Why You Should Listen

In this episode, you will learn about integrative approaches to healing Traumatic Brain Injury.

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About My Guest

My guest for this episode is Dr. David Musnick.  David Musnick MD is a Sports Medicine, Functional Medicine, and Internal Medicine physician in Bellevue, WA practicing at Peak Medicine.  He has developed a Functional Medicine approach to healing the brain after concussion and Traumatic Brain Injury originally presented at an Institute for Functional Medicine annual meeting in 2017.  He has written the chapter on Concussion and Traumatic Brain Injury in the book Integrative Neurology.  In his practice he integrates supplements, exercise, diet, and treatment for metals, toxins, mold, and infections.  He has expanded his approach to also treating Mild Cognitive Impairment.  Dr. Musnick is also a specialist in Prolotherapy and all aspects of Orthopedic and Sports Medicine.

Key Takeaways

  • What is the pathophysiology of brain injury?
  • What are the common symptoms of head injury?
  • Can a TBI be a trigger for Mast Cell Activation Syndrome or activation of the limbic system or Cell Danger Response?
  • How long after initial injury can treatment protocols realistically expect to lead to improvement?
  • What are the stages of brain injury?
  • How is the brain protected from further damage after injury?
  • What is the role of the blood-brain barrier in brain injury?
  • What role does excitotoxicity play in brain injury?
  • How is reducing neuroinflammation approached?
  • How are microglia shifted to the health-promoting M2 type?
  • What is the role of Nrf2, and how is it activated?
  • What is the role of oxidative stress after brain injury?
  • How are mitochondria supported in a brain healing program?
  • How is the migration and survival of nerve stem cells supported?
  • What is the role of the vagus nerve in brain injury?
  • How can nutrition be used to support optimal brain healing?
  • How is optimizing brain oxygenation approached?

Connect With My Guest

http://PeakMedicine.com

Interview Date

May 13, 2020 

Transcript

Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  

[00:00:01.15] Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

[00:00:14.06] The content of this show is for informational purposes only and is not intended to diagnose treat or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice, or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

[00:00:35.01] Scott: Hello everyone, and welcome to episode number 119 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. David Musnick, and the topic of the show is Traumatic Brain Injury. Dr. David Musnick is a sports medicine, functional medicine, and internal medicine physician in Bellevue Washington, practicing at Peak Medicine. He has developed a functional medicine approach to healing the brain after a concussion and traumatic brain injury originally presented at an Institute for Functional Medicine annual meeting in 2017.

He has written the chapter on concussion and traumatic brain injury in the book ''Integrative Neurology''. In his practice, he integrates supplements, exercise, diet, and treatment for metals, toxins, mold, and infections. He has expanded his approach to also treating mild cognitive impairment. Dr. Musnick is a specialist in Prolotherapy and all aspects of orthopedic and sports medicine. And now my interview with Dr. David Musnick.

This is my first show on traumatic brain injuries or TBIs and concussions. Head injuries can play a major role in chronic illness, and addressing them often leads to higher ground. I'm very excited today to have Dr. David Musnick here to share approaches for recovering from TBIs in his integrative practice outside of Seattle. Thanks for being here so much today, Dr. Musnick.

[00:01:59.26] Dr. David M.: You're welcome.

[00:02:01.12] Scott: What drew you to the world of medicine? And more specifically, how did you become interested in working with patients with brain injuries? What was your background and experience in traumatic brain injuries and concussions? 

[00:02:13.22] Dr. David M.: It's a long story, what drew me to the world of medicine. But in regard to working with people with head injuries, I went to medical school at the University of California San Francisco. And I actually did a rotation in a Santa Clara Valley Medical Center and spent two weeks in the brain injury section and two weeks in spinal cord.

And that got me interested in those areas of those. I mean, in order to be there, you'd be hospitalized for a head injury or spinal cord injury, but that initially got me interested. But that got me interested in physical medicine and in rehabilitation. And then I went on past my internal medicine to do a sports medicine fellowship and then practice sports medicine.

And I would see patients with whiplash and neck injuries, and head injury in the sports medicine part of my practice. But I would have a lot of patients that were being managed by neurologists, asked for my opinion on things, and I was gradually accumulating information about things like BDNF and neural inflammation and brain challenging systems in games, and neuroprotection and things. And then, in the fall of 2016, the Institute of Functional Medicine asked me to create an integrative functional medicine approach to healing the brain after a head injury in order to present it at the brain meetings that they were going to do; Brain and Neuroplasticity in Los Angeles in June of 2017.

So I took on the challenge because the program I had developed wasn't as comprehensive as it needed to be. And wasn't as research-based as it needed to be, so I took on the challenge of reading every research article and putting together the pathophysiology in a real integrated program to heal the brain after a head injury that it really makes sense every step of the way I think.

[00:04:33.16] Scott: Talk to us about the common types of head injuries that you see in your practice. Do they have to be a significant traumatic accident, or can even a small, often-forgotten bump to the head become a contributor to a long-term chronic illness?

[00:04:50.07] Dr. David M.: Well, yes. So I see lots of car accidents and where they might not even actually hit their head, but there's this coup-contrecoup force. And often flexion and extension, or it depends most people are around it, but it depends on that type of force. And I see mountain bike injuries where people fall off their mountain bike. I see ski injuries, snowboard injuries, and then I see people fall. Then I see kids who bang their hands on almost anything.

And what I would say is that the amount of the head injury that's caused has to do with many different factors. Because sometimes people that have what seems like milder head injuries will still have quite a few symptoms. And so every patient I see I've got to put it together about the picture that they have, the stakes that they have, the pathophysiology.

Why they're having so many symptoms, or the symptoms they're having, I have to characterize at what brain regions are having symptoms in that person because then I need to treat those brain regions to sort of restore, reserve, and get well above reserve.

[00:06:11.17] Scott: Can we have a head injury or TBI that's not the result of some external physical trauma? So things like chemical exposures or mold exposures? Can those lead to what we're talking about here in terms of brain injury?

[00:06:25.04] Dr. David M.: They could lead to brain injury, but not the same type of brain injury. So when we talk about the pathophysiology, we realize that a lot of other things are actually compromising people's brains. And causing insults to people's brains, and like mold biotoxins, like co-infections, like neurotoxins, we're exposed to a lot of neurotoxins. Like LPS, lipopolysaccharide from postprandial endotoxemia. And so a lot of people have different things going on even before the head injury and then the head injury happens.

And so what I would say is that a classic head injury is physical trauma. Now the things you're talking about are non-physical insults to the brain that one has to also take into account in regards to brain health.

[00:07:28.19] Scott: What's the difference between a TBI and a concussion? So can I have a traumatic brain injury without concussion? Can I have a concussion without a TBI?

[00:07:39.23] Dr. David M.: You can have a traumatic brain injury with a concussion, but you can't have a traumatic brain injury really without a concussion if it's traumatic. You can have a concussion without a subsequent traumatic brain injury. So the way I characterize this, and it's kind of important because there's a number of terms being used.

So there's concussion which is the actual event that someone fell, hit their heads, possibly saw stars or lost consciousness, that's the event of the head injury. I had someone might say well they had a concussion. Well, post-concussion syndrome is many different symptoms after that headache, dizziness, nausea, decreased appetite, poor sleep, mood instability; there are all kinds of symptoms that are characterized under post-concussion syndrome.

But traumatic brain injury is really deficit in reaching the regions of the brain that will show up when you do testing with either questionnaire, and that's how I do it. Or history taking and physical exam, that there's a deficit in function in parts of the brain, and therefore we characterize those people as traumatic brain injury. And of course, if someone had a bleed and they're unconscious or in a coma, that's a severe traumatic brain injury. Most of what we're talking about here would be mild to moderate traumatic brain injury, without a definite brain bleed.

[00:09:23.22] Scott: You just touched on some of the symptoms, but what are the symptoms that one should watch for after they have a head injury that might then lead them to consult with someone like yourself? And then taking that a little bit further, many people listening have a chronic illness maybe have not thought about a head injury or traumatic brain injury as a contributor. What are some of the clues that might lead them to want to explore this area further?

[00:09:50.01] Dr. David M.: Yes. Well, if you've had a head injury before, and now “you're having something else going” on and you're having brain symptoms. Brain fog, cognitive dysfunction, problems with memory, problems with executive function. Problems with organization, mood instability is a big deal. Then just the fact that you've had a head injury, that person has had a head injury or head injuries before, could have lost to damage to neurons and synaptic density, so that now whatever they're dealing with even if it's a little head injury in addition to the other ones.

Or they have mold biotoxins or co-infections, which could be causing much more loss of function that we might ordinarily think it would. So the head injury part is important to deal with at any time that someone's having cognitive symptoms or emotional instability, liability. And my thinking is I would not want a person to have a head injury without having this approach, because this approach that we're talking about, that I'm going to be talking about more deals with the pathophysiology.

Deals with trying to augment nerve stem cell migration and health, and then the restoration of synaptic networks. And those concepts are not thought of in a conventional method of basically make the diagnosis and refer to a few therapists, which is the average treatment because there are no drugs for traumatic brain injury. And since there are no drugs in the conventional approach, they will diagnose it and then refer to a few different therapists.

[00:11:49.03] Scott: What is the contribution of a TBI in the development of later, more serious neurological conditions like Multiple Sclerosis or Parkinson's or ALS or even Alzheimer's? And then where does CTE or chronic traumatic encephalopathy, where does that fit into this discussion around traumatic brain injury?

[00:12:10.08] Dr. David M.: Well, traumatic brain injury has been implicated as a possible risk factor for the possible future development of dementia and CTE or chronic traumatic encephalopathy. As well as autoimmune diseases of the brain. And the reason for this is, and we'll be getting into this in more detail, but the reason for this may be because after traumatic brain injury a person can develop antibodies to the blood-brain barrier and even antibodies to different brain tissues.

And so the concept of blood-brain barrier antibodies and antibodies to different brain tissues with neural inflammation can set the stage for these autoimmune diseases. Now, I know that there's a relationship between head injury and Alzheimer's, head injury and different types of dementia, head injury and Parkinson's. I'm not completely clear in the literature about head injury and MS or ALS, but it would potentially make some sense in regard to the concept of auto-antibodies.

[00:13:42.24] Scott: Could a traumatic brain injury be a trigger for some systemic hypersensitivity in patients? For example, Mast Cell Activation Syndrome? Or could a TBI be a trigger for impacting the limbic system in some way so that our perception of what is safe versus not safe around us is impaired in some way?

[00:14:05.05] Dr. David M.: Well, yes, absolutely. A TBI can affect the limbic system, which you can think of as the emotional regulation system. And I see some patients that are presenting with head injuries with mostly emotional symptoms, mood instability, irritability, very quick to get angry.

So yes, I treat a lot of people with the limbic system, what I'll call limbic system injury and dysfunction after head injury. And it's not simply a ''drug problem'' that they need an antidepressant or something. They need healing of the limbic system.

[00:14:51.18] Scott: And do you see Mast Cell Activation Syndrome as a potential result of a brain injury? Or is there not necessarily a connection between those two?

[00:15:01.00] Dr. David M.: Well, I definitely see people with a head injury and Mast Cell Activation Syndrome. I mean, probably one could link them. I've had a hard time finding absolute mechanisms there; I mean, if someone has had Mast Cell Activation Syndrome and then had a head injury, the Mast Cell Activation Syndrome can make it more difficult for them to heal. And that you have to work on stabilizing the Mast Cell Activation Syndrome and doing things to stabilize mast cells.

Because that's going to be acting up in the GI tract and the release of a lot of histamines can make for mood instability being even worse. And so I'd say yes, so this brings up position what you have to think about when someone has a head injury. Because it's not the usual, which is the doctor rules out a brain bleed and then says rest. And then they get referred to a neurologist, and they say I'm going to refer you to a speech therapist or physical therapist, an occupational therapist.

That's all fine, but it's like what's the goal of those treatments? And the real questions need to be what's the goal of the treatment you're referring someone to do, what is the path of physiology and the other conditions that can affect the brain, that you need to keep thinking about while you're trying to heal the brain in that particular individual, including Mast Cell Activation Syndrome, including neurotoxins, including infections, including immune system dysfunction, EMF. There's a lot you have to think of to help heal someone's brain, yes.

[00:16:58.27] Scott: So when someone comes into your office, how do you assess and ultimately diagnose a traumatic brain injury. Do you get some benefit from MRIs or CTs or PET scans or NeuroQuants or any of those types of things? Or how do you arrive at the conclusion that a TBI may be in play in a particular patient?

[00:17:18.17] Dr. David M.: Well, what I summarize about imaging studies is they're mostly not useful. So CAT scans are useful initially if one suspects a bleed, like a significant head injury, or moderate head injury, to rule out a bleed. And that would be done usually the first day, possibly the second day. It would be useful for really bad headache after a head injury or hit to the temple area; we're trying to rule out a temporal artery bleed.

And then after that, CAT scans really are not useful. And I've seen patients that have had multiple CAT scans because they go back with more symptoms. And then some doc will do another CAT scan; I'm like thinking oh my goodness, this person was in radiation therapy because they're getting CAT scans, and they're being exposed to the radiation of the CAT scans. So I'm okay with one CAT scan to rule out a bleed during the first day or two, but not any CAT scan after that unless there's a concern of another bleeding.

Because that imaging study is not good for things other than bleeds and big tumors. MRIs, in general, are not sensitive enough to pick up a head injury. The NeuroQuant is an MRI of sorts that can pick up loss of brain tissue, but it's not generally that useful. It doesn't help me get necessarily my treatment that much, but will cost the patient a fair amount of copay or if it's an auto accident, will take a lot out of their plan, and I don't find it that useful.

The only time I use NeuroQuant is in a medical-legal case, where I'm involved with taking care of the person who was hit in a car or hit as a pedestrian or something. There's a medical-legal case against the person who hit them; then, a NeuroQuant may be helpful. A NeuroQuant can actually also backfire, because if you don't find anything, then the other side says well, you didn't find anything. So in PET scanning, I don't find that helpful; SPECT scanning can be helpful.

I don't order it that much. I'm generally doing a history, doing a really in-depth neurological exam with really good balance testing and a really good neurological testing. And I have a questionnaire that I use that's a three-page questionnaire that tests each brain region with questions on a scale of 0 to 4 to see if there are issues in that brain region, and that's one of my most useful tools.

[00:20:02.28] Scott: When we have a head injury, let's talk about the underlying process that follows or pathophysiology that happens in terms of the impact to the brain. Is it that there's a circulation deficit or hypoperfusion? Is it that there's reduced oxygenation? What are the mechanisms that follow the head injury?

[00:20:23.11] Dr. David M.: Well, initially, you have this shearing; you have shearing forces on tissue that starts damaging the tissue biomechanically. And then you have bleeding, but small amounts of bleeding, not like one big pocket of blood, but small amounts of bleeding. And then you have deficits of oxygenation; those are the initial processes. And then, those processes start other pathophysiology like excitotoxicity processes, and we can go into detail and these other pathophysiology processes.

But mitochondrial energy deficit, and neural inflammation, blood-brain barrier changes. So there's a sequence of events that I think of depending on how many days out they are from the head injury, which gets into what we call staging. But the pathophysiology has been outlined really well in studies on mice and rats so that pathophysiology has been outlined fairly well. But the funny thing is most doctors don't take any of it into account to treat the patients.

[00:21:44.11] Scott: Are there specific areas of the brain that are more sensitive to the impact of a brain injury or concussion in terms of the symptom potential that could be created? So, for example, is it worse to get hit in the back of the head versus the front of the head? Or are any of these potentially problematic?

[00:22:01.23] Dr. David M.: Well anything is problematic, because I mean very common people get hit on the back of the head Like let's say you're in an auto accident, someone rear-ended you. You're going to likely at least the back your head on the seat rest support. So that would be some kind of impact. But if you didn't hit your head that much, you could move your head a lot in a whiplash in a coup-countrecoup.

So that could injure both the frontal lobe and the cerebellum, the hindbrain. Now oftentimes, the temporal lobe gets injured because there's bony structure in the brain which the temporal lobes are up against. And so in a flexion-extension injury or in a rotational injury, part of the temporal lobes is often going to get injured as well. The hippocampus frequently gets injured, which is your memory center, and what's also interesting is the vagus nerve gets tractioned very commonly, and that gets injured. But with frontal lobe injury, you get all kinds of problems with executive function, organization, planning. If it's really bad, people are losing their vision.

So I mean every brain area has its problems, and I think it's extremely important to be able to tell the patient you are showing deficits in these regions, and like list the deficits and the regions, and this is going to be my plan to rehabilitate these regions. Because if you can figure out what brain regions have been injured, then you can actually, as part of your program, do brain training for that region.

[00:23:52.00] Scott: How is the conventional approach, we've talked about this a little bit, how is the conventional response or approach to a head injury different from how you're approaching concussions and TBIs? What is your goal of therapy?

[00:24:05.11] Dr. David M.: Well, I do everything that the conventional approach does in regards to label the diagnosis, do a complete neurological exam. My exam might be even more detailed, especially with balance. And then like I said, my knowledge of this is because I've had so many patients telling me what happens when they go to the neurologist or the primary care. They just keep telling them well, what can you expect you have got a concussion, you have post-concussion syndrome, you have mild TBI. So sometimes they'll be referred to a speech therapist.

Referral to a physical therapist may make sense if they have balance problems, I do that. Assessing them for vision problems, really important in referring them to a trauma vision specialist, really important; I do that. But what's not done in the conventional approach is to look at the underlying pathophysiology and talk to the patient about how do we modulate this, how do we decrease neural inflammation, how do we decrease cytotoxicity.

How do we augment mitochondrial function, how do we improve the ability of nerve stem cells to survive? There's a whole lot of pathophysiology that's going on, which then can lead to what we call secondary brain damage. So the initial brain damage is caused by the hit to the head or the motion to the head, the secondary brain damage is everything that goes on after that, and the conventional approach is not addressed at all, really.

And then I do use a lot of supplements and vitamins in my program because there's been a lot of research with mice and rats where they're using different supplements and vitamins to see what can be modulated in regard to neural inflammation in the pathophysiology. So I will use certain supplements, vitamins, and dietary interventions. I have never had a patient tell me what they were doing in the conventional approach that any dietary interventions were used.

So my program is quite expansive in terms of addressing the pathophysiology, addressing any comorbid things like co-infections and EMF and neurotoxins and mast cell activation. I addressed the issue of autoimmunity, the blood-brain barrier, as well as autoimmunity to brain tissues and then talk about how to protect the brain. How to stimulate the brain, and then how to modulate the different pathophysiology processes and then work on the lifestyle issues of exercise and sleep, and diet that really affects the brain.

[00:26:59.27] Scott: So the way I maybe would summarize it is that the more conventional approach is to watch and wait, and your approach is more about creating a healing opportunity for the patient.

[00:27:11.06] Dr. David M.: Yes, and addressing the specific pathophysiology and comorbid issues that are really important to preserve brain tissue, to improve synaptic density and improve brain function.

[00:27:26.06] Scott: How long after a head injury can one hope to still improve their situation? If the injury was years ago, is there a point where it's too late? Is there still hope? And do younger people respond better to treatment than older people?

[00:27:43.00] Dr. David M.: Well, yes, and that's an interesting question. So any time after a head injury, I've had patients literally ten years later, well what is CTE? It's like people years later. So I've had success with any number of months or years after a head injury. Now younger people do seem to heal faster than older people because they have more brain reserves theoretically. They have more brain reserve, of course, because you start out in more brain reserve.

What's really interesting is young people generally respond incredibly well to Frequency-Specific Micro-current for brain healing. But in general, they respond extremely well. Like kids in elementary school, they're more likely to re-injure themselves, because they don't have as much spatial awareness and will re-injure themselves in physical therapy. But they generally heal better. The older the person is, the more likely they have less brain reserve at the time they got the head injury.

Because we can have brain shrinkage over time from aging, and that just brings up the issue that a lot of the things that I'm talking about are very important for keeping your brain healthy. And so it's a lot of things I'm talking about in terms of pathophysiology, it's very related to brain health in general because I don't assume that anybody necessarily has a perfectly healthy brain. I mean, we all have stressed brains in some respect; they're one of our more stressed organs.

And we have to do things to generally try to keep our brains healthy. And a lot of the concepts in regards to the pathophysiology after brain injury, some of the pathophysiology is going on when people haven't had a brain injury that they have to do things for brain health in general. So hopefully that answered your question.

[00:29:39.02] Scott: So you've talked about this concept of brain reserves, which I kind of think of as the brain's ability to adapt to some stressor. What is brain reserve? What are some of the factors that influence how much reserve we have? And should we be doing things to increase our reserve, even if we haven't had a known injury?

[00:29:59.01] Dr. David M.: Well, yes, we should be. In general, I think everybody, especially people over the age of 25, should be doing things to increase brain reserve, because the brain reserve you have in different brain regions, the less likely you're going to have symptoms. There are a very high incidence and prevalence of Alzheimer's and dementia and people with brain dysfunction in the United States in Canada all around the world.

And so it's not as low as we were taught in medical school, it's like there's a lot of people with brain issues including mild cognitive impairment, brain fog. People said I'm not as sharp as I was, or people saying what can you expect like in my mid-50s. I mean, I'm thinking your brain should be healthy in your mid-50s, and they think it shouldn't be. So brain reserve the way I explained it to a patient is I'll draw a graph, and in this graph, I have a line. And I'll say let's just talk about this part of your brain that works on memory, like the hippocampus, okay.

If you go below the level of brain reserve, you're going to start having problems with short-term memory. In other words, the level of brain reserve in terms of this concept is below which you have known problem symptoms that you are aware of, the person is aware of, maybe someone else is aware of. I mean it's pretty bad if that person is having symptoms and they're not even aware of it, and that happens too, but that's usually in more advanced cognitive impairment or Alzheimer’s, they're not even aware of it.

But when people are aware okay, I think I'm having some issues I can't remember that person's name, I can't find a word. I go into a room; I can't remember why I went in there, I keep losing things. So that's a concept in terms of below a level of reserve, that person's going to have symptoms. The higher the person is above that level of reserved in that area in the brain, the less likely they are to have symptoms from either a head injury or from all the other things that are insulting our brains. You don't need to have a head injury to have memory problems or the different problems people are having these days with the brain; there are many things that are affecting their brain. So I tell people, we not only want to get you just above the level of reserve, because you might not have symptoms there, but then you're more susceptible.

As for instance, I had a patient who was having just, for instance, memory problems; she hit her head on, I think was a rental car hood in Europe. And then she followed my program and got a lot better, but because of certain reasons and she couldn't continue doing it to really increase brain reserve. Because I tell people you're not even stopping supplements until you're three months without any symptoms in these brain regions, in these particular brain regions.

At least three months, because what do people usually do, they stop treatment when they're asymptomatic for a week, they just stop treating oh I'm fine. Well, in terms of the brain, that's just barely above the level of brain reserve. We want them much better than that. Otherwise, they're susceptible to stress and other things they could bring them below the level of reserve again.

[00:33:26.07] Scott: So what are some of those other factors beyond head injury that influence how much reserve we have? What are some of the stressors that reduce our reserve?

[00:33:34.27] Dr. David M.: Yes, and you can even think of reduced reserves as reduced neurons, reduced synaptic connection, reduced synaptic density. Loss of microglial tissue or microglial cells, the M1 phase is more inflammatory and less functional for neurotrophic factors. So there are many things, I mean like EMF, exposure to electromagnetic fields, some people more sensitive than others. I'm very concerned about 5G because I think that's really going to stress people's brain reserve and the blood-brain barrier.

The neurotoxins that people take in from food, the lipopolysaccharide that gets released from post-endotoxemia, postprandial endotoxemia, and lipopolysaccharide can injure the brain and cause neural inflammation if they've had mold biotoxins if they've had any infections in the brain. And I'm not talking about outright bacterial infections; I'm talking about chronic smoldering infections. I mean, there are so many things that can compromise the brain and especially stress, but also lack of sleep.

I mean, it's been shown that people that sleep less than or equal to 6 hours a night have neural inflammation that persists for at least a week and can damage the blood-brain barrier. So lifestyle things will affect the brain, and all these other conditions will affect people's brain that can affect brain reserve, including the former head injuries if they've had any.

[00:35:16.25] Scott: So let's come back to this idea of stages that you mentioned, so what are the different stages, what are the unique characteristics of each stage? And at a very high level, how does the stage of the head injury impact your exploration and your putting together a treatment protocol?

[00:35:34.00] Dr. David M.: So I would characterize the stages in a certain way as acute, subacute, and chronic, and this characterization has been done with many different injuries. Musculoskeletal injuries can usually be characterized that way. But what's interesting in Frequency-Specific Microcurrent, we use that characterization for musculoskeletal injuries and for head injuries. So the acute stage is when there are more issues leading the mechanical shearing forces, hypo-oxygenation, and excitotoxicity is going on then.

There's the beginning of neural inflammation, and maybe that stage you might say is occurring for the first week. And what's interesting about that is that hyperbaric oxygen can be very appropriate that, because hyperbaric oxygen increases oxygenation. So whereas I see patients that the other doc didn't even think about hyperbaric oxygen until they're very chronic, okay, well, you haven't responded in this therapy and that therapy.

Somebody read about HBOT, let's try that. It's very appropriate right in the acute stage. So HBOT is actually appropriate in the acute stage and the sub-acute stage. It's most appropriate then, as opposed to simply in the chronic stage. So in the sub-acute stage, people are dealing a little bit more with mitochondrial dysfunction in regard to energy dysfunction, the inability of the mitochondria to produce enough energy.

They're dealing with excitotoxicity, and they're dealing with potentially, and I said not everybody is, potentially blood-brain barrier issues. They're dealing with the loss of neurons, the loss of function. So the people can deteriorate from even what it seems like how they were doing in the first week, and even starts deteriorating more as the neuron density and the synaptic density gets less in the subacute phase until we start doing some things to try to regain that function. And then, in sub-acute phase, there's damage to the microbial population, as well as damage to the neuronal population and the synaptic density. And there are probably not enough neurotrophic factors; it just depends on how their brain operates in regards to producing neurotrophic factors, what they're doing to induce neurotrophic factors.

These are things like a brain-derived neurotrophic factor to stimulate neurogenesis and synaptic density. In the chronic stage, that the majority of people are dealing with issues that chronic symptoms that haven't changed for a while, they've plateaued; that might be after ten weeks. They plateaued, they're having light sensitivity potentially they're still having headaches. There could be unresolved neck issues, but they're having problems with memory or emotional lability, different cognitive issues in brain regions that just haven't resolved.

And then in those stages, the important things are asking questions like what do we do to augment nerve stem cells. What do we do to augment synaptic density? What do we do to shift the microglial cells away from the M1 morphology, more into the M2 morphology? What do we do to increase brain-derived nerve growth factor and these trophic factors, and of course, improving lifestyle factors, diet? And what do we do to train the brain, what brain training can we do because brain training is really important for increasing synaptic density, increasing brain reserve? So chronic phase for people can go on and on and on.

Now, if someone has no symptoms and has past level of brain reserve in all brain regions, can you still say they're in the chronic phase? No, you probably wouldn't. You'd say they're asymptomatic; they've healed from the brain injury. We don't know how much absolute healing they've had, but you don't always know until they had another brain injury or something that insults the brain to see how easy it is for them to have symptoms.

[00:40:05.19] Scott: You've touched on a number of these components of your treatment model, but talk us through as we get into more treatment discussion, what are of the components of the treatment model that limit brain damage that increases brain reserve and leads someone towards a path to healing their brain injury?

[00:40:23.20] Dr. David M.: Well, one of the most important things would be to limit and modulate neural inflammation. So neural inflammation would be inflammatory modulators in the brain itself. And so, limiting neural inflammation is really important. So that's one thing, and neural inflammation is limited by having enough sleep, deep sleep, more than eight hours ideally. Neural inflammation is limited by protecting the brain from neurotoxins, protecting the brain from lipopolysaccharide.

So working on the gut and the GI tract is extremely important. Neural inflammation is limited by a special type of curcumin called Longvida that passes into the brain. So curcumin is extremely important in limiting neural inflammation. And then flavonoids will modulate neural inflammation to some extent. So that's a big component, and then limiting excitotoxicity is really important, because excitotoxicity can lead to cell death.

But it also leads to substances inside the cell, neuronal cells, or microglial cells leaking out into the surrounding tissue like mitochondrial components or ATP. Different things, even neurotransmitters, just leaking out into the surrounding tissue that are very inflammatory and keeps up the excitotoxic response. So really limiting excitotoxicity is very important. And I'd say there's free radical damage that's caused by the excitotoxicity and by mitochondrial dysfunction.

So limiting free radical damage it's really important because radicals damage neurons, they damage microglia cells, they damage the blood-brain barrier, they damage brain tissue. And then it's really important to then evaluate and treat potentially the blood-brain barrier. It's important to evaluate and look at the concept of can we mobilize and improve the survival of nerve stem cells because nerve stem cells only exist in certain parts of the brain. And the only way to get new nerve developing is to help the nerve stem, either migrate and survive because they can become new nerve cells, which then put out the synaptic dendritic connections.

So that's a very important goal as well. And I think we will talk more about other aspects, but improving synaptic transmission is important, especially with serotonin and dopamine. And what's really interesting is dopaminergic transmission in the brain which really affects mood, focus of concentration, it can really get disrupted which brings up the issue of genomics, because one of the things that I do in my program, I test the genetics of dopamine transmission and want to work on that if it seems like there are genetic issues that person has regarding neurotransmitters, and as well as methylation issues. Because you can really augment and optimize those things. So those are just some of the pathophysiology that we have to address.

[00:44:13.17] Scott: You've talked about protecting the brain from further damage after a head injury, how do we protect the brain from further damage after an injury?

[00:44:22.19] Dr. David M.: Well, I always give a person recommendations and say look, I don't want you doing any things that are physical that could risk falling or hitting your head. So like for three months minimum, but especially the first six weeks. We don't want a secondary head injury, because there's a phenomenon called the second impact syndrome that can be very severe, and conventional neurologists they all know about that.

So we don't want people participating in contact sports. I'll often restrict physical education in children, so they're not likely to hit their heads. I'll tell kids when they're playing with other kids. The funny thing is you get to tell kids to keep about two feet apart from other kids, not six feet apart because they swing their heads around. So I tell adults not to go up on ladders, you know anything that might affect a fall.

If it's winter and there's snow on the ground, I tell them to get this yak track or micro crampons on the bottom of their shoes, so they won't slip and fall. If there are any balance issues, I'll ask them to use trekking poles or if it's bad, a walker, or something. Just anything to help decrease the risk of falling, and then if they have balance issues, I'll them see a physical therapist to work on balance issues or gain issues. I'll have them wear stable shoes, more stable shoes, so they're less likely to fall and work on vision issues. So those are things, and then other things are like putting them on an organic diet, a non-GMO diet.

A diet high in flavonoids will protect the brain, and then I will institute electromagnetic field protection suggestions that I want that person to do as much as possible. Like, don't hold a cell phone to the head, use speaker mode, use a blue tube instead of a Bluetooth device. Blue tubes you actually see the air tubes, which actually I have them here, I'll show you. Can you see these blue tubes? They're very clear, and they have almost no electromagnetic fields.

So I have to use those when using the cell phone. I ask them to turn the router off at night, so they're not being exposed to as much Wi-Fi. So there are a lot of suggestions I have which we're calling brain protection. And if there are bicyclists, I ask them to get a 6D helmet because 6D is a company that has designed bike helmets with two shells that have grommets in between, where the shells, if you fell, will take up rotational forces. And what's interesting is the rotational forces are some of the worst forces on the brain. So like I'll make a recommendation especially if they're mountain bikers, but even if they’re road bikers get a 6D helmet, so that protect yourself if you fall, because most bike helmets are not that protective.

[00:47:38.28] Scott: Very nice. Let's talk a little bit about the blood-brain barrier permeability that you've mentioned. I've heard in the past Dr. Dietrich Klinghardt suggesting that EMFs potentially open the blood-brain barrier.

And that many of us or most of us in our modern society are walking around with open blood-brain barrier. Does this allow infections and toxins to enter the brain? Does a head injury itself also open this barrier? And then what are some of the techniques that we use to reseal a leaky brain?

[00:48:10.06] Dr. David M.: Yes. Well, yes, people can have, I call it blood-brain barrier permeability or blood-brain barrier autoimmunity. So what's interesting is that the blood-brain barrier has a structure, and it's composed of capillaries and brain cells, mostly astrocytes, glial cells. That there are proteins that are supposed to keep it sealed off, and these proteins are similar to the ones in the gut like zonulin, occludin, and actin, very similar.

And they're supposed to keep it tight enough, so that only certain sizes of molecules can get into the brain and waste products can get out, okay. And so what can happen is in the area of the injury, the blood-brain barrier can be damaged and become more permeable, become more leaky more permeable. If that happens, then yes, like lipopolysaccharide from bacteria can get into the brain is extremely inflammatory.

Neurotoxins from diet are more likely to get into the brain, less like pesticides, herbicides, metals. And yes, people can have a blood-brain barrier that's not functioning very well. And so if I see anybody with any kind of brain symptoms, a head injury or not because I see a lot of patients consult with a lot of people that don't have head injuries but have brain problems. One of the first things I'll do is I'll check for antibodies to the blood-brain barrier. I mean, the only evidence we really have is, does someone have an antibodies SB100 protein? And there are actually other antibodies that can be checked.

So I'll check SB100 and a few other antibodies with a panel. And depending on if someone's having a lot of cognitive issues, I'll also check antibodies to the brain. Because by definition, it's almost impossible to have antibodies to brain tissue without having antibodies to the blood-brain barrier. And so I think it's extremely important to assess and treat the blood-brain barrier in any brain-related set of symptoms, head injury or not, very important to do it with head injury. Now I don't talk about re-sealing a leaky blood-brain barrier, that's a good way of putting it.

Because we can talk about that to a patient, but then they think about that Flex Seal stuff or whatever they just put over the hole. Now I love that commercial because he does so many things with it, I wish we had a Flex Seal type of thing for the brain. But there are things that can be done to help heal a leaky blood-brain barrier. Now what I'd say is once it's diagnosed from the antibodies, I want to make an important point.

That the treatment has to go to the time where we get another antibody test, and they have minimal or no antibodies to the blood-brain barrier. So I think that's extremely important, it's like when are you done? You're done when maybe there are no symptoms for three months. But also these tests have to become negative or very minimal, that's really important we have to retest. So I will put people on R-lipoic acid fairly high doses of it, riboflavin may have some effect on the blood-brain barrier.

We absolutely have to reduce electromagnetic fields like I talked about, that's very important. And I definitely use Frequency-Specific Microcurrent to heal the blood-brain barrier. I designed frequencies and programs for the blood-brain barrier a number of years ago, as soon as I started getting these tests back.

And nobody really had designed really an approach to the blood-brain barrier. So I said okay, I'm going to design the frequencies with the programs, but the sequences of frequencies. So I'll use that in my patients that are local, or sometimes I'll set up patients that are far away with Frequency-Specific Micro-current to heal the blood-brain barrier.

[00:53:01.01]Scott: Let's talk about the excitotoxicity a little bit more. So how is the excitotoxicity contributing to symptoms after a brain injury? And then, how do we minimize or address this excitotoxicity issue in a treatment protocol?

[00:53:17.15] Dr. David M.: Yes, okay. So to make it somewhat simple, because the excitotoxicity is very complicated. But one can think of; there's something called an NMDA receptor on a cell. And there are a number of things that can set off the NMDA receptor, but if it's excessively stimulated, then a lot of calcium can rush into a cell very rapidly. And one of the end products of excitotoxicity is cell death, the release of internal content as to the outside and reactive oxygen species, oxidative stress in the surrounding tissues.

And so it also creates energy failure, it contributes to mitochondrial dysfunction. And so it's interesting because it occurs in the acute and subacute phase, but I've seen patients in the chronic phase where I think they have excitotoxicity. And it's part of their pathophysiology in the chronic stage to calm down the inside excitotoxicity. And it's not usually thought of hey, is it still going on? I asked the question; I have to ask the question of what pathophysiology is going on in any patient.

So it's very interesting actually that excitotoxicity may be somewhat countered by magnesium, and especially magnesium threonate. Magnesium threonate apparently gets into the brain better than regular magnesium. What's also interesting is there is a product called PEA may counter excitotoxicity, and I think I said that riboflavin may do that.

Also, a lot of people take calcium supplements for bone support; I take them off of all free calcium. I don't want anybody on free calcium, so they're on bone support, they're off of it. If they're taking calcium supplements, they're off of it. I don't want any more free calcium going into the brain. But I think the excitotoxicity can really increase emotional lability, brain fog, all kinds of symptoms in the brain, fatigue.

[00:55:54.28] Scott: So let's talk now about microglia a bit more. So microglia do things for us like producing BDNF that you talked about, trimming synapses. We know that after a head injury, that they can shift to this pro-inflammatory M1 form that you mentioned that we ideally want this anti-inflammatory M2 form. So how do we shift the microglia back to this health-promoting M2 type?

[00:56:23.21] Dr. David M.: Okay. So what's really interesting about microglia, they're support cells. What a lot of people don't realize is about 90% of a person's brain is support cells, and 10% is neurons and synaptic connections. So the microglia are part of the support cell network. Now healthy microglia have these extensions, almost like these arms, these extensions that come off of them. And they actually migrate, and they move, and one of the jobs they do is they trim synaptic networks. And so you want healthy microglia because you want them to be able to trim the synaptic networks, After all, you want synaptic networks to be ideal biomechanically and structurally to be able to transmit what they're trying to do.

And so what happens is if microglia gets injured, and they can get injured in many different ways, then they can get what's called activated or primed. There's a term called prime microglia where they lose the normal morphology, and they become more looking like an amoeba without the projections. And so what we want ideally is for them to still have some of the projections, but if they're still like in the amoeba form, you want them to be like more of the M2 phase.

Now the M2 phase is theoretically a beneficial phase, it's anti-inflammatory, and it's producing neurotrophins like brain-derived nerve growth factor, neurotrophic factors that it's pro-support. Think of it as pro-support and anti-inflammatory. The M1 phase is very inflammatory, producing a lot of inflammatory cytokines; it doesn't produce the neurotrophic factors and is part of the problem. So you say the M1 phase is part of the problem of ongoing brain damage, the M2 phase is augmenting repair and support.

And so the question is how to shift the morphology, but it also brings up an interesting question. We often cannot get areas that have been injured in crime completely back to the normal microglial cells that we're going around and moving and pruning. But we can try to shift them to the M2 phase. So the research on this, one of the most helpful things is flavonoids, can help do this like luteolin and apigenin and in terms of diet, luteolin is a bit hard to get, but we can get it from radicchio lettuce. And apigenin, we can get from celery and parsley.

So I talked about the brain salad, which is going to at least have radicchio, celery, and parsley. But in addition, it's going to have broccoli sprouts because broccoli sprouts will activate Nrf2, which will decrease inflammation and oxidative stress. So then blueberries will have this purple anthocyanins in them that also helps with the morphology issues and also decreases oxidative stress. And I tell people to get the wild frozen ones because the wild frozen ones have much more purple than even regular organic blueberries.

And I don't want anybody eating blueberries that are not organic, so wild frozen ones are very purple, and they're very good for you. Now I'm looking into things like PEA and CBD in terms of this issue. But what's interesting is there's some research that PEA, certain things in combination will sort of neutralize each other. So I've started using PEA in some people, I don't use CBD typically with the patients unless there are certain indications. Because there is some information, the PEA and CBD may not be as useful together.

[01:00:28.00] Scott: Very interesting. Let's talk a little bit about the role that a traumatic brain injury might play in let's say Lyme disease and co-infections or viruses that might have been present in the person's system for years or decades.

Do you find that people that have chronic infections prior to their head injury are more likely then to have a more significant brain injury because they already had less reserve? Or conversely, do people that have a previous head injury potentially have a more severe presentation of Lyme disease if they get infected later? So how does the head injury impact our potential for the development of these chronic infections? And is there some immune shift that happens after a head injury in terms of Th1/Th2 balance?

[01:01:17.27] Dr. David M.: Yes. So it so happens there's research that supports that head injury decreases Th1. The Th1 system becomes less effective, you might say. Head injuries seem to decrease natural killer cell population and activity. So everything you can think of in the innate immune system is going to get less functional. The Th2 system is going to increase in its actions.

So you're going to have an immune shift and an immune dysfunction which then may open the way for infection, infection in hollow spaces like the gut, infection in other hollow spaces like the sinuses, possibly infection in the brain. Now that doesn't necessarily mean that someone's going to get a brain infection after a head injury, it just means that the immune system is going to be less capable of keeping say viruses in a dormant state, or keeping Lyme of co-infections in a dormant state, because you can have reactivation of these problems after head injury.

So if someone has a lot of these issues and has had problems before, it's probably going to be, they may be reactivated and worse after the head injury that can cause a prolongation of symptoms, and they need to be addressed. But the best way to address them is to rebalance the immune system, and not just go after them with trying to kill them.

[01:02:57.10] Scott: Dr. Bob Naviaux talks about this concept of the Cell Danger Response, and so I'm curious can a brain injury be the activating event or the trigger for the body going into a Cell Danger Response or this stuck protected state?

[01:03:14.22] Dr. David M.: Well, I've really looked into this, and I really like his work, and I think it's absolutely fascinating. When I was talking about excitotoxicity, the cells release ATP and all kinds of substances, and parts of cells that will then trigger other cells and tell them hey, there's a big problem here. Now it seems like that it's possible that we need to consider a Cell Danger Response, especially in people that have experienced severe fatigue before. I think they're more likely to go into a cell danger response than people that haven't.

So people that have Lyme and co-infections mold, other insults to the brain are probably likely to go into more of this fatigue and prolong mitochondrial dysfunction than people that haven't had that. So it is something I consider, I think it's difficult to find this in the research.

[01:04:14.28] Scott: You've talked about the importance of sleep in reducing neuro-inflammation, supporting recovery from a head injury. What are some of the things that are most effective for your TBI patients in terms of sleep support? And then generalizing that, what are some of the other keys to reducing neuro-inflammation?

[01:04:34.09] Dr. David M.: Well, it's very important for people to have a bedtime, and most adults don't have a bedtime. So most people go to bed too late, they have a delayed onset sleep phase. So I want people going to bed after a head injury like 10ish, 10:30. To wear blue light blocking glasses around 8:00, to get off their devices an hour before they want to go to sleep. Have dimming lights so that they're not exposed to bright light.

And take melatonin an hour and a half before they want to go to sleep, because most people, if they take it, they take it right before bed. It doesn't work that way; it's a circadian rhythm adjuster. So, 1.5 hours before they want to go to sleep, much better. Some people need controlled-release melatonin to keep them asleep. And then I also use tapping, I teach people tapping the Emotional Freedom Technique. And there's a tapping app that's really good, and if people wake up in the middle of the night, I'll have them do some tapping for anxiety or racing mind. I'll also use some homeopathics for racing mind, that can be helpful.

But also exercise during the day augments sleep at night, and any kind of stress management can augment sleep at night. In terms of reducing neural inflammation, it's a huge subject. So diet is really important, an anti-inflammatory, so diet I think EPA, DHA, but more DHA type oil is important. Healing leaky gut in the microbiome is extremely important, because the GI tract in any mild to moderate head injury patient will often get disturbed; they can develop leaky gut.

And the microbiome can change; they can have the LPS in the bloodstream going in the brain. And then treating the vagus can be very important in regard to that issue. So working on the gut, healing the gut is very important. And then the direct things like the Longvida curcumin, and there is a supplement that contains the flavonoids that I use in my patients. Will be very important than the Frequency-Specific Microcurrent. Definitely, I use to decrease neural inflammation. 

[01:06:55.28] Scott: So Nrf2 you mentioned earlier as well, I know there's a connection there between inflammation also. What is Nrf2? How do you support that in a recovery program? How do we activate this Nrf2 pathway?

[01:07:10.23] Dr. David M.: Well, Nrf2 is a transcription factor. And if it's activated, our bodies can use our own antioxidants and our own anti-inflammatory products that it's like our own innate system of anti-inflammation and free radicals suppression. So, the Nrf2 transcription factor can be activated in a number of different ways.

Aerobic exercise can activate it, but it needs to be done in more than just a very low level. It's known that curcumin may be able to augment it, DHA; omega-3 fish oil can do it. Green tea may have some effect, and sulforaphane from broccoli sprouts may have some effects. So that's why in every one of my patients, I'm having them doing certain things, like these things, to activate their own Nrf2 system.

[01:08:13.29] Scott: Oxidative damage is another factor in head injury that you've mentioned in terms of pathophysiology. What's the trigger or driver of the oxidative damage? And then what are some of the tools that you use to quench this excess oxidative stress?

[01:08:29.26] Dr. David M.: Well, the excitotoxicity and neural-inflammation are big triggers, any kind of mitochondrial damage is a big trigger. And so, I'm activating Nrf2 with the things I talked about. And there are other things that you can use to quench free radicals like the polyphenols and blueberries, the wild blueberries. Using alpha-lipoic acid, also there are certain types of free radicals that are very damaging like peroxynitrite.

So I would use molecular hydrogen, these little tablets that dissolve in water. And have people dissolve them in about eight to ten ounces of water and drink it within two minutes of it being dissolved to quench free radicals. So I think we can deal with that fairly effectively.

[01:09:32.10] Scott: Mitochondria are very numerous and dense in the brain, so how do we support the mitochondria to produce more energy to be used in support of the healing process? And is there a role for red light therapy, or photobiomodulation in terms of supporting the mitochondria?

[01:09:49.23] Dr. David M.: Well, there are different aspects of supporting mitochondria; it's not just increasing ATP; we want to support the membranes. We want the mitochondrial membranes to be extremely healthy; we want to support the electron transport train in the mitochondria. There are a lot of aspects in supporting the mitochondria.

Now B vitamins and minerals are extremely important, so I want everybody on a really good either B vitamin product or on a multiple that has methylated B vitamins. The only ones sometimes I don't use is methylated B12 if they have a COMT gene issue. But I want everybody to be on good B vitamins; I want them to be on enough magnesium and zinc.

Because there are so many aspects of what's going in a mitochondria that we need the right minerals, so a good multiple will usually cover those bases. CoQ10 I think there's a role for it, but I think people need a lot more CoQ10 than just 50-100 hundred milligrams. And sometimes CoQ10 doesn't seem to be as well absorbed. So we might need to use higher levels, use it twice a day, use different methods to get it absorbed better. And I forgot to say glutathione is very important with oxidative stress. So increasing NAC and glutathione is very important for oxidative stress. So that can also aid mitochondria. NAD+ and methods of increasing NAD+ can be extremely effective for people to increase brain energy, so they have less brain fatigue, increases mitochondrial function. But we need a fair amount of it, and there have been different mechanisms of delivery.

There's the sublingual form; there are nasal sprays, there's a nasal spray called Synapsin. There are sprays that go in the mouth to try to increase it, so I think that should be a goal Frequency-Specific Microcurrent increases ATP production. So that's my primary tool. Laser can increase ATP production, so I think there's reason to use laser around the head, but also around the neck, because if people have a full head of hair, the lasers is not going to penetrate very well. So that's my approach to improving mitochondrial function.

[01:12:14.24] Scott: Beautiful. Yes, I put on my transdermal NAD just before talking with you, so that my brain can hopefully try and keep up with you. 

[01:12:24.16] Dr. David M.: Yes, that's another mode of delivery, that's a really good mode of delivery.

[01:12:28.28] Scott: Yes. Let's talk a little bit now about the loss of neurons and the synaptic density issue that results from changes in blood supply, oxygen delivery, mitochondrial damage, excitotoxicity. All of these things that you've talked about. How do we minimize the loss of neurons, and actually support the creation of new neurons or neurogenesis?

[01:12:49.07] Dr. David M.: Well, that's limiting, so the first part of that is how do we minimize the loss, and then how do we increase the neuron density and the synaptic density. So the first part is thinking okay, what can we do to decrease neural inflammation, what can we do to like decrease excitotoxicity, what we do to augment mitochondrial functions, so the neurons don't die. All these pathophysiologies that I've been talking about; how do you improve cell signaling? Those are really important to have it.

So it depends when we see the patients because if we use hyperbaric oxygen initially, I think that might save neurons. If I use Frequency-Specific Microcurrent, I get the patient early enough, that might save neurons if I'm interrupting the neural inflammation if I'm working on quenching the free radicals in the excitotoxicity that will decrease the loss of neurons supposedly. That's why those things are so important, and they're not being done with the average person. The average person will sort of let's see how you do, we'll see you back in a month, and we'll record your symptoms. None of that is being done; it's just all that secondary brain damage is going on.

So then when we want to think about supporting neurogenesis, nerve stem cells are only in a few places in the brain, I wish they were in every part of the brain that would make me very happy, but only a few parts of the brain. They’re in a place called the dentate gyrus, they're in the hippocampus area, and they’re only in a few places. And so there are some things that can be done to augment stem cell migration.

Now with a head injury supposedly, even if you don't do anything, stem cells may be mobilized. There's information to show that, but we want to increase the survival of these stem cells, therefore decreasing neural inflammation, excitotoxicity, free radicals, and augmenting mitochondrial function and decreasing autoimmune mechanisms, improving the immune system of the brain. It's all very important to allow stem cells that are migrated to survive.

And then there are certain things that will improve their survival. Like I think, low dose lithium and taurine and even melatonin have been shown in some studies to improve survival of nerve stem cells or even augment their migration. Taurine has been shown in some studies to augment their migration. And then we want to increase neurotrophic factors like brain-derived nerve growth factor and other neurotrophic factors because those are thought to help with nerve growth and especially synaptic density and projections from the dendrites and encourage the growth of the neurons. And how to preserve them, because it's almost like the fertilizer and water almost for your plants.

Those trophic factors are really important for decreasing loss, for promoting the maximm amount of healthy neurons, and then we want to promote synaptic density by challenging areas of the brain; that's the brain training part of it. We have to challenge areas in the brain, stimulate it so that we have more synaptic density.

[01:16:23.25] Scott: How significant is lithium orotate in supporting these growth factors and nerve stem cells? Is that a big player in a recovery protocol?

[01:16:34.06] Dr. David M.: Well, I will use it in every one of my patients. And part of the problem I have is having people think that I don't think they have bipolar because I'm using lithium. Now, if someone's already on lithium on high doses, I keep them on those doses. So if they have bipolar and someone put him on lithium, I keep on the high doses. But in general, I'll use lower dose lithium like 20 milligrams of lithium orotate.

I think it's pretty important; I think that I have better results with the people that will go on than low-dose lithium. I haven't really anybody have side effects on it, it's low dose, it's only 20 milligrams. But it does seem to stimulate brain-derived growth factor in studies.

It increases nerve growth factor in multiple areas of the brain. It increases brain-derived nerve growth factor and may induce nerve stem cells in the hippocampus. So I think it's pretty important. It's not very expensive, it's pretty important, and usually, it has no side effects.

[01:17:41.15] Scott: You've said in some of your past lectures that if you could use only one supplement in brain injury, that supplement would be taurine. Why is taurine so pivotal?

[01:17:52.26] Dr. David M.: Taurine helps regulate osmolarity and osmolality, in the initial stages when there's so much fluid congestion in the brain, it's important. It seems to have studies that show that it augments nerve stem cells.

It may be involved in modulating excitotoxicity. So taurine can have a number of roles, it's very inexpensive. And so, I say I have everybody on taurine 1000 milligrams twice a day, I take it every day myself.

[01:18:37.01] Scott: Nice. We know that exercise is important for healing the brain. You've talked about it in terms of Nrf2 activation, increasing the BDNF, helping with plasticity, improving sleep, decreasing stress and anxiety. Is there a specific type of exercise that is more ideal for supporting brain healing?

[01:18:57.09]Dr. David M.: Well, aerobic exercise seems to be more effective than strength training. And then in the studies, the aerobic exercise needs to be in a zone. So the zone theoretically would be 220 minus the person's age times 70 percent, and 220 minus the person's age times 80% and somewhere in that 70 to 80% or 85% zone. For about 45 minutes, it's time-dependent.

Now any exercise is better than none, but in order to stimulate brain-derived nerve growth factor with exercise and stimulate Nrf2, we need to have enough of the intensity to accomplish this. And this is often a problem people because they don't want to get to that intensity because they're so fatigued from the mitochondrial dysfunction, but it's very important that they try to get to that goal.

Strength training could have a role, but not as much of a role as the aerobic training in terms of brain healing, and then training balance is also important if they have balance dysfunction. But that's more important in terms of healing the cerebellum if they've had a cerebellar injury.

[01:20:04.13] Scott: You've mentioned brain training applications, are there specific apps that people can use on their phone or devices that are helpful in moving theirs towards health?

[01:20:15.06] Dr. David M.: So what I would say is brain training you better think of it as the increasing synaptic density, synaptic connections. And so you want to think about where does this person needs to improve brain reserve, what parts of the brain are still having problems, then we need to train those parts of the brain. So if it’s the hippocampus and memory, I'll have people actually get animal memory cards and put them on the carpet and turn them over.

I'll have people use that Simon game from memory. I'll have them if they're having problems with words or word-finding get vocabulary cards, and use those to train the brain. And then I do like BrainHQ, so BrainHQ I think is really good. Luminosity is good, but I think BrainHQ has a lot of training for people. And sometimes people have problems with computers, and they're light sensitive they can't use BrainHQ. So there are certain books that they're about ten dollars on brain training that people do. People have to do multiple different things, not just crossword puzzles, multiple different things. And the training has to be particular to the region of the brain that is having the problem.

[01:21:30.28] Scott: You mentioned that the vagus nerve can be injured when a head injury occurs, that leads me to thinking of all the other effects then things like SIBO or small intestinal bacterial overgrowth that can be a result of vagus nerve dysfunction.

You mentioned that Frequency-Specific Microcurrent can be helpful in many areas, but in vagus nerve particularly as well. Do you use any vagal nerve stimulators? What are some of the tools you use to optimize the health of the vagus nerve?

[01:22:01.13] Dr. David M.: I would say the primary tool that I use to optimize the health of the vagus nerve is Frequency-Specific Microcurrent because it's so effective. And I'm good at that; I have that available. I will have people gargle; I'll have people sing, I'll have people do vagus nerve exercises. But I think often the vagus nerve needs to be actually healed, like physically healed, like if it's been tractioned.

The other thing that can happen to the vagus nerve is that lipopolysaccharide; other things can actually go retrograde up the vagus nerve into the brain. So I often have to treat the vagus nerve with Frequency-Specific Microcurrent for the things that might actually be damaging it. Then you have to work on healing the gut. I mean, you have to assess for SIBO in people, microbiome changes, leaky gut, intestinal permeability, and work on healing those things with a functional medicine perspective, along with healing the vagus.

Because if some of that has persistent SIBO, small intestinal bacterial overgrowth, you're going to have brain symptoms from that. But they'll also probably have vagus nerve problems, and vagus nerve problems after a head injury can contribute to SIBO because if motility slows down, then a person is more likely to get SIBO.

I think that it's very difficult to heal SIBO without some mechanism or treatment of the vagus nerve. That's why in my programs to heal SIBO; I will use treatment for the vagus nerve, both the exercises and the microcurrent. And if I see patients with SIBO without head injuries, I'll have much better results than if I don't treat the vagus nerve.

[01:23:51.08] Scott: Talk to us just a little bit as we start wrapping up about what foods are the most supportive of optimizing brain healing.

[01:24:00.04] Dr. David M.: Well, first of all, I say I want people to buy, choose organic because I want to limit all the neurotoxins. So choose organic, and if they're going to eat meat, it's going to be grass-fed grass-finished. I don't want GMOs in the diet because they can adversely affect the gut for sure and maybe the blood-brain barrier. So we want to increase things with these flavonoids.

So like parsley, celery, radicchio lettuce, cloves have a lot of flavonoids, so they could add cloves to a smoothie. And so they can make like a salad with those different things in them, and add broccoli sprout. And I really like to make pesto, so I have this brain pestos that I have people make, and you can get these pesto makers.

There's one by Hamilton Beach that's a glass pesto maker, and it's incredible, it's only like $26, $30. And so I like the glass because it doesn’t have plastics, and so you make this brain pesto where you load up like parsley and then extra-virgin olive oil. Hopefully, one of the polyphenols like the Koroneiki Olive from Greece and then you put parsley, broccoli sprouts, watercress for the liver. Some radicchio, organic pine nuts, and blend it up.

And then you can even put a little bit of dandelion for the liver as well. And then you got a brain liver pesto that's really helpful, and then people can use that and then put that on things that they might otherwise not want to eat like the healthy cruciferous vegetables. And then choline is really important, we need a lot of choline to heal the mitochondrial membranes, and the cellular membranes in the brain. So things that contain choline are pretty important.

I have people go on the pasture-raised eggs, chicken certain organic chicken; pasture-raised chicken may be helpful for that. And then I don't want acrylamide in the diet, so we want to limit things that are browned. We don't want the browning meat, browning eggs; we're going to really limit brown things. Don't want them eating chips because those are brown, don't want them eating much crackers because those are browned, so those advanced glycosylated end products will also be inflammatory. But the acrylamide is also in coffee, so if my patients want to drink coffee, I want them drinking a very low acrylamide coffee, which is a very interesting thing because all coffee contains acrylamide.

So first of all, the coffee has got to be organic. I do like a coffee called Purity because they check for acrylamide levels. And they have figured out the roasting temperatures, the temperatures to roast to have the less acrylamide in it. So acrylamide is kind of important to decrease as well because it's a neurotoxin.

[01:27:11.27] Scott: We talked about oxygenation being low in brain injury. What are some of the tools that can be used to improve oxygen? You mentioned in the early stages; you might use hyperbaric oxygen therapy. Can something like pulsed electromagnetic field therapy be helpful in terms of circulation and oxygenation?

[01:27:30.11] Dr. David M.: You know I would say what I use mostly is HBOT hyperbaric oxygen, and I use vinpocetine, and ginkgo, those are the tools that I use for oxygenation. I mean, I have tried different pulsed magnetic field devices, and I'm not really clear on how they might improve circulation. Now there are some pulsed magnetic field devices like some of the mats that might improve microcirculation.

But I don't think that's maybe the most direct way to do it. But I'm not adverse to that as long as they're not being exposed to electromagnetic fields. But I just don't know if there's been demonstration in the brain that says a PEMF mat will increase brain circulation. I know in the feet or the extremities that it might.

[01:28:24.18] Scott: Peptides are a popular topic these days. Do you find or use peptide therapies in your patients with traumatic brain injuries?

[01:28:32.23] Dr. David M.: Well, yes, but like I use BPC 157, especially to heal the gut. So I use it orally, and I might use an injectable for someone that has a lot of injuries because often I'm treating their injuries too. But there was a peptide called Cerebrolysin that was very helpful, especially in chronic head injuries. It's not available anymore, so that has to do with certain regulatory agencies with peptides. So, unfortunately, I haven't an access to the peptides that I wanted like Cerebrolysin.

I don't think anything was as good as a peptide for brain healing as Cerebrolysin. Now, there are some peptides to actually help the immune system. So sometimes I might use thymosin alpha 1 for that. But in general, more using just BPC 157 to heal the gut lining and people that have had gut problems after head injuries or my patients with GI problems.

And there's the issue about augmenting growth hormone with peptides, if someone has really low growth hormone and there may be a role for that too with head injury, after head injury if they have really low IGF-1. There might be a role for the peptides there too.

[01:30:03.11] Scott: Have you found any role for stem cells or exosome therapy in recovering your patients from brain injury?

[01:30:10.25] Dr. David M.: Well, there's definitely research on this, that both certain types of stem cells and exosomes may be helpful. The mechanism of action, I don't think has been that well determined and making sure that the source of the exosomes is really clean is really important. In my programs, I have not used stem cells or exosomes.

But I do think there's a role and definitely, in really difficult cases, especially moderate to severe head injuries. I think they should be tried because those cases need sort of much more aggressive treatment, and there are some studies on the use of them IV that I think are encouraging.

[01:31:02.20] Scott: What's the relevance of this information for anybody wanting to keep their brain healthy even if they haven't had a head injury, or for potentially preventing things down the road like mild cognitive impairment or dementia or treating those issues if you're already experiencing them to some degree.

[01:31:19.21] Dr. David M.: I think there is a tremendous amount of relevance. So as I've delved into, like how to heal the brain after head injury and the pathophysiology and understanding the function of each brain region. Then I realized that certain types of pathophysiology are really important to look at with anybody with cognitive impairment. Someone says I feel brain fog; I just don't feel like I'm thinking as quickly or I get fatigued using my brain, or they're having problems with planning or organizing or word-finding or their memory and a lot of people are.

You don't have to have a diagnosis of MCI or mild cognitive impairment, and certainly, people can have these problems with mold and biotoxins. There are many things that can cause this, many things that can cause cognitive impairment. So I think people need to be thinking about one thing, how do I keep my brain healthy. It's just like how do I keep my heart healthy, how do I keep my muscles healthy and that's become an important question I think that people should ask, or how do I keep my patient's brain healthy? How do I access my patient's brain function is part of keeping them well.

And so there are certain pathophysiologies that I think are really kind of important to think about. Neural inflammation is really important to think about in terms of keeping your brain healthy. And in treating patients that have cognitive impairment of any sort. Because a lot of us have neural inflammation, and I don't even ask the question anymore, do you have any neural inflammation? I think we all have neural inflammation.

How do we modulate it? How do we keep it to a minimum? Excitotoxicity is there much excitotoxicity, that's another thing. I think mitochondrial health in the brain is really important in supporting mitochondrial health. I think sort of activating Nrf2 is really important to decrease oxidative stress. I think protecting the brain from electromagnetic fields is really important. And then this whole thing about autoimmunity, I think anybody with brain symptoms that haven’t had a head injury, really should be treated for antibodies to blood-brain barrier and antibodies to different brain tissues.

Because if there is brain autoimmunity, the immune system is in significant dysfunction, and then there's going to be a lot more loss of neurons and microglial cells. So assessing and treating that is really important along with assessing and treating the gut because if someone has leaky gut and intestinal permeability and blood-brain barrier permeability, that's like two gates that are open, that shouldn't be open at the same time.

So I think brain health is really important, there's a lot of crossover between the pathophysiology of brain injury and the pathophysiology of any kind of brain dysfunction. I think it's really important for us to think about, especially the ones that I mentioned in terms of keeping the brain healthy or helping people that have cognitive dysfunction to improve and recover from.

[01:34:41.19] Scott: Yes, that's beautiful. So we've taken this now from a conversation that was helping people with a head injury, and really generalizing your approach your protocol to being able to help essentially any of us, and so I think that's a that's a beautiful thing.

I feel like many people with chronic illnesses have probably not explored the potential for head injury as a contributor to their condition; seems like that could be worthwhile.

So how can people find practitioners that do this work? Are you doing telemedicine consultations now for people that need support, or do they need to come see you in Seattle? And then have you published your approach in any journals or books or anything that people can learn more about your work?

[01:35:21.25] Dr. David M.: Yes, well, I do telemedicine consultations, and I will do telemedicine consultations all around the country or even in Canada or elsewhere. Now because of licensing issues, I'm licensed in state of Washington. If I do telemedicine, I usually have to consult with the person's care provider. Whether it's an acupuncturist or physician, then I'm consulting with their care provider, and I do telemedicine consults all around the country and Canada.

And very few people know this program; I mean I've given lectures at the Washington Association Naturopathic Medicine, lectures to the British Columbia Association Naturopathic Medicine and lectures for your meeting The Forum for Integrative Medicine. And then to the Institute of Functional Medicine. But I would say that this is a very intensive program where it requires a lot of, not just listening to one lecture, but using it and really working with the material, assessing the brain regions.

And so I don't necessarily have a network of people that I can refer to now to do this programs. I just don't, I'd like to set up a training program for it at some point, but I haven't done that. But I have written an article, and it's in the Townsend Letter, May 2019 someone can just Google Townsend Letter May  2019, bring up that article. And then I've written a very extensive book chapter on the Integrative Medicine Approach to Healing the Brain, and it's coming out in the Oxford University Press book, it's called Integrative Neurology.

I'm hoping it's going to be published in the fall; I heard it's going to be published in September. And then my website www.PeakMedicine.com has links to a documentary, a docu-series that was done the Broken Brain Docu-series, so people can download that, it has links to the Townsend Letter. But also has information on my practice and telemedicine, Peak Medicine, that's how people can reach me.

[01:37:45.24] Scott: My last question is the same for every guest, and that is what are some of the key things that you do on a daily basis in support of your own health?

[01:37:53.24] Dr. David M.: Well, I try to work out every day for at least 45 minutes. What's really interesting is there's new information that while you're working out, if you challenge your brain at the same time, you create even more brain-derived nerve growth factor. So if I get on my home elliptical and then I'm watching a challenging webinar or listening to a challenging lecture, that will work my brain at the same time.

So I try to do that. So working out, and then I don't actually have wireless in our home, it's all wired through Ethernet. We had our bedroom painted with this EMF shielding paint and the windows with something called clearcoat put on them to decrease electromagnetic fields in the bedroom. I take things for my brain every day like taurine. I'm on Cogumen; I have a NAD that I take under the tongue. I'm doing all kinds of things for mitochondrial health.

I'm challenging my brain constantly, because I'm constantly learning just constantly going to meetings, reading articles, constantly learning challenging my brain. And then I try to manage stress. So I do the tapping to manage the stress because stress is not good for your brain.

And I run Frequency-Specific Microcurrent on myself and my brain sometimes believe it or not. And I even have a laser cap that I use, so I'm doing a lot. I mean a lot, my work depends on my brain, so I better have really good brain function. So yes, those are some of the things that I do.

[01:39:43.21] Scott: Beautiful. I first learned about you from Dr. Dietrich Klinghardt, and he has tremendous respect for you. I've heard him speak of you very highly, and so that I think says a lot because I hold him very highly.

It's clear that your brain is very functional, and it's also clear in our conversation, in today's conversation, but also past conversations that you just really care a lot about finding solutions for your patients that you have a very strong passion for the work you do in helping to minimize the struggle of other people. And so I just want to thank you and honor you for what you're doing, for all your work and appreciate your time and generously sharing with us today.

[01:40:23.21] Dr. David M.: Thank you very much.

[01:40:25.17] To learn more about today's guests, visit Peakmedicine.com; that's Peakmedicine.com. Peakmedicine.com.

[01:40:33.27] Thanks for your interest in today's show. If you'd like to follow me on Facebook or Twitter, you can find me there as better health guy. To support the show, please visit Betterhealthguy.com/donate. If you'd like to be added to my newsletter, visit Betterhealthguy.com/newsletters, and this and other shows can be found on YouTube, iTunes, Google Play, Stitcher, and Spotify.

[01:40:58.25] Thanks for listening to this BetterHealthGuy Blogcast, with Scott, your Better Health Guy. To check out additional shows and learn more about Scott's personal journey to better health, please visit BetterHealthGuy.com.

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  BetterHealthGuy.com is intended to share my personal experience in recovering from my own chronic illness.  Information presented is based on my journey working with my doctors and other practitioners as well as things I have learned from conferences and other helpful resources.  As always, any medical decisions should be made only with the guidance of your own personal medical authority.  Everyone is unique and what may be right for me may not be right for others.