A Mild Concussion Can Change the Brain for Months – The Hidden Biology Behind Post-Concussion Symptoms with Dr. Aaron Hartman | Post-Concussion Syndrome | E162

20 to 40% of mild traumatic brain injury symptoms— patients will have symptoms for up to 6 months later. So almost half of people who had some kind of brain injury can have symptoms, 20 to 40%, up to 6 months later. So all of a sudden, what appears not to be a big deal can be if you're having symptoms. And ultimately you have to think about these symptoms are your brain is on fire, your brain's inflamed. And ultimately one organ being inflamed, like your liver or your kidney or your gut or your skin or whatever, can affect your entire body. Welcome back again to a second part, part 2 of our series on post-concussive syndrome, concussions, traumatic brain injuries. We're going to keep on diving into this. Today we'll talk mainly about what the actual process of concussion actually looks like from a chemical standpoint, talk about what's actually going on in your brain. I want to talk about first some myths about head injuries that are even Today we talk about, you know, it's just a small ding. It was just a small concussion, not a big deal. So I'm going to talk about a little bit of those and then talk about what actually happens when you have a concussion. So you can appreciate the complexity of it. Also to understand why it's potential to have ongoing symptoms for potentially years after what seems to be a small event. And just something you should be, be aware of. Again, if this information is helpful, please like, share, subscribe. That's how we get this information out there. It also helps us know what topics you're interested in and helps us just know we're going the right direction with helping individuals. 'Cause the whole point of us doing this podcast in general is to educate, encourage, and empower people to take charge of their health. So what are some myths about concussions? The first one is that, you know, it's not a real concussion unless you get knocked out, unless you lose consciousness. That was like the almost, you know, sine qua non. If you didn't get knocked out, go back in, you know, the sport, the game, et cetera. When I was doing my training, We've moved away from that, but there's still a lot of older, you know, who coaches the young kids? Older people, people like me are coaching their kids' sports. And so, a lot of like quote-unquote not professional or less competitive, you know, sporting things. A lot of parents and they're communicating with their kids that it's not that big of a deal because you didn't get knocked out or you were only dizzy for a few minutes. That's the first myth. And that the second myth is that if you don't have symptoms for more than 24 hours, it's not that big of a deal. Or if you don't have like a memory issue for more than, you know, 12 or 24 hours, it's not that big of a deal. Any change in the way your brain's working or functioning is a big deal. The second thing is 20 to 40% of mild traumatic brain injury symptoms— patients will have symptoms for up to 6 months later. So almost half of people who had some kind of brain injury can have symptoms, 20 to 40%, up to 6 months later. So all of a sudden, what appears not to be a big deal can be if you're having symptoms. And ultimately you have to think about these symptoms are your brain is on fire, your brain's inflamed. And ultimately one organ being inflamed, like your liver or your kidney or your gut or your skin or whatever, can affect your entire body. If your brain's still inflamed, that can affect your entire body. And a lot of the things we— criteria we use, return to play after an athlete gets a brain injury, for example, don't adequately address the reality of ongoing brain inflammation from a concussion. A couple overarching themes. A brain injury is a whole body phenomenon. If your brain's inflamed, it affects your whole body. We'll talk about this a little later, but cytokines, you remember cytokine storm from the whole COVID weird thing. And people having— I actually had anxiety for about a month after having COVID. That was my brain being on fire. And I actually could test markers for that. You can actually have viral infections, we'll talk about this later, that can actually mimic the symptoms of a brain injury. Or if you had an old one, they can come to the surface. And anything that affects your brain, your brain is your master regulator of your entire body, regulates your sleep-wake cycles, mood, temperature, hormones, satiety, Hunger. So all of a sudden, anything that affects this regulatory organ is going to have a systemic effect. So you have to kind of keep that in mind when we talk about this. Any injury to your brain is a significant injury. So what actually is going on in concussion? What's the actual process? Well, first you have a mechanical event, you get hit. And what happens is that has a slight disruption in your blood-brain barrier, which is a larger structure, but actually affects the integrity of the cell walls and membranes. And this causes a chaos in your ions, electrolytes, potassium, magnesium, calcium. And what happens is you get this receptor called the NMDA. This is probably a little, might be a little too sciencey, but the NMDA receptor gets excited, releases potassium. Potassium flows out of cells, calcium flows in the cells, and thousands of neurons will depolarize simultaneously, almost like a seizure. I'm going to talk about one of the theories behind, you know, here in a little bit about concussions, but An electrical standpoint, a concussion looks a lot like a seizure. Keep that in the back of your head as we get to that a little later on. What then happens after the injury is you get a crisis of energy production, you know, in your mitochondria, which make, you know, use potassium ATPase, pumps out ions, creates an energy gradient so you can make ATP. That gets disrupted. So the mitochondria in your brain and neurons don't function quite as well, don't make energy quite as well, and it affects glucose metabolism and you start hypermetabolizing glucose. So, all of a sudden, the injury causes a metabolic issue revolving around energy production and glucose. Well, if you have metabolic syndrome, your sugars are high, you have insulin resistance, all of a sudden, there are a lot of things. And it's really interesting, diabetics, some of my worst concussion patients have been diabetics with uncontrolled diabetes. So, all of a sudden now, if you get a brain injury, hey, your sugar's creeping up, insulin's creeping up, A1C is creeping up. This could be an epiphenomenon, a secondary phenomena from your actual brain injury, which is a really interesting concept. The mitochondria can have persistent damage and all of a sudden this potassium calcium stuff stays dysfunctional. We'll talk about this a little later when we talk about therapies. But if your omega-3, omega-6 balance is off, if your fatty acids are off, if you've been eating lots of processed fats, if you have a magnesium deficiency, a potassium deficiency, all these things can set you up for your concussion being worse. And there's some interesting data that we, that came across earlier on my training in the military with actually omega-3s after concussion being brain protective and even CBD, particularly football players being brain protective. The point is, is there are things you can do to help block this process if it happens or things you have on board if you're a high-risk individual, like, you know, have a sport or whatnot that can actually be brain protective. A quick favor.

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Ultimately, this affects the axons, which are the little roots that go out of your nerves, and they can actually start breaking down. All of a sudden now, this one nerve injury, nerve injury affects nerves downstream. And all of a sudden, this one thing that caused this miniature seizure-like activity now has a downstream effect. The next thing happens, you know, the blood-brain barrier gets disrupted, blood flow gets disrupted, and you can actually have decreased blood flow to injured areas. There's actually a watershed effect if you've had multiple of these where if you have, you go from a hypermetabolic to a hypometabolic, so over to under metabolic area, it can stay like that for years after an injury and then you have a second one or a third one that flares up. So all of a sudden now you have to think about previous injuries and it's all result in brain neuroinflammation. Your brain is on fire. There's actually an interesting book, Brain on Fire, that's actually about a young lady who had a virally induced autoimmune phenomenon and she developed a severe psychosis from it. We have severe examples of that, but we also have examples of people after flu, after COVID, after a whole lot of things, your brain gets on fire from an injury, but that can happen from other things as well. This week's release of cytokines, interleukin-1, TNF-alpha, And actually, some of our patients actually measure these cytokines to see, is your brain still on fire? But the ultimate point is fire begets fire. Once you have a spark in the right milieu, this little small injury can turn into, you know, a little small spark can turn into a forest fire. And in some individuals, it doesn't turn off. This is how a small injury can result in a chronic long-term term injury. You know, a couple things to think about. People like, oh, you know, I feel better, it's a day later, da da da. It's not just how you feel, it's how your brain's functioning, how your gut is functioning, your mood, your sleep. And the thing about it is you can't pick this stuff up on a CAT scan or an MRI. You really need to have do like a functional MRI, a SPECT scan. There's actually some, you know, qEEG, the blood biomarkers we talked about to see if this process is going on. And this is, these are all research things. I'm not really available to the average person. So typically what happens in sports, we use surrogate markers, which are things that help us look at brain function. So like in professional athletes, college athletes, they'll do like a neurotest on the sideline. So, my patients will use this thing called CNS Vital Signs or BrainHQ to actually measure. These are neuropsychiatric tests to see if your brain's not functioning optimally. So, in athletics, for example, in college athletics, you want one done before the athlete has an injury and you compare afterwards. So, a lot of ways to look at this. But what I think is really intriguing about this is the seizure theory of concussions. And I think this might interest a lot of you all. You know, in 2002, they looked at post-concussive brain EEGs. EEG is when you put all the little stickers on your brain and actually can measure your brain electrical activity. They saw was that after a brain injury, the EEG looks like someone after a generalized seizure, which is interesting. Concussion symptoms like loss of consciousness, amnesia, autonomic disturbances. Those of you who are familiar with POTS and dysautonomia, confusion. These, this all sounds like postictal, the period after having a seizure. And a lot of explanations of why, you know, the heart, how hard you got hit, you had this small brief like ectoplasmic storm, like a myoclonic seizure-like thing. This can potentially explain not just the EEG findings, but why after a seizure, people have a lot of these strange symptoms. That's like a miniature quote-unquote seizure, which becomes important now because, well, how do you deal with things like that? Magnesium, omega-3s, working on gut health. You know, when you get a brain injury, you get leaky gut really bad. So, binding up endotoxins, things we'll talk about in some later ones. But the point is that's underlying physiology of a brain injury. What sets you up for a more severe brain injury is not necessarily how hard you're hit. Think professional boxers versus my patient I mentioned who hit her head at Home Depot and had seizure, had post-concussive syndrome issues for like almost 6 months.

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It's not that necessarily the degree of the injury, it's the milieu. It's your omega-3 balance. It's, is your gut inflamed? Do you have low vitamin D? Do you already have mold exposure? Did you already have reactivation Epstein-Barr? Et cetera, et cetera. And then the small head injury sets you up for a whole host of things. The point being is that if you're having issues with your general health and you have a history of some small minor brain injuries, it can actually play out in future experience, but also there are therapies you can do for it. So we're going to stop there. We're at about the 11-minute mark. We're going to keep on going on. And hopefully this is helpful for, to help those individuals out there understand what's going on in small traumatic brain injuries. But all this story becomes important now because when you start putting together a therapeutic Plan for a person. It's going to be based on how you got where you're at. Not just was this a football versus a soccer versus a car accident versus roughhousing with your kid and you trip and fall and hit your head, whatnot. But what your setup before that was to help with your symptoms. I've recently had a friend, one of their kids was in a car accident and had some post-concussive syndrome issues for up to a week. And it was interesting with this one young lady how just doing a floatation, float tank, A magnesium bath had such a profound impact on slowing her inflammation. And that's something I use a lot in my post-concussive patients is actually sensory deprivation. Because I mentioned the NMDA thing before, right? One of the, I will say cures, one of the treatments for that is actually IV magnesium, which is not available to most people, but the float tanks are in most cities. So we're going to keep on going with this series. We'll stop here, try and keep these short and sweet. We are going to talk about therapies, things to look for, but I want you all to appreciate the nuance of concussions and brain injuries doesn't have to be severe. It can be mild and you can have symptoms for years afterwards. And understanding those nuances helps guide how we treat patients. So if this information is helpful, please let us know. Again, the reason we're doing this is because people asked about it. And so if there's a topic you'd like us to talk about, please let us know. Cause I enjoy doing this. One, cause I have to, I do some research, refreshing research just to make sure nothing's changed, but also education, encouragement, empowerment is what we're all about. And if you're educated about your health situation, that results in encouragement and empowerment to take charge of your health. So anyway, take care. We'll talk to you soon.

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