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How to Heal From a Traumatic Brain Injury with Dr. Kabran Chapek: Rational Wellness Podcast 143

Dr. Kabran Chapek discusses How to Heal from a Traumatic Brain Injury with Dr. Ben Weitz.

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Podcast Highlights

2:17  Dr. Chapek just published a book, Concussion Rescue: A Comprehensive Program to Heal Traumatic Brain Injury, which he wrote partially while riding public transportation to and from work each day, so he dedicates this book to bus route 532.

3:07  Traumatic Brain Injury involves a blow or jolt to the head and minor traumatic brain injury is actually major cause of mental health issues that is often overlooked as a cause. A concussion is a form of mild traumatic brain injury where there is a loss of consciousness.  The standard protocols for treating such injuries have not improved at all in 20 years.  There are many others who have a brain issue, such as dementia, memory problems, depression, anxiety, etc. and this can be due to a past brain injury.  Mild traumatic brain injury is one of the silent causes of mental health issues and nobody knows about it.

4:40  Even the NFL, which is supposedly focused on reducing head injuries with their current concussion protocol, but they are not doing anything about the many minor slaps and blows to the head that do not involve a concussion but that are cumulative and can result in Chronic Traumatic Encepalopathy (CTE).  CTE is the condition highlighted in the movie Concussion and it cannot be diagnosed with a CT scan. This has even led some football players to retire early to avoid permanent brain injury.

8:37  A whiplash car accident can result in a brain injury without ever hitting your head.  This is because the skull has many sharp, bony ridges and the brain is soft as butter.  During a whiplash accident, you can have a shearing of the neurons between the cerebrum and the brain stem as the heavier cerebrum slushes forwards and then backwards in relation to the brain stem. and you also get a secondary injury from the cascade of inflammatory mediators and oxidative damage that results from this. A chronic inflammatory state can result, leading to damage to the brain over months and even years.  Dr. Chapek sees patients coming to see him at Amen Clinic with complaints of depression or ADD and a SPECT Scan finds that they have structural damage to their brain and sometimes it takes repeated asking (up to 10 times) during the history taking till the patient recalls hitting his head or some other trauma to his head.  Once this is determined, the patient is placed on a program involving diet, lifestyle and nutritional supplements to heal the brain and the depression and other symptoms often resolve.  Even though it may be years later, you can still heal your brain.

15:38  Dr. Chapek, as part of his evaluation of patients, besides taking a careful history, will use an online cognitive tool, WebNeuroIt measures attention processing speed, memory, and then emotional states of depression, anxiety, emotion identification, and it’s simple and somewhat objective. It is validated and correlated with MRI.  At Amen Clinic they also do SPECT imaging, which is like 3D imaging of the brain. 

20:27  If a patient has had an acute head trauma, then they should go to the hospital and get a CT scan to rule out a brain bleed or major damage.  Most of the time this will be negative. MRI is best for looking at the brain vasculature and for looking for amyloid plaque in dementia.   After a head injury or concussion, it is good to do a CT or MRI first to rule out severe injury and then if it is negative, do a SPECT scan to pick up mild traumatic injury.  Here is a good paper explaining the utility of doing both types of scans: Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review.

22:00  Dr. Chapek also likes to do some lab testing including looking at nutrient status. He likes to assess serum zinc, RBC zinc, copper, vitamin D, B12, homocysteine, inflammatory markers, hs-CRP, and lipids (cholesterol).  If any of these nutrients are low, it is harder to heal from a brain injury.  He does not like total cholesterol levels to go below 150, since a healthy brain needs plenty of fat and cholesterol.  The medical profession is a bit overzealous now trying to drive LDL levels down as low as possible using statins and the new PCSK9 inhibitor drugs and this may be sacrificing the brain for the heart.  Having a good vitamin D level is important for healing from a brain injury.  Vitamin K is also important.  Dr. Chapek also measures the Omega 3 index and the Omega 3:6 ratio.  Hi likes his patients have at least 3 gms per day of EPA and DHA.  Dr. Amen completed a study demonstrating the benefits of omega 3s and other nutrients for NFL players after head injuries and had them take 3 gms of Omega 3 fatty acids (fish oil), Gingko, Vinpocetine, Acetyl-L-Carnitine. NAC, alpha-lipoic acid, Huperzine A, and phosphatidylserine in a formula and also a multiple vitaminReversing brain damage in former NFL players: implications for traumatic brain injury and substance abuse rehabilitation. They experienced a 70-80% improvement in cognitive symptoms. 

31:41  25 to 50% of people with brain injury have damage to the pituitary gland, your master hormone gland.  Thus various hormone levels can be affected in head trauma, such as thyroid, adrenals, growth hormone and testosterone in men, and estrogen and progesterone in women.  Dr. Chapek said that we can measure IGF-1 and IGFBP3 levels first thing in the morning in order to monitor growth hormone levels and he said that a good target level for IGF1 is over 200.  This is very controversial now in the anti-aging community where lower levels of IGF-1 are considered better for anti-aging purposes, by Dr. Valter Longo and others.  But Dr. Chapek feels that there should be a balance between lowering IGF-1 levels with fasting and raising IGF-1 levels for growth and regeneration purposes for the neurons in the brain.

36:59  In Dr. Chapek’s book, Concussion Rescue, he talks about a first aid kit for the brain.  There’s a study of active service members in the battlefield who were getting exposed to IEDs. Those who were immediately given N-acetylcysteine (NAC) 86% recovered within a week, whereas only 42% of those who did not get NAS (received a placebo) recovered within a week.  Amelioration of Acute Sequelae of Blast Induced Mild Traumatic Brain Injury by N-Acetyl Cysteine: A Double-Blind, Placebo Controlled Study  NAC is a precursor to glutathione.  In this study, the soldiers were given 4 gms immediately and then 2 gms twice per day for 4 days. Then 1.5 gms twice per day.  This is why NAC is one of the ingredients in Dr. Chapek’s Concussion Rescue first aid kit.  Vitamin D (5000 mg) and vitamin C (1000 mg)  are also part of the program.  We can also use liposomal glutathione under the tongue and even topical gluatione is worth a try, such as to the back of the neck. Curcumin (500 mg) from turmeric is also part of the first aid program.  Omega 3 fats. MCT oil powder or capsules to enhance the brain’s utilization of ketones for fuel.  Branch chain amino acid powder.  Infrared light to the back of the neck can also be helpful.  Exogenous ketones can also be helpful.

43:01  They used to use IV corticosteroids for spinal cord injuries until the CRASH trial published in 2005 study showed it increased mortality, so they stopped doing this.  Inflammation is part of the way the body heals and it is best to dampen but not shut down the inflammatory process.  It is not clear if icing the brain is helpful or not.

45:48  The ketogenic diet appears to be the best diet for healing the brain after trauma. It has been shown to help with other neurological conditions and Dr. Chapek’s clinical experience is that the keto diet helps the brain to heal.  He recommends no more than 30 gms of carbs per day, which requires eating a lot of fat with each meal by adding mayonnaise, avocados, and coconut oil, and by eating those fat bombs.   It can be difficult to digest this much fat, so taking some ox bile can help with digesting them. 

48:50  Sleep is also very important for brain healing, but patients after head trauma often have trouble sleeping and getting into deep sleep.  You don’t necessarily need to do eight hours of sleep straight. But you need at least a four hour chunk to get several cycles of REM sleep to get that restorative sleep. Growth hormone is released during deep sleep.

50:53  Dr. Chapek pointed out that high intensity interval training is another way to increase growth hormone production. 

52:14  Brain training can also be very helpful, including meditation, which strengthens the frontal and temporal lobes of the brain.  Neurofeedback can also be helpful. And there are online brain training games like BrainFitLife that was developed at Amen Clinics, where Dr. Capek works.  There is also Brain HQ, Cogmed, and there are many other brain training programs available. But it is important to train different areas of the brain, so if you’ve been doing cross word puzzles for 30 years and you are really good at them but you are not so good at math, then do some Sodoku.

54:50  The structural alignment of the cranial bones and the spine is also very important to insure the cerebro-spinal fluid flow through the spinal cord and brain, as well as insure blood flow and neurological flow to the brain and spinal cord.  This is where Chiropractic and Osteopathic medicine can play a role in brain healing.

56:00  Hyperbaric oxygen can also be very helpful to push oxygen in for healing of the brain and for the brain to be more metabolically active.

 

 



Dr. Kabran Chapek is a Naturopathic Doctor and a staff physician at Amen Clinics and the author of a new book, CONCUSSION RESCUE: A Comprehensive Program to Heal Traumatic Brain Injury. Dr. Chapek is available to see patients at Amen Clinics Northwest in Bellevue, Washington and the phone is 425-250-9564. Amen Clinics has a website where their custom nutritional supplements are sold, BrainMD.com.  Dr. Amen offers a number of online courses for both patients and practitioners at Amen University.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello Rational Wellness Podcast listeners. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please give us a ratings and review on Apple podcasts or wherever you get your podcasts. Also, if you’d like to see a video version, go to my YouTube page. And if you go to my website drweitz.com, you can find detailed show notes and a complete transcript.

Our topic for today is Healing From Concussions and Other traumatic Brain Injuries with Dr. Kabran Chapek. Our focus will be on using a functional medicine approach to help patients heal from either resent or a past traumatic brain injuries.  A traumatic brain injury, which may or may not include a concussion is caused by sudden damage to the brain, caused by a blow or jolt to the head. Common causes include car or motorcycle accidents, falls, sports injuries, and assaults among many other types of trauma. According to the CDC, there are over two million new head injuries in the US per year. Dr. Kabran Chapek is a naturopathic doctor and a staff physician at Amen Clinics and the author of a new book, Concussion Rescue-

Dr. Chapek:        Hey, there it is.

Dr. Weitz:            … A Comprehensive Program to Heal Traumatic Brain Injury. Dr. Chapek uses a functional and integrative approach to the treatment of patients with traumatic brain injuries, Alzheimer’s and dementia, PTSD and anxiety disorders.

Dr. Weitz:           Dr. Chapek, thank you so much for joining me today.

Dr. Chapek:        Oh, it’s my pleasure and an honor to be here.

Dr. Weitz:           Excellent. So I’d like to start the interview by asking, how did taking a bus to work help you write this book?

Dr. Chapek:        No one’s asked me that. That’s awesome. I’m a busy guy. And also, it’s there’s always something you can do. So riding bus route 532, from Edmonds to Bellevue just is like, I had the time and it’s focused time. It’s like I get the most done. And so I devote this book to bus route 532.

Dr. Weitz:           Soon, we’ll be able to do that when the driverless cars come in. We’ll get to sit back and read and work on our-

Dr. Chapek:        Can’t wait.

Dr. Weitz:           Good. Okay, how many more books will get published?

Dr. Chapek:        Right.

Dr. Weitz:           We’re just going to get people reading them.

Dr. Chapek:        Yeah.

Dr. Weitz:           So can you explain what traumatic brain injuries are? What’s the difference between a traumatic brain injury and a concussion? You refer to traumatic brain injuries as a silent epidemic in your book.

Dr. Chapek:        Yeah, so concussion is just a form of mild traumatic brain injury. So when we talk, we’re talking TBI, traumatic brain injury. A concussion is all the treatments are going to be pretty much the same, as far as this is concerned. Of course, severe brain injuries like life fighting to the hospital. That’s a severe brain injury and needs a different approach than what’s in this book. Really, the book is targeted for those who have had a concussion and haven’t gotten better. And those people who have some other brain issue whether it’s dementia, memory problems, depression, anxiety, and it may be due to a past brain injury, you just didn’t know about it. So those are the two.

And then, in my past 12 years working in mental health, one of the major causes of mental health issues is mild traumatic brain injury, and nobody knows about it. And that’s why I call it the silent epidemic because like you said, there’s millions of Americans going to the ER every single year, the number has actually gone up, even though death rates have gone down. The number of people suffer, and part of it, there’s more people, but the solutions haven’t gotten better. The standard protocols haven’t changed a bit in past 20 years. Well, not much.

Dr. Weitz:            Right. And we can look at the NFL as an example of this because everybody knows about concussions but really, the movie Concussion came out, it talked about a condition called traumatic … Was it chronic?

Dr. Chapek:        Chronic Traumatic Encephalopathy, CTE.

Dr. Weitz:            Encephalopathy, exactly. And so this is a condition that doesn’t require a concussion. It can occur from a series of lower level blows that lead to damage to the brain that actually was only discoverable after slicing the brain up and looking at it with a microscope and conventional CT scans didn’t show anything. And so therefore, even current NFL protocols, which are all focused on when the patient has a concussion are still not really addressing some of these milder forms of brain injury that become chronic and overtime get worse and worse.

Dr. Chapek:        Mm-hmm (affirmative). Yeah, absolutely. I think that’s the key that we had. Brain injuries are cumulative, whether it’s from a concussion or subconcussive hits to the head. There’s a study done on football or high school football players, these kids and just playing high school football showed cognitive changes and brain injury on fMRI, functional MRI. It’s like, oh my God.  So these bright, young future leaders and contributors to society are damaging their brains by playing high school football, most of them are not going to become professionals and even if they do, some are actually starting to not say, you know what, I can’t remember who it was but there’s a really talented I think he’s a 49er. He decided not to go on because he didn’t want to suffer brain injury.

Dr. Weitz:           Yeah, I remembered he like retired at age 25 or something like that.

Dr. Chapek:        Yeah. And so this is starting to happen. Pop Warner, parents are pulling their kids out. And I think it’s really smart because they’re recognizing damages cumulative these … we’re seeing these retired athletes, these heroes who are now some of them, like Dave Pear, publicly said, “I regret ever playing football,” even though he missed his career and because he had dementia at age 50.

Dr. Weitz:           Wow.

Dr. Chapek:        The rest of his life totally changed. He has anger problems, memory problems, depression. And that’s like a delayed reaction. So some people think that’s one of the common myths of brain injury that I had this car accident. I was fine and then a month later, why is did this person change?  Why are they angry now?  Couldn’t have been the car accident because it was so far away. But actually, it was a delayed like, swelling slowly increases. There’s chronic inflammation that is under the hood, like you can’t see it.  Inflammation under the skull. That’s part of why it’s the silent epidemic because, just President Trump not to take politically into this, politics into this, but then.

Dr. Weitz:           Talk about a brain injured person.

Dr. Chapek:        Oh, my God. Don’t get me started there, but that’s not what I meant. I meant like he made comments about minimizing. Did you hear about that? Minimizing the veterans who had–had there was a missile strike?

Dr. Weitz:           Yeah. He said they just had a headache or something.

Dr. Chapek:        Yeah, he said, “Just a headache.” These are valuable. These are service men that are putting their lives on the line. So what if it might have been, might not have been? Let’s at least take it seriously and assess them. And let’s not take a chance with their precious people, our brains like that’s who we are, God.

Dr. Weitz:           Absolutely.

Dr. Chapek:        So it’s frustrating.

Dr. Weitz:           We mentioned car accidents. Isn’t it the case that you can have a whiplash injury, never hit your head on a window and still have a brain injury?

Dr. Chapek:        Yes, exact great point. You can have injury from it’s just it’s acceleration deceleration. And it’s horrible, think Shaken Baby Syndrome. Severe brain injury lifetime of disability potentially or death from just shaking a baby. Their brain is so soft. This is why, it’s as soft as butter. The skull has many sharp bony ridges and it’s really hard. So there’s nowhere for the swelling to go.  And it’s like, you can look, you can Google this. But brains if you take a brain out fresh brain, put it on the table. It’s a pile of goo in a few hours.

Dr. Weitz:            Right.

Dr. Chapek:        So the brain is very vulnerable. We’re not designed to hit our heads, in the movie Concussion, rams, they have some spongy bone, woodpeckers, there’s some shock absorber. But humans, no. We’re like the last people to-

Dr. Weitz:            And part of what happens in a car accident is the car is moving at a certain rate of speed and then suddenly stops. And so what happens with the neck is that the body moves forwards the head stays back because it doesn’t weigh as much. Then the body stops and the head moves forward. So you get this deceleration acceleration, injury that occurs at the shearing of the muscles and deaths etc in the cervical spine. But within the skull, you also have this differential between the weight of the skull and the weight of the brain. And you can also get this shearing between the … with the cerebellum and the cerebrum and the brain stem, which is fixed. And so you can get this diffuse brain injury that can occur from a whiplash without any damage that had.

Dr. Chapek:        Great description. Yeah, perfect. Exactly. And so that’s the primary injury, damage to the neurons, breaking of the tissue, stretching of the axons. And then there are secondary injury, and that’s like the cascade of inflammatory mediators, the oxidative damage. It’s like rusting from the inside out, free radicals are produced, Calcium is released, exciting mitochondria, they burn out is what happens and become very … There’s like this glucose spike and then drop and so there’s this metabolic deficit. This hungry organ, this brain that uses 20 to 30% of calories in our diet all of a sudden has less glucose and it’s damaged. So that’s secondary injury, that chronic inflammatory state. It’s like a fire that hasn’t been put out. It continues to smolder for months and sometimes years is where we want to intervene.

Dr. Weitz:            Right. And sometimes patients come into your office, and they don’t even realize it. They’ve had a brain injury.

Dr. Chapek:        Right. That’s key to assess them thoroughly. Now, four out of 10 patients who come to Amen Clinics, because we do brain imaging, we can see that they’ve had an injury, but they’re coming for some other reason. They’re coming for ADD, depression.

I had a patient, we’ll call him Jeremy. And he was 21 when he came in, he’s this jazz drummer, this really bright kid. But on the inside, he was suicidally depressed every single day of his life from age 14 to 21. He’d seen some great therapists, tried every class and medication and was still suffering. He was referred by one of really good therapists in Portland. And he’s been smoking pot every day just to feel better, bad relationship. He was dating a girl who was borderline and a lot of difficulty. And so when we came in, came in from depression, treatment resistant depression. We scanned his brain and he had clear evidence of brain injury. Damage to his left temporal lobe, left frontal lobe.

And it was asymmetrical the type of imagery we do is called SPECT, S-P-E-C-T. It’s functional, looking at blood flow versus MRI, which is structural. We showed him the scan and nowhere on his history had he listed a brain injury. So I said, “Jeremy, have you ever …” This is what you have to do is think back so we minimize it. “Have you ever fallen out of a tree? Have you ever dove into a shallow pool? They were falling off a log? Fallen off your bike? Ever been in a fight?” “No, no, no.” “Have you ever played contact sports?’ And his mom was there said, “Oh, remember you started playing football and you’re about 13 years old. And you’re matched up against the coach’s son who was already six feet tall and you were the scrawny little kid whose got pounded every day and would have headaches.” At that time he was diagnosed with ADD, started having trouble in school and started having depression, which started the next year.  And so by putting him on a program to help him heal his brain, he started to feel better within the next several months, the depression lifted and he’s about to graduate from the Berklee School of Music in the next, this is two years later and broke up with the girl, not smoking pot, doing good.

Dr. Weitz:            That’s great. I saw where in your book you described asking patients sometimes up to 10 times during their initial consultation if they’ve had some sort of brain injury because patients so often don’t remember or don’t connect the dots.

Dr. Chapek:        Right? We think if I didn’t go to the ER, if I didn’t lose consciousness, it must not have been that bad.  It couldn’t be contributing, so that’s one why people don’t and also there’s amnesia.  And we just forget and so it’s like the same with when you’re looking for mold in a home while doing functional medicine you have to ask specifically, or if you are looking for toxicity, because we tend to not think about it. This is the same for brain injury, it’s really helpful to ask your patients or to think back in your life. Okay.  Have I actually and as I started working at Amen Clinics, when I first scan my brain didn’t look so good.  I was like oh crap. Don’t show Dr. Amen my scans.  I need to get this, I need to heal this.  And what must have happened oh, I did fall.  I never lost consciousness.  But I did fall off my skateboard a few times. I fell out of trees, the real active kid. And I can tell you my story about how hoping to heal and improve my brain and re-scanning later, but it is possible to actually improve even if it was many years later, you can actually heal from that fact.

Dr. Weitz:            Right. So we were talking about history, which is first part of a workup for somebody with a traumatic brain injury, or one of these other conditions like ADD.  Does your initial paperwork include some assessment of cognitive function?

Dr. Chapek:        Yeah. Great. In addition to the history, yes we do. We use WebNeuro. This is a cognitive tool. It’s web based and can be repeated. We like that so-

Dr. Weitz:           You logon to the internet and a patient goes out the questionnaire online?

Dr. Chapek:        Yeah, measures attention processing speed, memory, and then emotional states of depression, anxiety, emotion identification, and it’s simple and somewhat objective so that can be repeated three months later how are we doing?  Six months later, how are we doing? And it’s less invasive.

Dr. Weitz:           Why do you like that questionnaire better than so many others?

Dr. Chapek:        It’s validated. It’s also correlates with MRI.

Dr. Weitz:           Okay. 

Dr. Chapek:        They have it correlate to a database. There’s other good ones out there. But the other reason I like it, it’s not just cognitive function, it also does affect or take into account emotional states.

Dr. Weitz:           Okay.

Dr. Chapek:        Because sometimes it’s hard to tell if the memory problems or attention problems are actually due to depression or anxiety or how much is playing in there and that can get missed.

Dr. Weitz:           Right? Good. If you can send me a link to that, I’ll put it in the show notes.

Dr. Chapek:        Happy to.

Dr. Weitz:           And then so we have history, we have some this form of cognitive testing, and then do you typically do an MRI or a CT scan?

Dr. Chapek:        Sometimes. We like SPECT imaging for picking up more subtle changes. We actually have the SPECT scanners in all of our clinics.

Dr. Weitz:           Now what exactly is a SPECT scanner? Do you use an MRI or it’s a completely different machine?

Dr. Chapek:        It’s more like a CT scanner.

Dr. Weitz:           Okay.

Dr. Chapek:        How it works is a patient is injected with a little bit of radioactive isotope.  We use technetium.  It’s about equivalent radiation to a head CT scan. So think about the difference, and then so they’re injected, then you lie on the table and it’s not really a die but the technetium goes to the brain to the most active parts and gets fixed there and then emits a signal which is picked up by the camera as it spins around their head. So a CT camera radiation in taking a picture. This is like the brain emitting a signal and picked up by a camera that spins around the head. So there’s no tube that you go in like an MRI, it’s more just goes around the head and it’s … Most hospitals have some form of SPECT imaging for heart studies and for brain studies. It’s similar to PET differences being PET is much more radiation and is mostly looking for amyloid and different glucose metabolism in the brain.

Dr. Weitz:           Amyloid would be more beneficial for a patient with Alzheimer’s?

Dr. Chapek:        Right. And we say yes or no for Alzheimer’s, Parkinson’s, but the thing is with PET, it’s none. It’s less specific. It tells us less about what else is going on. Yes, it answers a question beta amyloid. So if it’s negative, that’s very reassuring and helpful.  But if it’s positive, that could be amyloid due to past brain injury, could be due to Alzheimer’s dementia. It’s based on history, where a SPECT imaging, you can see it’s like a 3D image of the brain. And you can tell, “Okay, the temporal lobes damaged or the frontal lobes damaged?  Is it the cerebellum? Is it the limbic system? Is there a lot of depression associated with limbic activity?” And in that way, for example-

Dr. Weitz:           Can you do it without the contrast material?

Dr. Chapek:        No, not the SPECT.

Dr. Weitz:           Okay.

Dr. Chapek:        So that’s that. If people can’t do radiation or get a needle, an injection, then it’s very small needle but still, some people have needle phobia.

Dr. Weitz:           I just worry about that stuff. I know there was a report that the MRI contrast with gadolinium that the gadolinium tends to build up in the brain.

Dr. Chapek:        Yes. So this is radiation. So in 150,000 scans, no reactions.

Dr. Weitz:           Oh, okay.

Dr. Chapek:        Because it’s just radiation and sailing. There’s no actual die, although it feels like that. So that’s hopefully helpful.

Dr. Weitz:           That’s good. Okay. So typically at a hospital, they’ll do a CT scan, what are they looking for there?

Dr. Chapek:        So if you’ve had a concussion, you do want to go to the hospital, go to the ER, make sure there’s no brain bleed, especially after concussion. If you have slurred speech, can’t stay awake, you keep passing out. There’s many warning signs, but and you’re looking for brain bleed. So Liam Neeson, his wife, Natasha Richardson. She was skiing on the bunny Hill at Mount Blanc, a couple of years ago and fell, hit her head waved off the emergency personnel said, “I’m fine, I’m fine.” But then the next day she had a massive brain bleed. So I think it was a subdural hematoma and died, so sad.  We need to we need to rule out the worst. CT scan is still important for that. But basically it’s just looking for a brain bleed or major damage. It’s mostly negative and it’s not sensitive at all picking up mild traumatic brain injury.  In fact, there’s a study done in the journal PLOS One in 2013, I believe that looked at 2400 patients who compared SPECT to MRI and CT and found that SPECT imaging picked up mild traumatic brain injury and 94% of the cases that was missed in MRI so it’s more sensitive, but MRI is useful and looking at vasculature and dementia. And the two together is actually a helpful combination.  Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review.

Dr. Weitz:           Cool. So what type of lab testing can be beneficial and working up patients with traumatic brain injury?

Dr. Chapek:        Love doing labs, love doing labs looking for nutrient deficiencies because oftentimes there are like zinc deficiency, vitamin D. And if you’re low, it’s been shown in many studies it’s harder to heal.

Dr. Weitz:           How do you test zinc deficiencies? Do you do one of these nutrient panels like the NutrEval or the micronutrient test, are you doing serum or red blood cell?

Dr. Chapek:        We just do serum because there’s more research on serum. But I like if I’m really concerned, I’ll do serum and RBC zinc, red blood cells zinc too, because serums outside the cell, RBC is inside the cells. It’s nice to know both. And if someone’s low in serum zinc, they’re low, for sure. But I do like the other panels as well. It’s just for screening, we’ll do serum zinc and we want the levels to be closer to 100 or above. And that copper ratio we want copper to be around 100 or below high copper associated with inflammation although you do need some copper as well. And we do, so we look at nutrient deficiencies.

Dr. Weitz:            You look at the zinc copper ratio?

Dr. Chapek:        Mm-hmm (affirmative). Yeah, zinc copper ratio.

Dr. Weitz:            And you want that to be what?

Dr. Chapek:        I think greater than 1.3. But I don’t calculate it. I want serum to zinc to be around 100 or above and copper around 100 or below, essentially.

Dr. Weitz:            Okay.

Dr. Chapek:        So I keep it simple. And then I look at vitamin D, zinc, copper, B12, homocysteine, inflammatory markers, hs-CRP, look at the cholesterol. Actually want cholesterol to not be too low. High cholesterol is associated with heart disease, low cholesterol associated with brain disease.

Dr. Weitz:            Right, so what level cholesterol is associated with brain disease?

Dr. Chapek:        Below 150.

Dr. Weitz:            This is for total?

Dr. Chapek:        Total. Thank you. Total cholesterol below 150 is associated with suicide and homicide.

Dr. Weitz:            And what about LDL? Is there a cut off for that as well?

Dr. Chapek:        I don’t know the answer for that one. I just don’t total. It’s a good question.

Dr. Weitz:            Okay.

Dr. Chapek:        But usually the LDL is what makes it go a little higher or too low.

Dr. Weitz:            What I’ve seen LDL below 60 I think is problematic with lowered brain function.

Dr. Chapek:        Perfect. Now, thank you for telling me that. It’s good to know. And it’s like their brains are 70% fat by dry weight.

Dr. Weitz:            Yes.

Dr. Chapek:        And we need that fat the brain loves it, it loves cholesterol. So it does well with cholesterol so a higher fat, lower carbohydrate diet.

Dr. Weitz:            And I do think in cardiovascular medicine today there’s, we’re a little bit too overzealous in trying to drive that LDL as low as possible. And now that we have some of these new PCSK inhibitors that can be added to statins, people are celebrating getting the LDL down to 40. And I think we’re overzealous on that not looking at some of the negative effects of that.

Dr. Chapek:        Yes, sacrificing the brain for the heart.

Dr. Weitz:            Exactly.

Dr. Chapek:        That’s so sad. Well, sometimes I can get cardiologists and primary care Doc’s to lower the stat and if we talk about the brain and the heart, and it’s like, tell them hey, we need I understand risk factors. And there’s more benefits beyond just cholesterol lowering effects of statins that are preventing heart attacks. But come on, do we really need it to be 100 total cholesterol, can we just go up to 150, 160 and see if memory improves at that point because a lot of people are having memory problems from too low cholesterol.

Dr. Weitz:           Yeah. And vitamin D is very important, right?

Dr. Chapek:        Oh my gosh, it’s a real key, like it’s going to be hard to recover from brain injury. If vitamin D is deficient. There’s certainly studies to show this. If your vitamin D levels are low prior to injury, then you’re going to have more post concussive symptoms. These are animal studies, but I think they do apply to humans because there’s a number of human studies. Giving vitamin D after injury helps in the recovery process, especially progesterone and vitamin D or other things with vitamin D, because it’s neuro anti-inflammatory.

Dr. Weitz:           Right, and essentially, vitamin D is a hormone, even though it’s not often referred to as that and the interesting thing is, a common recommendation is just go out in the sun and it makes a lot of sense that our body make vitamin D from the sun, but my clinical experience is even practicing in Southern California where we have plenty of sun and even patients who are going out in the sun, often present with very low vitamin D levels.

Dr. Chapek:        Fascinating. So even I was hoping maybe at least you’d have good vitamin D patients but not the case.

Dr. Weitz:           It’s amazing. You would think nobody would be deficient in vitamin D in Southern California and they are. And by the way, for most patients, it’s not easy to bring their levels up to what I consider most functional medicine doctors consider a therapeutic level which is say 50 to 70 or 60 to 80 nanograms per milliliter and we often find we have to go to five or 10,000 units per day to that level.

Dr. Chapek:        You have to work hard at it. I agree with you. Vitamin D is key. Vitamin D is key. Yeah, absolutely.

Dr. Weitz:           We’re big on vitamin K too.

Dr. Chapek:        Vitamin K is important. Yeah, absolutely.

Dr. Weitz:           That works synergistically with vitamin D, uses arterial calcification, important for bone and …

Dr. Chapek:        Are you checking Omega-3 index?

Dr. Weitz:           Absolutely. Yeah.

Dr. Chapek:        I think that’s a great one. And we’ve been doing that I think it’s also helpful because, you can actually measure your Omega-3 to 6 ratio course. And Omega-3 is important anti-inflammatory but also helping heal the the cell membrane and the neurons. So that’s another key aspect.

Dr. Weitz:           Yeah, they’ve been some really good studies on the higher dose Omega-3s for brain injuries right?

Dr. Chapek:        Absolutely, yeah.

Dr. Weitz:           What dosage level do you like for Omega-3s?

Dr. Chapek:        Minimum of three grams, EPA DHA calculated not just total Omega-3, but EPA DHA three grams a day. That’s what we used in the NFL study. So we had 30 NFL retired players, we had them take three grams of Omega-3, they took Ginkgo fossa title searing Acetyl-L-Carnitine. NAC alpha-lipoic acid, Huperzine A, and anthocyanins in a formula with a multiple vitamin. That’s it for supplements and three grams of Omega-3.

We had them exercise, lose weight if they needed to. They ate a … they were treated for sleep apnea, many of them had sleep apnea. And some were given hyperbaric oxygen. And then after six months, believe it was 70 to 80% improvement in cognitive symptoms. So again, that testing before and after attention, memory, processing speed, less anger, less depression, and their brains look better. We could prove this, we could actually document on their scans terrible, and then better.

Dr. Weitz:           Wow! Awesome. When was this study published?

Dr. Chapek:        This was in I believe, 2013, 2014.  I’ll find it and you can put a link if you want to on that.

Dr. Weitz:           Yeah, that would be great.  I’d love to do that.  So I know we’re going to get into supplements in a few minutes a little more, but since we’re on the Omega-3 thing, some practitioners recommend focusing on DHA when it comes to the brain.  And there’s a number of supplements on the market now, including a prescription one that’s mainly DHA. What about using more DHA than EPA or you find the balance better?

Dr. Chapek:        I find the balance better because and I think a little bit of it depends on where you’re at in the process. If it’s acute brain injury, a higher EPA, chronic brain injury you’re trying to rebuild, probably more DHA. My rule of thumb is at least three grams total EPA/DHA, higher EPA to DHA, but at least 1,000 of DHA because that’s what’s been shown in many of the studies for memory and dementia.

Dr. Weitz:           And is there a target you like to hit on either the Omega-3 index or the Omega-6 to 3 ratio?

Dr. Chapek:        We try to shoot for eight to 10. In the studies in around the world, there’s less schizophrenia, less depression if the Omega-3 index is higher like in Japan, so that’s where we’ve shoot. What do you shoot for?

Dr. Weitz:           I like eight to 10 as well. I like to try to get the six to three ratio below four ideally below two. Two is really difficult.

Dr. Chapek:        Yeah, I haven’t seen that very often.

Dr. Weitz:           Yeah, I keep mine below two but I have to take six to eight grams of EPA/DHA.

Dr. Chapek:        Wow, that’s awesome.

Dr. Weitz:           So hormones are often affected by brain injuries. Why is that?

Dr. Chapek:        25 to 50% of people with brain injury have damage to the pituitary gland, your master hormone gland, and it’s because it’s like an upside down ice cream cone. It’s very boldness at the bottom and is surrounded by the sella turcica this very bony ridge, so same idea with this-

Dr. Weitz:           This is inside the skull?

Dr. Chapek:        Deep inside the skull. And so with that acceleration deceleration injury, or a hit to the head and especially a concussive blast injury which many veterans come back with, it can penetrate and damage and hit that pituitary gland. So especially it happens in concussive blast injuries, but also in our football players.  They damage the pituitary fully or partially and if that pituitary is damaged, we will have deficiencies in thyroid hormone, there’s less TSH produced, growth hormone, testosterone, estrogen, progesterone in women, low adrenal function. The top two being growth hormone and testosterone in men, estrogen, progesterone in women. And these hulking guys, these football players 20 to 30% of them have deficiencies in testosterone and growth hormone.

Dr. Weitz:           Yeah.

Dr. Chapek:        I was trained by Dr. Mark Gordon endocrinologist out in your neck of the woods, who’s really done a lot of good work with the veterans and military folks on how to assess and treat for hormonal deficiencies and that really enhanced healing for people. It’s like we need the nutrients for decreasing inflammation. We need the hormones for growth and healing and really accelerating that. Putting the brain into a healing environment where it can heal.

Dr. Weitz:           How do you assess growth hormone levels?

Dr. Chapek:        IGF-1 and IGFBP3.

Dr. Weitz:           Okay.

Dr. Chapek:        First thing in the morning. That’s really the best and if there is a-

Dr. Weitz:           What the target for IGF-1.

Dr. Chapek:        Over 200.

Dr. Weitz:           Over 200?

Dr. Chapek:        Mm-hmm (affirmative).

Dr. Weitz:            Interesting.

Dr. Chapek:        Yeah. According to quoting, Dr. Gordon and there’s this debate between IGF one right.

Dr. Weitz:            I was going to bring that up right now for people don’t know. Actually in a functional medicine in anti-aging world, we have Dr. Valter Longo from USC. And he’s been finding that lower IGF-1 levels are associated with greater longevity.

Dr. Chapek:        Mm-hmm (affirmative). It’s like a tug of war. Of which it’s low. Oh, no, it’s high. So that growth hormone folks, anti-aging folks, high levels, and then it’s the low calorie diet folks, low levels. And I think it’s like there’s this in between, that’s-

Dr. Weitz:            Absolutely.

Dr. Chapek:        It’s like the same in the bones osteoblasts and osteoclast. You don’t want too much. And then the brain there’s APP gene. So this is the Dr. Dale Bredesen’s work and this is his whole theory cannot condensed into the APP gene.

Dr. Weitz:            Right, exactly. We have this just like in the bone where you have this balance of osteoblasts cells that are producing new bone and osteoclast cells which are clearing away, broken down junkie volume and you need this balance. Same thing in the brain, we used to think you had all the neurons you were ever going to have for the rest of her life. And it was just a question of holding on to as many as you can. But now we’ve learned that there’s a turnover of neurons throughout our life, and that we have this neuro, we have production of more neurons and a breakdown of neurons and we need that balance as well.

Dr. Chapek:        And what it’s not one thing that causes that to shift. It’s putting all of them together. It’s the diet, the supplements, the hormones, no toxins, healthy thinking, and that’s what will create that healthy balance between the two verses tons of growth hormone or really low calorie diet. We need to put them together to actually … It is not one thing that heals the brain, it’s a multitude.

Dr. Weitz:            Absolutely. And just to add something to this discussion, because right now you go to an anti-aging conference and it’s pretty much all you want to lower growth factors, you want to lower IGF-1.  The first study that actually showed a reversal of the aging time clock….  That’s one of the new things in anti-aging medicine, it’s they have these biological methylation time clocks.  So Dr. Horvath from UCLA and some other doctors have come up with these ways to measure longevity.  And the first study that was actually shown to show a reversal of one of these aging clocks was utilizing growth hormone and DHEA.

Dr. Chapek:        No kidding. There you go. You get on these tracks and-

Dr. Weitz:           There’s got to be a balance and I totally agree with you on that. In your book, Concussion Rescue, you talk about a first aid kit for the brain. When someone sustains a head injury. Can you talk about what that is?

Dr. Chapek:        Yeah. So I got to tell you about a little bit of science to help it make even more sense.

Dr. Weitz:           Lot’s of science, we love the science.

Dr. Chapek:        Theodore Roth is this undergraduate student at Stanford, and he got to implant an intracranial microscope into the mouse skull. And watch what happened when he hit these poor little mice and cause a concussion and never been seen footage. This is in the journal Nature 2013 where you actually saw oxidative damage, saw the microglia the resident macrophages are immune cells in the brain swell and try and eat up the the damaged tissue, fill in spaces and gaps, saw the tearing and ripping of the vessels and permeation of fluid where it shouldn’t be.  And he didn’t stop there, though. He then applied glutaraldehyde to the mouse skull, which is thinner than the human skull, and saw if applied immediately, there are 67% less cell death. If applied, within three hours, there was 50% less cell death. So there’s this window of time in which to act. And so why are we just standing on the sidelines watching and hoping players get better and in your car, you have a car accident? I hope I get better. Why aren’t we doing something immediately?

In the journal PLOS One 2013, there’s a double blind placebo controlled trial with 81 active service members, they were in the battlefield and an IED would go off, they’d run to the medic or be carried to the medic and then immediately give them either NAC or placebo and the group that got NAC, 86% of them recovered from concussive syndrome after a week, whereas 42% recovered after a week.  Amelioration of Acute Sequelae of Blast Induced Mild Traumatic Brain Injury by N-Acetyl Cysteine: A Double-Blind, Placebo Controlled Study

Dr. Weitz:           That’s amazing.

Dr. Chapek:        Yeah, just NAC. N-acetylcysteine precursor to glutathione.

Dr. Weitz:           That’s one of the most amazing traditional compounds.

Dr. Chapek:        Isn’t it? There’s so many studies on it and we need to be using it. So I can tell you the dose that they used in this study. Four grams immediately they met it gave them four grams, and then days one through four, they were given two grams twice a day. Days five through seven they were given 1.5 grams twice a day. Pretty pretty high doses, and then they stop.

Now, if it was my patient, or my family member or myself, I would take it ongoingly 1.5 twice daily after that, it wouldn’t hurt and I would take vitamin D, I would take vitamin C. This first aid kit outlines all of those and the specific doses.

Dr. Weitz:           Changing glutathione being being used topically on the back of the neck?

Dr. Chapek:        That would be cool. If it penetrates and gets in, the back the neck makes sense when carried in.

Dr. Weitz:           That’s what you put in your book, right?

Dr. Chapek:        Yes.

Dr. Weitz:           Yeah.

Dr. Chapek:        Uh-huh (affirmative). And also light therapy to the back of the neck.

Dr. Weitz:           Okay.

Dr. Chapek:        Possibly, too.

Dr. Weitz:           So is that you are talking about like infrared or what type of light?

Dr. Chapek:        Red light, infrared light. I think that’s helpful.

Dr. Weitz:           Though, is that helpful by itself or it works synergistically to help get the into the glutathione into the tissues?

Dr. Chapek:        It’s just by itself, it would work. So both glutathione and red light. Topical glutathione is worth a try. I would always do topical plus oral NAC because we still don’t know. There’s various companies out there. Is it good what you’re taking or not and it’s not widely available. But if you can get some good quality glutathione topically or IV even better, or nebulized, I would do it.

Dr. Weitz:           And of course now we have Liposomal glutathione and it’s available for oral usage.

Dr. Chapek:        My kids hit their head, Liposomal glutathione under the tongue immediately. I give them NAC, vitamin D. I just carry this around with me.

Dr. Weitz:           So go through your whole first aid kit. So it’s NAC, glutathione, go ahead. What are the rest of them?

Dr. Chapek:        Curcumin because turmeric from turmeric it’s from the spice and it’s not only anti-inflammatory, it does something special, it opens up the aquaporins so when there’s swelling, there’s nowhere for the brain to go against inside of the skull so that can cause damage and sometimes it delayed damage. So that is an important one. Vitamin C doesn’t get enough respect, antioxidant vitamin C.  Vitamin D of course. Omega-3 fatty acids. MCT oil, because like I said there’s a spike and then drop in glucose metabolism. And so MCT oil will help feed into the ketone production and then provide an alternative fuel source. There’s a study where they had a patient in a coma, either gave them IV glucose to just try and overcome that low glucose metabolism, or not.  And if they gave them IV glucose, their utilization of ketones for fuel from their brain was 16%.  And it went to zero.  So they were actually their brain was trying to use those ketone bodies.  So we want to enhance utilization of ketones for fuel into the brain by MCT oil and branched chain amino acids useful for recovery after I go for a run, but also for healing the brain from brain injury.

Dr. Weitz:           Cool. Awesome. I know for spinal cord injuries, they’re still protocol where they use IV prednisone.

Dr. Chapek:        Yes. Great point.

Dr. Weitz:           Haven’t they also experimented with like, ice water in the veins or something like that.

Dr. Chapek:        Yes. Right. Now this is a great, great point. And as I’ve been thinking about this, and trying to understand how best to approach healing the brain from brain injury, I looked at the literature, and there were many failures. There’s been over 35 large scale trials that have all failed to find the one thing that cures a brain from brain injury. They used to give corticosteroids which makes sense, lower inflammation throughout the body. This was done for 30 years, up until 2005 when they did the CRASH trial, and they said, “Okay, what is this actually helping?”  More people died who were given corticosteroids.  So they stopped. It was a standard of care until 2005.  We don’t want to just totally slam down inflammation.

Dr. Weitz:           Right.

Dr. Chapek:        The brain is more complicated and has many other mechanisms that are trying to heal.

Dr. Weitz:           The inflammatory process is part of the way the body heals. It’s sending those those immune cells to the area, and we want to dampen it down, but we don’t want to stomp it out.

Dr. Chapek:        Exactly. Well said. The ice water thing, I just was talking to someone the other day about this certainly saves lives. In surgery, they cool the brain in the body so that they can decrease the swelling and edema and that now there’s those caps like the ice caps, possibly to help with healing. And I don’t know.

Dr. Weitz:           Those for chemo to reduce hair loss.

Dr. Chapek:        Yeah, and when I was writing the book, I’m open to looking at new literature. But when I was looking into this, all of the studies showed it didn’t help.  It didn’t help.  And I don’t know if it’s maybe too powerful like the corticosteroids it actually decreases inflammation too fast and too much or maybe they’ve done more research and figured out maybe it is helpful.  Maybe I need to relook it.  I’m open to that.  But at least when I looked at it before, wasn’t helpful.

Dr. Weitz:           You mentioned MCT oil. What do you think about the exogenous ketones?

Dr. Chapek:        I think they can enhance the ketogenic diet really well, and I think they should be used. I mean, they should be part of the first aid kit. All right, put those in mind KETO//OS, and I have those little packets, and that’s what I’m going to do if I ever hit my head or my family members, because at least the brain will be getting some ketones.

Dr. Weitz:           Right.

Dr. Chapek:        Your listeners probably know.

Dr. Weitz:           Which brings up what’s the best diet for healing from a brain injury?

Dr. Chapek:        The ketogenic diet’s really popular right now.  It’s a fad, but it has been around a long time since the ’20s for seizure disorder. And it’s essentially restricting carbohydrates to less than 30 grams a day net carbs, which isn’t much.  A couple of apples.  And so if you restrict that the body will be forced to burn fats for fuel, which can get into the brain much easier. There’s fewer steps to use for fuel ketones, and that’s why it’s called a ketogenic diet. And so it’s been studied for various neurological problems, brain injury, there’s a few studies they’re working actually right now, on a study in humans with the ketogenic diet, which is going to be done this year. It’s certainly safe.  And it’s been studied for other neurological conditions.  And I think it really helps.

I had a patient who was an airline pilot, who had been knocked out in a bar in Australia and couldn’t fly back, cognitively impaired and he wasn’t able to work for two years. So I was working with him ongoingly.  He’s now able to go back to work just this year recently, which is awesome.  But for a while there, he just was overwhelmed and many people with brain injury can’t take something well, many of our patients, they get overwhelmed by the protocols. He’s like, okay, what’s the one thing I can take? I can’t do all this.  And I said, Let’s forget the supplements let’s do the ketogenic diet.  And so he got into that.  His energy improved, his sleep improved, he started feeling better and then he could add in the supplements again, and now like I said, he’s going back to work now.

Dr. Weitz:           That’s awesome.

Dr. Chapek:        I was a key for him.

Dr. Weitz:           Yeah, so your keto, your recommendations for the ketogenic diet is 30 grams of carbs?

Dr. Chapek:        Mm-hmm (affirmative). Yeah, 30 grams of carbs a day. I recommend doing it for three months and reassess. Is it working or not, give it a good try. It’s hard.  I did it myself after recommending it for people. It took me three weeks to figure out what the heck to eat and to get it figured out.

Dr. Weitz:            It’s actually hard to get the level of fats up.

Dr. Chapek:        Mm-hmm (affirmative). It really is, and a couple tricks that I tell people, you do have to push the fats, you have to add fat to each meal. It’s not just like eating a fatty steak or eating eggs that have fat you have to add fat to each meal, mayonnaise, avocados, coconut oil, eat those make those fat bombs. And I had a hard time digesting all that fat.  Honestly, I got a little nauseous.  So I took Ox Bile, bile salts, and that helped me be able to digest all that fat and then I did much better.

Dr. Weitz:            Right. Yeah, it’s true. Our bodies enzyme systems are adapted to the types of foods we need. If we change that diet and suddenly add a bunch of fat. It’s not ready for that.

Dr. Chapek:        Mm-hmm (affirmative). Exactly. That makes sense.

Dr. Weitz:            So you mentioned sleep, what part does sleep play and healing from brain injuries?

Dr. Chapek:        It’s hard to heal without good sleep. I would say it’s nearly impossible to fully recover without good sleep. Sleep is needed for the brain to restore and heal is when you’re in deep sleep, there’s like lip channels that open and help the brain detoxifying.  In deeper stages of sleep, you produce those hormones that you don’t otherwise like growth hormone, testosterone. And also the brain just needs to get into those deeper stages to really heal and restore. And it’s one of the curses of brain injury that nearly 30 to 70% of them, people with brain injury have sleep problems, and that’s what they need to heal, but they can’t sleep and they’re tired. Oh, it’s like the lights are flickering, and they’re like the neurons are on but not all the way on. They’re firing and not firing. So during the day, they’re tired at night, they can’t sleep. And a lot of people can relate. A lot of people have sleep problems.

One of the recommendations in the book and that we talked about will help anyone to see problems whether it’s turning off the screen an hour before bed. That’s a big one. Not having light in your room, turning the clock around, making sure it’s dark and quiet and cold just for sleep and sex, only the bedroom is just for sleep and sex only.  And that’s not that you have to sleep eight hours solid or doesn’t count. You can do chunks at time. But ideally like a four hour chunk, at least once a night is what I recommend, because you need a couple of REM cycles to really get that restorative sleep. And then you can go pee or wake up, whatever, but go back to sleep. So take away some of that stress and pressure and perfectionism around perfect sleep, doesn’t have to be that but just getting good rest waking up feeling somewhat rested.

Dr. Weitz:            Yeah, and one of the things you point out is growth hormone is often released during deep sleep. And that’s one of the reasons why sleep is so helpful.

Dr. Chapek:        Right? Absolutely. It’s very hard to produce growth hormone without deep sleep. And interval training is another way if people are trying to increase their growth hormone, you can increase it almost 500% if you do really intense interval training, and that will last for a couple of hours.

Dr. Weitz:            For people aren’t familiar, what it what exactly is interval training?

Dr. Chapek:        Oh yes. So interval training is in a nutshell going fast then going slow, sprinting and then moderate pace, sprinting and moderate pace. One easy protocol actually learned from Dr. Mercola was you do a 90 second warm up 30 second sprint 90 second moderate, 30 seconds and you repeat that eight times 20 minutes and you’re good and so a sprint can be doesn’t have to be running. It can be I often do the recumbent exercise bike on the gym or you can run you can go run a block, jog a couple blocks, run a block, jog just fast even walking fast walking slow walking.

Dr. Weitz:           I heard Peter Attia on his podcast and he was saying he likes to use 10 seconds blasts. He says you can really only go run all out for 10 seconds.

Dr. Chapek:        Yeah, that makes sense. It makes sense.

Dr. Weitz:           Anyway, I think as long as you get that intensity up, and-

Dr. Chapek:        Yeah, that’s the key.

Dr. Weitz:           … your weekly routine, you’re good.

Dr. Chapek:        Intensity is key.

Dr. Weitz:           So what about brain training as part of the recovery process?

Dr. Chapek:        Brain training is a real key and I like to think about it in stages. So first we reconnect the wire, so to speak. So we’ve got the chemistry right with the nutrients, the diet, the sleep, structural integrity, and then retraining the brain, so we can do meditation. There’s a pilot study showing that an eight week meditation training course improved fatigue quality of life in patients with brain injuries, which is huge because it’s so hard for anyone to meditate, myself included is the most hardest thing I’ve ever done, but it really strengthens the frontal lobe and the temporal lobes, which is focus and memory. And also-

Dr. Weitz:            It really should be the simplest thing. It’s really just calming your brain.

Dr. Chapek:        I know, but it’s frustrating. It’s so simple, but so hard and it’s so good for the brain. And then there’s more advanced brain training, like neurofeedback, where you have wires connected to your brain to understand the electrical activity, you work with a coach who can coach you on areas that specifically for you that are weak that need to be strengthened and doing a series of this. So you can do brain games on like an app. So we have BrainFitLife at Amen Clinics, which has brain training games, there’s brain HQ, there’s cogmed, which you work with a psychologist on, there’s many programs improve working memory. There’s lots of different brain training programs out there. Any of them are good, some are better than others. And part of it’s cross training, training areas that you’re weak in. So talk with dementia patients about this a lot like, you’ve been doing crossword puzzles for 30 years, you’re really good at them. But you’re not so good at math. So let’s do some Sudoku.

Dr. Weitz:            No, I find the same thing with patients coming in with musculoskeletal complaints. And the ones who are like super flexible, love to do yoga all day long. And they hate doing strength training, which is what they need.

Dr. Chapek:        That’s exactly what they need.

Dr. Weitz:            Usually you’ll find what you’re really good at is what you’re not going to get much benefit from. And you’re not as good at. If you’re super flexible, you’re probably going to do better at focusing on more strength training. And if you’re super tight and have very low flexibility, you’re probably going to get a lot more benefit out of yoga, which you probably don’t like to do because you’re not good at, but that’s an indication that that’s what you need.

Dr. Chapek:        I’d love to talk with you about the structural piece, because that’s an area that you’re more of an expert in than I am, but I recognize the importance of early on because, a in Naturopathic Medicine. Philosophy is looking at the whole person treating the cause and making sure that structural alignment is there.

Dr. Weitz:            Right.

Dr. Chapek:        I did miss this for a while. It’s like we have to have structural alignment so the cerebral spinal fluid and blood flow can be going to the brain and so in the book I talked about NUCCA or Upper Cervical Chiropractic, Atlas Orthogonal and Dr. Scott Rosa’s work, functional neurology, neuro cranial restructuring. It’s like little balloons up the nose. So just making sure that craniosacral, making sure that the that the bones are in alignment, the tissues in alignment, so that everything works properly because you can’t supplement that away, right.

Dr. Weitz:           Absolutely, yeah. No, it’s probably an under discussed part of the Functional Medicine approach.

Dr. Chapek:        Cool.

Dr. Weitz:           So let’s see. One more thing you also mentioned the benefits of hyperbaric oxygen.

Dr. Chapek:        So that’s something that I recommend people do either early or late. And I like to layer it in because of the cost and the time involved. But hyperbaric oxygen is essentially a chamber, like you’ve seen divers go into after they go deep and then they have the bends to push oxygen in and push nitrogen out. The same idea can be used for stroke and brain injury and other conditions, but essentially, you’re under pressure, oxygen is pushed to the deeper structures and it can help the brain to become more metabolically active and to heal.  And so you need to do a series of treatments 40 at least to start all in a row if possible. And 1.3 to 1.4 atmospheres, so that’s the pressure in the chamber, it doesn’t have to be a ton. That lower pressure over time that seems to really help heal. And if I had one magic bullet, the one thing that I could do to help people heal from brain injury, it would be hyperbaric oxygen.

Dr. Weitz:            A lot of the athletes are using it. I know LeBron James has one that he uses regularly.

Dr. Chapek:        Oh, he does.

Dr. Weitz:            Yeah. What do you think about ozone, which is another way to add deliver oxygen to tissues?

Dr. Chapek:        I’m not as familiar with ozone. I guess I’ve thought of it mostly for treating Lyme, infections and things like that. It’d be interesting to look at though, interesting.

Dr. Weitz:            I mean, if hyperbaric oxygen works, and essentially it’s adding the oxygen into the brain, I would think that ozone would be beneficial as well.

Dr. Chapek:        Yeah, There’s NAD, IV NAD would be-

Dr. Weitz:            Yes.

Dr. Chapek:        So a lot out there.

Dr. Weitz:            Nicotinamide riboside.

Dr. Chapek:        Right. Energize into the … especially if there’s almost all patients with brain injury have fatigue, some element of fatigue.

Dr. Weitz:            Mitochondrial support, yeah.

Dr. Chapek:        Exactly. Their mighty mitochondria, those energy producing cells, and they need some help. So there’s ketogenic diet, antioxidants, NAD, hyperbaric oxygen. The key really is not just one thing, but putting the pieces together.

Dr. Weitz:            Absolutely. And from a functional medicine approach, one more thing I would suggest is gut health because of the gut brain connection, which is crucial.

Dr. Chapek:        Absolutely agree with that. And a lot of people actually will start having food allergies after brain injury. And it’s like, why is that? The brain is injured the Vegas nerve can be … there’s less peristalsis, there can be constipation and leaky gut. And so it makes sense what you’re saying that we need to have healthy gut so that there’s less inflammation in the gut, there’s less inflammation in the brain. So …

Dr. Weitz:            Great.

Dr. Chapek:        Love it.

Dr. Weitz:            Thank you Dr, Chapek. It’s been a great discussion, any final thoughts you have for our listeners? And then if you could tell us how patients can get ahold of you and find out about seeing you or finding out about your programs and as well as your book.

Dr. Chapek:        Great. No, it’s been an honor to talk with you. Really, it’s been great. And the one thing I’ll leave you with is that it’s never too late to heal the brain from injury to at least try. Even if it’s been many years. It’s never too late. And three, go back to the drawing board. Your brain is your most precious asset. Let’s really optimize it. So whether it’s think back, have you had any head injuries? Have you had any concussions? Could that be contributing to your issues today, or your patient’s issues? Or have you not recovered from an injury? Those are the two things to think about, and that it’s not too late for you. Even if you’re in your ’60s, ’70s, ’80s we can always improve our brain. And that’s so important because that’s who we are. Our brains are who we are and that’s so precious.

So that’s why I wrote this book and you can find it on Amazon. Wherever books are sold. There’s an Audible version and we’re coming out with the program next week. We filmed me doing a set of the video series on the book Concussion Rescue, which people can watch.

Dr. Weitz:            Cool.

Dr. Chapek:        And that’s it. BrainMD, which is where we sell supplements and stuff and also Dr. Amen’s books. And there’s Amen University is what it’s called.

Dr. Weitz:            Okay.

Dr. Chapek:        Where I’m at Amen Clinics Northwest. So you can just Google that. Amen Clinics, Northwest, we’re in Seattle. And we see patients from all over the country. People come in from Idaho, Alaska, California, wherever, and I do collaborate with other Amen Clinic doctors. So someone does an evaluation in New York with Dr. Sood or Dr. Grin, I will sometimes do a consult with their patients if they need me to, so happy to help.

Dr. Weitz:            Awesome. Thank you Dr. Chapek.

Dr. Chapek:        My pleasure. Great to meet with you.

 

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