Concussion Recovery with Dr. Kabran Chapek: Rational Wellness Podcast 315
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Dr. Kabran Chapek discusses Concussion Recovery at the Functional Medicine Discussion Group meeting on June 22, 2023 with moderator Dr. Ben Weitz.
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Podcast Highlights
3:13 There are two main points to this talk: 1. Traumatic brain injuries are a significant cause of mental illness, incl. depression, anxiety, anger problems, and headaches. 2. There is a standard concussion protocol, but we need to take a more holistic approach and we need to look at treating the cause of the damage.
4:47 There are a lot of patients that have had a traumatic brain injury and don’t know it. You might have to ask your patient a series of patients till they recall an incident in which they fell out of a tree, had a car accident, played contact sports, etc.. It is important to figure this out because it is a different treatment approach if there’s a brain injury. Even a whiplash car accident without hitting your head can result in a traumatic brain injury. We need to understand that the brain is composed of very fragile tissues and has the consistency of jello. In fact, if you take a fresh brain out and set it on the countertop, it’ll be dew in a few hours because it will melt.
10:00 There’s a standard concussion protocol with baseline testing preseason and referral to a medical provider when needed an MRI or CT scan and Tylenol and Advil and ice. But we need to go further. The primary injury of concussion is actually ripping of neurons and shredding of tissue. What we tend to see in our offices are the secondary injuries from the cascade of inflammatory and oxidative stress on the brain that continues after the initial trauma. There is a massive glutamate dump in the brain that stresses the mitochondria and there is a flooding of calcium. There’s free radical production and oxidative stress. There are also glucose deficiencies in the brain. Fortunately, studies with mice shows that glutathione, a simple nutritional intervention, applied to the mouse skull reduced brain cell death by 67% if applied immediately and by 51% if applied within three hours. Between 29 and 60% of those who have a concussion, will go on to have a post-concussion syndrome, a chronic brain injury. If you sprain your ankle on the filed of play we have a protocol that involves applying ice, compression and elevation that we apply immediately. But with head injury, we simply watch and wait to see if a post-concussion syndrome develops. We should have a concussion rescue program to save brain cells that we apply immediately after a head injury.
16:04 A better approach to traumatic brain injury would be to address structural integrity, to look at sleep, nutrition, supplements, exercise, and brain retraining exercises. We should also include some imaging–a SPECT brain scan and some questionaires to fill out to assess cognitive function. T-B-I from Brainline.org is one good questionaire that assess for trauma, behavioral change, and impact on daily functioning. Other cognitive assessments include NSIBA, MoCA, and CNS Vital Signs. There is also an app, CRR (Cognition Recognition and Response), that athletes and coaches can use to track concussion recognition and response.
28:23 SPECT brain scan. A meta-analysis shows that 99% of the reviewed articles show that SPECT brain scans pick up subtle differences in the brain, indicative of mild brain injury, whereas CT and MRI did not pick these up. Raji CA, Tarzwell R, Pavel D, Schneider H, Uszler M, Thornton J, et al. (2014) Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review. PLoS ONE 9(3): e91088.
28:58 Labs recommended: 1. CBC, 2. CMP, 3. HsCRP, 4. Lipid panel, 5. Hormones, including morning Cortisol, IGF-1, IGFP3, Testosterone, Full thyroid panel, 6. Nutrients, incl. zinc, copper, ferritin, vitamin D, B12. Growth hormone can be affected because the pituitary in the brain can be damaged by brain trauma. The adrenals and thyroid are also often affected.
33:09 Pregnenolone and DHEA are two precursor hormones that can be affected with TBI and it can be helpful to supplement with these, esp. if you are working on correcting adrenal dysfunction. Pregnenolone can help with anxiety, memory problems, insomnia, irritability, and hypervigilance because its a calming hormone that stimulates GABA activity in the brain Progesterone. There are hundreds of studies on progesterone and TBI and it holds a lot of promise as a treatment for TBI, including in the hospital. But they also need diet, sleep, the structural component, hormones, and supplements for a comprehensive approach to get results. The dose used in most of the successful studies on progesterone for TBI is 200 mg per day. There was a trial–the SYNAPSE trial in which progesterone failed, but Dr. Chapek has talked to the researchers on this and he still thinks that progesterone is helpful. Dr. Chapek mentioned a case with a Marine who had TBI and he had headaches, fatigue, depression, suicidal thoughts, very low libido, extreme agitation, and irritability, couldn’t be around his girlfriend. His LH, FSH, and his testosterone were low for his age, so he was prescribed clomiphene to stimulate his gonads and all his symptoms went away. So this was due to low pituitary function.
42:05 Sleep is very important for brain recovery and 30 to 70% of TBI patients have sleep problems. One study showed that TBI patients tend to have low melatonin, so giving melatonin can be helpful.
42:54 Nutrition. The brain is a really hungry organ and it uses 20-30% of the calories we ingest. After a brain injury there will tend to be low glucose and it can stay down for a while because the glucose transporters are damaged. During this period, it may be better to follow a ketogenic diet, so that you brain can use ketones for fuel. Unfortunately, if you are hospitalized, you will be given IV glucose, which will likely make things worse. Adding some medium chain triglyceride oil and exogenous ketones can also be helpful.
42:12 Nutrients. Some important nutritional supplements to consider are Omega 3s, B vitamins, vitamin C, Vitamin D, Gingko and vinpocetine for blood flow, AlphaGPC/Citicholine and Huperzine A for increasing acetylcholine levels, NAC and Lipoic acid for antioxidant support, Acetyl-L-Carnitine and CoQ10 for brain mitochondrial support, and phosphatidylserine for cell membrane support. N-acetylcysteine (NAC) really has some good data to support its use. It’s an antioxidant, anti-inflammatory, and it helps with glutamate excess. (Eakin K, Baratz-Goldstein R, Pick CG, Zindel O, Balaban CD, Hoffer ME, Lockwood M, Miller J, Hoffer BJ. Efficacy of N-acetyl cysteine in traumatic brain injury. PLoS One. 2014 Apr 16;9(4):e90617.) Here is a study looking at the administration of NAC on the battlefield to soldiers after traumatic brain injury that show amazing benefit with NAC administered at high dosages right away for a week–first 4 grams, then 2 grams per day for 4 days, and then 1.5 gms for 3 days. There was 81% reduction in symptoms after a week as opposed to a 40% reduction in those who did not get NAC. (Hoffer ME, Balaban C, Slade MD, Tsao JW, Hoffer B. Amelioration of acute sequelae of blast induced mild traumatic brain injury by N-acetyl cysteine: a double-blind, placebo controlled study. PLoS One. 2013;8(1):e54163.) You might want to have an emergency kit and if there’s a TBI you administer right away high dosages of NAC, vitamin C, omega-3 fish oils, and curcumin. Dr. Chapek recommends curcumin at a dosage of 500-1000 mg twice per day for the first month after injury. Curcumin is anti-inflammatory and it reduces IL 1 and opens Aquaporin 4, which reduces swelling in the brain. An optimal level of vitamin D for concussion should be 60-80 ng/mL. IV vitamin C can be helpful at 10,000 mg per day but oral vitamin C is also very helpful. Alpha lipoic acid reduces glial scar formation. Zinc is important for brain healing and also for ADHD symptoms.
Dr. Kabran Chapek is a Naturopathic Doctor and he has been a staff physician at Amen Clinics in Seattle, Washington since 2013. Dr. Chapek is an expert in the use of functional and integrative treatments for traumatic brain injuries, dementia, Alzheimer’s disease, PTSD, and anxiety disorders. He wrote a book, Concussion Rescue: A Comprehensive Program to Heal Traumatic Brain Injury and he also offers the Concussion Rescue course. Dr. Chapek’s website is https://www.amenclinics.com/team/kabran-chapek-nd/.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Welcome everybody. I’m Dr. Ben Weitz, and this is the Functional Medicine Discussion Group meeting. Our topic for tonight is healing from traumatic brain injuries, including ones that have happened in the past using a functional medicine approach. A traumatic brain injury, which may or may not include a concussion, is caused by sudden damage to the brain caused by a blow or jolt to the head, common causes include car or motorcycle crashes, falls, sports injuries, and assaults. And according to the CDC, there are over two million new head injuries in the US. Dr. Kabran Chapek is a naturopathic doctor and a staff physician at Amen Clinics, and the author of Concussion Rescue: A Comprehensive Program to Heal Traumatic Brain Injury. Dr. Chapek uses a functional and integrative approach to the treatment of patients with traumatic brain injuries, Alzheimer’s and dementia, PTSD, and anxiety disorders. Dr. Chapek, thank you so much for joining us.
Dr. Chapek: It’s a pleasure to be here. Thanks, Dr. Weitz.
Dr. Weitz: Excellent.
Dr. Chapek: All right, let’s get into it. So I’ve been working at am Amen Clinics the past 10 years, and a lot of the patients that we see have had a traumatic brain injury, as you mentioned, and some of them didn’t know they had it until we scanned their brain. So we’re known for doing brain SPECT imaging. We’re going to talk about ways to assess the brain, including SPECT imaging, but also things you can do in the office, including lab tests or cognitive tests that are very useful and can be done tomorrow. And why I’m so passionate about this is that it’s really a common problem. Three million Americans go to the emergency room every single year with a concussion. So those are the ones we know about. But how many kids on the soccer field or friends, loved ones, they bonk their head and they see stars? That’s enough to have a… that could be considered a concussion or brain injury. If there’s any symptom, which is, such as seeing stars, feeling a little dizzy, woozy, that’s enough to be considered a concussion. And then there’s also the sub-concussive hits to the brain that we know from football players who have many repeated hits to the head, that’s cumulative damage and can cause brain injury and inflammation in the brain.
Really, there’s two main points to this talk that I want to convey. It’s very simple. First is that traumatic brain injuries are a significant cause of mental illness in this country, including depression, anxiety, anger problems, headaches. And it’s not being recognized, because we can’t see the brain or we think, “I’m fine. I hit my head, I saw stars, I’m fine.” But then if symptoms don’t occur immediately, I think, “Okay, it must be due to something else.” And we’ll talk about that. The second point is that while there’s a standard concussion protocol and there are standard treatments, which are great, the approach is not comprehensive enough. We need to take a more holistic approach. We need to look at treating the causes of healing or the causes of damage, and just really more thoroughly help these patients out. And so it’s these two main points, and we can ask questions, we can discuss, there’s a lot of different aspects to this. And my plan was to go through some of the mechanisms fairly quickly, some of the myths, some of the science of how it works, and then get into some of the treatment strategies, because I really want you to have that in your tool bag as you start working with patients.
The first thing is, I would say at Amen Clinics, just to pick it up, first of all. I mean, we see so many people and we can fall into the pattern of treating our patients with depression with a certain approach or look for certain things psychologically. But one in six of the patients that we see at Amen Clinics have had a brain injury on their scans and some didn’t know about it. And so it’s important to ask, and if you’ve ever heard Dr. Amen speak, he talks about this, where he’s asked patients, “Okay, so have you ever fallen out of a tree? Off of a log? Had a car accident? Played contact sports?” And they’ll say, “No, no, no.” But then they’re, “Oh, yeah, I did fall off my bike when I was 10, does that count?” And maybe that’s when depression symptoms started. And it’s a different approach, it’s a different treatment approach if there’s brain injury. So first off, just ask your patient multiple times. It’s kind of like in functional medicine, if someone has environmental illness, they may not think they have a moldy house, so you have to ask them specifically, “Do you have any mold in your home? If you had a roof leak? Flooding? Mildewy smelling basement? Ever had water damage?” It helps to ask specifically about brain injury. People tend to blow it off, not think about it, just sort of forget about it.
Dr. Weitz: And by the way, Dr. Chapek, you can have a traumatic brain injury without actually hitting the head, correct?
Dr. Chapek: Correct. Correct. Yes, just by having whiplash. If it’s enough to cause damage to the neck, that rapid acceleration/deceleration force can certainly damage the very fragile tissues in the brain. In fact, if you take a brain out, a fresh brain and set it on the countertop, it’ll be dew in several hours, just because it kind of melts. It’s so fragile. The other thing to keep in mind is it can be delayed. Symptoms can be very often delayed. I had this pastor who came in who had a car accident, and he was fine for the first week or so, but then the next Sunday, he couldn’t write a sermon, because he had had this car accident and inflammation had gotten to the point finally where he started having symptoms. This is a really common problem.
I had this other guy who was a baseball player, and he was an outfielder, and he was running for the ball and he collided with another outfielder and lost consciousness just for a couple seconds. And he was apparently fine, until the next day, and he started having anterograde amnesia. But it was like 50 First Dates, if you’ve ever seen that movie, where she can’t form a new memory. So he has about four days of memory, and they thought he was faking it or he was depressed or something like that, but it was actually due to brain injury. They thought because it was a day apart, it couldn’t have been due the brain injury. But it clearly was, when he scanned his brain.
Let’s see, this is to illustrate how soft the brain is. It’s about the consistency of jello. And look how hard this skull is. That’s why it can be so easy to damage the brain. These are common symptoms. Doesn’t have to be loss of consciousness, but certainly that would count, any of these symptoms, confusion, memory loss, feeling dazed, they’re common symptoms.
And Ben talked about some of the myths. There’s all of these myths. So if you wearing a helmet, you can’t have had a concussion. If you’ve had a negative MRI or CT scan, it wasn’t a concussion. These miss concussions all the time, or brain injuries all the time. Symptoms starting days later, don’t have to lose consciousness, all of those are symptoms of concussion, or those are myths. I don’t know, I think popular storytelling really exaggerates the myth that people are fine after… It makes a really good movie plot if someone gets knocked out and then they wake up later, but then, oh, if they don’t have any light sensitivity, they’re not confused, they just keep running and going. These people would have post-concussion syndrome and be disoriented. I think it adds to the diminishing symptoms of concussion.
And so here’s a standard protocol, baseline testing preseason, referral to a medical provider. If there’s symptoms, see a doctor, see a coach, see a trainer. This is all good stuff. I mean, we don’t want to not do these things. We just need to go further, further than Tylenol and Advil and ice. We’re going to talk about more than that. That’s really important. What actually happens? Well, mostly what we’ll be seeing in our practices are due to secondary changes from brain injury, not primary. Primary injury is actually ripping of neurons, shredding of tissue. The secondary injury is essentially due to this cascade of inflammatory and oxidative stress on the brain that continues. So it’s really low grade. It’s like a fire that smolders. And I think why symptoms are sometimes delayed until a point the swelling gets bad enough or the cells that are damaged finally degrade. One of the mechanisms is essentially there is a massive glutamate dump. So brain injury, there’s this glutamate release, it kicks up the circuitry in the mitochondria, all of this excess of calcium floods, that excites the mitochondria. There’s free radical production and oxidative stress. There’s glucose deficiencies, and utilization is low by glucose transporters. It’s really kind of a complex cascade, and it’s more than just inflammation. There’s low blood flow and oxidative damage and stress. It’s really interesting, this researcher, this is actually an undergrad researcher at Stanford, Theodore Roth, and he did some studying of mice. And he was able to implant an intracranial microscope into the skulls of these mice. And then poor little mice, they got a brain injury, and you were able to see happens. So uncompressed means uninjured, and the red line is a blood vessel. And then these green squiggles are microglia, sort of the immune cells in the brain, like the macrophages that are supposed to eat up damaged tissue.
And so on the right side after compression, you could see in real time sort of this injury, and then these macrophages, microglia swell and start building up and pulling in tissue. And there’s dead cells and there’s less blood flow. So that had never before been seen. But what I thought was very fascinating that he did next was he applied glutathione, this antioxidant, to the mouse skull, and saw that if glutathione was applied immediately, there was 67% less cell death. And if applied within three hours, there was 51% less cell death. But he changed the outcome for these mice brain cells with this very simple but powerful intervention. So showing the microglia, macrophages on the left, they’re nice and swollen, but with glutathione they go back to their normal size. So that’s a huge insight.
When we think about brain injury, I love this quote from Seth Godin, “We need to go back to the drawing board. Isn’t the drawing board the place where all the best work happens? It’s not a bad thing, it’s the entire point,” in that we now understand the mechanisms more clearly. We don’t want to just watch and wait, and hope the brain gets better. And the brain is your most important asset. Why would we let our children just get concussions and then wait and see if they have an alleviation of symptoms?
It’s common around 29, depending on the research you look at, between 29 and 60% of people who have a concussion, it will go on to become post-concussion syndrome, chronic brain injury. And we have this window of time in which to act. Like if you twist an ankle on the field of play or you hit your head, we all know to grab ice. Rest, ice, compression, elevation, it’s so clear, everyone knows it. Almost even before you see the swelling start, someone’s grabbing ice. “Oh, you knocked your ankle, it’s twisted. Let’s get…” But when we hit our heads, we just kind of watch, wait, test. Why don’t we apply and do things immediately that will save brain cells, and maybe prevent post-concussion syndrome? There’s actually a lot of data out there about this. And really the reason I wrote this book, because there’s a lot of research, I put it together, to share it with people. Because there’s millions of people having concussions all the time, and they may not know about this. Should I keep going? Questions so far?
Dr. Weitz: No, I think we’re good.
Dr. Chapek: So what would be a better approach? How should we approach this then? Well, in addition to the standard protocol, we want to correct structural integrity. I’m talking to one of the world renowned chiropractors, Dr. Weitz here. We’re going to talk a lot about structural integrity, so important. Something I missed actually for the first few years working at Amen thinking about brain injury, that’s a critical piece. Sleep has to be a key piece, nutrition, supplements, exercise, and brain retraining. So we’ll talk about all these things. I think a better approach would be doing some labs in addition to all of these things and some imaging. So SPECT imaging, of course, but you can also do pencil/paper tests. So there’s the TBI from BrainLine, which assesses for trauma, behavioral change, impact on daily functioning. So it’s a list of questions that can be done. The NSIBA, Ohio State University has a TBI Identification Method. There’s the MoCA, which we use for assessing for dementia and mild cognitive impairment, but it’s also useful for assessing levels of functional impairment from brain injury, another cognitive conditions. So we can learn how to-
Dr. Weitz: Is that kind of in general, would most of the cognitive assessment tools for dementia also be beneficial in this realm?
Dr. Chapek: A lot of them would, yeah. Like the mini-mental status, the MoCA, I think-
Dr. Weitz: What about the CNS Vital Signs?
Dr. Chapek: Yeah, we do a version of that called Total Brain assessment, but CNS Vitals is a really robust method to assess. Yeah, absolutely. Because you want to measure cognitive domains in attention, processing speed, executive functioning, recall, and short-term memory. You just want to get all of that, if you can, and see where… Because some people have deficits in more with focus or some more with memory or some more with behavior like irritability or depression. Yeah, it’s individualized. So actually, yeah, that was my next slide. So ImPACT testing, CNS Vital Signs, Total Brain. There’s apps, the CRR, concussion recognition and response. It’s kind of nice, because coaches or athletes can use this and you can track symptoms with it, and it gives suggestions and things, so it’s helpful.
Dr. Weitz: What would you say for, say, a chiropractor or somebody treating musculoskeletal injuries, somebody comes in with a whiplash injury, and what would be the easiest way to just get some sense whether there might be a head injury? Because a lot of times the patients aren’t quite clear. They did a CAT scan of their brain at the hospital and the hospital says, “Well, everything’s fine.”
Dr. Chapek: Yeah, I think if they’re having any symptoms, my threshold would be very low. I think just based on the patient’s symptoms and they hit their head, I would say, “Yes, you have a concussion. You need to be treated.” And then you know, can do cerebellar tests and looking in their eyes, looking for nystagmus and things like that. But oftentimes those are negative. If they’re positive… I think that’s one thing is with the eyes, and some of the, I don’t know, functional neurology chiropractors are really into that-
Dr. Weitz: Yes.
Dr. Chapek: … and very useful. Very useful. Good question. And imaging, of course. So very interested in imaging. And there’s a difference between MRIs, which is looking at structure, and functional imaging like SPECT imaging, PET imaging that looks more at function. And we’ll talk about that a little bit. This is not a patient, this is from a movie, the movie Whiplash. But it reminds me of a patient that I had who was a jazz drummer, we’ll call him Jeremy. And he had been suicidally depressed since around the age of 14 to 15, been on several different classes of medication, working with a great therapist, and still just drinking alcohol, using cannabis. It was the only thing that kind of alleviated some of his symptoms. And he is really struggling.
And he came in and this is what his brain looked like. This is him on the left. So there’s asymmetrical decrease. This is the bottom of a brain, color doesn’t matter. This is the left temporal lobe, and this is a prefrontal cortex. So his left side is very damaged and injured, and the right is a healthy scan, healthy brain, should look very full and round. And I said, “Jeremy, when did you have a head injury?” He said, “I never have had a head… What are you talking about?” And I said, “Well, okay, hmm? Have you ever fallen out of a tree? Off a log? Had a bike accident? Car accident?” “No, no, no.” “Ever played contact sports?” “Oh, okay. I did start playing football around age 13, 14. It was tackle football. I was a scrawny little kid. I was matched up against the coach’s son and he would just tackle me so hard, and I would feel kind of dazed.”
And so he had had these head injuries and brain injuries that he didn’t realize were brain injuries, because he couldn’t see it. And so we started treating him for brain injury, instead of for depression, and focusing on these areas of the brain. And he started to improve. He stopped drinking alcohol, stopped smoking pot, no more suicidal thoughts, and started getting into his jazz drumming, getting better, and eventually went to college for music. He went to Berklee School of Music in the Northeast, in Boston, and doing great several years later. So I think this is helpful. If patients have tried lots of things, they’re having mental health symptoms, think brain injury. Ask them at least four or five times, “Have you ever had a brain injury?” And look at treating, using some of the things we’re going to talk about.
Dr. Weitz: Is there any way to get that same type of imaging through an MRI? Maybe doing an MRI with volume?
Dr. Chapek: I do like the volumetric MRIs. Yeah, those are useful. Especially in kids, there’s so much brain reserve, it’s just not going to show up.
Dr. Weitz: Okay.
Dr. Chapek: So SPECT imaging-
Dr. Weitz: I just hate using a form of imaging that requires radiation and using contrast agent as well, correct?
Dr. Chapek: Correct. There’s no contrast, but there is some radiation. It’s about equivalent to a head CT or CAT scan. So there is some, but it’s not a lot. And yeah, I think, sure, we don’t want-
Dr. Weitz: So no contrast in a SPECT scan.
Dr. Chapek: Mm-hmm. No contrast in a SPECT scan, pure radiation and saltwater, so there’s really no risk of allergic reaction. But, yeah, there is a small dose of radiation. And there’s clinics all around, you can refer, and just order scans at our clinics, and that’s one option. But, yeah, there’s other ways to assess too, like asking them the questions, and doing some of the cognitive testing is a good way.
Dr. Weitz: Sure.
Dr. Chapek: Clearly football damages a child’s brain. And this is healthy, this is [inaudible 00:25:03]. This is from a professional athlete on the right, just holes everywhere, likely headed towards CTE, chronic traumatic encephalopathy. Can’t be diagnosed, it’s just diagnosed on autopsy, but we have worked with a lot of these football players and they’re headed towards that, chronic traumatic encephalopathy.
Dr. Weitz: In terms of kids playing football, is it more dangerous if they play football at… Is there a certain age like, oh, it’s better if they not get a trauma before a certain age because the brain is more vulnerable? Or…
Dr. Chapek: Yeah, I mean, I would say before age 25, I mean, honestly. Well, so this study that they did… Yeah, I mean, I think the younger they are the worst it’s going to be, that’s a good point. That’s a good question. I don’t know if they look at… This study was done with fMRI, ages 15 to 19 year old males, and they found that… Essentially, the punchline is they scanned three groups. One group had known concussion. And the second group had no known concussion. And the third group, they didn’t think they had had any brain injury from playing football, but it turns out that they did from neurocognitive testing and fMRI. And so just showing, sub-concussive hits made an impact. And it was 11 of these players, age 15 to 19. So, gosh, I think, flag football, something else. I love sports and stuff, but it’s got to protect the brain, the most important…
Dr. Weitz: And how bad is it to head a soccer ball?
Dr. Chapek: Also, bad. Yeah, I’m a soccer player. I cringe, but it’s pretty heavy. I don’t know if it’s… I just saw a soccer player today, he’s 60 now, but you could see some denting in the frontal lobe, and it’s likely from lots of headers. So not helpful, worsens focus and that, I think. Yeah, I’ve headed lots of soccer balls too, and I played soccer and I love the game, but I wish that there was a way to play without headers somehow. Anyway.
Dr. Weitz: Is it wearing a helmet in soccer, do you think that’s beneficial?
Dr. Chapek: I think that would help. Yeah, I think that would help lessen the blow. I think people would still get those sub-concussive hits, but it would be a lot better, especially for crosses or big kicks that you’re… When I was playing at intermural, low level, I would just chest it. And they’re like, “Hey, why didn’t you head the ball, you could have headed it?” “Nope, not worth it for me.” Got some flack for that, but… This is just a study comparing SPECT to MRI. So essentially 99% of the reviewed articles, this is a meta analysis of 212 studies showing that SPECT really does pick up subtle differences, whereas CT and MRI are useful for bleeding risk, but not so useful for picking up mild injury. This is just another brain injury showing low cerebellum, which happens as well.
I think this is useful to measure lab tests. So learned a lot about this from Dr. Mark Gordon. And he’s really done a lot for teaching about pituitary dysfunction from brain injury causing… Many of the concussive symptoms that we attribute to brain injury are actually due to low hormones, low cortisol, low testosterone, low thyroid, and repleting those can be significantly helpful. Yeah, this is Mark Gordon here. And that can be tested with a simple blood test. This is Dr. Kevin Yuen, he’s a neuroendocrinologist. He’s down at the Barrow Institute in Arizona. And since essentially published that 28% of retired NFL football players have pituitary deficiency and low testosterone or low growth hormone or both. And they need repleting.
Dr. Weitz: Do you use IGF-1 as a measure of growth hormone?
Dr. Chapek: Yes, I think, [inaudible 00:30:14]-
Dr. Weitz: And what-
Dr. Chapek: … Dr. Gordon-
Dr. Weitz: … level of IGF-1 do you consider problematic?
Dr. Chapek: So IGF-1 and IGFBP3, those are the two. And I think-
Dr. Weitz: What’s the second one?
Dr. Chapek: IGFB, as in boy, P as in papa, 3.
Dr. Weitz: Okay.
Dr. Chapek: And I believe that IGF-1 has a 10 minute half-life, and IGFBP3 has 24 hour. It’s much longer than actual growth hormone, which is just seconds. It’s always going to be low pretty much if you test it in the morning, but IGF-1 I [inaudible 00:30:55]… So the reference range, per Dr. Gordon, is around 200 or above. And so a lot of the hormone folks are really into higher level’s better. And then you go over here and talk to the longevity folks and low IGF-1 is better.
Dr. Weitz: Valter Longo, and he says it should be below 175, that-
Dr. Chapek: Mm-hmm. So there’s this tug-of-war, and so who’s right? I think it’s a matter of finding balance. What’s going on with that patient? Do they have symptoms? Do they have low muscle mass? Do they have significant fatigue? Maybe they need a boost and their growth hormone needs to be higher. So, yeah, it’s interesting, the push and pull on that.
Dr. Weitz: Jama asked, and what do you do if the pituitary is spewing out ACTH after traumatic brain injury, while cortisol is low?
Dr. Chapek: So if ACTH is high, then the pituitary is working, it’s not injured, but it seems the adrenal glands are not responding to that. So figure out what’s going on with the adrenals would be my answer to that. And it may be due to the stress and the trauma of the brain injury, maybe due to sleep or insomnia, problems like that.
Dr. Weitz: And do you check adrenals with the salivary cortisol test?
Dr. Chapek: I do prefer that, yeah. The four point salivary cortisol. I’ll often do a morning blood cortisol test, because we’re ordering other labs as well. But if we really want to assess adrenal function, it’s that four point cortisol is the way to go. The three big ones to look at gonadotropins and growth hormone, corticotropin and adrenals, and thyroid, so the sex hormones, the adrenals, and the thyroid and growth hormone, and pregnenolone, of course. So the precursors, DHA and pregnenolone, which if you’re having adrenal problems that may be part of the issue is needing the precursors. And they’ve studied pregnenolone in veterans and mild TBI and found it helps with insomnia, irritability, hypervigilance. Because it’s this calming sort of increasing GABA receptor activity in the brain that’s like a neurosteroid and [inaudible 00:33:41]-
Dr. Weitz: Really? Really interesting.
Dr. Chapek: Anxiety, and I think it’s keynotes would be anxiety and memory for pregnenolone. And sometimes you’ll need it… See it feeds over here into cortisol, and so I find it very helpful to add pregnenolone and DHEA if you’re working on adrenal dysfunction.
Dr. Weitz: Interesting. So let’s say it’s a man, what level of pregnenolone do you like to supplement with?
Dr. Chapek: Well, I’ll do lab tests to try and get them to around a 100. But usually don’t need more than 30 to 60 milligrams a day, male or female. That’s a good question. And there’s actually hundreds of studies on progesterone and TBI. It seemed to hold a lot of promise as a treatment for traumatic brain injury, like severe traumatic brain injury in the hospital, in the ER. But when they got to larger scale studies, it failed to show benefit. And the reason is similar to what Dr. Bredesen will share with you is that when it comes to the brain, it’s not one thing that causes the problem. Remember it’s this whole cascade of oxidative damage, inflammation. Doing only one thing is not really going to help, ultimately. It’s like the diet, the sleep, the structural, the hormones, the supplements really a comprehensive approach, a functional medicine or naturopathic medicine approach is really the way to go.
Dr. Weitz: Do you sometimes-
Dr. Chapek: And so-
Dr. Weitz: … supplement progesterone for men with head injury?
Dr. Chapek: Yeah. If they have traumatic brain injury, I will not hesitate to give progesterone-
Dr. Weitz: Interesting.
Dr. Chapek: … to them. So you can do topical, you can do oral. I may use a little lower dose, but the dose is typically, they use in these studies, are around 200 milligrams a day. And the trial that failed was called the SYNAPSE-trial. And I’ve reached out to some of the researchers and talked with them, and I think it’s very helpful still. I think it’s part of the protocol in my book to use for severe traumatic brain injury. So in my book, there’s like this chapter on the first aid for your brain, kind of what to do immediately after. I don’t really have progesterone there. Progesterone because you don’t want everyone just taking progesterone willy-nilly. But I think it is a useful aspect. [inaudible 00:36:44]-
Dr. Weitz: Yeah, it’s a great clinical pearl. I don’t normally include pregnenolone and progesterone when I test hormones and that.
Dr. Chapek: Yeah. And for this situation, yes, it would be indicated. This guy, so he was a gunner in the Marines, and he had headaches, fatigue, depression, suicidal thoughts, very low libido, extreme agitation, and irritability, couldn’t be around his girlfriend. So here’s his testosterone for a 30-year-old, really good shape, he was very fit. And you can see here his LH and FSH were just really low, 1.6, 1.5. Low testosterone for his age, really should be closer to 600. And for him we used clomiphene, so stimulating the gonads, stimulating the testes to produce testosterone. He’s 30, we don’t want to use actual testosterone. And went back up to actually a 1,000. And all of his symptoms went away, headaches gone, energy back, libido up, not agitated. So it’s kind of this thing about low testosterone can actually be irritability as much as too high a testosterone can be irritability as well, Goldilocks. So some of these symptoms, I think, can be, again, due to low pituitary function.
So here’s an option for lab panel. Lots of tests to do. Structural, very important. These are the seven philosophical principles of naturopathic medicine, address and physical alignment. As I said, I was missing this for a while. And when I realized, oh my gosh, this is key, really was helpful, especially if someone is having dizziness, daily headaches, daily headaches, pressure, fullness in the head never goes away. We want to think about impingement on this cerebral spinal fluid flow and blood flow.
This can be addressed with physical therapy, chiropractic, cranial sacral, and upper cervical chiropractic in particular. So essentially, Scott Rosa has done a lot of research in this area, misalignment in C1 and C2 brought on by head or neck trauma can contribute to either distension of the cerebellar tonsils, down through the frame and magnum, so the cerebellum sort of plugging the spinal cord and causing impingement and flow. Or just misalignment and impinging upon CSF flow and blood flow. Here’s a picture of that on the side view. So the stenosis or the blockage of the spine here and then pooling and CSF, which looks white here, in the prefrontal cortex, and then reduction of that stenosis due to an adjustment, probably. Then the brain is gray again and normal, so it’s flowing.
So this is a very important one. And sometimes on MRI this gets missed. And so Scott Rosa is into doing an upright MRI, so standing or sitting in an upright posture can reveal the impingement. So for example, the cerebellar tonsils are descending down into the space where they shouldn’t be, and then line down it’s normal. So just gravity kind of pulls the brain back up. So I’m actually curious what your thoughts are, Dr. Weitz. I refer a lot to upper cervical or NUCCA chiropractors really focused on that area or cranial sacral therapists that are really highly skilled to help with structural integrity. What are your thoughts about that or other approaches? I’m eager to learn.
Dr. Weitz: Yeah, sure. I think that makes sense. As well as chiropractic neurologists, they’re also trained to use specific exercises and some other approaches.
Dr. Chapek: Especially, I find if there’s dizziness, functional neurology chiropractor is really helpful. Dysautonomia problems, POTS symptoms, and that very, very helpful.
Dr. Weitz: Yeah, I’m not an upper cervical chiropractor, but we regularly adjust the upper cervical spine. And a lot of times-
Dr. Chapek: Good.
Dr. Weitz: … find that very helpful for headaches and some of these other symptoms.
Dr. Chapek: Well, that’s good to hear. Okay, awesome. Yeah, I think that’s key. Sleep, very important, of course. And why is this? 30 to 70% of TBI patients have sleep problems, so just make sure to address that. And why is it the case? One study showed low melatonin production after TBI, sometimes just giving melatonin helps. I would say that’s a smaller percentage, but it does help. Hypocretin is this wake promoting chemical, which is suppressed, so you feel kind of tired during the day and just can’t sleep well at night. I think also just the neurons are damaged and the brain is firing improperly, and sort of brain’s awake when it’s supposed to be asleep, and sleepy when you’re supposed to be awake.
Switching to nutrition, very important topic. So we know that the brain is really a hungry organ. It uses 20 to 30% of calories in the diet, just straight to the brain. So imagine your plate, that’s a quarter of what you’re eating just for your brain. And so what this diagram is showing is that after a brain injury, there’s this orange line which is a spike in glucose, but then a drop. And so it goes up and then it goes down, and it will stay low for long periods of times. So there’s low glucose, because glucose transporters are damaged, brain can’t use glucose as well. That’s what we think. And so what do we do about that? Doesn’t the brain need glucose? It’s the main fuel source, yes. And in fact, there’s another fuel source that the brain loves, which is ketones. So ketogenic diet, very popular, fad diet, but there’s a lot of neurological benefit to the ketogenic diet. Number of studies on Parkinson’s, Alzheimer’s, and migraine headaches, seizure disorders, ketogenic diet is useful for many different conditions. If it’s right for you, it can be very helpful. There’s an ongoing study right now with humans and ketogenic diet. So there’s not a lot of data, but there’s no other diets for TBI and it has the most evidence to date. They gave glucose to some patients that had had a brain injury and found that actually it suppressed ketogenesis. So there was some degree of ketogenesis, like the brain was actually using 16% ketones, beta-hydroxybutyrate and acetoacetate for fuel for these comatose patients. Their brain was using some ketones for fuel and some glucose, but they gave them IV glucose and it completely suppressed the ketone production. And so it made things worse. So you don’t want to just give sugar, basically.
Dr. Weitz: And if you’re hospitalized, you’re going to get that, right?
Dr. Chapek: It’s likely you’re going to get some version of that, yeah. And the other crazy thing is that they used to give corticosteroids as the standard of care in the ER for TBI, because it was, we think, okay, inflammation, corticosteroids, suppress everything, good. But more people were dying who had that done, because it’s not just a simple thing. You don’t just suppress everything. And so they don’t do that. That’s not a standard of care anymore. It’s a multifaceted approach. You want to do things that are gentle, broad spectrum, multiple mechanisms of action, like food, like supplements, like herbs and plants. So I’m a big fan of ketogenic diet, if it’s right for you.
Oh, goodness. This is a story about a teacher that essentially had to stop working because of a brain injury. And doctor told her, “You’re going to recover in two weeks.” Three weeks later, she couldn’t do her job. Actually, I saw her six months, she hadn’t been working for at least six months. She’s on long-term disability, couldn’t look at screens, couldn’t read. And the ketogenic diet was one of the elements, that was one of the key things that helped her. And she found that she was able to start working again, eventually, energy came up. And another thing that helped her was upper cervical work.
Dr. Weitz: Can you point out on these images what we’re looking at?
Dr. Chapek: What we’re looking at, oh yeah. So these little bumps here in the middle are the temporal lobes, and they’re kind of bumpy. They’re kind of squared off. They should be rounded full like tires or balloons filled up. The temporal lobes are damaged, memory issues, mood issues, light sensitivity. And then on the top, on the right, there’s these bumps in the back. That’s where she kind of hit her head was in the back. So you see these dents in the back. Doesn’t mean she has the dent in her brain, necessarily, but those are injured cells that need help. And so ideally if you re-scan the brain after doing some healing work, it should sort of smooth out and buff out is what it would look like.
Here’s some data on keto. Looking at core nutrients. We want to look at lots of different things like omega-3s, B vitamins, thinking about ginkgo, vitamin C, phosphatidylserine, acetylcarnitine. We’re going to go through a couple examples. This is actually the trial that I was talking about, the CRASH trial, with worse outcomes with corticosteroids. Like NAC, N-acetylcysteine has a good amount of data on it. It’s a molecule that increases… It’s an antioxidant, anti-inflammatory, helps with that glutamate excess. And so it’s really kind of an ideal nutrient for acute brain injury. And you may be aware of this study done in 2013, they had 81 active duty military professionals. In the field of war, they get a concussion, they run to the medics tent and they give them a big dose of NAC. They gave them four grams and then two grams twice a day for four days, and then one and a half grams twice a day for three days, so basically a week. And so they had two groups. The group that had the NAC had 81% reduction in symptoms after a week. And the group that didn’t get the NAC had a 40% reduction in symptoms. So 40% got better anyway, but 81% got better who took the NAC. So in the book I talk about sort of a list of things, in addition to the NAC, but that can be in a kit. So it’s like you have it in your glove box, so if you, god forbid, get in a car accident, you can just take some of these things immediately. Or you’re on the sports field, you have your athletic tape, you have your ice packs, you have your little PBI first aid kit to take. Because we know brain cells are being damaged immediately. You can’t see if there’s damage. Why wait a week to see if you’re going to have symptoms? Why not just take it? Take NAC, vitamin C, omega-3 fish oils, curcumin. Like integrated therapeutics curcumin, which sounds amazing, there’s lots of good curcumin out there.
Dr. Weitz: And aren’t a lot of these nutrients, that anti-inflammatories, is it a good idea to have a loading dose first?
Dr. Chapek: Yes. Yes. So for example, it depends, if it’s a kid or adult, but essentially kids are half the adult dose, it’s a 1,000 milligrams twice a day or more of curcumin. And it’s like that first week, but really it’s the first month. I would consider the first month to be acute. So if you actually are having a concussion, I recommend the full month of higher dose supplements like this, and certainly the first week. And if it’s sort of just a preventive prophylactic, “Hey, I hit my head on something. I saw stars for a second. I’m not really having symptoms, but I want to be cautious,” which I recommend, take it for at least a few days. And hopefully you’re already optimizing your vitamin D levels. Vitamin D, if your levels are good before an injury, you’re less likely to have post-concussion syndrome. If your levels are low before an injury of vitamin D, you’re more likely to have post-concussion symptoms. There’s a study out of Oxford University about this.
Dr. Weitz: What do you like to see as a optimal vitamin D level-
Dr. Chapek: 60 to 80.
Dr. Weitz: … for concussion? 60 to 80. Yeah. Okay.
Dr. Chapek: Yeah, that’s my recommendation. And I’m up here in Seattle, in the northwest, it’s hard to get enough sunlight to get vitamin D levels up, so you pretty much have to supplement. And vitamin C, simple vitamin C, but it’s actually a really potent antioxidant for the brain. Especially after injury, you need more. They did this study with vitamin C and E in severe brain injury and found that it helped. And they used, actually, in this one, they did a study with 10,000 milligrams of IV vitamin C for TBI patients in, I think it was Iranian study, and it found that it reduced brain swelling. And they also gave vitamin E via injection, 400 IUs a day, so not that much. And that improved the outcomes of these patients. Which for them it’s like living, they didn’t die. So it’s pretty amazing. So oral vitamin C, good stuff. Alpha lipoic acid reduces glial scar formation, great antioxidant. Another simple one, zinc is a significantly helpful treatment after brain injury, and also useful for ADHD symptoms at times. At Amen Clinics, we did this study with players, so we had 30 of them. And prior to the study they were having in general problems with attention, motivation, mood, and sleep. And they had 80% improvement after six months of essentially taking the supplements that we were talking about.
There’s this… Actually, oh, it’s right here is a list: Ginkgo, 120 milligrams a day; phosphatidylserine, 150 milligrams a day; phosphatidylserine, a 1,000 milligrams a day; NAC, 600 milligrams; alpha lipoic acid, 300; huperzine A, 150; vinpocetine, 15 milligrams; and then three grams of fish oil a day and a high potency multi. And then we did have them exercise and treat sleep apnea, if they had sleep apnea. So sort of this holistic program. Didn’t include hormone treatment, didn’t include structural support, this was all prior to that work. But you can have a significant… And this was many years later, so it’s not too late. Even if you’ve had a brain injury 10, 20 years prior, it’s not too late to at least try and improve healing and brain function, and think about it in those terms. I think that’s fascinating to think about how many of your patients you’re treating who have had a brain injury, and that’s maybe partly why they’re getting better with a functional med approach is because you’re helping their brain function better. And maybe part of it was a past injury.
This is a picture of a lineman who played for 16 years professionally, he’s now like 60 years old, and essentially has dementia symptoms, can’t find his way to the grocery store. He’s angry. He’s depressed. He’s suicidal. And his brain looked a lot better after 18 months of care. And this is with hyperbaric oxygen, by the way. This is with supplements, exercise, diet, weight loss, and hyperbaric oxygen, which is a really powerful intervention. It’s an oxygen chamber, it’s pressure, time intensive, expensive. You have to go in every day for 40 sessions, maybe 80 sessions. However, it’s very powerful.
Dr. Weitz: I was just listening to somebody who was on Dr. Hyman’s show talking about ketogenic diet, and this was for cancer, but he was saying that, “If you get in hyperbaric oxygen while you’re in ketosis, you’ll get a real big bang for your buck.” You’ll get a bigger benefit.
Dr. Chapek: Wow, with mitochondria, I bet. Well, that makes a lot of sense for brain injury. I hadn’t considered that, but I think that makes a lot of sense. I’m going to start recommending that if people are able to do both. Gosh, that does make sense. Because with keto, it’s not like you’re at in ketosis, technically, the whole time. It’s like you’re going to try and stay in for periods of time, then you eat, you’re going to go down, you’re going to come back up again. All these things affect it, but if you can try and peak while you’re in hyperbaric, I think that, gosh, that makes a lot of sense.
Dr. Weitz: Somebody asked about fasting for traumatic brain injury, which has similar benefits to ketogenic diet.
Dr. Chapek: Yeah, there’s a couple animal studies on that, actually, where they showed the rats that, basically, they had them fast after a brain injury, survived more, function better after the brain injury. I don’t know about humans. I think that’s very individualized, but you definitely don’t want to eat a lot of sugar and carbs afterwards. You would want to either intermittent fast, fast, keto, something, at least, low-carb, higher protein, and fat. Fasting is so individual. Because I think there’s potentially some risk there, the brain is already low in glucose. You start fasting, there’s that initial phase where it takes time to get into ketosis and your brain might be suffering more, initially, even if it’s helpful after a day or two. But maybe if you’re used to fasting, you’ll go into that faster. A lot of variables there. But, yeah, it’s interesting to think about.
Dr. Weitz: Oh, what about [inaudible 00:58:33] the use of glutathione?
Dr. Chapek: I think that’s tremendous. I think harder to have in your first aid kit, because it’s so fragile, but you can actually get those little packets, Tri-Fortify packets. You could use, I think either one NAC or glutathione. There’s that mouse study with the topical glutathione. The mouse skull is very thin, and they shave it down, and so it was almost like getting right into the brain. I think human beings [inaudible 00:59:05]-
Dr. Weitz: So for human, to rub it on the back of the head, you don’t think you’d get any absorption?
Dr. Chapek: I don’t know. I don’t think so. I would go more with oral liposomal glutathione or NAC.
Dr. Weitz: And what about [inaudible 00:59:18] IV glutathione?
Dr. Chapek: Oh, that would be best. Yeah, if you can get it.
Dr. Weitz: Now, Steve asked, can you overdo IV glutathione? Steve, you want to unmute yourself and ask your questions?
Steve: Thank you, Doctor. I have a female patient who’s got anxiety, depression, and her MD’s given her glutathione daily with a million [inaudible 00:59:44] other things. They changed her meds. She’s gone from Lexapro to Zoloft to Abilify, and plus daily glutathione last five days. And I’m concerned that’s going to be over [inaudible 00:59:54]-
Dr. Weitz: And daily IV glutathione.
Steve: Correct.
Dr. Chapek: Well-
Steve: Thank you.
Dr. Chapek: … I think there is that risk, detoxing too fast or sort of overwhelming the system. Yeah, I think there is that risk. I would kind of track with them and see, is it helping? Is she getting better? If she is soaking it up, if she’s not getting better, you may want to reduce it.
Steve: Thank you.
Dr. Weitz: I mean, the other possibility is if she has any considerable amount of toxins and she’s taking that much glutathione, she might be liberating those toxins, and so she could be having a reaction because of that. So you might consider adding some binders.
Dr. Chapek: Good idea. Yeah, good call. Kind of double-edged sword, speaking of glutathione, there’s also exercise. Should you exercise after a brain injury? Answer really is, yes, you should exercise. And now out of Stanford, there’s some recommendations, which I think make a lot of sense, is that you want to start exercising pretty soon, as long as it’s not worsening symptoms. You want to start increasing blood flow, you’re going to get BDNF, and just sort of improve someone’s mental state when they feel like they’ve been taken out of the games. And I recommend looking into Stanford’s standard protocols around this. It’s very useful. There’s some handouts that they have. Let’s see.
Dr. Weitz: Somebody also asked about nitric oxide stimulators.
Dr. Chapek: That’s an interesting idea. I haven’t looked at it, to be honest. I’d be curious to go to PubMed and see what the literature shows. I think theoretically it makes a lot of sense.
Dr. Weitz: Possibly, increased blood flow.
Dr. Chapek: Yeah, makes a lot of sense. That’s good. Brain exercise, also, don’t want to overdo it, but also very helpful to start. And you can do meditation. There’s a quality of life study on mindfulness meditation after brain injury. Brain training with neurofeedback is really helpful after brain injury as well. And-
Dr. Weitz: Oh, you know what? I want to ask a question about exercise. What about using with exercise something that restricts and increases oxygen flow?
Dr. Chapek: Right. I’ve heard of those devices.
Dr. Weitz: I just interviewed Dr. Heather Sandison and she’s using it as part of her Alzheimer’s program in some of her patients.
Dr. Chapek: Yeah, is this the exercise with oxygen or a different one?
Dr. Weitz: I think so. She said, “Hey, you get oxygen deficit and then you have a control and then you have a lot of oxygen.”
Dr. Chapek: And you flood in… Yeah, that sounds like exercise with oxygen. I do recommend that for Alzheimer’s and dementia. And if people can’t do hyperbaric, I’ll recommend it. But for brain injury, I don’t know. It seems like those tissues are fragile and damaged. I think it kind of depends. Like if it was acute, first month, maybe a few months, I probably wouldn’t, but I would do hyperbaric. And then if it’s more chronic, it’s been years or something, I think then it would be worth a try certainly, to kind of revitalize the brain and increase oxygenation. I would kind of look at where they’re at in their recovery process. That’s a great question. Yeah, I like it because it does have exercise in it and oxygen, so it makes sense. [inaudible 01:04:03]-
Dr. Weitz: Now, when you use hyperbaric oxygen, should antioxidants be restricted around the time of using the hyperbaric oxygen? Or would that not… Or would it be synergistic?
Dr. Chapek: I think it would be synergistic. I mean, the hyperbaric oxygen is going to increase… There is an antioxidant effect already, and we’re using it more not to kill stuff, we’re using it more to increase blood flow and oxygen and activate stem cell growth and all of this. And really it’s low pressure, long periods of time. So this is showing a hard shell chamber, but doesn’t have to, I’d say most patients do the soft shell chamber, 1.3 and 1.4 atmospheres. And it’s really the time in the chamber every day, five days a week for 40 sessions, ideally, if they can swing that. Reassess, they may even need more, or renting a chamber, buying in a chamber, big investment. If I only had one treatment, like say, “Okay, you can pick one thing,” I might choose hyperbaric oxygen for brain injury, because it helps so many people. But I also would suggest, it’s going to work better and you may not need it down the road. So it’s like if you do the labs, you do the history, you do the testing, sort of, this is my idea here.
Let’s see, first visit, you do diet, sleep, supplementation, exercise if needed, order labs. They come back, review the labs, change, tweak, add hormones, add nutrients. They should then be getting better in the first one to three months. If they’re not, then layer in hyperbaric oxygen, then you know your investment is working. And this is similar to what we’ll do for dementia patients as well. And sort of add the hyperbaric after a little bit of time, unless you can afford it or you have access to it and you just want to do it acutely, then do it. There’s no risk or harm in layering it. But-
Dr. Weitz: What about red light therapy to the brain?
Dr. Chapek: Yeah, great question. There is some data on this and I’ve certainly recommended it. I’ve seen it work sort of 50/50. Some patients find it really useful, some not so helpful. Like the Vielight therapy helmet. There’s a couple other ones out there that you put on the neck, infrared and red light, and it makes sense. It turns on mitochondria and activates cells, but for some reason it just hasn’t been as powerful as some other treatments.
Dr. Weitz: Susan asked about the use the vibration plates during the exercise for a traumatic brain injury.
Dr. Chapek: Is it a risk to vibrate them?
Dr. Weitz: Or could it be beneficial?
Dr. Chapek: Yeah, I don’t know. You guys are asking questions I haven’t thought about. This is interesting. What do you think about it, the vibration plates? Are there any risk there with the shaking? I don’t really understand. Doesn’t think so.
Dr. Weitz: Yeah, I’m not sure. I could see where there could be a possible risk.
Dr. Chapek: Yeah.
Dr. Weitz: Might be too much at the beginning, maybe.
Dr. Chapek: Right. I think so. I wouldn’t do it in the beginning.
Dr. Weitz: Steve asked about magnetic therapy. We’ll just send him for an MRI. No.
Dr. Chapek: Steve, are you thinking like TMS or like-
Steve: Exactly. Exactly.
Dr. Chapek: Yeah. There’s some data on that actually for brain injury, after sort of later stages, if they’re not getting better. And it’s really cool is we’ve had some [inaudible 01:08:21] target using SPECT imaging. So you saw that guy with the low left temporal lobe, left frontal lobe, and I’ll say, “Okay, focus the magnet here, left temporal lobe, left frontal lobe.” And that’s very helpful for a lot of folks. But, yeah, I would say the strongest treatments are really some of the basics like ketogenic diet, the supplements, and things like exercise, and then fixing structural integrity. I can’t highlight that enough, how important it’s to do the structural pieces. Getting into see your good chiropractor and getting things aligned is just helpful for so many.
Dr. Weitz: Have you used peptides?
Dr. Chapek: A little bit. A little bit. I’ve been kind of cautious. I’ve kind of gone with what most of the literature shows and sort of the basics, but, yeah, they’re promising. They’re powerful, powerful… Mostly I’ve used them with low growth hormones like sermorelin and things like that. That’s where I’ll certainly use peptides. Because there’s not a lot of other natural things besides exercise that work for increasing growth hormone levels.
Dr. Weitz: Yeah, I’m thinking like BPC 157, cerebrolysin.
Dr. Chapek: I use cerebrolysin a little bit, couple cases, didn’t seem to help, but I’m not an expert. I think BP 157’s a really good call for acute TBI, maybe [inaudible 01:10:00]-
Dr. Weitz: Have you tried that intranasal synapsin I mentioned?
Dr. Chapek: No, I was just thinking about that. Oh, that’s an interesting… I’ve used it with Alzheimer’s and dementia some, but it’s a good idea to try for TBI certainly. I’ll probably experiment with that now.
Dr. Weitz: Cool.
Dr. Chapek: Great.
Dr. Weitz: Okay.
Dr. Chapek: What a great group you have.
Dr. Weitz: Thank you. Any other questions? Everybody get their questions answered? Okay, excellent. How can listeners, viewers who are here now or who are listening to this on the recording, how can they get ahold of you, find out about your work?
Dr. Chapek: To you all here and the future listeners, I’m Dr. Chapek. I’m at Amen Clinics Northwest in Seattle, and we have a clinic here. There’s 13 clinics across the country, California, New York, Florida. Patients can come here and see me in Washington. We have other great naturopathic doctors in other clinics and psychiatrists. I do see patients via Zoom, mostly. And I also have a book, Concussion Rescue, so if you want more information, want to read in depth, it’s designed to be used for clinicians as well as patients to help sort of about how to approach this really important issue of traumatic brain injury.
Dr. Weitz: Excellent. Thank you so much and thank everybody who joined, and we’ll see you next month.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way, more people will discover the Rational Wellness Podcast. And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.
