How to Heal from Post Concussion Syndrome Naturally

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey, everyone. I had back on the podcast today, Dr. Titus Chiu. He is the author of BrainSAVE and an integrative and chiropractic neurologist. This is an area that I think people could really benefit from considering going through an evaluation, especially if they’ve had any prior head trauma, but perhaps even not that obvious is where a mild trauma may be enough for some people to be thwarting their ability to heal, move forward, have less food, reactivity, less reactivity to stress, and less reactivity to their environment.

DrMR:

There were a few real pearls here, one being his remark that history is the most important test that he has. I want to second that and just point to the fact that I: A, agree with that, and B, that a large reason why I feel that myself and the doctors at the Center are obtaining better results over time is the podcast, the chance to pick the brains of different experts in different areas like neurological health, abdominal and pelvic adhesions, sleep-disordered breathing, and progressively build into our initial paperwork better screening questions to make sure that before you even see the doctor, that they already have a pretty good suspicion with supporting evidence as to whether or not there could be adhesions, sleep-disordered breathing, or potentially a neurological imbalance. Very, very important, and I just love how he corroborated that someone’s history and, at our Center, what we can glean from a combination of a questionnaire then cross-referenced first by our health coach and then finally in a visit with a doctor can really make sure that we have the most refined picture of the person put together.

DrMR:

We also discussed how there’s this spectrum, similar to gut health, where interventions can be used to help get someone out of a degree of pain, suffering, and reactivity on the one end of the spectrum, and at the other end of the spectrum, can be used for better performance and optimization. And that applies to the gut in perhaps you have less upset from a glass of wine or more tolerance for eating bad food. That’s kind of performance, and perhaps the neurological equivalent of that would be higher tolerance to stress or a longer ability to focus, as just a few general examples.

DrMR:

We discussed some of the available units that are supposed to stimulate parasympathetic or vagal nerve activity. A Xen unit is one and Apollo Neuro is another, so we did discuss some of those devices. We also discussed a potential vestibular tie-in to exercise intolerance, and more broadly how Titus is looking at the connection of the brain as it pertains to exercise intolerance. So a few important insights there, and we also discussed how he was actually able to adapt much of his practice to a telehealth model when lockdown went into effect, thus making it even easier for people to acquire a personalized assessment and corresponding neural rehab or optimization plan. So just a great podcast all around. It was the second time he was on the show, and I really enjoy our conversations.

DrMR:

I also want to point you to the clinic if you’re in need of help, and I’m happy to say that our clinical team is growing. All of these conversations actually lead me to reflexively even further tune our paperwork to make sure that the vitally important background on an individual is as sharp as it can be so that we really have the most complete picture about the individual as possible so we can use the least amount of testing, the least amount of dietary changes, the least amount of supplements, and get someone through the confusion and to their goal of feeling better as quickly as possible. So in any case, we will now go to the conversation with Dr. Titus Chiu on brain health.

DrMR:

Hey, everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio back with Dr. Titus Chiu, who wrote a great book that I recommend routinely in the clinic for those who I suspect to have some type of post-concussion syndrome or a cortical imbalance, just some bonk on the head that seems to have started around the same time that fatigue, depression, insomnia, or IBS started. And he was on the podcast a couple of years ago now discussing that. We’re going to do kind of a part two, which I’m really excited about because one of the things that he just mentioned off air was as we all kind of had to do when lockdown went into effect, was convert his practice as much as possible to a telehealth model, which I wasn’t aware could be done for brain or neural rehab, but it’s exciting to me because now it makes it more accessible to more people. So Titus, I’m excited to have you here to learn more about that, and hopefully get a few pearls for how to get my brain humming along on all cylinders.

DrTitusChiu:

Absolutely. It’s so good to reconnect with you. We had a great conversation last time and I’m looking forward to today.

DrMR:

Let’s give people a real short synopsis of your background and what you do in the clinic, because some people may not know that there’s this legitimate syndrome known as post-concussion syndrome where people can be knocked out unconscious, or sometimes not even, I believe, knocked out fully unconscious and they have these lingering symptoms afterwards. So kind of give us the quick primer for those who missed the first conversation.

Background and Post-Concussion Syndrome

DrTC:

Sure. So my name’s Dr. Titus Chiu, functional neurologist, number one best-selling author, and I specialize in helping high-achievers go from thriving to surviving after concussion. My whole journey began over 20 years ago when I was in a really bad car accident that almost took my life. I tried everything within conventional medicine to fix my brain, and I was shocked that there really wasn’t anything out there. So I went outside the box and I went back to school. I got a post-doc in clinical neurology, a master’s in nutrition, and I studied chiropractic acupuncture and everything I could get my hands on to figure out what was going on with my brain and also take that information and share with my patients.

DrTC:

But yeah, like you said, when it comes to post-concussion syndrome and concussions in general, the interesting thing is you don’t even need a physical trauma to your head to experience a concussion. You definitely need a trauma to your brain to have a concussion, but you don’t actually need to be hit on the head. I’ve had patients who, after riding a rollercoaster, like a strong jostling, or maybe even in a car accident if they had a whiplash and they didn’t even hit their head, develop concussion symptoms after that. So that’s one of the most surprising things I discovered in my journey. You actually don’t even need to hit your head to develop concussion and concussion symptoms.

DrMR:

Well, let me plant a flag there just for one second. Are there a couple key questions that you ask, because I’m always trying to refine our paperwork so that even before we see a patient, we have sleep-disordered breathing as a potential item with a certain degree of confidence we associate to it based upon their history and the questions that we strategically ask in the paperwork. Are there a few that are important as kind of early phase general screening questions?

DrTC:

Yeah, definitely. The most obvious is, in our intake process, we have a space where we ask if you’ve had a history of a concussion, injuries, or trauma. So typically from there, if I see something like whiplash, that’s one thing I’ll definitely explore. That’s the surprising thing, that even minor injuries, like I’ve had patients who’ve fallen off their bicycle. They don’t land on their head, maybe they land on their wrist, but the whole force from that then creates this concussion profile in their nervous system. To answer your question, do you have a history of concussion or head injury? And then in addition to that, do you have a history of trauma or injuries? And then from there, when I get on that first consult with them and I’m talking to them, I ask them and explore those things.

DrTC:

Especially if they don’t know, and that’s the thing. I’ve worked with a lot of patients and just by the nature of my specialty, most patients and clients who reach out to me, they know. They know that they had a concussion and all their symptoms began afterwards. But I would have to say before I began to explore that whole realm and specialize in concussion, like years ago when I was just seeing more neurological conditions in general, that would be one of the things that I would begin to explore in greater detail. I’d be like, “Well, are you sure you didn’t have a concussion? Did you even have a whiplash?” And then a lot of times, it’ll then jog their memory, like, “Actually, yeah. Around the time that I started to have that IBS and the brain fog I got in a really bad car accident. I didn’t lose consciousness or hit my head.” So those are the things that I start with, and then obviously as you know, I really explore their history in great detail to get to the root cause for their symptoms.

DrMR:

Okay, good. So that’s good for me to know, because we essentially have a question that asks if there has been any head injury, trauma, plus or minus concussion as one question, and then to your recollection, did any of your symptoms start around that time? Just so we have these pre-screenings, and again for our audience, at the clinic we’re really trying to make sure that there’s the minimal amount of information that has to be vectored at your visit with your doctor because I’ve found that people often forget stuff if they’re doing it right there on the spot. So if you give them a chance to really sit alone and think through it, and then we try to refine the narrative when we have a chance to speak with them. So, good. That’s really helpful for me to know that we’re not missing anything.

DrTC:

Totally. And to add to that, you can have something on your intake form that says, “Have you had a history of concussion?” And then the next box would be, “Are you sure?” Because that’s usually how the history process goes. The first interview is like really exploring that. But like I said, most patients who reach out, they already know. They’re like, “Yeah, after that car accident, I hit my head. After that sports injury, that’s when I developed the light sensitivity and the anxiety and the brain fog.” So it’s pretty straight forward, but like I said, when I began to explore this whole, I think hidden epidemic of concussion, I really explored that with my patients to really make sure that wasn’t a contributing factor.

DrMR:

Sure. And just to kind of testify to this, I have to credit the late Dr. John Donofrio, who was formerly the head of the Chiropractic Board of Neurology for opening my eyes to this, because when I was early in my career I lectured with him at a few spots across the country with his seminar series that he did. And I would just watch him do what almost seemed like magic, and I’ve told the story on the podcast before so sorry for those who’ve already heard it. He’d take someone who had vertigo and couldn’t stand with their feet together, close their eyes, and then not fall over and do an assessment and teach the audience, “Okay, this is indicating a misfiring in this region of the brain. If we adjust here and use laser simulation there, we should be able to rectify that.” And three minutes later, the person is able to stand up straight and not fall over.

DrTC:

It’s pretty amazing. That’s stuff I see so often in my practice, both like we were talking about in person, but also virtually. Just doing these little challenges, these little therapeutic trials, sometimes it’s like bam, you see changes immediately. It’s not like 100% all the time; it’s not like you do something and they’re cured or they’re healed completely, but it gives us clues as clinicians that we’re moving in the right direction. Through the miracle of neuro-plasticity, when we continue with those different things, whether it’s a certain eye movement, a special movement of their body, or maybe listening to specific tones in their ear, once those things give us an improvement in the nervous system and we can see that through objective testing, then we know we’re moving in the right direction and we just continue from there. It’s actually a really exciting investigative process for me as a clinician.

DrMR:

Sure, and it’s similar to what we do at the Center, in regards to what is going to be the main factor or factors that move the gut in the right direction. Will it be more carbs, less carbs, more fermentation, less fermentation dysbiotic treatments, anti-inflammatory treatments? You really use people’s feedback, the response, to steer. So, yeah, I think we’re similar in how we kind of work through this in these cascading decision trees or algorithms that the patient’s feedback is crucial to steering.

DrTC:

It’s completely data-driven. Obviously too, there’s the human experience when you talk to your patients and really understand the bigger picture of what’s going on with them, but it’s cool that we can correlate the data with their symptoms and then therefore the data with their improvements in their symptoms.

DrMR:

Yeah, and that’s how data is useful in my opinion. If it’s just treating numbers, that’s where I think a lot of the functional medicine field is going awry. It’s a test forward and a data forward model, and they’re actually putting the subjective experience of the patients in the back seat. And that should actually be what’s forward. It should be a treatment and response forward algorithm, and the data are kind of woven into that. That’s where I think we really see eye to eye.

DrTC:

Absolutely.

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Brain Health in Sensitive Patients

DrMR:

Now we do want to come to some of these tests that people can do virtually and such. But before we do that, you had made a remark that I wanted to open up for people, because I think this’ll land for a lot of our audience, which is sensitive people and the brain. We have people in our audience who might be sensitive to foods, to supplements, to the environment, maybe some people who have had or suspect mold exposure. We’ve discussed how something like, as an example, limbic retraining therapy can really help to attenuate some of the reactivity in those cases. But there’s another element to this, and I’d love for you to give your perspective on how we should be thinking about the brain in sensitive patients and what your type of therapeutic interventions may offer this cohort.

DrTC:

Yeah, definitely. It’s really interesting because prior to my whole exploration into post-concussion syndrome, I worked with a lot of patients who had auto-immunity. In general, I find patients who had auto-immunity were sensitive just kind of by nature, so to speak. So the fascinating thing was I worked with these patients who are “sensitive,” and then I started discovering this other group of patients who had these symptoms and that the typical protocols that I’d do wouldn’t really move the needle. When I explored their history in greater depth, like I said earlier in this conversation, I discovered that a huge group of them had a history of some type of concussion. And so from there, it was interesting because many of these people, not all of them, like the concussion patients I work with, the majority of them were not sensitive. Prior to their concussion, they were just normal people. They could go about eating whatever foods. They could be exposed to chemicals and not fall apart.

DrTC:

So it was really fascinating because I discovered that, on one hand, a lot of my auto-immune patients were just sensitive, really highly-sensitive people, versus my concussion patients who developed sensitivity after their head injury, or their concussion, like we said. And so it really made me ask the question, “Well, what’s going on here?” We can unpack this on so many levels, but as you probably know, after a concussion, especially if it’s strong enough, a person can develop a breach of their blood-brain barrier. The blood-brain barrier is this protective structure, the single cell layer that protects your nervous system from the outside world.

DrTC:

As you know, you can actually do tests for integrity of the blood-brain barrier. I discovered that a lot of people who develop sensitivities after their concussion had a breach of the blood-brain barrier. So there is this physical trauma that happened after the concussion or the head injury, but then from there, it triggered what we call in the research the second hit, where you have this physical trauma and it creates inflammation in the nervous system and maybe a breach of the blood-brain barrier. Then it triggers a systemic inflammatory response that might impact the gut, for example. And then from there the gut, as you know, launches a massive systemic inflammatory response that could then either release cytokines into the central nervous system or trigger leaky brain, the blood-brain barrier permeability, and then get in, leading to that second hit. So that’s what I find is one of the biggest root causes for sensitivity after a concussion.

DrTC:

As you know, there are other things as well from there that lead to a whole neuroinflammatory cascade, activation of microglial cells, and all those different things that happen from a neurochemical perspective. So that’s one of the things I see happen in the brain after a concussion, breach of the blood-brain barrier leading to sensitivity. But in addition to that, the physical trauma could impact the different neural networks that make up our nervous system and give us the ability to do things like balance, coordinate, and have clear thoughts and be focused. So if there’s actually injury to the physical structures of the brain, then the symptoms and the sensitivity are very specific to different types of triggers.

DrTC:

As an example, on the one hand, if it’s someone who’s developed sensitivity because they have a breach of the blood-brain barrier, typically anything will trigger their symptoms. Their nervous system is just inflamed, and then they experience things like brain fatigue or brain fog, and what’s known as sickness behavior syndrome where they just feel so unmotivated and don’t want to get out of bed. And a lot of them experience depression.

DrTC:

So that’s the neuroinflammatory trigger for sensitivity, whereas the other one, when I was describing the physical reasons, like if you have an injury to physical structures of the brain and it’s not just an inflammatory response, then I find people typically become sensitive, but to only very specific triggers. So as an example, there’s an area of the nervous system that we actually talked about in our last podcast called the vestibular system that gives us the ability to perceive where our head is in space. It’s like proprioception and body awareness. I find if there’s injury to that specific neural network, the triggers will then be specific to the vestibular system. Meaning maybe if they are in a car or if they move really fast, they move their head really quickly, then those are the triggers that will lead to sensitivity. So they become very sensitive in this one particular area.

DrTC:

For me as a functionologist, I can have a conversation with someone and in five or 10 minutes, I’m like, “Yeah, I’m pretty sure this is the neural network. Here’s the root cause.” Whereas again, the first profile is more like the neuroinflammatory patient. By the way, as you know, when I describe this it doesn’t even have to be after a concussion. A person could develop neuroinflammation from exposure to chemical toxins, to food sensitivities, to even emotional stress or things like hypoxia, but that’s besides the point.

DrTC:

So like I was saying, for the neuro-inflammatory patient, they become sensitive because of a breach of the blood-brain barrier. And we know that because they’re sensitive to almost anything coming in. Any sensory signals like lights or sounds or movements as well as cognitive, like if they have to think about things. Many of the patients, especially if it’s really severe, they just don’t want to get out of bed and they ended up feeling depressed in what we call sickness behavior syndrome. Whereas the other hand, after a trauma, you can actually have injury to specific regions and that’s more physical structures of the brain, but then it’s specific to what’s actually happened.

DrTC:

My point is that it’s really important for different patients out there who are struggling with symptoms, and you have to figure out what the root cause is for their sensitivity. Is it just that they’re sensitive by nature? Again, a lot of the auto-immune patients that I work with are just born sensitive to all different types of things, whether they’re mental or emotional. Or was it after a concussion? Usually if it develops after a concussion, it’s either, number one, the neuro-inflammation going on because of breach of the blood-brain barrier, or number two, there’s specific injury to regions of the nervous system. And you can actually have a combination of both those scenarios, but at the end of the day, once you can get to the root cause for that particular person, what’s going on in their nervous system, then you can devise and put together a plan that actually strengthens those areas and helps shift those microglia cells back from this inflammatory state to one of healing, like the healing response. And there’s a bunch of different natural ways that we can do that. Obviously through diet, supplements, lifestyle changes, as well as brain training exercises.

Treating Sensitive Patients

DrMR:

Well, a lot there to unpack and respond to, and I love it. One thing I think is really worth echoing is your comment about some people being more sensitive than others. I think that’s important because, as I’m sure our audience knows, I’m becoming increasingly concerned that with the test and diagnosis heavy nature of functional medicine, we’re all trying to help people, yes, but we’re inadvertently pathologizing things that to a large extent are normal. Small perturbations in hormones or vitamin levels, and it’s, “Oh, you’ve got this or that syndrome.” Let’s say you are a little bit constitutionally environmentally sensitive. Well now you’re labeled with MCAS, mast cell activation syndrome.

DrMR:

What we’re doing at the Center now is really converting our language to non-pathological language. As just one example, to reduce the psychological burden on patients, we’re no longer using the acronyms MCAS, and we’re saying, “Oh, you might be a little bit histamine intolerant.” We’re not using the term mycotoxicity, we’re just saying “mold.” Because we’re not trying to further ingrain in people this pathological sickness or there’s something wrong with me, because some of these things are just that you’re normal and we’re all operating at different normals. Some people are fast, some people are slow, some people are tall, some people are short. Some people have skin that won’t burn, some people have skin that will burn. We’re trying not to feed into those differences as being a thing, a condition, a syndrome, a what have you, and frame them as you’re a strong person who can and will be healthy, there’s just this little monkey wrench in the system. We’re going to try to take care of that, and we anticipate you’re going to be just fine.

DrTC:

There’s so much unpack there. The whole psycho-neuro immunology component of healing that’s I think obviously in conventional medicine is not really acknowledged. That’s why you have the placebo-controlled trials, because sometimes the power of the mind has the ability to impact health or disease. So I think that’s so important, the whole mindset piece and “languaging.” And that’s why when I work with patients and clients, I will use data, I will run labs, but then it’s like what’s healthy and normal for them? Again, going back to those two sets of patients that I would work with throughout the years, especially the concussion patients, it’s like what they’re experiencing now is definitely not what they were prior to the concussion, so I’m always trying to not so much compare them.

DrTC:

Obviously as you know with data and lab values there’s what’s optimal and what’s within range, and you’ve got to look at that, but at the same time I put that in the context of what’s normal for this person. For me, when I work with patients who have concussion, it’s pretty black and white. They were healthy, relatively healthy, or at least adapting, and then after their concussion they weren’t. To me, it’s easier to see that, whereas for people who are sensitive in general, typically patients who develop auto-immunity, then it’s kind of harder to tease that apart. But what I have found across the board, regardless if they’re sensitive to begin with just by nature, and there’s nothing wrong with that, or if they’re sensitive after trauma, I’ve found that the approach to a sensitive patient is completely different than it is for the majority of other people out there.

DrTC:

You might have the same exact supplements or diet, but I’ve learned over the years, working with a lot of sensitive patients, the way you actually communicate, like what you’re saying, but also how you recommend they take it.

DrMR:

Slow and steady and simple.

DrTC:

Yeah, exactly. So for a real world example, I might have a supplement protocol that I recommend for a patient, but I’ll be like, “Okay, start with this one first and see how you feel. Take that for two or three days, and if you feel okay, then start the next one. I’ll be the first to admit that I made the mistake in the past of just giving a person everything. Here’s the whole supplement protocol, here’s the diet, here’s everything. They would try it and they’d get so overwhelmed because again, they were sensitive.

DrTC:

As an example, when I work with patients obviously with concussion, one mistake I’ll see therapists and clinicians make especially with rehab is that they overdo it. As a general patient profile, patients I’ve worked with have developed symptoms after concussion, but then on top of that, when I do a workup, I either find out that they have a lot auto-immunity by taking the history obviously, or through testing we discover together that they have auto-immunity. My point in saying this is a lot of patients who I’ve worked with who have both concussion as well as something else going on besides the concussion, the type of rehab they need might be the same exact exercise, like eye movement exercise, or head movement, but the intensity has to be totally taken into account for them.

DrTC:

I see so many therapists who are trained to the best of their ability. They understand vestibular rehab, eye exercise, or vision therapy, but many times they might not understand how that needs to fit in for a person who’s more sensitive, like someone who has auto-immunity. So one of the biggest things I see is clinicians giving too much of a therapy too fast. It’s kind of like that idea, just push through it, fight through it, and you’ll be fine. And I find that for sensitive patients that is the worst way to approach it. It’s like you take three steps forward and then 10 steps back.

DrMR:

I appreciate your perspective because this is one of a tenured clinician, who just like me, started off with all this theory and probably a degree of dogma that accompanies any field. It’s kind of a testing heavy, treatment heavy scenario, and at least we’ve learned our way out of it. The providers for whom I hope we can shed some light on are the ones who think, like you said, you have to work through it. While you may feel bad for three months before you feel better, I haven’t found that really to be true for anyone. It’s usually too aggressive or they’re reacting or what have you.

Exercise Intolerance

DrMR:

I don’t want to derail this topic, but I did hear you say something from the last few comments that I wanted to circle back to. With a vestibular lesion of some sort, do you see that parallel with exercise intolerance? Because at the Center we see some patients who don’t have a high tolerance for exercise, and I’m wondering if that could be more movement than their vestibular system could handle. I’m assuming that would present with dizziness and nausea as opposed to someone who just says they’re just tired and it’s more of like a chronic fatigue crash than it is vestibular. Is there any parsing of those two entities that you might be able to color in for us?

DrTC:

Absolutely, yeah. I see this all the time. The top three things that come to mind when you talk about exercise intolerance are number one, gluten sensitivity. Number two, dysautonomia. And then finally, number three, vestibular issues. And also, mitochondrial issues. When I’m taking the history of a patient, the fastest way I parse through it is I figure out what type of exercise they’re intolerant to. So if they say something like, “Oh yeah. When I go for a hike and the terrain is really windy. I feel terrible.” Or, “If I go for walks, I feel okay, but then after about 10 minutes I don’t feel well, and especially if I go jogging I feel terrible.” So then I’ll ask them if they’ve ever tried sitting on a stationary boat and exercising. They’re like, “Oh yeah. When I’m on a stationary bike, I feel fine.”

DrTC:

Right there I know that one of the biggest root causes for their exercise intolerance is probably vestibular, because when you’re sitting on a stationary bike, you’re not bringing the vestibular system into play. What I mean by that is the vestibular system perceives movement of your head. So if someone’s going for a walk or someone’s going for a jog or a hike, they’re moving their body and they’re moving their head around. And one of the jobs of the vestibular system is for every movement of the head there’s a specific eye movement reflex that happens so you can maintain your vision and not have blurriness or nausea when you’re walking. Also there’s another reflex that is triggered by way of what we call the vestibular spinal tract that connects your inner ear in your vestibular system to your spinal stabilizing muscles.

DrTC:

So when you’re moving, if your vestibular system’s working well, your eyes will move accordingly and your muscles will fire accordingly so you don’t lose your balance. And so if there’s an issue with the vestibular system, when there’s any type of challenge, meaning someone’s even just walking, moving their head quickly, in a car, or going on a hike, and they develop symptoms and “exercise intolerance,” but they don’t when they’re sitting on a stationary bike because their head’s not really moving, then I know without a doubt, or am 99% sure, that when I do testing, I’m going to explore the vestibular system. Whereas if a patient’s like, “Yeah, I feel terrible no matter what I do. On a stationary bike, a treadmill, if I go for a walk or anytime I exercise and my heart rate goes up.” If it’s all exercises then I’m looking at something like either gluten sensitivity, dysautonomia, or mitochondrial issues.

Dysautonomia

DrMR:

This concept of dysautonomia is also what I wanted to circle over to. Donofrio would describe this as a cortical hemisphericity meaning that you have your left hemisphere of your brain and your right hemisphere of your brain, and if they have equal strength or equal firing amplitude, they’ll inhibit sympathetics and they’ll allow this sympathetic vagal tone to be where it should be. I know that was a bit of a simplified heuristic to help people wrap their minds around it, but I’m just wondering with dysautonomia, meaning an imbalance in the autonomic nervous system, are you finding that there’s a hemisphericity, a brain hemisphere imbalance and a kind of Vagal nerve tie-in? For our audience, the Vagus nerve is what helps to regulate the parasympathetic rest, digest, and relax. Are all these interlinked? Is this common, or is it maybe not as easy as the hemisphericity model would suggest?

DrTC:

Yeah, that’s a great question. The hemisphericity model, looking at the balance between the left hemisphere of the brain and the right hemisphere of the brain, is a great starting point. You can have dysautonomia due to a lot of reasons, but if it is truly just a neurological root cause, there’s so many other areas of the nervous system that impact autonomic function. There are obviously the hemispheres, the prefrontal cortex especially, the hippocampus and you can have left and right imbalances. But then even going back to what we were talking about with the vestibular system, the vestibular system has a powerful connection with the autonomic nervous system. Things like vestibular imbalances could also lead to dysautonomia. The brain stem, definitely, because the brain stem is kind of like the closest link between your nervous system and regulation of your body and the autonomic functions like heart rate and digestive function, et cetera.

DrTC:

So there’s multiple areas of the nervous system that can trigger dysautonomia. Actually, in terms of concussion, I find that the most common ones are typically the inner ear and the brainstem and not so much the higher centers of the brain, the hemispheres, so to speak, like the neocortex. But again, most of the patients I work with have concussions and the inner ear is very easily susceptible to trauma after a head injury. But it’s definitely part of that whole neurological stress response. What I mean by that is we have the HPA axis, which is the neuroendocrine stress response, but then you have a neurological stress response. There’s this massive fiber of neurons that connect your prefrontal cortex with your brain stem. So you can have problems with the stress response that have nothing or very little to do with your adrenal glands and actually are really more neurologically because of issues with…

DrMR:

Blasphemy. Blasphemy.

DrTC:

I mean, you look at the research and what sits at the top of HPA axis is the hippocampus and the prefrontal cortex. And that’s the thing, it’s just physiology. There’s neurological stress reactions, but then there’s also endocrine by way of the humoral system, chemicals, hormones, and neurotransmitters that are carried through blood pathways, but then you also have these neural pathways that don’t travel through the bloodstream. There are specific nerve pathways that we described. I think the best one that everyone knows about these days is the Vagus nerve. Within the brainstem, you have three parts of it. You have the midbrain at the top, the pons, and the medulla at the bottom. So top, middle, and bottom. And at the junction of the middle and bottom, what we call the pontomedullary junction is where you house the actual nucleus, the cells that make up the Vagus nerve.

DrTC:

So it’s like you have these brain cells or these neurons in your brain stem at the lower part of it that then send a signal by way of the Vagus nerve to all of the different body regions that create the autonomic responses. That’s not by way of the adrenal glands. I mean, it could be influenced by things like cortisol and norepinephrine, but that’s an electricochemical pathway versus just the humoral endocrine pathway.

DrTC:

Anyway, we’re totally nerding out here. My point in answering your question, yes. Over the years, I’ve found that the hemisphere model, looking at the brain as left brain versus right brain is a great starting point, but then there’s so many other regions of the nervous system. And depending on what functions we’re talking about, if we’re talking about autonomic functions, there are specific neural networks that are associated with autonomic function that go beyond just the prefrontal cortex or the neocortex.

Oversimplifying Treatment

DrMR:

Right. Well, I have a similar potential oversimplification that I’m wondering if this irritates you. I could probably think of a whole myriad of these canards that frustrate me with my specialty of gut health. People thinking that the way to improve their parasympathetic sympathetic balance or their autonomic function is just to do gagging exercises two times a day and that’s going to fix everything. I fear it’s one of these oversimplifications that are floating around out there. Now it’s not also to say that I suspect this is overly daunting to assess and get right, but I think people listen to a podcast or read a blog, they take away one kind of side comment from a clinician, then before you know it I have patients who are all gagging themselves. They’re coming in and saying, “Well, I’ve been gagging myself for two months, I don’t know why my SIBO and IBS hasn’t gone away.” Is that a fair criticism? Is that something that frustrates you?

DrTC:

Yeah. I mean, there’s several ways of looking at it. I think it’s great that information is available. Sometimes those little tips here and there can change a person’s life. So on that note, I think it can be positive, but obviously it’s not as simple as that. It’s just like, if someone would say that the miracle for everyone for whatever health issue you’re struggling with is vitamin D. It has to be personalized, and there’s so much more to that. We discussed that in great detail in the last podcast, but really at the end of the day, it needs to be personalized. So if someone out there tries something like gargling because they think it’ll activate their Vagus nerve and it helps them, that’s awesome. But if they do it and it doesn’t help, it doesn’t necessarily mean that they don’t need to activate their Vagus nerve. It might not be the right specific pathway, because there are multiple ways of activating the Vagus nerve that travel along different neural networks, meaning has to be personalized to each person.

DrTC:

Also the intensity of it. Last time, we talked about how we can use electroceuticals to activate the Vagus nerve. There’s even surgical implants you can use to activate the Vagus nerve. So just because gargling didn’t help, doesn’t mean that it’s not the right thing they need to do. Maybe it’s just the wrong intensity, or there are other ways of activating the Vagus nerve. For a lot of patients of mine who have digestive symptoms, one of the best ways of activating the Vagus nerve if they’re not doing it already is chewing their food. When you chew your food down and you actually chew to the level where it’s almost like water, like a liquid, you’re helping to masticate and breaking it down so then your stomach doesn’t have to do too much peristalsis when it’s down there. But also, there’s a specific nerve reflex between the TMJ, your jaw, like the trigeminal nerve and your Vagus nerve. So when you actually chew your food, just the physical action of doing that triggers the Vagus nerve, but specific to digestive function. So gargling might not help, but maybe chewing their food would, as an example.

DrTC:

There are also ways of activating the Vagus nerve by way of other pathways related to the eyes as well as the inner ear. I think last time we also talked about visceral manipulation or belly massages, which have these pathways. The Vagus nerve is kind of a hot topic these days, but you want to be really clear as to what we’re actually trying to accomplish there, what is right for this person. You can activate the Vagus nerve by way of vestibular pathways or by way of these visceral pathways, these somatic reflexes. And it has to be personalized to the patient.

DrMR:

Well that’s good to know, it affirms my suspicion. And also great comment that those tidbits, when they land for someone, are really helpful and can sometimes be life-changing. So yeah, I should definitely acknowledge that.

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Vagus Nerve Stimulation

DrMR:

What about a Vagal nerve stimulator? I have here a Xen unit or aka, a Neuvana unit. I’ve just started kind of tinkering with it. I guess they have an updated model they sent me with more user-friendly instructions. I’m wondering if that’s something that you’ve experimented with? Do you have any recommendations for how someone may want to consider using one of these? For our audience, it essentially looks almost like a little cell phone-like device with headphones, and the headphones kind of buzz and pulse. Apparently this offers a degree of Vagal nerve stimulation.

DrMR:

I did do a brief research query on the use of these and it seems that they can help with either depression or anxiety, but I saw some other studies that they may actually worsen sleep apnea. I’m not sure if it was apnea specifically or just insomnia. This was a quick poke in the PubMed, so take that with a grain of salt. But yeah, I’m wondering what your thoughts are on these kinds of direct-to-consumer VNS units.

DrTC:

Yeah, there’s a lot out there because, as we know, the Vagus nerve is a really hot topic these days, especially in like the biohacker world, but also in functional medicine and functional neurology. So there are a lot of devices out there. I don’t have experience with that one in particular, but I have experience with other ones. If it’s right for the person, it can be a game changer, resetting the nervous system. And that’s the thing, I’d be curious to look into this actual device you’re talking about. It’s interesting because there are a lot on the market these days because it is such a hot topic that there are a lot of these claims that it’s a Vagus nerve stimulator, but I’d be curious to see the research regarding how they come to that conclusion. How are they actually activating the Vagus nerve? There are a lot of different ones out there. There are ones that vibrate the wrist and they say it activates the Vagus nerve, but I actually don’t know any pathway for that.

DrMR:

I think that’s the Apollo Neuro. I did some experimentation with that device.

DrTC:

I mean don’t get me wrong, I hear a lot of great feedback from people who use that.

DrMR:

But it could also be placebo, so there’s always that skeptical nature. I forget how much the device costs, but I think it’s a couple hundred dollars. If that gives someone a sense of protection or benefiting their health and that shows up in a measurable way, even if it is placebo, I’m not fully opposed to it, but I think we’re both a tad skeptical. So it’s like, what kind of evidence?

DrTC:

Actually, I’m not so much talking about placebo. I think placebo is always involved in any type of intervention for the most part, but that being said, I’m just talking about the actual physiology. We can go off on this idea of placebo because I’ve thought about it a lot. But for example, if you do acupuncture, there’s going to be a placebo component, but there’s also the physiological responses that sticking a needle into someone will trigger in a person’s nervous system. So that’s what I mean by that. I’m curious how these companies say it activates the Vagus nerve, because the Vagus nerve is a very specific nerve from the bottom part of your brain stem that goes to different organs like the dilator muscles of your pupils, for example.

DrMR:

Maybe they’re making a little bit of an inferential jump to. You know way more about this than I do, but to my understanding, the extremities’ mechanoreceptors are afferent to the parasympathetic, and maybe they’re making this claim.

DrTC:

That’s what I mean. And even for example, with the pupil constrictors, that’s a different nerve pathway. But the Vagus nerve goes and communicates between your nervous system and all these different organs, blood vessels, glands, and things like that. So if you’re yeah. But again, if it works, there’s a physiological reason for that too, because if there’s a little vibration that does trigger a nerve response and then depending on the technology and neural feedback processes. Another really great one out there too is HeartMath, which is pretty much like a neural feedback device. You synchronize your breathing with images and you can actually see measurable changes in your heart rate variability. And from there they’re saying, “Okay, one of the functions of the Vagus nerve is to impact heart rate variability.”

DrTC:

Anyway, I’m just kind of nitpicking it. At the end of the day I think if a lot of these devices are targeting the right neural network for that person, it could be a game changer. There are different electroceutical devices that I use in my practice, but a lot of times the way I’ll come up with which device to recommend will be through your history and then the neurological exam, because then from there I can identify the weak link in the nervous system and the specific pathway that we want to activate. Do I want to use something like the Apollo? Do I want to use something like HeartMath? Do I even want to use something like these bone conducting headphones, or do I just want to have the person chew their food more? It’s all revealed in that whole process, the investigative process.

Neuroplasticity

DrMR:

I want to jump there after this question, which would be for someone in a boat like my own, which is feeling pretty darn great and mostly concerned with better output, better energy, better performance, and I would say just overall under this moniker of performance optimization, is this something that the assessment also works to find, I’m assuming something like more of a subtle imbalance that might give you a 10% gain? Is there some benefit there to be had?

DrTC:

Oh yeah. Over the years, and it’s really part of my whole journey, I made this discovery, it’s not even my discovery but I embodied it, and that is the miracle of neuroplasticity. Once you identify the area of the nervous system that’s the weak link, and then you give specific exercises or neuroplastic therapies to strengthen those areas, not only can you help people recover from things like concussion, anxiety, or depression, but you can also take the same exact principles of neuroplasticity and take someone who’s healthy and take their brain to the next level. Like I said, I went through that whole process myself. After my car accident, the car accident I was in 20 years ago, I developed these concussion symptoms and my life fell apart for quite some time. So I had to really rebuild my brain from the ground up.

DrTC:

But once I got healthy again, I would take the same exact principles that I learned and realized that I can apply it and take my life to a whole new level. In many ways, not all, but in many ways I actually see that I’m healthier and my nervous system is stronger, more resilient, and functions at a higher level than maybe when I was 18 when I was inflamed and had all these health issues even before my concussion. Like in your question, you can try a blanket approach, like, “Oh, I heard this guy say if you gargle or if you spin in a chair your brain will work better.” You can take that approach, but if you really want them to get like personalized and get faster results, then the assessment process is so invaluable, regardless if you’re trying to recover from a concussion or you just want to hack your nervous system and get better at whatever’s important to you, whether it’s thinking, whether it’s athletic performance, even emotional resilience or emotional intelligence, EQ so to speak.

DrTC:

So that’s the beauty of neuroplasticity. I’ve discovered that they are the same principles whether you’re trying to heal from something or you’re trying to take your life to the next level. And with a thorough evaluation, you can really figure out what are the weak links in my nervous system and what are the right exercises that can be used to strengthen my brain. It’s the same thing with functional medicine, right?

DrMR:

Same thing with the gut, especially. I do the same sort of thing in the clinic.

DrTC:

Only testing will reveal these things. I don’t know if a person has breach of the blood-brain barrier. There are clues that might be in the history, but with objective testing, then we can really see it black and white, and then from there, track progress, as an example. But that’s the thing, even in an assessment process, there’s different levels of that. If anyone’s interested in working with me, if they’ve had a concussion, even before I talk to them or learn anything about them, I already have like a 5,000-foot view of what’s going on just because there’s patterns. And then when I have a conversation or they fill out some intake forms, then I have like a 500-foot view. And then when I actually do a history and talk to them in great detail, then it’s up close, an up and personal view. And then when we do testing, like neurological testing or lab testing, then we actually have this chemical level view, like a cellular level of what’s happening. And every step of the way when I gather more information, then I could put together a plan that really accelerates their healing process or helps them reach their health goals a lot faster.

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Telehealth Consultations

DrMR:

Let’s discuss how you’ve converted some of these assessments to be able to be conducted in a predominantly telehealth climate. Some of this seems like it makes a lot of sense, but just for my own edification, and I’m sure the audience is also wondering if they wanted to do this, what does a telehealth visit look like with something that you would have thought may have really required an in-person presence?

DrTC:

Yeah, that’s a great question. I’m sure you know too, as a clinician I’ve learned over the years that the number one best assessment tool I have is a conversation with the person, the history. So right there so much can be revealed. And the cool thing is there are a lot of technologies, like I use different software that can actually measure brain function. I use this one that measures vision as well as cognitive function and balance, three core areas of brain function. It’s a computerized system from which we can get objective data looking at reaction time and balance and eye movement tracking. Those are really important because those are windows into these different neural networks that I was describing earlier, like looking at visual neural networks related to eye movements, what we call the ocular motor system.

DrTC:

So if a person doesn’t score high in that test, then I have an idea that when we discuss a plan moving forward we’re going to do things to retrain their eye movements. If they have issues that are mainly cognitive that the testing can reveal, then we can do things that are more related to cognitive training. And obviously with balance, we do things related to balance strengthening balance. So part of that whole process is the same thing I do in office. We get intake forms, I’ll review a person’s history beforehand, and even then I’ll have a really good idea of which direction to go. Then I have a video consultation with them and I explore their history in greater detail, figuring out what are their triggers, what are the things that help them?

DrTC:

And those are huge clues because I understand the physiology underneath that points me to the root cause. And then from there, we can do this completely virtual remote testing. They actually do it in the comfort of their own home. They download a little app to their smartphone and they can perform these tests of vision, cognitive function, and balance. And then if I think it’s necessary to go even further, I can actually do a lot of neurological testing via video consult. I can look at how a person balanced, their reaction time. I can even do some eye movement testing depending on how well the connection is and get a lot of information from there. And the whole purpose of that comprehensive process is to really get to the root cause. I’m always asking the question, why? Why does this person have these symptoms? Why do they have anxiety after their concussion? Why do they develop brain fog, brain fatigue, and headaches after being on the screen for 30 minutes?

DrTC:

So through that whole process of the history, of the computerized functional brain testing, and then sometimes if needed, the virtual neurological testing, I have a great idea of what we need to do. Obviously, in addition to that, we can run the functional lab tests as needed, such as blood tests, urine tests, all of that can be done completely virtually. And the awesome thing is we’re able to work completely, 100% virtually with a lot of the patients and clients. I give them an at home brain training program to strengthen the areas of their nervous system that are the weak links, and based on questionnaires as well as functional lab tests we might run, I could put together a plan looking at diet, supplements, and lifestyle, and they take off running.

DrTC:

Sometimes depending on if I think they need the technologies, a lot of the technologies like the one you mentioned earlier, the Apollo and the HeartMath, they can purchase those on their own and then use them at home. So then I walk them through how it fits into their overall program. And that being said, especially with everything shifting virtual since last year, I found that a lot of it can be done completely virtually. And then for patients who I think need additional advanced neurological assessments, they actually then come in office. They either will travel from parts of California or flying in to see me. I’ve had patients fly internationally, especially before the lockdown and everything or whatnot. And then I can do a really in-depth neurological exam for the patients who really need that extra TLC. And then we can use the more advanced treatment technologies like low-level laser, oxygen, or infrared, things of that nature.

DrTC:

You know what I found in those whole process is that the first foundational steps can be handled completely virtually, and then from there, some patients then would need an in-person visit, but I found a lot of them actually don’t.

DrMR:

And you establish the precedent there based upon your book, which I can testify that I’ve simply had some patients just read your book and go through the exercises and it’s been notably helpful for them.

Episode Wrap-Up

DrTC:

Yeah, exactly. That’s what I was saying earlier about that 10,000, 5,000, 500-foot view. With the book, even if I’ve never met a person before, I’ve been through it myself. I healed my brain from a concussion. I’ve worked with thousands of patients over the years, so I know these patterns and I developed that BrainSAVE approach, the step-by-step system. And it’s cool because the more I do it and the more latest research comes out that I’m always looking into, I refine that. Like BrainSAVE, I think I wrote that three years ago now, in 2018, I think. Even from then it’s come a long way because I’m always refining it based on what’s the latest research out there and stuff that works for people.

DrMR:

Well, will you remind people of your website, and wherever you’d want to point them online to connect with you and also the book title and where they can pick that up?

DrTC:

Yeah, definitely. So my website is brainsave.com. I actually have this quick PDF, a quick start guide to the Vagus nerve because we talked about some exercises that you can do, at home, simple, low-tech things. But in addition to that, I’ve laid out a few technologies that if people need a bigger dose to their Vagus nerve, or at least triggering that parasympathetic response, there’s some things on there as well. I’m pretty sure the direct link is brainsave.com/vagus. But if you just go to brainsave.com, you’ll be able to find it.

DrMR:

Awesome. All right my man. Well, thank you for the work that you’re doing. You’ve definitely made it easier for me to refer for this when I see it flagged on my paperwork. I’m probably going to do a virtual consult with you just to see if I have anything here that I can tune up, just because I would like to see if there’s any kind of foil on my neurological aerodynamics. So expect to get an email from me. I’ll try to be somewhat compliant.

DrTC:

Awesome. I look forward to hearing from you.

DrMR:

Awesome. Well, yeah, thank you, sir. Again, I appreciate you coming on. And folks, if you resonated with any of this, it doesn’t have to be a big laborious process. I think the book is a great first step, and then if you don’t get to where you’d like to after the book, reach out directly and go through the virtual consult to make sure that your brain health is as tuned up as it can be. And Titus, thank you again.

DrTC:

Awesome. Thanks so much for the invite. It’s great talking to you.

DrMR:

A hundred percent. Same.

Outro:

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