Limits: The official guidance is that we should eat no more than 6g of salt a day
Tracey Cawdrey monitors the salt content of every meal she eats — though not for the reason you might expect.
For the 44-year-old product manager isn’t worried she’s eating too much salt. She’s worried she’s eating too little.
The conventional advice — backed by everyone from the NHS to the British Heart Foundation and the Scientific Advisory Committee on Nutrition — is to reduce salt intake where possible, owing to its links with high blood pressure, heart disease and stroke.
The official guidance is that we should eat no more than 6g of salt a day, which is around a teaspoonful. But Tracey, from Stretford, near Manchester, is one of a growing number of people following a controversial plan devised by a U.S. neuroscientist which involves eating twice that amount — with occasional extra scoops of ‘emergency salt’ — in a bid to keep migraines at bay.
‘Before I switched to eating more salt two years ago, I was suffering a migraine most days, one episode rolling into the next,’ says Tracey.
‘I was turning up to work looking half dead. My skin was grey and there were bags under my eyes. My daughter was three at the time and getting used to the idea that her mummy always had a headache.’
Over the years, Tracey tried numerous treatments prescribed by her doctor, as well as cutting out potential triggers such as chocolate, caffeine and cheese — ‘all without success,’ she says. ‘But if I stick to the salt rules, I don’t ever get a full-blown migraine.’
The ‘rules’ were developed by Dr Angela Stanton, a 65-year-old neuroscientist from Southern California, who had herself suffered from migraines from the age of ten.
Her theory, built on six years of personal research, is that the 15 per cent or so of the population who get migraines need extra salt because they have highly sensitive, ‘super alert’ brains.
‘Super-alert people have more brain cell connections than most of the population,’ says Dr Stanton. ‘So they need a bigger supply of electrolytes — the minerals in the body that carry electrical charges which keep us alive.
Life-changing: Tracey Cawdrey monitors the salt content of every meal she eats
‘And 90 per cent of these minerals are sodium or chloride — in other words, salt, which is a compound of both elements.’
Her solution — or protocol, as she calls it — is for migraine sufferers to drastically increase their salt intake. What’s involved is more demanding than simply tucking into an extra packet of ready salted crisps: it requires a careful balance of salt, particularly the sodium in it, and another key electrolyte, potassium.
This mineral is best consumed through potassium-rich fresh meat, vegetables, fruit and dairy products, says Dr Stanton.
In fact, we all need the correct balance of electrolytes to maintain a whole range of automatic processes, including the working of the brain, nerves and muscles as well the creation of new tissue.
Once there is an imbalance — caused, for instance, by excessive exercise or diarrhoea — it can cause nausea and lethargy. Balance can be restored with salt tablets or an electrolyte drink.
Prolonged imbalance causes more serious symptoms such as muscle weakness, seizures and irregular heartbeat.
But according to Dr Stanton’s theory, anyone susceptible to migraine is extra-sensitive to insufficient levels of sodium as well as chloride, with the correct balance for people with migraine needing to be identified individually and then maintained rigidly.
An average ratio for a migraine sufferer, she says, is two parts potassium to one-and-a-half parts salt consumed at each meal, although for some it’s equal amounts of both, while others need twice the amount of sodium to potassium.
‘I believe that if I keep my electrolytes balanced, I keep my migraines under control,’ she says
Sticking to the ratio involves monitoring levels of potassium in each meal and adding extra salt in order to ensure you get your correct balance of sodium to potassium. (Dr Stanton has devised an online calculator to help people work out how much they need.)
‘I always start with the potassium and then make sure I’ve taken enough salt to balance the electrolytes,’ explains Tracey.
‘For instance, in the pork I’m eating there might be 500mg of potassium, and in the vegetables, another 500mg, and a little bit more in the cream in the sauce. I can then see that I still need an extra 600mg of sodium to ensure that meal is balanced.
‘So once I’ve finished my meal, I make sure I take enough salt — about a quarter of a teaspoon — in order to stay migraine free.’
Convenience foods and refined carbohydrates are avoided on the basis that the glucose (sugar) they provide can affect the electrolyte balance, according to Dr Stanton. She herself usually consumes around 12g of salt a day (including the salt in her food).
Dr Stanton recommends that every sufferer should start the day with one-eighth of a teaspoon of salt or a salt pill. ‘The migraine brain is very active while sleeping,’ she offers, by way of explanation.
Migraine specialists, however, are entirely unconvinced.
‘Certainly, the Migraine Trust would not support any advice for patients to self-medicate with extra salt,’ says Dr Brendan Davies, a consultant neurologist at University Hospitals of North Midlands NHS Trust and a medical trustee of the Migraine Trust. ‘Nor is there any evidence that people with migraine share certain characteristics such as being “super-alert”.
‘However, there is substantial evidence to suggest consuming more salt causes high blood pressure, and increasing intake will cause harm in some cases at least.’
Dr Stanton admits that the protocol remains unproven, at least in terms of the gold standard of randomised trials, although she claims to have helped more than 4,000 people worldwide.
There have been some intriguing scientific findings, such as a study in 2016 where scientists at the Huntington Medical Research Institutes in California tracked the salt intake of 8,819 people over five years. Writing in the journal, Headache, they said those with the highest levels of dietary salt intake had the fewest migraines.
The researchers admit the result was a surprise. ‘High sodium levels generally make neurons — brain cells — more excitable, so the idea that they in some way inhibit or prevent migraine activity is puzzling,’ Dr Michael Harrington, a molecular neurologist who led the research, told Good Health.
Yet despite his findings, Dr Harrington does not recommend increasing salt intake to prevent migraines because of the risks linked to high salt consumption.
Tracey says she herself was initially sceptical, too. She’d been on a variety of mainstream migraine medication for eight years and found none helped long-term. ‘Some tablets worked but only for a while,’ says Tracey.
Over Christmas 2015, Tracey came across Dr Stanton’s salt protocol online. She first tried it out with a scoop of table salt washed down with a gulp of water. At the time she was in the middle of a migraine and, she recalls, immediately felt better.
‘I was still very sceptical, though,’ she says. ‘Lots of things had worked for me for a while and then had stopped.’
But she bought Dr Stanton’s book, Fighting The Migraine Epidemic: A Complete Guide and joined her Facebook page, and then started changing her diet.
‘It’s really hard at first,’ she says. ‘I love food. I love eating out. And you have to be really motivated, especially at the beginning, as it’s quite confusing at first.
‘My diet today is lots of dairy, fresh meat, fresh fish and low carb fruit such as strawberries and blackberries and salad.’
The result, she says, is that she has her life back again. ‘As well as working full-time and looking after my daughter, I exercise three or four days a week and I’m learning Spanish, all way beyond what I could have done before.
‘I believe that if I keep my electrolytes balanced, I can keep my migraines under control.’
However, Peter Goadsby, a professor of neurology at King’s College London, reiterates there is no evidence for the ‘salt protocol’ and so it can’t be recommended.
But he is sympathetic as to why people with migraine may be tempted to try such extreme and untested treatments as the condition has been poorly served by mainstream medicine.
‘However, there is now a preventive drug specifically developed for migraine called Aimovig.’ This has just been approved by the European Medicines Agency and ‘should soon be on prescription from GPs’.
The Migraine Trust advises consulting a GP first if you are considering consuming more salt.