The Impact of Impacts on the Brain with Joseph Maroon #559

Foreign a state of high performance. You're listening to bulletproof radio with Dave Asprey. Today's episode is filmed on location at the American Academy of anti aging medicine, which is where 27,000 physicians, well, a few of them that show up, but 27,000 physicians are members of a group that's been working for 26 years to define aging as something that we can attack and change and reduce and maybe even reverse medically and with lifestyle. And it's given me the opportunity to see many great friends and to make some new ones and to meet people who've done decades of work to change the world. And today's guest is one of those gentlemen. He is a neurosurgeon, 78 years old, who is very, very well known because he's the guy who created a test that 13 million people have taken to understand the impact of impacts on your brain. So he studied traumatic brain injury. He's the first neurosurgeon in the NFL and a name you might have heard if you have ever watched the movie concussion, Although the character in concussion has very little to do with. With the real Dr. Joseph Maroon. Dr. Maroon, welcome to bulletproof Radio.

David, it's a pleasure being here and a pleasure meeting you. For all of your phenomenal accomplishments and what you've done to assist with anti.

Aging programs, coming from you, that's a huge compliment.

Thank you. Well earned.

Anytime you get a chance to meet a neurosurgeon who's practiced for decades and decades, it means that they've had the chance to accumulate some wisdom and to see this incredible sea change that's happened in a field. And you'll see that in almost anyone who's practiced medicine for many decades. Well, here's what we did in the 60s. It was a little bit different than what we do in the 70s. And they have this long view of the evolution of a field. And the first thing I'd like to know, Dr. Maroon, is what's changed since you started looking at the brain?

Well, in terms of concussion, I think you're exactly right. The most important thing is perspective, as it is in anything in life. And I've had the good fortune to have perspective from the 80s to the 90s to the present day in terms of what's evolved. And there's been a huge evolution from how many fingers can you count? And a little ammonium chloride or smelling salts, and then back into whatever the game might be, rugby football or whatever. Due to the observations of the potential long term effects of concussions, there's been a major, major sea change of rules at every level from the NFL to Pop Warner to USA today football, with the exclusive purpose of providing a safe opportunity for kids at all levels, so to speak, to participate in a phenomenal game that incredible human life. Lessons are learned. General MacArthur said it very well. He said he had this. This plaque placed on the playing fields facing the. The. The playing fields at West Point. And it said, on the fields of friendly strife are sown the seeds that on other days and on other fields will lead to victory. And that's so true. Teamwork, getting up when you don't want to get up, going through some degree of pain, are all lessons learned. So the whole goal of the rules changes is to provide safety. And quite frankly, particularly at the youth level, it's never been safer. And we're looking at other sports. Girls soccer, we know now has an incidence of concussions equivalent to male football players.

Wow.

So it's a big problem. It's being addressed as best as possible without completely eliminating the sport and the lessons learned. On the fields of friendly strife.

You're saying this based on 13 million data points, or at least more than that, probably because you actually looked at the effects of traumatic brain injury on people. How did you develop that body of research that became the standard in the field?

Well, very early on, coach Chuck Noll, who was the coach of the Pittsburgh Steelers for many years and four super bowl championships, I told him that his star quarterback couldn't play against the Dallas Cowboys the following week. And he said, why not? He said, because. I said, because he's had a concussion. And the guidelines at that time said if you had a concussion, you had to stay out a minimum of two weeks. He said, well, who wrote the guidelines? What evidence based knowledge did you use to put those together? He was very challenging. And he said, if you want me to keep somebody out of playing football. I went objective data and somewhat chagrined, but he was correct. I collaborated with a neuropsychologist, Mark Lovell, and we came up with a test subsequently called impact, which is a neurocognitive test that assesses reaction time to 1/100th of a second memory, the ability to process information. And I went back and I said, well, now we have to baseline the whole team, which was a little resistance doing neuropsychological tests on a professional football team. However, we did do that. He acquiesced and encouraged it. And subsequently it's become the standard with every major sports organization, 12,000 high schools, as to get A baseline before you return to a contact sport, with a neurocognitive test as one piece of information to make that decision.

It's kind of funny, we used to say years ago, oh, you've had your bell rung or these other things, oh, get up and walk it off sort of things. And I had a couple pretty substantial tbis over the last two years. One of them had a bleed. I had amnesia for a week. Light sensitivity, nausea, couldn't play go fish with my kids. I'm a pretty smart guy. And it was really weird because it happened. I had these symptoms and it was just wrecked. The time before that, I hit my head really hard, actually, I think I had it bleed that time. But amnesia, I can't remember the order of operations after it happened. It's not real amnesia, like from the movies, but enough that it's all jumbled when I try to remember it. But I remember the day after that. I recorded five podcasts in a row. And recording five podcasts in a day is a herculean feat. I almost never do that, but it just lined up with my calendar. And at the end of the day I said, man, I'm a little tired. And then I woke up the next day and I couldn't count my fingers. I was completely zombified. And then I swore a lot for a month or two and ended up having to do some neurofeedback as well as specific nutritional protocols to put my brain back together again. And thank goodness I have access to hyperbaric and everything else. So I recovered and stem cells in my brain, whatever, I recovered faster and better than I'm supposed to. But for people who've never had a tbi, I can tell you I went from I'm kicking ass to I can't play go fish, right? And because I'm swearing at everybody now, what's your explanation for someone? What would you tell a family member of someone who has their first concussion? What would you tell them to expect? How would you describe what it's like?

First of all, what you're describing is terrifying. There's no question about it. You know, is this going to be permanent? Is it long lasting? Fortunately, 90% of concussions clear within a week, maybe two weeks, 8 to 10% of patients will develop what's called the post concussion syndrome. And this can be associated with memory impairment, with mood disturbances, sleep disturbances, and can really be very debilitating.

What about depression? Is that in there as well?

Yes, absolutely. Mickey Collins, who's the head of the concussion Clinic at the University of Pittsburgh will see in that clinic close to 10,000 new patients a year with concussions from all kinds. And they have absolutely huge database. And he has actually, you know, we used to think that you didn't have a concussion unless you lost consciousness.

Right.

We now know that 90% of concussions are not associated with loss of consciousness, only 10% are. And that he has subdivided the concussive syndrome into several separate segments. For instance, one of migraine. Some patients just develop migraine headaches following.

Yep.

Others are vestibulo ocular unbalance, unsteadiness, feeling foggy. Another is cervical cephalgia, pain in the neck, head. Another is somatic with headaches, nausea, vomiting. So each of these can be sub characterized and then there's a tremendous overlap.

Right.

Each of these can. There are specific protocols for dealing with each. And before we used to think that we would cocoon patients in other put them in a dark room, no stimulation. You clearly overdid it in terms of taxing your brain. Your brain will prowess the next day. We advise rest for the first few days to let the brain recover and then very specific types of exercises and gradually increase with aerobic activity, which we used to say none at all for a week or two. The consensus now is that's not the best form of therapy. And we can go on and on about what is what, you know, what does help. I'm a proponent of omega 3 fatty acids and natural anti inflammatories. We've written papers on neuroinflammation as the underlying genesis of many of the syndromes and symptoms that occur.

Neuroinflammation is an interesting topic because with my history of having high levels of toxic mold in my house, having high levels of chronic stress and probably mercury levels earlier in life, I certainly had some higher mercury levels. The these are all things autoimmunity that trigger chronic inflammation, including neuroinflammation, even things like ADHD and autism and Asperger's syndrome. And Asperger certainly runs in my family and I certainly was somewhere on the spectrum when I was younger at least. And those are all tied together with neurons and glial cells, parts of the brain getting inflamed and concussion is also tied together. What's the difference between what happens in the brain with a concussion and this other lifestyle based inflammation?

Complex question. I mean complex answer to a straightforward question. You know, what is neuroinflammation? Let's just go back to concussion for just a second. What happens to the brain.