How to heal from a brain injury: Part 2
Updated: Dec 13, 2020
Concussions lead to a whole host of problems that can last for years or even decades later
Concussions predispose 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 stem cell 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 (this is the same intro as part 1)
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 continue 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?
Harder time learning new things
Irritable, impulsive, anxiety, depression
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.
6) Control blood sugar
Our brain is a relatively small organ, composing only 2% of our total body weight. However, it consumes over 20% of total blood sugar utilization. This means it’s a very demanding organ.
A brain injury has the capability to damage part of the brain responsible for controlling our daily rhythm; telling us when it’s daytime and when it’s nighttime. This can lead to alterations in blood sugar control and stress hormone (cortisol) regulation. Consequences of this process can contribute to diabetes, weight gain, fluid retention, and cardiovascular disease.
In addition, a brain injury ultimately leads to an instant increase in energy demand. However, our brain cells are less capable of processing energy. This leads to an “energy mismatch”. This energy mismatch results in poor neuron firing, and can eventually lead to neuron death. Thus, it’s important to either give the brain an alternative energy source or fix the blood sugar regulation impairments that can result from the injury.
Blood sugar and brain health have a two-way relationship. This means a brain injury can lead to blood sugar regulation issues and this can result in further brain injury. It turns into a downward spiral. In fact, this relationship between blood sugar and brain health is so foundational that the association is clearly linked with Alzheimer’s disease. Researchers are now referring Alzheimer’s disease as “Type 3 Diabetes” due to the fact that Alzheimer’s disease is in large part due to metabolic issues.
It’s crucial to get a handle of blood sugar control in order to break this cycle and prevent further metabolic brain injury. Blood sugar impairments are also linked with inflammation, which we know from part 1, is an important part of healing the brain.
So, what are some ways we can regulate blood sugar? I could write a whole 3 part series on this alone, but I’ll do my best to break it down. First, you need to get a comprehensive evaluation on your blood sugar control.
Unfortunately, a fasting glucose and A1C that is commonly ordered at your conventional doctor’s visit is very insufficient to understand the full picture- these two tests are just the tip of the iceberg. We need to order a couple different tests that give us an idea of how hard your body is working to maintain normal blood sugar levels and if there are abnormal spikes in blood sugar that are not picked up with a fasting glucose or A1C.
After understanding where the problem of blood sugar control is, we can then use nutritional, supplemental, and pharmaceutical (if necessary) interventions to treat the root cause. For example, this may look like a higher protein, low carb diet, focused on specific types of fats and nutrients to treat the energy producing part of the cell. We can use this in conjunction with specific supplements around mealtimes to alter specific hormones necessary for proper blood sugar control. This along with other lifestyle interventions and a quality exercise program can lead to stellar results in blood sugar control and brain health as a result.
7) Promote neuron growth and health
It’s normal to lose neurons. In fact, an individual loses an average of 30% of a part of their brain called “gray matter” between the age of 7 to 60 years old. This is just a normal part of the aging process. However, very fast neuron death is problematic for obvious reasons.
We want to hold onto our neuron activity for as long as possible and promote growth and healing of the connections between our neurons and other brain cells.
As I mentioned before, death of neurons is a common result of brain injury. Certain regions of neuron death lead to specific deficits in brain function. For example, death of neurons in the hippocampus (the memory-forming region of the brain) can lead to memory loss and symptoms consistent with Alzheimer’s disease. This is due to brain injury causing a sharp decrease in neuron frequency of firing. Ultimately, this results in the brain’s immune cells to “eat” and destroy these neurons.
Fortunately, there are some tactics that we can deploy to slow down or halt this process. Progesterone is a natural sex hormone that may help in this area. The studies examining progesterone for concussions is mixed in results. However, much of the beneficial outcomes come from using progesterone either before a concussion occurs (which is not practical for most people) or after the acute phase of a brain injury (after a month or so).
Another strategy we can use is to augment/increase a chemical called brain derived neurotrophic factor (BDNF). Nutritional compounds such as flavonoids, polyphenols, rutin, luteolin, an bacopa have all been found to boost BDNF levels. These can be found in both dietary and supplementary forms. Exercise can also quadruple BDNF levels in the brain- all the more reason to work with your clinician to find an exercise program that works for you.
Taurine is a naturally-occurring amino acid that has also been found to repair neurons and promote their growth. It’s also been shown to decrease brain inflammation, heal the blood-brain barrier, and protect neurons from further damage.
Finally, specific brain exercise can be used to promote neuron connections. Often, brain injury can lead to impairments in specific regions of the brain such as memory, language, math and analytical thinking, and attention span. We can use specific brain exercises to make new connections in these parts of the brain and promote a process called “neuroplasticity” which I’m sure many of you have heard about. Long-story short, this is a theory that states that our brain is capable of changing if we give it a reason to. Brain exercises can be a tool to promote our brain to change and make new connections after an injury.
8) Address stress chemistry
There is no doubt that a brain injury is a stressful event. After an injury, your brain can get stuck in “fight or flight” mode. This is characterized by an increased heart rate, high blood pressure, increased muscle tone, and post-traumatic stress or hyper-vigilance.
One study noted that more than 20% of participants had stress hormone (cortisol) imbalance. This can lead to impaired memory, diabetes, inflammation, susceptibility to infection, and further neuron death if not addressed. Furthermore, stress can result in mood imbalances, chronic pain, and impaired cognition/ability to think.
In order to fully heal, you must find ways to address altered stress chemistry. For most, this can accomplished through a well-designed nutrition and lifestyle plan. However, sometimes it takes a functional medicine clinician to fix the root cause of stress hormone imbalance (infections, blood sugar imbalances, toxic load, nutrient imbalances, mitochondrial dysfunction).
9) Look for hormone imbalance
Hormone imbalance is a frequent result from concussions. In fact, 28% had a deficiency in hormones released form the brain such as growth hormone, thyroid hormone, and sex hormones such as testosterone.
There are many other reasons for hormone imbalance and these factors should be addressed before taking hormone therapy. However, with multiple concussions, the brain connections can become so damaged that hormone replacement therapy (e.g. testosterone) may be needed.
10) Find the right dose of exercise
Throughout the last two articles in this series, I’ve alluded to exercise being an important part of a comprehensive treatment plan. It is able to increase compounds (e.g. BDNF) required for neuron health, increase natural opiate levels, control blood sugar, augment growth hormone, and indirectly oxygenate your brain.
One study noted that mice that waited 5 weeks to start exercising had better long-term outcomes than mice who directly started exercising.
This aligns with common concussion protocols that has a person gradually increase their exercise levels as their symptoms tolerate. For many patients, this means finding a program that gradually increases aerobic and higher-intensity fitness as your symptoms allow for.
11) Master your nutrition
As you can imagine, nutrition is a very crucial part of healing your brain. I know you’re probably thinking “what’s the best diet to accomplish this?” I wouldn’t be doing you any service in trying to answer this because it really depends on what the limiting factor is. For example, if your blood sugar regulation is the main problem, then we need to find a meal template that works best to solve this. If the limiting factor is inflammation coming from the gut, then it’s finding a meal template that serves to optimize gut health.
There is a litany of research looking at ketogenic diets for seizures with promising results. Since, seizures and concussions share some similarities, I see the potential to use a ketogenic diet in those healing from brain injury if a patient is very motivated.
We can also utilize supplemental ketones in those wanting to get the benefits of a ketogenic diet but don’t necessarily want to be too restrictive with their diet. I have written an article directly addressing this topic that you can find by clicking here.
The bottom line
This is the end to our 2-part series on healing a brain injury.
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.
I hope you found this information useful and helpful in your journey back to a healthier and happier life.
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