Chiropractic treatment and concussion treatment supplements point at speeding recovery and helping to prevent post-concussive syndrome
Your brain is the foremost nutrient-dependent and energy-demanding organ in your body. It weighs about three pounds and has the consistency of Jell-O. An injury to the brain can quickly become a threat to your body’s health on a systemic level.
A concussion is a head injury from direct or indirect forces, with or without loss of consciousness, that causes persistent symptoms such as nausea, vision disturbances, dizziness, headaches and fatigue. Every year more than 3.8 million concussions are reported; many more go unreported and undiagnosed. More than 500,000 kids every year are treated in an emergency room for sports-related concussions.
Early treatment to avoid cognitive impairment
Early concussion treatment is tied to faster recovery and better long-term outcomes. Effective treatment within the first week — preferably within the first few days or even the first few hours — is critical. Appropriate care initiated in a timely span can lead to recovery in around 20 days, while delayed treatment (8-21 days after injury) can extend the time needed for recovery to 30 days or longer — and may be linked to post-concussion syndrome.[i]
Concussion injuries cause shearing (tearing) of neurons in the brain. The injury results in changes to the metabolic and chemical makeup of the brain, which can affect the cells’ ability to communicate and even function normally. This can lead to apoptosis (cell death), mitochondrial dysfunction, oxidative stress, and ultimately, cognitive impairment.[ii] The central treatment goals are to heal damaged neurons, restore neural communication and decrease the brain’s inflammatory status.
While concussions can cause immediate symptoms, such as a temporary loss of consciousness, headaches and dizziness, some effects can continue days or even weeks after the event. This is called post-concussive syndrome, and its signs and symptoms include:
If left untreated, treated late, or treated incorrectly or incompletely, post-concussive syndrome can become chronic, with persistent symptoms lasting for more than three months after the initial injury. Chronic post-concussive syndrome can lead to long-term health issues such as migraines, dizziness, memory problems, brain fog, fatigue, and sleep disturbances that interfere with daily life.
While chiropractic treatment, proprioception and vestibular training, and steady-state exercise are components of my concussion protocol, added to my armamentarium are active treatment with laser therapy and concussion treatment supplements pointed at speeding recovery and helping to prevent post-concussive syndrome.
In the acute recovery phase of a concussion, transcranial laser therapy has been shown to be highly efficacious. It helps reduce pain, swelling, and inflammation and improves cerebral circulation.[iii] It also helps improve neurological performance[iv] and stimulates the growth of new nerve tissue.[v]
Low-level laser therapy (LLLT) helps modulate oxidative stress and nitric oxide production and downregulates pro-inflammatory microglial cytokine expression.[vi] In my practice, I use low-level laser therapy with a 635-nm wavelength. This wavelength modulates the signaling pathways in the NF-kB inflammasome and is valuable for reducing neuroinflammation.
In general, laser therapy suppresses the pro-inflammatory mediators that are produced in excess with a concussion and helps the brain and gut cope with the cascading metabolic effects. The protective effect of LLLT may be ascribed to improved energy production in the mitochondria (the tiny power plants that provide energy in the cells) and selective modulation of pro-inflammatory mediators.[vii] Laser light is absorbed by chromophores, specialized light receptors found in all your cells. The chromophores trigger positive chemical changes that stimulate the mitochondria, producing more of the chemical signaling molecules that are key to accelerating tissue repair, reducing inflammation and pain, and creating an anti-inflammatory microenvironment in the brain.[viii]
Laser light can stimulate other healing pathways, including those that improve energy production in the cells. The light may also affect nitric oxide production in the cells, leading to improvements in the blood circulation of the injured area of the brain. All are critical for repairing the damage sustained in a concussion.[ix]
Beneficial effects of the treatment include:
- Increased angiogenesis — growth of new blood vessels
- Decreased edema (swelling)
- Increased lymphatic drainage
- Increased blood flow and cerebral oxygenation
- Decreased neuron excitotoxicity
- Anti-apoptosis — reduced cell death
- Increased antioxidants
- Increased production of neurotrophins — neuron growth factors
- Increased synaptogenesis — a growth of new synapses
Concussion treatment supplements and increasing BNDF
Laser therapy has an additional benefit that is extremely valuable for treating concussion: It stimulates the production of brain-derived neurotrophic factor (BDNF).[x]
Often called fertilizer for the brain, BDNF is crucial for repairing injured neurons and growing new ones, restoring communication among neurons, and reducing the long-term risk of neurodegeneration. BDNF helps the neurons fire together again — and neurons that fire together, wire together.
Treatment to increase the natural production of BDNF is a cornerstone of concussion therapy. In addition to low-level laser treatment to stimulate BDNF production, concussion treatment supplements and a ketogenic diet are needed to support BDNF production, both in the acute phase following the injury and for several weeks afterward as the brain continues to heal.
The primary goals for post-concussion nutrition are healing the structural damage from the concussion while managing the inflammatory status of the brain to prevent long-term damage. They can be achieved through dietary supplements and a ketogenic diet.
Concussion treatment supplements that are known to improve BDNF production and attenuate the inflammatory cascade include:
Vitamin D — Vitamin D is neuroprotective — it promotes the production of heat shock proteins, which help maintain neurons’ integrity and support brain cell survival after a brain injury. Additionally, vitamin D can help prevent post-concussion syndrome, where concussion symptoms linger on — sometimes for months. More generally, vitamin D downregulates the NF-κB pathway and has an anti-inflammatory effect on the brain. [xi]
DHA and EPA — The omega-3 fatty acids EPA and DHA are effective for reducing inflammation from a concussion. DHA has been shown to increase BDNF levels in people with traumatic brain injuries. In addition, DHA helps build robust and flexible cell membranes in neurons. EPA suppresses the production of inflammatory prostaglandins and other inflammatory chemicals and has been shown to reduce biological markers of brain injury, oxidative stress and cellular apoptosis.[xii] Both fatty acids improve the integrity of the brain’s white matter and increase the volume of gray matter in the frontal, temporal, parietal and limbic areas, improving brain structure and function.
Glutathione — After a concussion, glutathione levels in the brain drop, making the neurons more susceptible to damage by free radicals. Supplementation with glutathione precursors, including vitamin C, selenium, vitamin B3 and N-acetyl-L-cysteine (NAC), is essential for providing the building blocks to bring glutathione back up to neuroprotective levels.[xiii] Because glutathione is a protein, it needs to be taken in the form of liposomal oral supplements to get past the stomach’s digestive juices.
Magnesium L-threonate — Magnesium is vital for brain function — you need it as an essential cofactor to make many of the enzymes involved in brain functions. It is significant for manufacturing the neurotransmitters that let neurons communicate. Magnesium also helps prevent delayed brain injury and post-concussion syndrome. Supplements of magnesium L-threonate cross the brain-blood barrier more effectively than other magnesium forms and don’t cause digestive upsets. We also know that high levels of magnesium in the brain and cerebrospinal fluid are related to a lower incidence of Alzheimer’s disease and brain aging.[xiv],[xv]
Taurine — Taurine is an essential supplement for a complex and compelling reason. The neurotransmitter glutamate enters neurons to move signals through them via a receptor called NMDA (N-methyl-D-aspartate). Normally, NMDA receptors let controlled amounts of glutamate into the neurons, which in turn excites them and activates the brain’s areas related to learning and memory. But when a concussion injures neurons, they release large amounts of glutamate. The surge of glutamate excites the neurons too much (excitotoxicity), which leads to impaired function and even neuron death. To restore the ability to form new pathways between neurons (in other words, to restore regular learning and memory abilities), we need to block the excess glutamate.[xvi] We can do this with supplements of taurine, which protects neurons from glutamate-induced neuronal toxicity.
Curcumin — The active ingredient in the spice turmeric, curcumin is a vital supplement for treating concussion. Curcumin passes through the blood-brain barrier and has powerful antioxidant and anti-inflammatory effects. After a traumatic brain injury, curcumin supplements can help reduce cognitive impairment, help stabilize energy use in the brain, and reduce membrane damage in the neurons.[xvii] In animal studies and in small human trials, the supplement raises BDNF production. Curcumin also increases blood flow to the brain, protects brain cells against free radical damage, supports anti-inflammatory pathways and enhances DHA’s bioavailability.[xviii]
Boswellia — Boswellia (Boswellia serrata) is an herbal extract that may be particularly beneficial for concussion patients with diffuse axonal injury (DAI), a type of traumatic brain injury resulting from a blunt injury to the head. Boswellia has been shown to encourage neurorecovery by enhancing cognitive function.[xix]
Creatine — In the brain, creatine has powerful neuroprotective effects. Levels decrease after a concussion. Raising them with supplements helps prevent brain damage following traumatic brain injury by preserving function in the mitochondria and increasing energy production in neurons. Supplemental creatine provides immediate energy to heal brain cells. Creatine also improves cognition and significantly decreases headaches, dizziness and fatigue after a concussion.[xx]
Pro-resolving mediators — Reducing inflammation in the brain from a concussion is extremely important for avoiding long-term tissue damage. The body can usually resolve inflammation after it passes the acute phase, but the final resolution of lingering brain inflammation may be drawn-out in concussion. Supplements of special pro-resolving mediators promote the natural termination of the inflammation process by counteracting the damage from inflammatory cytokines, decreasing TNF-alpha and IL-6 synthesis, and increasing anti-inflammatory IL-10 synthesis.[xxi]
Acetyl L-carnitine — Acetyl L-carnitine energizes the brain, increases the neurotransmitter levels needed for memory, focus and learning, and repairs damage to brain cells.[xxii] It also helps increase the levels and components of the neurotransmitter chemicals needed for memory, focus and learning.
Alpha-lipoic acid — Alpha-lipoic acid lowers oxidative stress at the blood-brain barrier (BBB) and is an excellent antioxidant source.[xxiii] Alpha-lipoic acid’s anti-inflammatory and antioxidant properties help reduce edema and preserve BBB permeability following a brain injury.[xxiv]
Ferulic acid — A powerful natural antioxidant derived from plants, ferulic acid helps speed healing by increasing glutathione levels and reducing neuron death in the brain. It may also help with memory problems caused by a concussion.[xxv]
The ‘super five’ for concussion treatment supplements
Because the impact of a concussion is unique to each individual, some of the recommended supplements may help one patient more than they would someone else — and vice versa. Also, certain concussion treatment supplements are more helpful during the acute phase (the first few days after the injury), and others are more helpful later on or for treating post-concussion syndrome.
For most of my patients, I recommend starting with my “Super Five” brain supplements: DHA, pro-resolving mediators, magnesium L-threonate, glutathione and curcumin.
The Ketogenic Diet and concussion
After a concussion, following a ketogenic diet can be quite beneficial for speeding recovery.
Importantly, ketones trigger the expression of BDNF, and the diet offers other significant benefits in concussion. After a concussion, the brain’s ability to metabolize glucose is altered. Providing an alternative energy source in the form of ketones has been shown to help maintain energy levels in brain cells by helping prevent ATP depletion in the mitochondria.[xxvi]
Ketones help prevent neuronal cell death and help quell reactive oxygen species and inflammation. They also increase mitochondrial glutathione levels by activating the Nrf2 signaling pathway, which plays a pivotal role in triggering inflammation.[xxvii] The ketogenic diet also stimulates autophagy in the brain, helping to clear away cellular damage to neurons.[xxviii] Finally, the ketogenic diet effectively reduces neuroinflammation by inhibiting the NF-kB inflammasome and producing the pro-inflammatory cytokines TNF-alpha and COX-2.[xxix]
Patients with concussions and post-concussive syndrome can be challenging to treat. The addition of laser light application, concussion treatment supplements and a ketogenic diet has revolutionized my approach to treating concussion injuries. The synergy among these added elements has substantially improved my clinical concussion outcomes.
ROBERT G. SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, is a chiropractic doctor, clinical nutritionist, national/international speaker, author of Amazon’s #1 bestseller “Inside-Out Health,” and founder and CEO of Westchester Integrative Health Center. He graduated magna cum laude from the University of Bridgeport College of Chiropractic and has a Master of Science degree in human nutrition. The ACA Sports Council named him “Sports Chiropractor of the Year” in 2015. He is on the advisory board for the Functional Medicine University and is a seasoned health and wellness expert on the speaking circuits and in the media. A frequently published author in peer-reviewed journals and other mainstream publications, he is a thought leader in his field and practice. His new book, “Superhighway to Health,” was published in June 2021. He can be reached at drrobertsilverman.com.
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