Dr. Bennett Omalu wrote a piece in the NY Times explaining his rational for kids not playing football and other potentially traumatic contact sports until they can consent legally at the age of 18. Will Smith has the new movie ‘Concussion’ releasing this week, based on Dr. Omalu, and now the biggest topic in sports is OBJ’s maliscious head first illegal hit on Josh Norman. Head trauma is a hot topic every single week in sports. This has created quite the storm at ESPN with commentators and reporters either for or against age restrictions, ex-NFL players weighing in and other prominent neurologists giving their expert opinions. Almost everyone with kids has an opinion about this issue. All the talk seems to be about the concussion itself and the consequences later on, as if there is no way to reverse or prevent future injury. One of the most important components of this issue is being left out and completely skipped over and I am not sure why this is the case.
NUTRITION PLAYS A HUGE ROLE IN CTE AND SUCCESSIVE BRAIN TRAUMAS.
No one has brought this issue up. Why do you do think some players who have had repeated head injuries recover faster and seem to not be affected, where some players get hit once and seem to never quite fully recover? Is it genes? Probably not, as the Human Genome Project turned out to be quite the failure in terms of unlocking the end all be all of human genetics. We now know that nutrition, stress reduction, lifestyle, exercise and love can all improve our genetic profile, turning good genes on and bad genes off. This new field of genetic research is called epigenetics. That is not what this paper is about though. This paper is going to detail why EVERYONE has missed the boat when it comes to treating and talking about this issue. It is a nutritional issue, and inflammation is at the root.
When someone gets a concussion or traumatic brain injury (TBI) a whole cascade of things happens. Neuroimmune pro-inflammatory cytokines increase in number and invade the brain, and in some cases preferentially to the same areas affected in Alzheimer’s and dementia. Along with the pro-inflammatory cytokines, glutamate, aspartate and many other excitotoxins increase dramatically creating the perfect storm for brain inflammation and damage.
Glutamate is the neurotransmitter of seizures and increases with any type of noxious stimuli, like getting your head hit during a football game. It is also the most abundant neurotransmitter in the brain and necessary to proper brain function. When in balance the brain functions normally and glutamate is a good thing. In cases of trauma, glutamate can increase exponentially and create seizures, chronic pain, potentiate CTE and a whole host of other brain issues.
GABA is the neurotransmitter with the opposite function of glutamate and is its buffer. GABA balances out glutamate. The body is very interesting in that GABA is made from glutamate and requires a series of minerals, vitamins and amino acids to convert excitotoxic glutamate into calming GABA. Yet, do we recommend an increase in these nutrients for people who have had a TBI? I am yet to find a patient who reports the ER recommended or gave them nutrients to help their body make GABA more efficiently following a head trauma. GABA itself can be taken as a supplement, but has a terrible absorption rate. Magnesium, taurine and B6 are 3 nutrients needed for the conversion of glutamate to GABA. Why are these nutrients not a standard of care in TBI?
The brain does not have pain receptors so when the brain gets injured it reacts differently than other parts of the body like your toe. If you stub your toe, you feel pain and you do everything in your power to decrease that pain. When the brain gets hit, instead of it being painful (you may feel pain on the skin, as your skin has pain receptors) mood changes happen. Memory, poor attention, bouts of disorientation, confusion, headaches and other mental problems manifest. This is partly why the brain is so enigmatic.
CTE and the original dementia pugilistica have consistently been associated with brain atrophy with the frontal lobe being the most effective. The frontal lobe is what makes us human. It is our higher processing center. Brain atrophy has also been associated with dementia and Alzheimer’s meaning part of a healthy brain is having a full, adequately sized brain. Omega 3s have been found to increase the volume of the brain, which begs the question. Do patients with CTE or a history of TBI need extra omega 3s to prevent brain atrophy? The answer is yes and to follow that recommendation would be to address the fact that omega 3 supplementation has virtually no side effects. In fact, Dr. Mauro di Pasquale has found there to be a minimum of 14 studies per named disease supporting the use of Omega 3s in that condition. Minimally, in the event of a TBI or worse, chronic concussions, taking extra Omega 3s everyday would be so simple and a ‘first do no harm’ strategy to help alleviate the effects of brain atrophy and prevention of future symptoms due to brain trauma. Omega 3s have also been found to improve depression, anxiety, ADHD and many other brain issues, all which are symptoms of brain injury.
Total body inflammation and brain inflammation are implicated in TBI and also can potentiate a bad response. Researchers have found that in a high inflammatory state the brain becomes more susceptible to the excitotoxic state when a TBI occurs. Inflammation enhances excitotoxity. We could go on for days and days with mechansims and studies documenting inflammation and excitotoxicity but here is the low down. Total body inflammation leads to brain inflammation. This is a sort of priming for excitotoxity. When a trauma happens in this state the brain more readily activates the inflammatory cycle creating excess glutamate and other excitotoxins. Thus, creating a state where CTE can develop and flourish. Inflammation is a huge problem and in the words of Dr. Mark Houston, is one of the top 3 causes of all disease.
In terms of preventing brain injury or at least helping mediate it or treat it when it happens, shouldn’t an anti-inflammatory lifestyle, diet, supplement plan and workout structure be part of the picture? Why aren’t we educating our children, teenagers, young adults and professional players to the proper preventative measures? Living an anti-inflammatory lifestyle is a strategy to prevent the long term effects of head injuries. Wouldn’t this be a strategy to help make football safer?
The last lifestyle and preventative measure I want to address in this article is toxicity, environmental factors and detoxification. It is no surprise that toxins play a role in this. Toxins have been found to increase glutamate and inflammation. The majority of toxins are fat soluble which is bad for the brain, being it is mostly fat. Toxins readily cross the blood brain barrier and infect the brain. Research is finding that toxins “prime” the brain for excitotoxic conditions like a TBI. Why aren’t brain authorities (at least the ones on TV and getting media attention) advocating detoxification as a way to help prevent the traumatic effects of brain injury? Is it because nutrition isn't sexy? Does it not make enough money? Healthcare seems to be more about the latest gadgets than true prevention. Is that the case here?
Lifestyle Medicine is a platform that looks to maximize health through lifestyle, diet, supplements and detoxification through limiting exposure and supporting the body’s own detoxification processes. I will admit that I run a Lifestyle Medicine practice and we have a heavy focus on detoxification. The reason for this is simple. It works. People come in sick, fatigued, fat and experiencing brain problems. A detoxification program is one of the fastest ways to get people feeling their best (not just better) in the shortest amount of time. In terms of concussion prevention and making traumatic and injury prone sports safer, a proper prevention plan with an anti-inflammatory diet, Omega 3s (at a clinically effective dose), supplementation to support GABA production, detoxification and a lifestyle limiting environmental toxins and exposures. This minimally needs to part of the conversation and maximally needs to be implemented into the education strategies by the NFL and other football, hockey, soccer, lacrosse and other contact sports organizations and authorities.
I believe sports are a good thing for kids growing up. The ESPN personalities who were ex-NFL players were right. A lot of kids thrive in a sport environment and completely taking away a whole host of sports is not the answer. On the other side, head trauma and later in life brain problems are becoming a real issue. You have a 50% chance of losing your mind by age 85 which is alarming. Brain health needs to be a top priority and I believe nutritional prevention needs to be a staple in the discussion. Do kids who play contact sports, eat a healthy anti-inflammtory diet, take extra Omega 3s and get proper sleep have the same risk of head injury and CTE as kids who are stressed out, eating fast food, not sleeping enough and playing the same contact sports? My guess is not, and research will eventually support this. It is time to:
EAT RIGHT, LIVE RIGHT, SLEEP RIGHT, EXERCISE RIGHT, SUPPLEMENT RIGHT, DETOXIFY RIGHT, DRINK RIGHT & LOVE RIGHT
In proper brain health,
Dr. Kurt Waples
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**References available upon request.