The Neurochemistry Behind Post-Concussion Syndrome with Dr. Michael Lovich
Show Notes:
If you’re living with post-concussion syndrome and wondering about what’s actually going on in your brain that is making you experience the world differently than you did before your concussion, this episode is for you! Today’s guest is Dr. Michael Lovich, a concussion survivor who has dedicated his career to improving the lives of those struggling with post-concussion syndrome. Michael has tested out numerous different types of therapies, and has built up a wealth of evidence-based knowledge around the most effective treatment strategies. We discuss everything from the importance of nutrition when dealing with post-concussion syndrome to the physical and emotional manifestations in your body of overfiring neurons in your brain. As Michael notes, learning to manage the after-effects of a concussion can be a very lengthy process, but if you are equipped with the right kind of information, you can learn to live the way you want to once again!
Key Points From This Episode:
• Introducing today’s guest, Dr. Michael Lovich.
• Michael shares his concussion story, and what motivated him to pursue a career as a chiropractor and functional medicine practitioner.
• An in-depth explanation of what happens to your brain when you experience a concussion.
• Why the healing process after a brain injury is so different from the healing process after most other types of injuries.
• The two questions that your brain is there to answer.
• Our real sixth sense, and the impact it has on us when it’s not operating normally.
• What we can learn about our brains from taking the Romberg test.
• The two reasons that post-concussion symptoms can persist for a long time.
• Different types of post-concussion therapies that Michael has used with his patients, and what he discovered as a result.
• Challenges of following a low/no inflammatory diet.
• Two different methods of supplementation.
• Pain and anxiety explained on a neurochemical level.
• Why what you eat is important when you have post-concussion syndrome.
• The link between blood sugar levels and night terrors.
• Final words of wisdom from Michael.
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Transcript - Click to Read
[INTRO]
[00:00:05] BP: Hi. I’m your host, Bella Paige. Welcome to the Post Concussion Podcast; all about life after experiencing a concussion. Help us make the invisible injury become visible.
[DISCLAIMER]
The Post Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide, nor substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice, or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
[EPISODE]
[00:01:03] BP: Welcome to today’s episode of the Post Concussion Podcast, with myself, Bella Paige, and today’s guest, Dr. Michael Lovich. Michael is a board-certified chiropractor by the American Chiropractic Neurology Board and has earned credentials as a certified chiropractic sports physician practitioner. He has a diploma from the American Board of Sports Physicians and an international certificate in Sports Chiropractic. Dr. Lovich has also completed additional postdoctoral specialty training in blood chemistry, brain chemistry, neuroimmune, and neuroendocrine, functional medicine completed by additional postdoctoral specialty training in functional movement-based rehabilitation using therapeutic corrective exercises. Additionally, Dr. Lovich has served as a medical director, team doctor and our medical staff for various organizations and events and professional amateur, collegiate and high school athletic events, and high school athletics.
Welcome to the show, Dr. Lovich.
[00:02:06] ML: Thanks. Happy to be here.
[00:02:09] BP: So to start, do you want to tell everyone a bit about your background and how you got into helping concussion survivors?
[00:02:15] ML: Sure thing. This all started when I was in chiropractic school in Portland, Oregon. I was about halfway through the program when I went skiing on Mount Hood. And on a powder day, I caught an edge, flipped around, fell, broke my knee and also – I never hit my head, but I had a pretty major whiplash. Essentially, what happened was, I got a concussion. I started going to all the doctors. I went to my primary care doctor; they didn’t even refer me to a neurologist now that I think of it because I didn’t have any ablated neurological symptoms. They just were like, “Okay. Well, just take it easy and see you when you get better.” I went to the student clinic at the chiropractic school I was at and they also looked at me, like kind of shrug their shoulders like, “I don’t know. You look fine to me.”
I was sitting there like, “Well, my grades are different. My ability to remember things are different now. My whole processing is different now. The toughest part was, the ability to compare me to the average American held them back from comparing me to me, and what I used to be. I’m sure that’s a situation that many of your listeners deal with all the time is they focus on the, “Hey, you’re not dying. You’re stable. You have a stable neurological condition. You’re not bleeding, so you must be fine.”
I ended up going to a functional neurologist out there, who’s also a chiropractor by training. And he did an exam and we found things, we found things to improve. It wasn’t psychological things, because a concussion is a very physical injury. We did a VNG testing, where you measure all the conceivable eye movements out there, did bounds testing, did a neurological exam. I was looking at this, I was like – and he was explaining it as he went. I’m sitting there like, “Wait, I know all these things. We learned about them and neuroanatomy and neurophysiology. You mean that like, this is legitimate?” And he’s going through, and he’s explaining all the different things that was found, and he’s stares at me before and he’s like, “Are you sure you never had a concussion before this?” I’m sitting here thinking about it, I’m like, “No.”
But then like a couple weeks later, I was like, “You know, actually, I fell on my head when I was four years old. I have a scar over here for it. Is this real life?” Essentially, I was like, “Well, sounds like nobody knows how to do this.” So I’ll learn how to do this. That must mean there’s a number of people out there who need help, and who need care from somebody who can –who’s able to look at details and remember these things and not just kind of say, “Well, yeah, you look like a human, therefore you must be fine.” That’s how I got into this.
The first thing he said is, he’s like, “Here, I’m teaching this course called Mastering Brain Chemistry, you’d dig it.” I was like, “All right.” He said to me, “Hey, when you get there, get there early. You want to sit on this side of me, based off of what you found. If you sit on the other side of me, you’re going to burn out quick. You sit on that side of me, you’re going to last longer and remember things better.” As I learned and developed my knowledge in functional neurology, I realized, yeah, it has to do with visual pathways, and cellular activity, a lot of neurochemistry that we’re going to be talking about now. But my first entrance into the functional neurological world was a neurochemistry class, a three-day class. That kind of got me hooked.
[00:05:39] BP: I always think it’s interesting to hear people’s backgrounds. I liked that you touched on being compared to the average, because that was actually something that I had trouble with, especially when trying to get help in school, because I would do all these tests and they’d say, “Well, you’re in the normal range.” And then I get frustrated and be like, “Okay, I get I’m in the normal range, but I was a high functioning athlete at the time and was an extreme honor roll student. Like most of my grades were high 90s, hundreds on most exams, and all of a sudden, I couldn’t remember anything to write a test.”
I remember getting, “Oh! Your memory is average, everything’s average.” I was really frustrated, because I was like, “You’re not comparing me to me.” Before this, I had a crazy actual memory. I was that person that could read a book and tell you word for word from the beginning to the end. And all of a sudden, I could read a page and not tell you what was at the top of it. It was really frustrating for a while, which is why I think baseline testing is really important, especially if you know you might get a concussion by being in maybe an act of sport, that kind of puts you in a little bit more of a risk. I just want to talk about what happens to the brain when you have a concussion, because you mentioned yours, and you didn’t hit your head in your incident.
[00:07:01] ML: It’s complicated because you don’t have to hit your head. When the neurochemistry starts getting involved, you build pathways based on that. Like there’s some examples of some high-level NHL players. There’s one in particular that he would start getting another – the concussion chemistry was happening just from a player skating towards him, and it had nothing to do with someone even touching him, or getting a whiplash at that point. It just depends on how do you work with this neurochemistry piece in order to get things to calm down and start functioning again. But let’s take a classic example. If you went to the CDC website, and you looked at their Concussion Heads Up Educational Program, you’ll see the video at some point of their head getting slosh back and forth and the brain is soft. Think of it as like Jell-O, it’s about a similar consistency, and you can use – if you slosh the head this way, it’s going to like jam up and like push and compress into the wall there.
What happens is, the neurons, the cell stretches and twists. It doesn’t have to break. It just has to stretch and twist. That’s enough to create an issue. Now, sometimes it does break, sometimes some cells do get injured. Then on top of the normal inflammatory response, you have more inflammation there, which means it has to pull away the garbage, and otherwise, if that garbage sits there, it can turn into those like proteins. It’s like tau proteins that we keep hearing about. But typically, what happens during the initial injury, let’s just talk about the head sloshing back and forth. Doesn’t even have to be like an injury to it. You get unchecked ionic fluxes. What does that mean? That means that every cell has a charge, right? Proteins are negative and proteins are what cells are made of. The more protein you have in a cell, or the larger the cell is, the more of a negative charge it is. Instead of being a resting membrane, if you go online and search what a resting neuron membrane is, it’s like negative 55 millivolts. The larger the cell, the more negative it becomes, because there’s more protein, more negative ions.
What happens is, there’s a bunch of other ions that are around it. For example, that negative cell sits in a liquid solution and that liquid solution is basically made up of sodium and chloride, salt. It’s like salt water. You have the opportunity for positive ions to flow in and balance out the negative ions of the neuron, like sodium where you have negative ions that will flow in and balance out other positive ions, like potassium that may come in, so the negative ions would be like chlorine. Then there’s also calcium, which is also positive ions. You have all these different elements that you probably never wanted to hear again after a chemistry class, flowing in and out of the cell. When the addition of all these positive ions comes in enough to raise that resting membrane high enough, then it creates an action potential which allows the neuron to fire and communicate with the next neuron that it’s connected to.
What ends up happening is, all of these ionic fluctuations end up being unchecked. Positive ions are flying in faster than they should be, negative ions are flying out faster than they should be. What ends up happening is you get indiscriminate neurotransmitter release. If you’ve hung out on social media long enough, and I’m sure most of your listeners have, you’ll probably have some yoga, or wellness or health coach person posting really well manicured like pictures, like on Instagram of, “Serotonin is your happy molecule and dopamine is your reward mechanism.” They really mostly talk about those two because nobody wants to talk about glutamate or they talk about GABA, which is like, “Oh, if you have more GABA, you’re more relaxed.” That’s not how any of this works, unfortunately. That’s just marketing trying to get you to buy something.
With the way this works is, some cells and those cells are clumped together in structures will, yes, create more serotonin that connects to the next part of the brain that receives the serotonin. Where some areas will create, like the front of the brainstem, the top is going to create dopamine, which is going to go to your frontal lobes and it’s going to create activation. But it’s also going to create activation in, yes, the reward networks, but also your motivation. networks. Just your ability to move is dependent on dopamine. So if you have an absence of dopamine, you will literally sit in a chair and not move because you need dopamine for movement. During a concussion, you get this uncontrolled firing of different neurons going all over the place, so you get floods of dopamine, floods of serotonin. What does a flood of serotonin look like once it hits the frontal lobe? Too much serotonin in the frontal lobe looks like anxiety, because it is. That’s how it is. That’s how it happens. It has to do with not just too much serotonin, but it is the part of the brain that receives that serotonin able to handle that much stimulation. And if it can, it fires too high.
Think of it as setting the treadmill really, really fast, and then just try to jump on and catch up, you’re going to fall, you’re going to flop, it’s not going to be pretty. It’ll probably end up on the Internet somewhere. It’d be hilarious, but it’s stressful. And when those neurons fire too high in the frontal lobe, that’s the same process. It’s the serotonin driving anxiety.
What ends up happening is, there’s one neurotransmitter that we haven’t talked about yet called glutamate, which is a very excitatory neurotransmitter. It creates activation to all the neurons around it, because you have too much release of it. What happens is, it then pushes some of these pumps like sodium, potassium, calcium pumps and it makes changes to cellular function, which is really what we’re talking about here, the neural chemistry, the cellular function of how the brain works. Because your conscious experience of the world is a direct output of how well your brain is able to process information at the cellular level. And also at the organ level, the structural level.
To balance all this firing of all these neurons, the sodium potassium pump, which is supposed to balance things out, has to work overtime. That creates increased ATP, and if you’ve read a couple articles, you’ve probably seen ATP come across as a cellular energy molecule. An increase in ATP is going to increase the amount of glucose being produced and released by your cells, creating a hypermetabolic time period. That hypermetabolic time period creates a couple issues. The first one is, “Okay, so if I’m hypermetabolic, everything’s just working a little harder, what’s so bad about that?” But here’s the thing, when there’s a concussion, there’s decreased blood flow in the area, right? Imagine if you’re trying to drive a car and you only have a little bit of gas left, and imagine at the same time, because the same thing that brings nutrients to your brain, which is the blood flow, is the same thing that takes the garbage out.
Imagine driving a car where you plug up the tailpipe and put a tiny bit of gas in it and you just start gunning it. Things are not going to go that well. So you have less nutrients, you have more garbage in the brain, and then you create another round of the cellular energy crisis. So essentially, what’s happening in a concussion when it first happens is a big energy crisis. That’s why after you get this hypermetabolic state, you then get this depressed metabolic state, which is a couple of things. You get reduced magnesium that’s shown in the literature. That’s why people say usually, if you supplement with magnesium, sometimes patients help feel a little better. And then you’re getting excessive calcium. What does excessive calcium do? It does two things. It impairs mitochondrial activity, and everybody knows or remembers like this one line, you remember from biology class, what is it?
[00:15:44] BP: Powerhouse of the cell.
[00:15:45] ML: Yeah, you got it. Everybody’s got it.
[00:15:47] BP: Everyone remembers.
[00:15:50] ML: As complicated as science is, that’s the one thing that’s actually accurate when it’s said simply. So you impair that mitochondria, which means your cellular activity is now going to be continued to be depressed. You have layers and layers of changes into cellular activity, and it creates something that is really important in my clinics. It’s called cell death. Because when you push – and we’re not talking about like a stroke, where you have like a loss of a ton of cells right here. We’re talking about the smaller cells, the newer cells, the weaker cells, if you have an unhealthy brain to begin with, those cells are the ones that are not going to be able to keep up with weather, all the changes in this demand. If you think of – this is like a stormy sea, and you’ve got some large boats, and you’ve got some small boats, the small boats are going to get killed by these giant waves of energy, where the large boats are just going to kind of rock through it. They’re still going to have some issues, but they’re going to be able to weather the storm and get through it.
What does this look like though? When you have a lot of little changes in cells, and you have those little cells that are actually lost, the brain works differently than the rest of the body. The brain isn’t like a muscle. And the brain isn’t like a heart muscle, where if a tear happens to a muscle, it heals, and then it works the same exact way. In the brain, every little circuit has its own individual function, and a little tweak of larger functions when you put them together. What happens is, your brain ends up losing some of the function that is figured out over however many years you’ve been alive, which is a reason why when I explain things to patients to try to frame it correctly, so they understand why they’re trying to do what so they can get better, the brain does not heal. The brain compensates.
[00:17:48] BP: Yeah. I think it’s interesting when you say you have all the things that you’ve learned. It’s one of the tough things about recovery for a lot of people is that when they’ve suffered a concussion, all the things that you knew how to do before can be really tough, which is one of the hardest things about recovering, is you’re relearning things that you already knew how to do. It can be really tough. There’s a lot of things that you go through and your brain is going through a lot too.
[00:18:16] ML: A hundred percent. The toughest part is because you have a memory of what you used to be able to do and the way you used to do it, and you have a memory of how it used to be done. That cell might no longer be there. So one of the main things when I’m working with patients to try to say like, “Look, give yourself some slack. This isn’t just like, you rolled your ankle, now you have to learn how to walk again slowly. This is, hey, you may have to learn how to walk a completely different way, because your brain now has to adapt and change. It’s super important for anybody who has a brain injury, or concussion to give yourself slack. Guess you want to be better yesterday, but in the grand scheme of things, if you work every day, and you’ll keep working hard and keep knowing that it’s something that you can work through, and challenge yourself and get over. I don’t mean like get over it, but I mean like, if it’s a hump, you can get over. That is an opportunity for you to just understand and say, “Hey! I might have to do things a little bit differently. I might have to reteach myself how to lift my arm up. Because my brain just –I have the memory of it, but the things I used to use to make that happen no longer work the same way.” So remember, the brain doesn’t heal, it compensates. It’s our job together to take those compensations and make them effective and efficient, instead of being compensations that make things more difficult for your body.
[00:19:49] BP: I think it’s so important to touch on so many of those things. I like that you say energy crisis, because it’s actually what it feels like sometimes. It feels like surges of things like depression, anxiety or fatigue. Extreme fatigue is really common with a lot of survivors. You’ve touched on so many things already. Everyone, you can learn more about Dr. Lovich’s work and connect with him at deltasperformance.com. But with that, let’s take a quick break.
[BREAK]
[00:20:28] BP: If you follow us on social media, you may have seen a few posts about Concussion Connect, a place for everyone related to the concussion and brain injury community. We understand the need for a safe place to go separate from your regular social world, less overwhelming and more personal. Join Concussion Connect to have a place to share and get support along your survivor journey. Get access to our weekly support groups, and keep connected with members through a personalized and secure chat. Though a place for survivors, we also welcome all loved ones and professionals who are out to learn more about this invisible injury. Go to concussionconnect.com or find the link in our episode description today. I can’t wait to connect with you all.
[INTERVIEW CONTINUES]
[00:21:22] BP: Welcome back to the Post Concussion Podcast with myself, Bella Paige, and today’s guest, Dr. Michael Lovich. So we’re going to get more into brain chemistry, which I am sure a lot of you feel like you’re back in class for a chemistry lesson, but I think it’s really important for us to know the science behind what’s happening to a lot of us, because a lot of time we want to know why these things are happening, not just get told, “Oh yeah, these are symptoms of concussion?” Oh, yeah, it’s just normal. Well, sometimes we want a little bit more detailed than that. A lot of our listeners are prolonged concussion survivors or post-concussion syndrome survivors, where they have been dealing with this for a very long time, leading up to years and years, some even longer than myself. Can we get a little bit more and touch a little bit more on what’s happening and why some survivors are still dealing with these years after their injury?
[00:22:20] ML: I’d be happy to. It all comes down to what we were talking about right before that little break, it is because of the compensations that are made. To make things simple, your brain is really only there to answer two questions, “Where are you in relation to the world around you and where’s the world around you in relation to you?” You need to be able to map that out, and you in it in order to do what humans have evolved to do, which is feed themselves and then procreate, and so that way the genetics move on. Essentially what happens is, you use sensory systems, like remember, your five senses, there’s actually a sixth sense too. You use six different senses to figure out where you are in space and where the world is. Use your eyes to map out the world. You use your muscles and joints and touch to figure out physically where things are and where you are in space. You smell as a constant stimulus of what’s going on in the world around you. You use taste as what’s going on and to help train you to eat food and sustain yourself. But there’s another sensory system called the vestibular system, it’s your inner ear, it’s your ability to figure out where you are in space in relation to gravity.
Everybody knows that gravity is down, right? Well, your brain has to map out that appropriately. Otherwise, let’s say it’s mapping out gravity as in that direction, like down into the left, then your brain’s going to have some weird reaction every time you try to stand up straight, because it’s going to fire some muscles because if it thinks gravity to the left, and you feel like you’re being pulled down straight down, then you’re going to be firing muscles, because you must be leaning to the right. Right? So it’s going to be pulling you to the left in order to balance that out. You’re going to be chronically tight left-sided muscles. We’re talking about left-sided muscles like in your entire body, always tight everywhere on the left and the right sides just significantly better. And there’s a bunch of other neurologically mediated muscle patterns. But when you have issues with all these mapping systems, your brain ends up tightening up muscles in ways that don’t get better just from stretching them. It doesn’t get better from strengthening them or don’t get better from if you go to a chiropractor getting them adjusted. They’re the ones that keep coming back because your brain is now using tight muscles. Not as a, “Oh, I’m tight,” but as a compensation. Your brain is using tight muscles to say, “Oh, I need more information from this area because I don’t know where it is, where things aren’t working right, so I’m using this to tighten it up. And even though it doesn’t feel good if I loosened it up, now I take away my brain’s compensation.”
You can see, there’s errors sometimes in compensation. And if your brain doesn’t compensate appropriately or accurately, then you can get systems, and how you move, and ways you walk, and ways you think and ways you control your emotions, all based off of erroneous information, which makes it tough.
[00:25:40] BP: Yeah, and it’s all really tough, honestly, is my opinion about it. I think a few of us have had that feeling where that test, where they asked you to stand up, close your eyes, put your feet together and see if you don’t fall, kind of thing. I know, I don’t fall anymore. But years ago, I would every single time.
[00:26:03] ML: Did you notice you would always fall in the same direction?
[00:26:06] BP: Yes, I always fell to the right.
[00:26:10] ML: Isn’t that interesting? Most of our patients, we use that test, it’s called a Romberg test. If you’re Googling it, it’s R-O-M-B-E-R-G. Romberg test is great, because you can use it to see how a bunch of different systems all come together. We use it and we can move the head in different positions in order to bias certain parts of the systems to find out which ones are the problems, which are the ones that we need to work on first, and which are the ones that are working well that we can take and we can say, “Hey! We’re going to use you because you know what you’re doing. And we’re going to use you to help this other part that doesn’t know what it’s doing to help it along.”
When we’re working with these patients, symptoms can happen for a long time because of two things. It can happen because the compensations continue, and the compensations have some errors and need to be retrained. The second one is because they may have some prolonged inflammatory responses. There’s a bunch of cells in the brain called microglial cells. Those cells, when a concussion happens become ramified, which means they literally change their shape and start saying, “Warning, warning, something just happened.” It starts creating an outputting signal to the rest of the brain saying, “Hey! You need to start doing some inflammation, something bad is happening here.”
Here’s the thing, the immune system in the brain is so, so intertwined with everything. Because think of like one cell talking to the next cell, there’s an immune cell that literally wraps around that connection. It modulates it, it tries to take – it attenuates the information saying, “Hey! This should be a little more. This should be a little less.” If that immune system is on hyperdrive, then that’s going to change the way your brain is literally talking to itself. Over time, or in reality, that doesn’t always go well, because sometimes patients need to have some intervention to help calm down that inflammation.
Then you start finding all these after-effects. So we’re talking about ground zero, what’s happening here. And you can really go online, you can read articles and articles about the individual thing like “Oh, no. It’s a gut problem. Oh, no. It’s a hormone problem. Oh, no. It’s an X, Y, Z problem.” But if you keep going upstream, well, if it’s a hormone problem, what controls the hormones? Brain function. “Oh, no, it’s a gut problem.” What creates integrity in the gut? Your vagus nerve. What’s above the vagus nerve? Brain function. When you have – so instead of trying to chase all X, Y, Z, all these different things, it’s good to do it at the same time, but instead of like only chasing the things that seem simple, if we go after the brain, then these things start to get better on their own, and they only need a little tweak, instead of like 18 months of gut repair program.
[00:29:06] BP: Yeah. There’s a lot of those out there. And concussion recovery in general, I call it, it’s quite full of fads. It’s quite full of a lot of things that come out, but I’m not super against any of them. Because I think people that are trying to help is better for the industry considering we didn’t have any of that 10, 20 years ago in comparison.
[00:29:30] ML: For sure. The question is though, and this is – when we’re talking about neurochemistry, this is super important because that starts diving into supplements. The question is, if you just did a study based off of, you take X amount of people who are concussed and you just said, I give them protocol A, B, C, and D and I see how many of them improve that’s statistically significant. Most other people, if you touch somewhere along the big circle of concussion, if you touch something along there, you may have an improvement. But does that mean that it’s an efficient, effective improvement for getting a patient better faster? Or is it, that’s what they’d like to do and they’ve seen some results. So now they say, “I’ve got a concussion program, because I’ve seen it work before,” but they don’t have anything to compare it to, to say it works just as much, or more, or less than something else.
In our office, we’ve seen what works faster and what works slower because we’ve done a bunch of those different therapies. We’ve sent people for [inaudible 00:30:37]. We worked with a lot of supplementation programs. We’ve had patients who have tried hormonal therapies, and we see, what seems to be the fastest thing for getting people better; the stimuli rehab, visual rehab. We found that that seems to be effective. Now, is it the only thing? No, not at all. Sometimes there are complicating factors. That means we have to touch on some of these inflammatory processes. When we’re talking about neuro chemistry, that’s where I’d like to go with this. If that’s okay with you.
[00:31:08] BP: Yeah, sounds good. Yeah, I think inflammation is something we talk about a lot. Because I always explain, for a few years, when I started going through this, which was over 10 years ago, my head felt like it was on fire, actually, is how I would describe it, or the pressure would be really strong. I always used to tell my family to drill holes in my head, and I’d be like, “Oh, just drill a hole.” “What are you talking about?” I was like, “Well, then, I feel like it’ll work, and then my brain will have somewhere to go, and then I won’t be in this much pain.” I used to make jokes that I wish I lived in the stone age or a long time ago, when that’s how they started to solve headaches, was drilling holes in people’s brains and the tops of their skulls. It’s funny, because that’s how I felt.
But inflammation is something that a lot of people deal with, and I know you can maintain some of that with diet and things. But those diets aren’t easy. They’re not, you know, like a low or no inflammation diet, depending on your lifestyle isn’t the easiest thing to maintain, in my opinion at all. I don’t –
[00:32:14] ML: The rock and sticks diet.
[00:32:16] BP: Yeah. I like all foods, so that just – it’s really tough for me to even follow, because it’s a lot of work, it’s a lot of time. And sometimes you just don’t have time for things like that in your life to plan out weeks and weeks of meals. Say you have kids, and a family to feed as well. Well, I’m pretty sure they don’t want to do that diet either.
[00:32:37] ML: It’s expensive too, and it’s not the most tasty compared to stuff that we’ve used. But here’s the thing, like we’ve seen in the office, like some patients, they need those diets. They have some more complicated things going on. They got layers upon layers, and we need to use one of those diets. We’ve got other people that don't need the diet. They just need a little bit of brain rehab, they need a little bit of neurochemistry to help calm things down, and then they’re fine. Then you can see the differences when we’re working with patients, you can see which protocols are kind of like these ongoing protocols of, “You have this diagnosis. Now, this is you the rest of your life. So therefore, take these supplements forever.” Where we have some patients who have been coming to us with like a laundry list of supplements, or a shopping bag, like a literal shopping bag full of supplements.
I’m sitting there like, “When do you have appetite to eat? You don’t need any of these.” And they’re like, “Well, I went to this doctor who gave me this and this doctor gave me that because they read one paper that said, ‘Hey. Vitamin C helps with concussion.’” But no, like it does. Yes, there’s research that supports it. But if you continue to dive into the research, you will always find something to support a point of view when it comes to nutrition, if you keep going deep enough.
[00:33:54] BP: Yeah, I’ve done like the pillboxes. I go in waves, as everyone knows who listens to the show. I’m a terrible patient And it’s just a fact. I like to share it because I believe a lot of people are. I have done the supplement boxes and you know what, certain supplements, I know that when I take them, I do feel better, especially because I’m anemic. so things like iron and stuff, like I need it.
[00:34:21] ML: Yeah, but you need those.
[00:34:21] BP: Yeah, but I need those. But there has been different specialist I’ve gone to, and they actually gave me. It was like four pages of different supplements that I should go on, and I said, “Well, don’t you want to check my blood first?” was my first comment. I was like, “Where did this list, giant list of supplements come from. I don’t even know. Those won’t even fit in my pill box.” But it happens a lot.
[00:34:50] ML: So the supplements – there’s two different methodologies of supplementation. There’s wellness supplementation, which is good if you want to do a wellness program. But if you have a condition and I’m talking about even chronic conditions that are long term. You want to have a therapeutic program that’s a high enough dose, it’s hitting it hard. It may be a little more expensive too, because you’re using higher doses of things, especially of more potent things, because you’re trying to get a result. One of the ways that we do it in the office is we titrate it up, because everybody’s a little bit different. Some person might only need three, some people may need six. But you start at what we think is like the typical dose, like two to three. And then we say, “Okay. Every three days, we’re going to have you add another one.” It may take a few weeks before we figure out what is your supplementation dose, but we go high enough until we see a change. Then we back down just a little bit, we want to be right underneath the way you feel hasn’t change.
But Turmeric is huge, high dose turmeric is huge for reducing the pro inflammatory cytokine, or the signal molecule that tells the brain to turn on inflammation. There’s a bunch of different signal molecules. It’s really good at turning off and reducing one of the one of the major ones. But it’s not just turmeric, so you can’t just go out and eat the root. You have to get curcumin, which is the active ingredient in a large enough dose. And typically, what we found in my office and also what the research is showing, a gram, 500 milligrams to a gram is the minimum to see a therapeutic effect for using this. I think I did the math once before. I think you gotta to eat like 42 tablespoons of turmeric powder in order to get 500 milligrams of curcumin.
[00:36:38] BP: That’s like – I did the math once because I’m anemic for how much spinach I needed to eat to match what was in my supplements. Because someone’s like, “Why don’t you just eat a lot of –” I don’t eat a lot of red meat. “But why don’t you eat a lot of red meat, and why don’t you have a lot of salads?” I was like, “Do you know how much salad I have to have?” I figured it out a few years ago. I don’t remember it now. But it’s always interesting to compare. People don’t realize always how much is in a supplement pill compared to a food dosage of it.
[00:37:10] ML: That’s because you go on Instagram. You’ve got somebody with like the little square box there that’s saying, “Hey! If you need iron, you could eat all these foods.” And you don’t realize you have to literally all of those foods on the planet in order to get a therapeutic dose of it
[00:37:22] BP: All day, every day. All day, every day.
[00:37:25] ML: All day.
[00:37:27] BP: Yeah. That’s a lot.
[00:37:29] ML: The next one that we use all the time is resveratrol. Resveratrol is the active ingredient that you get from the skin of red grapes, or you can get it from Japanese knotweed extract. Resveratrol has a bunch of different factors in the body. It’s really, really good, but it also turns off one of those signal molecules in the brain, which allows your brain to start to reduce that inflammation. That one’s really good too. I think it was like – I think in order to get the equivalent of that in red wine, you’ve got to drink like three or four bottles of red wine by yourself, and I feel like that’ll create other problems.
[00:38:05] BP: Yes, definitely will, because we know that concussions often lead to things such as different coping mechanisms like drugs and alcohol. Because it’s a lot to deal with, it’s a lot of lifestyle changes. Can be a lot of pain, it can be a lot of symptoms. Don’t try the wine method. And speaking of all the different changes, mental health is something I like to talk about and pain is something else. Because for me, my pain and mental health kind of went like glue. If my pain was bad, my mental health tanked. If my pains started to go away, my mental health went up. It was quite the roller coaster and they were tied together. I want to talk a little bit more of the chemistry side of that mental health, because I think it’s important for us to know, like I said, why these things are happening. A lot of the time we blame ourselves for how we’re feeling, especially mentally. I think it’s important that we don’t do that.
[00:39:06] ML: I think that’s a really good point to bring up. If we’re talking about mental health from a neurochemical perspective, it’s actually, unfortunately, all the feelings that we feel kind of get really simple. I want people to prepare themselves for that, because when we’re talking about the cellular activity, you have all these experiences, and you have all these little scenarios of why things happen. And yeah, those are all valid. Those are all like really big parts of your life and the struggles. But when you’re talking about it from a neurochemistry perspective, it kind of makes things a little bit more simple. Which I like personally, because when I deal with that stuff, it gives me an opportunity to figure out how to fix it and or at least not fix it, but (a) prevent it or (b), when I’m dealing with an episode, what are things that I can do that I know physiologically will help calm me down?
Remember when we were talking about that inflammation, so we were talking about some of the things you can take, like supplements that would help with inflammation. The reason why we were talking about that, and the reason why we were talking about the compensation mechanisms before, and the reason why we’re talking about those little neurons dying off before, is because those are all parts of things that cause anxiety and depression.
[00:40:22] BP: For sure.
[00:40:23] ML: So it’s not just like, “Oh, these are happening, so I get anxious.” It’s literally that is your conscious experience. Right before those little neurons, when they’re like driving way too hard, the conscious experience of a neuron over firing is one of two things, depending on where it is in the brain and body. It’s either pain, or it’s anxiety, and you can tell which part of the brain is having that based off of what you’re feeling during the anxiety. It’s even more accurate to figure out based on how you’re feeling the depression afterwards, the feelings associated with the thoughts and depression afterwards are directly associated with where in the frontal lobe you’re having, or where in the limbic systems, more specifically, you are having this high firing neuron. Okay.
Taking a step back, your cerebellum is a huge driver of inflammation. It’s a huge driver and everybody knows, you’re probably familiar with the cerebellum, it’s in charge of coordination, of movement, balance of movement. Coordination, equilibrium, and balance. Those are the three things that we always think about as the cerebellum of movement. But it’s also coordination, equilibrium, balance of thoughts and emotions. Because it fires information to your brainstem, which then fires over to your frontal lobe. And when those systems work well, and everything is happy, then you just get function, like normal function, normal thoughts and everything is good. But if you get over firing, too much cerebellum ungated, too much midbrain ungated, your frontal lobe then takes the brunt of it. And your frontal lobe will start over firing, which means that you get that glutamate activation, that cellular activation that is going to be driving things way too hard. And then you also get after those little neurons undergo cell death, you get a spreading wave of glutamate released from those cells, pinging all the other cells in the area saying, “Hey! Everybody, party time. We’re all going to get active.” And then your conscious experience is nervousness and anxiety.
What does it look like afterwards? What it looks like afterwards is, now, you have a bunch of little neurons mixed in between that were driving way too hard and now are no longer there. And now the cellular metabolism of the entire structure is less, so you have a literal depression of cellular activity. But what you experience that as depends on which structure it is. It can be psychomotor fatigue, it can be physical fatigue, it can be mental fatigue, it can be guilt, it could be suicidal thoughts, it could be general depression. It all depends on which parts of the frontal lobe overfired and then underfired. What does this mean? What are the ways that we can control the systems so that way they don’t over fire, then under fire? That’s a big question.
The first one is reducing some of the things that make it closer to threshold. When I’m saying closer to threshold, the things that will make a neuron fire easier, faster when it shouldn’t, more protein, right? Bigger, stronger neurons with more protein, more negative, more negativity. We want negativity in our neurons, more negativity, bigger neurons, the way you make bigger neurons is by training them, exercising them in appropriate ways. Not keep pushing through until you finish the program, but exercising them within a tolerable world. Then little by little, you keep building those neurons stronger and stronger.
And then eating right. This is where eating right comes into play. Eating right isn’t going to fix a concussion, but eating right is going to allow your brain to grow. DHA is the essential fatty acid that allows neuron cell walls to be built. Fish, eating plenty of fish actually helps out a ton with creating neuroplasticity. Eating foods that don’t inflame your body so you don’t continuously kill off these little neurons as they’re starting to grow. That helps a ton too, or supplementation, reducing inflammation allows these neurons to have a chance to grow. Now there’s a couple things that you can also do. Supplementing magnesium, that magnesium helps to stabilize the neuron firing. So that way, when it starts getting pinged, it takes a little more effort and energy in order to activate.
Those are three ways. There’s many more and depending what we see with the patient, but those are three major ways that we usually use for helping patients. We want to stabilize and we want to allow neurons to fire in safe ways. The next thing afterwards is stable blood sugar. If your blood sugar goes up and down, your mood goes up and down because your cellular activity goes up and down. And every time it gets to the point where it’s way too high, you’re going to get that anxiety, those ruminating thoughts, the cyclic patterns. The cyclic pattern isn’t just all of a sudden your frontal lobe decides to think a lot. The cyclic patterns are part of a limbic circuitry between your basal ganglia, your frontal lobe that winds things up. And it does that when other frontal lobe circuits can’t inhibit it, which means even more reason for blood sugar stability.
[00:46:06] BP: It’s actually interesting that you mentioned blood sugar, because I’ve touched on it a few times on the podcast. I actually wore a glucose monitor for about six months. I used that to learn to regulate my blood sugar because I have extreme night terrors. I actually managed to reduce them significantly by learning how to control my blood sugar. That was really interesting for me to try and super easy to do.
[00:46:36] ML: Can we talk about that?
[00:46:37] BP: Yeah, for sure.
[00:46:39] ML: I would love to talk about night terrors, because so many patients have that. They think it’s just like, “Oh! I’m just like stressed out.” But it’s no, it’s concussion physiology.
[00:46:46] BP: It is, yeah. I knew it wasn’t me. What happened is I learned what to eat before bed, what not to eat, kind of things. So for example, last night actually, I eat sugar, like 11 o’clock. I was like, “Oh, no! That can’t be the last thing I ate, because that means I know I - it’s more likely that I’m going to get a night terror in my sleep, because my sugar shoots way up, and then it overcompensates, dips really low, and then my body tries to wake myself up with the night terror. What I did was actually, I ate something else after. Actually, I had a rice bowl. And then I waited a little bit before I went to sleep, made sure I felt okay and then I went to bed. So it is things that you can learn to control and adapt your lifestyle too. It just takes some testing.
[00:47:34] ML: That’s exactly it. Because so many people keep jumping on the train of, “Cortisol, bad.” The cortisol gives night terrors, waking up between 2:00 and 4:00 AM is usually when it is with just either night terrors, or nightmares or with sweats. Something sympathetic response. So we’re not talking about the wellness supervisors Instagram posts on what sympathetic versus parasympathetic is. We’re talking about –
[00:47:57] BP: I like your Instagram posts.
[00:47:59] ML: I see them all the time. I’m like, “No, that’s not how it works. That’s false, but good on you for selling it.”
[00:48:05] BP: It’s from doctors.
[00:48:06] ML: Exactly. That’s how it works, right? When you create these little – so you get this little thing of like, “Oh, no. It’s sympathetic, parasympathetic.” But in reality, it’s neurotransmitter function, but not just neurotransmitter function, it’s brainstem function. So here’s what happens. You have this unstable blood sugar. Blood sugar is associated with cortisol, and melatonin circadian rhythm, because you use cortisol to release sugar when you don’t have enough to make brain functions happen. You go to bed at night, you have your melatonin, you ate some food, and your body is trained, whether it’s through a concussion because of that hyper metabolism that we talked about earlier, or it’s because of just years of doing it wrong.
We train ourselves to release a ton of sugar just as soon as we eat it. And then we get this reactive hypoglycemia, which some people experience and you’ll notice they’re in it because they get super tired, and they need to eat food, or they get hangry and they need to eat food. Luckily, I’m usually the tired person, not the hangry person. If you ever feel anything other than hungry or not hungry, that means you have a blood sugar issue where even if it’s normal numbers, it means that the fluctuation of it is not. You get this fluctuation where the blood sugar goes down, and so your brain is releasing cortisol to then take glycogen, which is stored blood sugar from your liver and from your muscles and shoves that into the bloodstream. So that way you can keep doing the functions. And then after a while, your cortisol pathways, they’ve run out of the nutrients that they need to function, because you use too much cortisol, not too little cortisol. I mean, sorry, because there’s too much cortisol was used. So now the problem is, there’s too little cortisol, not too much cortisol. So then, what does your brain use to create more sugar? Epinephrine, norepinephrine, also known if you’re of a certain age, as adrenaline. You’re basically using adrenaline while you’re sleeping in order to get your body to get enough blood sugar. And that wakes you up in sweats, that wakes you up in night terrors. Those things are easily preventable. When I say easy, I’m not saying like, it’s gone like that, like snapping your fingers.
[00:50:27] BP: It took me six months of trial and error.
[00:50:32] ML: Six months of a straightforward process, where you knew that, “Hey! If you just get your blood sugar under control, then you’re going to feel better.” So the first step for anybody who’s got a brain injury is, “Okay. How do I get my blood sugar under control, because everything else is dependent on it?” But that doesn’t mean that you can’t get better without working on it, because there’s other systems that you can work on.
One of the things I wanted to bring up because we were talking about the neurochemistry of inflammation. A lot of people don’t know this, but there’s actually studies that show unilateral vestibular deficits. In other words, if one inner ear doesn’t work as well as the other inner ear, whether it’s due to damage, or due to just the software where it connects into your brainstem, if that’s just interpreting it differently. Asymmetry in those systems creates inflammation. So there’s a lot of different pieces and it just comes down to really going around and making sure that we’re hitting all the points and doing them all in a way than you would do it an order of operations that we’ve seen to be pretty effective in the office.
But doing it in a way that will say, “Okay. We gotta reduce the vestibular imbalance, then we have to start calming down some of the inflammation. After those, then we start slowly working on balancing blood sugar. After those, then we start doing a gut repair if needed at that point.” But when we’re coming from a neurochemistry perspective, certain things take a long time, certain things take a short time. It’s nice to start with the things that happen quickly. So that way, we get this more holistic plan of getting somebody at least improved and getting themselves back on the journey of healing themselves.
[00:52:03] BP: For sure. And I think it’s important to touch back. I am hypoglycemic, but that doesn’t mean I’m diabetic. I think a lot of people don’t always realize that. I remember, I actually got tested, I can’t even count how many times growing up, because they kept thinking I was a diabetic and my parents kept thinking I was a diabetic. It’s something to make note of that there can be something else wrong, and you can monitor it yourself. But remember, this is a reason why we talk to physicians and specialists before we try these types of things to balance out your own blood sugars. Don’t just wing it. This isn’t like, let’s just try this at home kind of thing. There are specialists out there that can help guide you through all of this and Dr. Lovich is one of those. Is there anything else you would like to add before we end today’s episode?
[00:52:54] ML: I would just say, remember that when you’re working, when it comes to concussion and TBI, it’s a process. Changes in neurochemistry can be made from a lot of different things, and making sure that you’re overturning everything to say, “Okay. What could be associated and what can be helpful. For example, making sure thyroid autoimmunity is checked if there’s a mood instability issue, which is then associated, which could be changed, because brain changes, hormone changes, thyroid changes. Just remember that every practitioner, sometimes you get practitioners that are super passionate about something that helped them. But that means that sometimes they get their blinders on, and they forget to look at everything for the person in front of them. It’s good to make sure that they’re part of a team, that they have colleagues that they refer to, for help. And also to make sure that you’re seeing the expert of each individual thing and works together. Not just one person that has their one favourite approach and can sell it really well.
[00:53:56] BP: For sure. And make sure that it is individualized to you, because that’s very important. Especially because brain injuries are not the same like we always say, that like a snowflake, no two are the same. Always remember that. I just wanted to thank you so much for joining us today and sharing some of your information and knowledge on brain chemistry after a concussion.
[00:54:19] ML: Happy to be here. Thank you.
[END OF EPISODE]
[00:54:25] BP: Support the podcast. If you truly love the podcast, please consider supporting us through our tip jar. Find the ‘support the podcast’ link in our episode description. All tips are greatly appreciated.
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