Caution: citrate supplements & migraines

My cautionary tale began years after my surgery, when I began suffering from migraines for the first time in my life.  These became increasingly frequent until I was getting them at least several times a week.  It took over my life, as you can imagine.  I'm sure I could have spent thousands of dollars on the medical merry-go-round with a neurologist and batteries of tests, but I decided to first see if there was a food or medicine culprit at play.  Cutting out the most well known suspects failed to help.  But to make a very long story short, there was a culprit, and it turned out to be (of all things) citric acid.  Once I cut out all citric acid, my migraines went away (100%).  From looking online, it seems I'm not the only one who has this reaction, though its not really well known.  Also, because it took years for me to develop this sensitivity, citric acid can obviously kindle migraines in some people over time.

Unfortunately, citric acid is ubiquitous in foods and supplements these day.  It was in my sugar-free drink that I consumed in large quantities and also in many of my vitamin supplements.  You might not think there could be much citric acid in supplements, but any mineral citrate (e.g., calcium citrate, magnesium citrate, zinc citrate, etc) is mostly citric acid.  For example, magnesium citrate is 85% citric acid and only 15% magnesium.  So if you are getting 500 mg of magnesium from magnesium citrate, then you are also getting over 2800 mg of pure citric acid.

Yes, we all know citrate mineral supplements are absorbed quite well, particularly for RNY patients because of the reduction in our available digestive acid.  So I'm not trying to talk anyone out of their favorite supplements.  But if you are a migraine sufferer and at wits' end as to the cause, you may want to try cutting citric acid out entirely for a couple weeks to see if it is triggering you attacks.  

The scariest part in hindsight is that I could have easily lived the rest of my life and never figured out the cause (probably ending up on chronic migraine meds to boot).

Anyway, hopefully the lesson I learned will help someone on this forum one day...

Thank you for sharing. Your story very well may save some a lot of pain and frustration.  I'm glad you found an answer and have stopped the migraines. 

How are you talking your supplements now? 

Very interesting!  Thank you for sharing your experience.

Thank you very much!  My migraines, (which used to be extremely rare) have increased since my RNY surgery.  I, too, am curious about how you take your supplements now.  Thanks!

~ Karen  :)

In response to questions as to what supplements I take, well that has been a little bit of a challenge to find ones without citrate.  I used to take the Celebrate bariatric line of supplements that had most minerals complexed as citrates.  Now I just take a Puritan's Pride ONE iron-free multi, plus calcium lactate powder and magnesium lactate powder (all of which you can buy online).

The Puritan's Pride multi has, in addition to everything else, 2000 IU of vitamin D3, 250mcg B12, 10mg B1, 10mg B6, 2mg copper, and 15mg zinc in absorbable forms in each pill -- so it hits most of the gastric bypass items with acceptable amounts if you add magnesium & calcium supplements.  Make sure to never take a multi that uses cupric oxide for its copper, as this has literally 0% absorption.  I rarely need iron, and everyone should take as little iron as they can get by with.  If your blood tests shows you need iron, as many find, I can tell you that Thorne's iron picolinate 25 mg is an insanely well absorbed form of iron.

As an aside, so many people on this forum are under the false impression that their bodies can barely absorb anything after RNY surgery, and that they have to mega-dose on every single nutrient just to stay alive.  There are definitely some specific nutrients you can get in trouble with over time, and you absolutely should get your blood checked, but there is an excessive drama-queen (both men & women) perspective on this forum that is not based in reality or research.  I think this false perspective adds to the anxiety people have about the surgery, which is unfortunate.  As just one example, it is an absolute myth that you malabsorb fat, protein, or carbs after RNY surgery (unless you have had the increasingly rare distal instead of proximal RNY surgery).  Malabsorption is actually not the mechanism by which weight loss occurs with this surgery.  It's actually sad just how many myths abound and survive, but you'd have to live on this forum 24/7 to combat them.