Concussion

• Any stressful event, like a hit to the head, can shut down pituitary gland in the brain, which is the body’s hormone generator

• Pituitary doesn’t work – estrogen + progesterone decline

J of Head Trauma Rehab Nov. 13, 2013

Why increased concussion?

• Diminished brain resilience syndrome: a modern-day neurological pathology of increased susceptibility to mild brain trauma, concussion, and downstream neurodegeneration

Surgical Neurology International 2014, June 14

Diminished Brain Resilience (DBS) Syndrome

Modern environment:

• Toxicant exposure

• Overuse of sunscreen

• Heavily processed nutrient-deficient foods

• Unhealthy omega 3:6 ratio in diet

Surgical Neurology International, 2014. 5:97

Diminished Brain Resilience (DBS) Syndrome (cont’d)

Altered physiology:

• Microglia activation

• Dysfunctional on/off switch modulating microglia state

• Disruption of gut flora

• Disrupted liver function/CYP enzymes

Surgical Neurology International, 2014. 5:97

Diminished Brain Resilience (DBS) Syndrome (cont’d)

Diminished brain resilience:

• Nutrient functional deficiencies

• Disruption of sulfate supply to brain

• Reduced protection against impact damage

• Activation of alternative biochemical processes with negative downstream consequences

Surgical Neurology International, 2014. 5:97

Diminished Brain Resilience (DBS) Syndrome (cont’d)

Neurological pathology:

• Increased susceptibility to concussion

• Reduced ability to heal spontaneously from uncomplicated single concussion

• Increased PCS and CTE

• Increased incidence of neurological death vs. mortality rates from other causes

Surgical Neurology International, 2014. 5:97

Increased rate of concussion

Food for Thought

• Traumatic brain injury leads to intestinal dysfunction and breakdown

Surprising answer

• Vagus nerve – the great wanderer

Brain cells’ reactions to concussive traumas

• Researchers from Brown University showed – irreversible damage occurs in brain cells about 6 hours after trauma

• Suggests that a window of therapeutic intervention aimed at limiting damage to the brain exists

Scientific Reports, August 2016

Traumatic brain injury and intestinal dysfunction: Uncovering the neuro-enteric-axis

Conclusion:

1) An increase in intestinal permeability and marked changes in intestinal histology 6 hr. following TBI

2) Expression of tight junction proteins-Zonulin and occludin decrease following TBI compared to sham animals

Journal of Neurotrauma, 28:1353-1359, Aug 2009

Gut to Brain Connection596

Vojdani A et al, FNRE, 2012, 2(3)

Diabetes takes a toll on the brain

• Type-2 diabetes associated with greater impairment of blood flow to the brain and sharper decline in mental acuity compared with nondiabetic people of similar age and health status – even over a 2-year period

• At end of 2 years – people with diabetes had greater decline in:• Gray matter volume

• Composite scores on mental tests

• Rates of blood flow to the brain than those in control group

• Also had greater increases in blood measures of inflammation

Neurology, July 8, 2015

Hemoglobin A1c

• Those who live the longest have A1c values <5.2%

• Elevated HgA1c levels start to shrink the brain

Neurology May 24, 2005;64:1704-11

Sugar triggers memory problems and neuroinflammation

Brain and Mental Performance Neurology Nov. 27, 2015

Research discovers that depression is an allergic reaction to inflammation

FeelGuide, January 6, 2015

A blow to the gut

• But diet can decrease species and diversity in gut flora in short period of time

• Diet-induced shifts in microbiota rapidly ratchet up inflammation

• Increased gut inflammation depletes supply of serotonin

• 90% of serotonin produced in the gut

• Inflammation converts serotonin to tryptophan that generates neurotoxic metabolites linked with depression and Alzheimer’s

Excess Weight at Age 50 Tied to Earlier Alzheimer’s Onset

Molecular Psychiatry, Sept. 2015

Alzheimer’s stem from infections

Harvard researchers report:

1) A virus, fungus or bacterium pass the blood-brain barrier membrane (leaky)

2) The brain’s defense system rushes in to stop the invader by making a sticky cage our of proteins (beta-amyloid)

3) The microbes becomes trapped and dies

4) What’s left behind - plaque

Journal Science Translational Medicine. June 1, 2016

Two Key Nutrients Help Stave Off Alzheimer’s Disease• Omega-3 supplements and antioxidants improve clearance of amyloid

beta protein and reduce inflammation of brain tissue, in people with early stages of Alzheimer’s

World Health Net, July 28, 2015

Dr. Dale Bredesen – Alzheimer’s Protocol

• Eliminate:• Simple carbs• Gluten• Processed foods• Increase vegetables and fruits• Increase wild salmon

• Decrease stress and increase sleep

• Supplements:• Melatonin: 2 mg• B-vitamins – methylated• D3: 2,000 IU• Omega 3: 2,000 mg• Co Q10: 200 mg

• Good quality oral hygiene

• Exercise: 30 mins. 4-6 days a week

• Fast 12 hours between dinner and breakfast

• Minimum 3 hours between meals

Buck Institute

The Brain Gut Connection

• Both a high-fat and a high sugar can cause changes in gut bacteria that appear related to a significant loss of “cognitive flexibility”

• Effect was most serious on high-sugar diet

Neuroscience. 6 Aug 2015; 300:128-40

Fat, sugar cause bacterial changes that may relate to loss of cognitive function• Oregon State University study: Both high-fat and high-sugar diet,

compared to normal diet, cause changes in gut bacteria that appear related to significant loss of “cognitive flexibility”, or the power to adapt and adjust to changing situations

Oregon State University. Public release Jun 22, 2015

Which type of exercise is best for the brain

• Jogging – steady state - most neurogenesis:

• The greater the distance, the more new cells produced

• HIIT – higher than sedentary

• Weight training – no neurogenesis

• Distance running releases BDNF

Optimal brain diet

• Depression-prevention study at University of Pittsburgh:

• 50% received 5 hours of problem-solving therapy (cope with life stressors); or

• Dietary counselling

• Results: Surprise! Both groups significantly reduced the risk of depression – by same amount

Scientific American Mind, March/April 2016;p.27-34

Optimal brain diet (cont’d)

• A study of more than 12,000 healthy Spaniards found – those who closely followed a Mediterranean Diet had a 30 percent reduced risk of depression

• Central feature – low in sugar, processed foods and fatty meats

Scientific American Mind, March/April 2016;p.27-34

Optimal brain diet (cont’d)

• In both animal and human studies, typical unhealthy Western diets appear to cause damage to the hippocampus

• Participants consumed poor quality diets over 4 years

Scientific American Mind, March/April 2016;p.27-34

PREDIMED

• 7500 participants

• Mediterranean Diet plus nuts protects against CVD

• PREDIMED participants – testing depression

• Results:• Lower risk for depression

• 40% drop in risk for diabetics

Mind Diet

• Hybrid of Mediterranean and Dash diets

• Mind diet rich in vegetables, berries, whole grains, nuts

• Diet helps slow cognitive decline

• Diet may help prevent Alzheimer’s

• Results: those who followed Mind diet for 5 years – achieved cognitive scores of people 7.5 years younger

March 19, 2015 Rush University Medical Center. Journal Alzheimer’s and Dementia, The Journal of the Alzheimer’s Association

Blood test for concussions

• New research bolsters evidence that a simple blood test may someday be used to detect concussions

• Protein linked with head trauma may be present in blood

• 2 proteins were studied and deemed “a substantial step” in diagnosing concussions

• UCH-L1: Protein levels rose quickly but declined substantially within 2 days

• GFAP – levels detectable during the week following injury

Blood test for concussions (cont’d)

• Blood Brain Barrier Proteins IgG + IgA

• Blood Brain Barrier Proteins IgM

BBB Permeability

Effect of the Suboccipital Musculature on Symptom Severity and Recovery after Mild Traumatic Brain Injury (TBI)

Conclusion: In mild TBI, the rectus capitis posterior minor is the only suboccipital muscle associated with symptom severity and poor outcomes

Fahkran S, et al. Am J of Neuroradiology. 2016

Inadequate helmet fit increases concussion severity in high school football playersConclusion: An improperly fitted football helmet is a risk factor for a concussion with more symptoms and of longer duration

Concussions of longer durations are also more common with an air bladder-lined helmet

Sports Health. May/June 2016. Pg. 238-43

Complete rest until symptom-free after concussion may not be best for recovery

New research suggests those who exercise within a week of injury regardless of symptoms have nearly half the rate of concussions symptoms that linger more than a month

American Academy of Pediatrics. Science Daily. Apr. 2016

Multidimensional Support for Brain Function

• Ingredients: thiamin, riboflavin, niacin, vit. B6, L-5-MTHF, vit. B12, NAC, Acetyl-L-carnitine, grapeseed extract – 3 caps daily

• Protects blood-brain barrier and supports mitochondrial function

• NAC and L-5-MTHF can cross blood-brain barrier

• Formulation protects against oxidative stress

• Neuroprotection

Post Detox Brain Protocol

• For patients suffering from fatigue, cognitive fog, or following heavy metal detox

• Mitochondrial resuscitate formula – 1 scp. daily

• Multidimensional support for brain function – 3 caps daily

• Cell membrane fluidity: • Alpha-lipoic acid – 2 sg daily

• Omega-3 fatty acids – 4 sg daily

• Optional: 1 pct. Detox support packs

Mitochondrial resuscitation – to target mitochondrial efficiency, neuromuscular health, oxidative stress and metabolic reserve

Magnesium (300 -600 mg) –ATP transport CNS, heart, skeletal muscle; calcium ion influx and apoptosis, muscle relaxation

L-Carnitine (500 – 3000 mg)

mitochondrial ß-oxidation of fatty acids for ATP production, waste removal, antioxidant and supports insulin sensitivity

Riboflavin (B2), Niacinamide, Vitamin C -mitochondrial function, nervous system support, electron chain transport

Taurine (600-3000 mg) -crosses the blood-brain barrier and plays a role in supporting brain health, rescues neurons from excess glutamate

Pryridoxine (B6)- Excitatory glutamate conversion to calming GABA, neuron life cycle, nervous system function, methylation, homocysteine metabolism

Neuropharmacology. 2012;62(1):304–312.Rowe WJ. Clinical Interventions in Aging. 2012;7:51–54.Manji H., et al. Nature Reviews Neuroscience. 2012;13:293-307.

Thiamin (B1)- oxidative metabolism of pyruvate, alpha-ketoglutarate, and branched chain amino acids

Vitamin C and Selenium –ROS scavenging, glutathione support

Chromium– insulin sensitivity

So, are we ready for Monday morning??

Look To the Future

MTHFR gene-folate:

1) Impaired methylation leads to - histamine

2) High histamine leads to release of Zonulin

3) Zonulin open tight junctions “leaky gut”

Support:

L-s

SAMe

Methylated B9 (body-ready folate)

Methylcobalamin (B12)

Yasko, Autism: Pathways to Recovery, 2009, chap. 2

The Science

• Nucleotides:• Basic building blocks of DNA• Play key role in metabolism

• Single nucleotide polymorphisms (SMPS) – important because they can change production and function of proteins in the body

• Examples:• CYP1A2 – the most influential gene in the metabolism of coffee• ACTN3 gene – type IIx muscle protein• EPAS1 gene variants -erythropoiesis and angiogenesis• COL5AI – type 1 & 5 collagen injury risk• FTO gene – obesity in humans

Look To the Future

• Nutrigenetics is making its way into athletics

• Nutrigenetics examines how an individual’s unique genetic code affects their response to different nutrients

• With this information, a doctor can prescribe a more personal regimen for nutrition to optimize an individual’s performance

Nutrigenomics

• Food is information

• Contains instructions that affect every biological function of your body

• Affects expression of your:• Genes

• Influences hormones

• Brain chemistry

• Immune system

• Gut flora

• Metabolism

Growing a functional nutrition practice

• Adding functional nutrition to your armamentarium leads to predictably positive patient outcomes and better practice revenue

• Office work, staff training and patient management flowcharts

How to integrate functional nutrition

Presenting patient

complaints

Subjective questionnaire to help doctor

identify underlying

issues

Flow chart to help doctors

create protocol

List of additional objective

testing options

Protocols to enable doctors to make confident

recommendations

Scripts for staff to reinforce

recommendations

Nutrition consult

• Express value, not price

• Doctor’s credentials and attributes

• Our program is based on structure, education, and motivation. Dr. X is an expert in clinical nutrition. We have an excellent support team to help you with the changes you may need to make in order to achieve your goals

Nutrition consult (cont’d)

• Consultation includes:• Thorough history

• Comprehensive nutritional test

• InBody Analysis (BIA)

• pH testing

• Zinc testing

• Blood lab evaluations

Nutrition consult (cont’d)

• Sent to office prior to appointment (emailed or faxed):• New patient intake form

• 3 to 5-day dietary intake/food journal (what you eat and when)

• Any supplements and/or medications currently taking

• Copy of recent blood work or test results

Missed appointment script

• Call within 15 minutes of missed appointment – reschedule

• Tone is key – smile when speaking

Nutrition

• Do you have enough products to get you through until your next appointment?

• Can you think of anything you may run out of between now and then?

• It is very important that you continue with the products the Dr. X has prescribed for you

Social media

• Website

• Google+

• SEO

• Facebook

• Twitter

• Instagram

• Pinterest

JOIN THECONVERSATION

@YourSportsDoc @NYChiroCare

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Inside-Out Health: A Revolutionary Approach to Your Body

Intro: A new view

Chap. 1: It’s all about your gut

Chap. 2: Your knee bone’s connected to…

Chap. 3: Toxins, toxins, toxins

Chap. 4: Inflammation nation

Chap. 5: Weight…Don’t tell me!

Chap. 6: Life in motion

Chap. 7: Let there be light

Chap. 8: Inside-out treatments

Chap. 9: Concussion from the inside-out

Conclusion: An inside-out life

Who’s awesome?

YOU ARE!