• Gavin Guard, Medical Director

How to heal from a brain injury: Part 1

Updated: a day ago


Key Takeaways

  • Brain injury predisposes you to developing other neurologic conditions such as Alzheimer’s, other forms of dementia, and Parkinson’s

  • Treating concussions and other neurological conditions requires a comprehensive approach of addressing inflammation, oxidative stress, over excitability in the brain, gut dysfunction, neuron health, and immune system control

  • These factors can be appropriately addressed with a plan that includes detailed nutrition, exercise rehab program, stress chemistry management, targeted supplements and pharmaceuticals, and functional medicine

Intro

An astonishing 1.7 million people sustain a concussion every year. Of these 1.7 million, 500,000 end up in the emergency department, 250,000 are hospitalized, and 50,000 end up dying. Furthermore 5.3 million Americans are thought to be living with concussion-related disability. These numbers are an underrepresentation due to the fact that 75% of concussion are classified as “mild” where the individual just brushes it off as just another bump on the head. This means that many people are suffering from the long-term consequences of a brain injury and don’t even know it.

Worldwide, 6 million people die from stroke each year. Unfortunately, this is become an all too common incident as rates of obesity, diabetes, and cardiovascular disease skyrocket out of control.

We will be discussing concussions and strokes (as well as other forms of brain injury) in the same article given the similarities to these diseases. Nevertheless, it is beyond clear in the literature that concussions and strokes can lead to numerous health effects that last for years and decades down the road.

In this article, we are going to review the long-term effects of concussions and strokes (focusing more on concussions). Specifically, we will uncover the main processes that lead to brain dysfunction.

If you understand this, you and your clinician can design a comprehensive treatment plans that targets these processes and allow you to get back on your feet.

Understanding what happens after a concussion

I want you to ask yourself two questions: Have you ever had a brain injury? And do you experience any of the following?

  • Headaches

  • Poor memory

  • Harder time learning new things

  • Difficulty concentrating

  • Irritable, impulsive, anxiety, depression

  • Balance problems

If you answered “yes” to these two questions, a past concussion could be playing a causal role in your symptoms.


Many times, a minor hit in the head does not result in any immediate symptoms. Think about the time your “bell was rung” playing high school football or soccer. Perhaps your coach told you that you were “fine” and to “get back in the game”. Little did they know that concussions can result in a disease with symptoms occurring years and decades later due to improper healing.

We now have good research to show that concussions, especially repetitive concussions, can lead to problems such as PTSD (post-traumatic stress disorder), dementia, depression, psychosis, aggression, and Parkinson’s.

Perhaps one of the most frightening results of repetitive concussions is something called “Chronic Traumatic Encephalopathy” or “CTE” for short. This is a condition seen commonly in former NFL players who have sustained multiple concussions. It looks a lot like Alzheimer’s disease with a vast reduction in brain volume and accumulation of abnormal proteins.

It’s important to know that concussions (and strokes) are not just a one-time event but rather the beginning to a long and harmful disease that can last for years (and decades) after the event.

Concussions should heal on within a 4-6-week process. However, this depends a lot on the severity of the injury and what you do about it to boost healing processes in the brain. Let’s discuss what happens after a brain injury and what you can do about it.

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1) Control inflammation in the brain

After a concussion or stroke, inflammation starts to ramp up in the brain. This is actually a beneficial thing if it occurs for a short period of time. Inflammation helps to clear the “danger signals” that can build up after an injury. However, chronic inflammation that lasts after the acute phase can be very problematic. So, the key question is whether acute inflammation will stay or resolve. We want the latter.

Immune cells of the brain are called “microglia”. These cells can tell what is “good” and what is “bad”. They destroy “bad” things like infections and damaged cells and leave alone what is “good”.

After a brain injury, microglia become activated and go to work cleaning up the mess. This is fine as long as these microglia calm down. The problem arises when these microglia become activated for a long period of time. This depends on what happens after the brain injury.

In concussions, microglia become activated for 4 weeks after the first concussion. If the person sustains another brain injury while healing from the first concussion, the microglia then become activated for another 16 weeks. If you sustain another concussion during this time frame, they become activated forever. This is why NFL players have a lot of problems in their brain in their later years.


So, after the acute phase, we want to shut down these microglia and turn them into their “healing” form called the “M2 type”. Fortunately, we have many tactics and nutritional compounds that can do this for us. Periodic fasting with a nutrition plan that is void of common food triggers can be beneficial. We can also treat gut dysfunction that can be a source of inflammation that can get into the brain as well.

There are also medications that can reduce inflammation. Some research points to the notion that aspirin may be better than other NSAIDs like Advil and Ibuprofen for inflammation in the brain. This is because the enzymes that Advil and Ibuprofen inhibit is important in memory, neuron activity, and actually, the resolution of inflammation in the brain. Low-dose aspirin taken with glycine and sodium bicarbonate (baking soda) might help it work even better, but we don’t have any direct studies looking at this.

2) Prevent autoimmunity of the brain

Autoimmunity of the brain cells is a common thing that happens after brain injury. This may be beneficial at first but can cause problems if not resolved. In fact, 30% of those with a severe concussion have been found to have antibodies against their brain tissue. It was higher in those with a genetic predisposition called ApoE4. This is a gene that is easily measured in a blood test.

We can measure brain antibodies with a blood test and use these markers to track progress in the healing process.

One author stated, “improving blood brain barrier function without identification of the root causes of neurological damage is unlikely to provide significant long-term disease improvements” (Wood et al). So, we have to fix the underlying cause of brain damage in the first place.


Learn how probiotics can help autoimmunity

This means healing the gut, getting good sleep, getting on a strategic nutrition plan, and calming down inflammation. Just like controlling inflammation, periodic fasting can be beneficial to help clear the “danger signals” stimulating the brain immune system. Proper sleep quality and amount is also important for clearing abnormal protein that is associated with Alzheimer’s disease.

3) Reduce overexcitation in the brain

After brain injury, there is a process called “excitotoxicity” where the brain system gets overwhelmed and overstimulated. This can eventually lead to a dramatic crash of the energy-producing system of the brain.

We can use magnesium threonate to put a plug on this overexcitation. Optimizing specific nutrients like vitamin B12 can put a cap on this overexcitation process. We also want to avoid exposure of things that can exacerbate this process. This means avoiding things in our diet like MSG, aspartate and other artificial sweeteners, and supplemental forms of calcium.

4) Oxygenate the brain

Our brain takes up 20% of the oxygen in our body. This means it’s a very “demanding” organ that requires a steady supply of oxygen to produce energy. Unfortunately, blood flow can reduce up to 20% following brain injury. This can lead to a deficiency of oxygen needed to keep up with the energy-demanding process of healing the damaged brain. This can lead to even more inflammation in the brain and the inability of immune cells to fight off infections.

In order to fix this, we need to fix anemia by addressing iron levels, B12 levels, folate levels and addressing any medications that can be decreasing absorption of these nutrients needed for oxygen deliverability.

There are also gut issues like small intestinal bacterial overgrowth (SIBO) and pernicious anemia (autoimmunity against the stomach lining) that can impair nutrients of these key nutrients required by our red blood cells. We can also use compounds to directly increase oxygen in the brain.

5) Promote cell energy levels (mitochondria)

Neurons are the main active cells of the brain and make up 10% of the entire brain tissue. Neurons need 3 things: oxygen, sugar, and stimulation. Part of our cells called “mitochondria” are responsible for taking all 3 of these inputs and making energy required for the neurons to do what they do.

After brain injury, we can see some issues with these energy-producing mitochondria. Brain injury leads to higher energy demands but decreased mitochondria function. This creates a mismatch between the two and can lead to symptoms such as poor brain endurance, the inability to stay focused for a long period of time, and difficulty concentrating.

Some research shows some antibodies against our own brain mitochondria which leads to even more energy failure. Furthermore, decreased neuron activity allows the microglia to “eat” them. This is due to poor mitochondrial function. This can be exacerbated by thyroid issues, low CoQ10 levels (can be due to statin use), physical inactivity, and inflammation.

There is a lot of research showing how to improve mitochondria function. This includes but is not limited to targeted exercise protocols, antioxidants in our food and in supplemental forms, medications such as aspirin, and low carb or ketogenic dietary plans. Interestingly, it looks like males may benefit more from antioxidants than females.

The bottom line

This is the end to part 1. In part 2, we continue what happens after brain injury and what you can do about it.

As you can probably imagine, there is no one drug or “miracle cure” that’s going to fix all of this. In fact, 96% of brain drugs and therapies undergoing FDA trials fail in latter stages of trials. We will probably never have the one answer to such a complex disease.

This is where functional medicine shines. By using the knowledge of physiology of brain function and how it gets altered after brain injury, we can design multi-modal diet, lifestyle, supplemental, and pharmaceutical interventions designed to address each of these issues.

Unfortunately, we will probably never have quality studies validating this approach given the differences of how people respond to brain injury due to sex, age, timing, and other differences of one injury from another. This is why I practice “evidence-based” but not “evidence-limited” medicine. I’m not going to wait until we have a 20-year trial of a specific drug to treat these specific processes that occur with brain injury. That would not be doing my patients any service.

One author states, “Many of these interventions, including sleep, diet, and exercise, have significant epidemiological, and increasing clinical evidence to support their use in the long-term treatment of neurological diseases” (Wood et al.). This points to the notion that functional medicine is best in scenarios such as brain injury and the long-term complications that come from it.

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I hope you found this information useful and helpful in your journey back to a healthier and happier life.

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Resources Cited


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Gavin Guard, MPAS, PA-C, CISSN

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