This is what Buchholz says in his “Heal Your Headache” book, too. He says that the triggers are additive. A small amount of one may not bother you, but add up small amounts of a bunch of triggers and the sum total may be enough to exceed your personal “threshold.”
Maybe I can tolerate a small amount of MSG, for example. Or maybe I can tolerate a small amount of cheese. Or red wine. But ingest all three of them on the same day and that might exceed my “threshold.”
In my mind, that’s what makes it so difficult to figure out. I’ve struggled with the concept of how to figure out whether I have triggers, and the following paragraphs are why I’m struggling.
And if you go on an elimination diet, isn’t there a chance that you might never figure out that it’s the combination of several triggers? For example, let’s pretend that I go on the elimination diet and eliminate all of the potential triggers. Then let’s pretend that I add the first one, MSG, back into my diet. I add in a small amount and I do OK. I do that for a week, and I do OK. So I assume that MSG is not a trigger for me and I continue to eat it.
Then let’s assume that I add cheese back into my diet. Remember, I’m still consuming the MSG because I assumed that it wasn’t a trigger. Maybe the cheese+MSG combination is still below my threshold, so it doesn’t cause a problem. So I assume that cheese is not a trigger for me, just like I assumed the MSG wasn’t a trigger.
Now let’s assume that I add red wine back into my diet. I’m still consuming MSG and cheese because I’ve assumed that they aren’t triggers for me. But maybe the combination of MSG+cheese+red wine is enough to exceed my threshold, and I begin to have MAV symptoms. I’m going to assume that it’s the red wine that is the trigger, because I had the symptoms when I added the red wine back in.
But maybe all three are really triggers for me, but I just hadn’t consumed enough MSG or cheese (or the combination of the two) to exceed my threshold. So most likely I wouldn’t know that MSG and cheese really are triggers for me, too, because I didn’t have a problem until I drank red wine and therefore I assumed that red wine was the trigger.
Am I over-thinking this?