Brain reserve is a level of structure and function below which symptoms of brain dysfunction can occur. The amount of brain reserve a person has can vary for different parts of the brain and depends on: Age, genetics, neurotoxin exposure, nutrient deficiencies, EMF exposure, genetics, infections, head injuries, etc.
There are similarities between Mild Cognitive Impairment and Traumatic Brain Injury.
• Cognitive dysfunction and loss of Cognitive reserve
• Loss of mitochondrial energy production and structure
• Loss of functioning neurons
• Loss of synaptic networks
• Neural inflammation
TBI can be thought of as loss of brain reserve and neuronal structure and synaptic connections from trauma to the brain. Certain factors would make healing from head injury slower include:
• Higher forces
• Stress
• Mood instability
• Social support
• Leaky gut and GI dysfunction
• Prior head injuries
• EMF exposure
• Neurotoxin exposures past and present
• Blood sugar and hormone status
• Food exposures
• Sleep quantity and quality
• Neck injuries and pain
• Brain viral and spirochete load
• Early vs late Functional Medicine and FSM care
• Nutrient and supplements supplied
• Brain and exercise training
Usual medical care after a head injury does not improve brain reserve or brain function in fact with usual medical care some or a lot of brain reserve is lost. Usual medical care is based on the labeling and matching model ie You have a head injury so what medication or treatment do we have to match with that; this method is very inadequate to help patients with Concussion and Traumatic Brain Injury.
Concussion is a head injury from direct or indirect forces with or without LOC that may lead to symptoms immediately or for weeks or months after an injury. Concussion may or may not lead to Traumatic Brain Injury. Symptoms may vary but have been called Post Concussion Syndrome:
• Headache Fatigue
• Dizziness
• Nausea or vomiting
• Fatigue
• Photophobia
• Sensitivity to sound
• Sleep dysfunction
• Visual symptoms
• Hearing problems
• Anxiety, Depression, Irritability
• Possibly PTSD
TBI is a brain condition with a loss of cognitive functions with an onset either after a concussion or with trauma to the brain from a head injury with or without skull trauma, such as a whiplash. Compression and shearing forces result in brain injury and brain dysfunction. Loss of consciousness is NOT necessary for a brain injury to have occurred; even seemingly minor incidents can cause ongoing problems. People can also develop a Traumatic Brain Injury from Surgery, Stroke, Birth Injury, and Medications. Patients can have Post Concussion Syndrome and Traumatic Brain Injury; although, Traumatic Brain Injury symptoms and signs will persist longer than post concussion syndrome.
Functional Medicine approach to Concussion and Mild Traumatic Brain Injury is different from the standard medical approach, which usually includes:
• ER or Dr visit, diagnosis is made
• CT Brain may be ordered and usually does show anything
• The patient or parents are reassured
• Follow up with family Dr. and rest is prescribed
• If symptoms persist may see a Physio and or a Neurologist
• The pathophysiology is not addressed
• The patient either stops having symptoms and loses some brain structure and reserve or continues to have symptoms
A Functional Medicine approach to brain injury can look at the stage and pathophysiology and specifically address what is needed to heal the brain and improve brain reserve. No matter how far out from a brain injury or how far into MCI there is always reason for hope. People can improve significantly that are 3 months, 6 months or years out from a head injury or MCI diagnosis but they must invest in their brain health and be willing to go outside the labelling and matching and lack of care model Targets for Treatment to Limit Brain Damage and Increase Brain Reserve
• Limit neural inflammation
• Limit excitotoxicity
• Limit free radical damage
• Induce NRF2 gene response
• Increase brain oxygenation
• Assess and Repair the Blood Brain Barrier
• Induce Neural stem cells to differentiate
• Stimulate Synaptogenesis
• Brain Protection strategies: protect the brain from further damage: brain injury diet, EMF measures, decreasing brain neurotoxins, improving the GI tract function
• Improving mitochondria structure and energy production
• Improving synaptic transmission
The Stages of Traumatic Brain Injury
Acute 1st 5 days: assess for brain bleed, rest and increase sleep, decrease brain congestion and excitotoxicity and improve brain oxygenation, start the brain injury diet
Subacute: 6 days to 2 months: need to also decrease brain inflammation and oxidative stress, Assess and treat the blood brain barrier. Assess for Pituitary and hormone issues. Consider use of Hyperbaric O2. Start strategies to increase trophic factors ie. brain derived nerve growth factor
Chronic Stage: People that are more than 10 weeks post a Concussion and Mild Traumatic Brain Injury can improve and many times a lot! At 2 months or more out we need to approach similarly to MCI
• Assess BBB for antibodies
• Assess for hormone issues
• Assess cognitive status
• Strategies to improve brain structure, brain reserve and function.
• Strategies to increase trophic factors and stem cells
• Strategies to increase synaptic connections and transmission ie: Synaptogenesis
Lifestyle Modifications that are helpful:
Neuroprotection
Sleep is important for healing the brain after TBI and with MCI; Stages 3 and 4 sleep are very important. A few tips are: 1) Set a bedtime between 10-11 if possible; 2) Set a time for preparation with low light; 3) Avoid blue light before bed; 4) Do calming things before bed and use Ashwagandha, 5HTP if necessary to calm the person down; 5) Have the person read in bed with a device on Airplane mode on a Kindle app with the black background and the nightshift activated; 6) No fluid within 1.5 hours of bedtime; 7) No more than 20 minutes trying to fall asleep
Dietary protection
• Low in processed foods and sugar
• Organic fruits, veggies and free range grass fed meat, poultry along with Pasture raised eggs
• Gluten and diary free
• Provide Choline for Acetylcholine as well as for Phosphatidyl Choline in cell membranes; Choline containing foods to supply a minimum of 500 mg a day and more like 3000 mg/ day( eggs, Chicken, turkey, collard greens, Brussels sprouts, broccoli, Swiss chard, cauliflower, and asparagus)
• Protein at every meal or snack
• Avoid browned proteins, eggs and meats to limit AGES and oxidative stress. AGES may
breakdown the BBB
• Avoid/minimize foods with Acrylamide(heat generated neurotoxin) as it is a neurotoxin (potato chips, coffee, browned starches)
• Use foods high in flavonoid Anthocyanins to block free radicals (blueberries, cloves, blackberries, strawberries etc)
• May consider a Ketogenic diet if the patient is not making excellent progress or is motivated and willing to do a ketogenic diet
• Stop Calcium supplements, stop all sources of Aspartame and MSG
• Magnesium Threonate may be able to pass into the brain better than other forms of magnesium
• Use Riboflavin
• Electromagnetic Fields – including Electrical; Magnetic; WIFI, cell phones, cordless phones and other Radiofrequencies; and all forms of screens
• Any of it can damage the brain and disrupt the blood brain barrier. To protect the brain in TBI or MCI:
• Limit Wi-Fi and turn it off at night
• Use bluetube, not Bluetooth headsets for phones
• Do not hold a cell phone to the head
• Place cellphones on airplane mode when in the car on on your person
• Opt out of Smart Meters
• Avoid all devices like Alexa, Google home etc as they produce high fields
• Avoid powerline adaptors
• Check for dirty electricity and block it
• Unplug all electric and smart beds and electric blankets and heaters
• Get an EMF analysis for the house if it is available in the patients area
Stress modulation
Limit stress in MCI and TBI: 1) Teach stress management with Heart Math, Tapping, meditation; 2) Test adrenal cortisol and DHEA for excessive cortisol and treat to limit Hippocampal damage; 3) Use L-Theanine and Ashwagandha to decrease stress; 4) May use 5HTP to decrease anxiety
Toxin protection
• Neurotoxins are chemicals or metals that damage nerve tissue or nerve function
• Limit neurotoxins in the diet and in water and in the air
• Avoid toxins in skin care products
• Avoid food from cans BPA
• Avoid acrylamide: fried foods, most coffee, crackers, chips
• Avoid Aspartame
• Avoid Hg in foods(avoid tuna, shellfish)
• Avoid diacetyl: popcorn with artificial butter
• Avoid Styrofoam cups
• Minimize alcohol
Treatments
Supplements:
1) Curcumin, R- Alpha Lipoic Acid, Elemental Hydrogen – to reduce inflammation and oxidative stress
2) B vitamins in a B Complex with activated forms of B vitamins; Use COQ10 and nicotinaminde Riboside (NAD+) – to support mitochondrial function as depletion of mitochondrial and consequently cellular NAD(H) levels may lead to bioenergetic failure and cell death
3) Increase Brain Derived Neurotrophic Factor:
• Low or high dose Lithium 20 mg
• Melatonin 1.5 mg
• Vitamin D 5000 IU or amount to get to 50-70
• EGCG Green tea extract
• Taurine
• Daily Brain Training
– Active use of the brain increases synaptic connections
– Online: BrainHQ online personalized brain training 20 minutes a day done as the personalized program or as courses like memory etc
– Games: Crossword puzzles, Scrabble, SIMON color flashing memory game
– Ping pong, dance lessons
– Consider a Speech Therapist or other cognitive therapist to oversee these ctivities at a minimum have a parent or SO oversee these
• Exercise – Aerobic heart zone(70-80% max HR) training for 30-40 minutes is the best stimulus; Resistance training is important for building muscle but not for BDNF; Have them do walking when they are able and start with 15 minutes, progressing to 10 minutes of heart zone training
4) Target: Brain Oxygenation
Decreased oxygenation is a significant problem in the first 4-6 weeks after the injury in areas in which blood vessels have been disrupted; Hyperbaric Oxygen at 1.3 – 1.75 ATM can be an excellent method of delivering oxygen to anoxic or congested areas in brain injured areas to:
• improve oxygenation
• Induce Cerebral angiogenesis and neurogenesis
• Improve both white and grey microstructures
• Induce significant neurocognitive improvement
Usually treatments are done (4-5 days a week) in groups of 10 treatments. It can be used for any stage of the head injury even chronic or CTE.
Vinpocetine to increase brain blood flow, reduces brain excitotoxicity, (may also decrease infarct volume) and Ginkgo Biloba are supplements that can help increase oxygenation.
Holistic Child/Adult Psychiatry offers comprehensive Concussion/Traumatic Brain Injury assessment and treatment, encompassing the philosophy and strategies described above.
Assessment:
1) Computerized Neuropsychiatric Screening testing, using CNS-VS and/or Cambridge Brain Sciences – can be helpful initially in determining effects fo the injury and to follow up with results of treatment
2) Right Eye Brain IQ testing – eye movements are excellent way to assess brain functioning. This assessment can both assess brain functioning following injury, assign home eye exercises and follow-up results of the treatments
3) Quantitative EEG – to identify the specific areas of the brain and/or connections between various brain areas that are affected
Treatment:
1) Functional Medicine methods, including lifestyle modifications, nutritional supplementation and medication if indicated
2) swLORETA Neurofeedback – hep the brain “re-route” and “rewire” around areas that are damaged
3) MedX Class 3b Laser and LED Cluster photobiomodulation – stimulate the mitochondria (energy factories of the brain) and reduce inflammation
4) Frequency Specific Microcurrent and Ondamed (PEMF) – reduce bleeding and inflammation; heal the Blood brain barrier as well as specific areas of the brain; treat orthopedic injuries such as neck problems; nerve pain treat emotional problems such as PTSD, anxiety and depression; stimulate the vagus nerve and other areas of the nervous system
5) Hyperbaric Oxygen Therapy (HBOT) – to increase oxygenation in the brain and nervous system and reduce inflammation
