us we are full, reducing appetite.  You are NOT going to get that from eating rice cakes! 

However, this diet method gave many people (including the author!) the false impression that one could eat all the fat and protein he/she wanted and would not gain weight.  Do not fall into this trap.  Everything in moderation.  You still need to watch overall calories in, calories out. 

A lot of low-carb foods are available now, compared with just a few years ago.  There are no less than 8 different sugar free sweeteners available, most of which are in our local grocery stores. 

Beware though, that although a brownie mix may have no sugar, and be touted ‘keto-friendly’ it still often times contains wheat, which is just as bad as sugar at spiking insulin.  Look to make sure that the wheat has been replaced with a less insulin-spiking flour such as almond or coconut flour.  Even then, you still need to take into account the number of carbs in these foods. 

Pros:  More successful usually than calorie restriction dieting, likely because there is less hunger on this diet 

Cons:  Care must still be exercised.  One cannot simply eat all things fat and protein in any quantity, and expect to lose weight.  There are other annoying features to this diet, such as trying to stay in ‘ketosis.’  Very easy to ‘fall off the wagon’ on this diet, especially when dining out, eating with friends, traveling, etc.  To do properly, one must educate onself on the various tips and tricks, as well as the traps and pitfalls.  One MUST supplement with vitamin C if doing a ketogenic diet.  You don’t want to get scurvy, after all....  Yes.  This has actually happened. 


Intermittent fasting.   


Back to insulin.  Remember, when insulin is low, we can actually burn our stored fat, but not when insulin is high.  We use this to our advantage.  We shrink our ‘eating window.’  We pick a specific time interval during the day in which we will consume calories.  Outside this time interval, we stick to calorie free beverages.  Initially, the window is perhaps 8 hours (from say, noon to 8pm), and we have nothing to eat until noon.  Then we stop eating at 8pm sharp. 

Over time we shrink this window, all the way down to 1 – 2 hours, essentially having 1 meal per day. 

At this point we are spiking our insulin once per day, it is then normalizing, coming back down to a baseline low level at which point we are able to burn stored fat. 


Contrast this to some high frequency meal diet plans from the 1980s in which the dieter was instructed to eat 8 small meals per day, usually consisting of high carbohydrate containing foods.  This was disastrous, for many, because the individual’s insulin was constantly elevated, never giving the body a chance to burn fat. 


Pros:  In some ways, easy to plan and implement, because it is literally something you’re NOT doing:  eating a meal. 


Cons:  Not eating takes some getting used to.  Dealing with hunger pain can be difficult, if not impossible for some individuals. 



Putting it together. 


I personally find that combining elements of all three of these diets to be the most aggressive, if not the most successful approach. 

But even if you are intermittent fasting, eating one low carb meal per day, watching the calories.... Even this approach is often unsustainable, due to food cravings, hunger pain, etc. 



The Edge 


I know that we tend to think of Will Power as a quality that everyone possesses (some more than others).  However, I also view Will Power as a quantity.  It’s like fuel in a tank, and you will eventually, sooner or later, run out. 


What if we could do the above, and get rid of, or at least minimize the pain of hunger altogether?  We would still have to deal with the psychological issues of mental cravings for food, but these would not have the associated physical sensations of hunger pangs, that is, the stomach grumbling at us, reminding us that we need to eat. 

There is a new class of medications that do this.  They are the GLP-1 type meds. Glucagon-Like-Peptide type 1 medications are smallish protein like molecules that mimic the activity of a hormone in the body to trick our brain into thinking we are full and don’t need to eat. 


The most commonly used medication at the moment for weight loss is semaglutide.  It has different brand names, but is commonly administered as a weekly subcutaneous shot. 

This class of medications has helped many people lose weight, “without even trying” when they were on the medication for different reasons, usually type 2 diabetes. 

For many struggling to lose weight, this type of medication may be just what they need to get to their goals. 

Of course, no medication is magical.  But when combined with diet and exercise, the results can be impressive. 




Every little bit helps.  Even just 10 minutes of walking will help in your weight loss efforts. 

There are many benefits to exercise, not just increased metabolic rate. 

Cardiovascular. HIIT (High Intensity Interval Training), Yoga, Lifting.  There are a lot of activities and skill levels to choose from.   

I find that HIIT is a good option for the busy individual because the time commitment is less. 

Also, lifting weights (carefully, under supervision/expert advice) is advantageous, in that this promotes muscle growth, and muscle is more metabolically active than other tissues, meaning that you will burn more calories at baseline.  Even just ‘laying around’ the individual with more muscle mass will burn more calories than he/she would otherwise. 

Moreover, people who exercise tend to live longer.