HEALING BRAIN INJURIES NATURALLY – Concussions and Head TraumaDr. Paul Hrkal ND June 29, 2015
Latest Science and Integrative Strategies for Treating Concussions and Brain Trauma
It seems that every week there is a news story highlighting the rising toll and damaging effect of head injuries and concussions. Traumatic Brain Injuries (TBI) are generating greater medical and research interest as public awareness grows, especially in regards to the impact on younger and more vulnerable populations. A recent study found there are approximately 30,000 concussions or head related injuries reported annually among the 12 to 19 year old age group, with over 80% being sports related. Car accidents, falls, and military duty also frequently cause brain injuries. While these numbers are increasing every year, the majority of concussions are still not being reported so the true numbers are likely underestimated.
What Happens to the Brain After a Concussion?
An explosion of recent research has uncovered some of the biochemical pathways involved in TBI. Emerging evidence shows that brain trauma from a concussion causes a complex cascade of neuro-inflammation. This process is started by an excessive release of neurotransmitters (brain signaling molecules) and excitotoxins (molecules that overexcite nerves causing cell damage). These molecules overwhelm the brain’s ability to function and repair itself, and ultimately damage the parts of the cell called the mitochondria which produce energy for cell survival.
In a mild TBI or concussion, the brain has the ability to stop the cellular damage with its own built-in antioxidant systems. This is why most mild concussion symptoms only last a few days to a week and resolve by themselves. The real problem occurs if a second injury happens while the brain is still healing. The cellular healing process can take up to two weeks even if the initial symptoms have resolved and a person feels “fine.” If a second impact occurs before the brain is fully healed, there can be an overwhelming amount of inflammation produced which permanently damages the mitochondria, disrupting the vital energy supply and ultimately resulting in nerve cell death and more severe, chronic symptoms. Incomplete recovery, early return to competition (without complete recovery), and multiple injuries (especially if in a short period of time), may contribute to the prolonged duration of symptoms and greatly increase the chance and severity of future concussions. Unfortunately, the reality is that many people underplay or hide their symptoms in order to return to activity earlier in spite of putting themselves at a much greater risk of more damage and lasting symptoms.
If Symptoms Last Longer Than a Week
While the symptoms of most uncomplicated concussions resolve after one to two weeks, a small proportion (less than 10%) of people have persistent symptoms leading to a condition called Post Concussion Syndrome (PCS).[2,4] Symptoms of PCS can vary for each person depending on the type and severity of the injury. Common symptoms include headaches, seizures, difficulty concentrating, poor memory, nausea, neck pain, jaw pain, depression, anxiety, and personality changes. The reasons and risk factors that cause certain people to progress to PCS are not quite clear, but experts now believe that multiple brain injuries, poor brain blood flow, cervical spine damage, and underlying brain stress (from inflammation, depression etc.) are contributing factors. The research does clearly show that chronic inflammation and mitochondrial damage are key drivers of PCS.
It’s also important to consider the supportive structures around the brain and in the neck as well. Every brain trauma causes severe stretching and damage to muscles and ligaments of the neck, face, and upper back which can refer pain to the head causing a variety of symptoms that appear to be from a damaged brain.
Chronic Traumatic Encephalopathy (CTE) is a very rare condition in which the brain starts to degenerate – similar to Alzheimer’s disease, which has been linked to multiple concussions. This condition has recently been highlighted in lawsuits against the National Football League (NFL) and National Hockey League (NHL) by former players who have received multiple concussions. Despite recent media attention, the research is still unclear if the concussions were really the culprit or if some other factor (i.e. prescription pain medicine overuse) is the real reason this is occurring. Considering the chronic inflammation that occurs after repeated concussions, there most likely is a strong connection but more research is needed to confirm this.
What To Do If You Get a Concussion
The first thing that should happen after a head trauma is evaluation by a medical professional who has been trained in an up-to-date acute concussion protocol. If you are an athlete at a sporting event, then this usually is a trainer, physiotherapist, chiropractor, medical doctor, or athletic trainer. They will determine if you are able to return to play that day, or if you need to be monitored and removed from activity. There is a very specific protocol (which includes rigorous physical and cognitive testing) that should be used by the healthcare practitioner in order to test if, and when, you are able to return to activity. If you weren’t injured in a sporting event, then you should seek medical attention at a hospital, with a family doctor, or at a walk-in clinic. In more complex cases, a referral to a neurologist may be warranted. After the acute assessment, which can rule out any life threatening injuries (like a brain bleed), the typical treatment and management for TBI is total rest:
- no physical or mental activity;
- reduction of sensory inputs (no bright lights, TV, and electronics that stimulate the brain) and;
- if symptoms continue, then physical rehab therapies and/or pharmaceutical drugs are often prescribed.
Unfortunately, these recommendations often don’t address the neuro-inflammation that is occurring in a concussed brain. So my recommendation is for all people with a concussion to be assessed by a qualified healthcare practitioner (see above) so they can properly diagnose your brain (and neck) injury, and look for integrative and complementary ways to start the process of brain recovery rather than just waiting or “pushing through the pain”. Ideally, you should consult a practitioner who has been certified by a program based on the latest protocols and scientific information (see www.completeconcussions.com).
Natural Compounds for Neuroprotection and Recovery
Conventional drugs have shown limited benefits for brain trauma since they don’t address the root cause of what is driving concussion symptoms. Currently, no neuro-protective treatment options exist that improve symptoms after a TBI. Now many researchers are starting to study a wide range of natural compounds and vitamins that have promising broad-spectrum, neuroprotective, and anti-inflammatory activity. Curcumin, green tea, essential fatty acids, resveratrol, and vitamin E are some of the compounds with potential therapeutic benefit in the treatment of TBI. The evidence for these substances is still very preliminary and there is much more research needed to confirm these effects in humans, but they offer potential options in a condition with no known treatment.
CURCUMIN – is an active compound found in the spice turmeric. It has attracted much interest as a potential treatment for many chronic diseases, including Alzheimer’s disease (AD), cancer, and heart disease due to its powerful anti-inflammatory and antioxidant properties. While results are still preliminary, curcumin extracts are showing positive benefit in neuro-recovery, cell membrane stabilization, and reduction of oxidative stress in animals.[8,9,19,11] Other potential therapeutic effects include increasing brain growth factors, chelating heavy metals, reducing cholesterol, and protecting mitochondria.
The problem with curcumin is that it doesn’t dissolve well in water, making its absorption through the digestive tract limited. It is important to point out that only free curcumin (not other curcumin molecules) is able to pass the blood brain barrier. Newer, fat soluble formulations, such as a curcumin extract called Longvida, appear to improve delivery into the bloodstream, past the blood brain barrier and into brain tissue.[12,13] Longvida curcumin was developed for neurological disorders by researchers at UCLA. Curcumin stands as one of the most promising neuroprotective and therapeutic agents in TBI and PCS due its excellent safety profile and wide ranging mechanism of action.
(Editor’s note: In addition, other brands of curcumin have been formulated for enhanced bioavailability, including NutriCure by NAKA. Alternatively, Ayurvedic physicians recommend cooking turmeric in oil, and combining it with black pepper, to enhance bioavailability of its constituents.)
GREEN TEA – like curcumin, is a well-known and widely consumed herb with broad-spectrum antioxidant activity. Its neuroprotective properties can be attributed primarily to the power antioxidant molecule called epigallocatechin-3-gallate (EGCG), the amino acid L- theanine, and to a lesser degree caffeine. EGCG has been shown to have antioxidant and anti-inflammatory effects in animal models of brain injury.[15,16,17] One unique aspect of green tea is that the L-theanine content may offer protection from excitotoxic injury that occurs immediately after a concussion. There is a clear need for more research, but promising evidence suggests that even regular dietary consumption of green tea may have a neuroprotective effect if a concussion occurs. A number of other plant compounds such as resveratrol (found in red wine) and anthocyanidins (found in berries) have also shown neuroprotective effects. Unlike pharmacological medications, these plant extracts have multiple modes of action and work synergistically with each other. They also support the function of the body’s own antioxidant systems and nerve repair systems. There have been a number of animal trials using plant compounds such as resveratrol, demonstrating an anti-inflammatory and neuroprotective effect in TBI, but like green tea, there have been no human trials to date.[19,20] Since these molecules are found in many colourful fruits and vegetables, it would be a safe recommendation for people with TBI or PCS to incorporate them into their diets.
OMEGA-3 FATTY ACIDS – have long been considered essential for brain development and function. Docosahexaenoic acid (DHA), and to a lesser degree Eicosapentaenoic acid (EPA), is primarily found in nerve membranes; they influence cell signaling and anti-inflammatory pathways. Since the human body cannot efficiently convert plant-based essential fatty acids to EPA and DHA, fish oil supplements are the best source of the active components. (It is important to note that, while consuming fish high in omega 3 fatty acids is desirable, the heavy metals and polychlorinated biphenyls (PCBs) found in most fish is a concern, especially for brain function.) A number of trials in animal models of TBI have found that DHA and omega-3 supplementation improves cognitive function, reduces nerve swelling, stabilizes cellular energy production, and increases nerve repair.[23,24] One of these studies showed that pre-injury dietary supplementation with fish oil also had a neuroprotective effect.
VITAMIN E – is a commonly studied natural compound for brain health since it has a powerful antioxidant effect, specifically in fatty tissue (i.e. nerves). A number of animal studies have found that vitamin E supplementation reduces nerve damage and improves cognitive performance following repetitive, concussive brain injury.[25,26] Interestingly, supplementation before the concussions also had a neuroprotective effect. A good formulation should provide all eight molecules of vitamin E, with the highest proportion being the potent gamma-tocopherol, which is considered the most anti-inflammatory component. In addition, vitamin E works with other antioxidants, such as vitamin C and coenzyme Q10 as part of an antioxidant network. This highlights the need to consume antioxidants together in order to support their proper biological function.
CREATINE, L-CARNITINE, ALA AND MORE – There are a number of other emerging nutrients currently being studied for TBI. Creatine, an amino acid found in muscles, has human evidence supporting its benefit in reducing symptoms after a concussion. Benefits were found for supplementation before and even after the injury, evidence that creatine can be used to prevent and treat neurological deficits after a concussion.[29-31] There are other promising supplements being studied, including acetyl L-carnitine, alpha lipoic acid, B12, ginkgo biloba, and magnesium.
HYPERBARIC OXYGEN THERAPY – Another intervention suggested to have beneficial effects on TBI recovery is hyperbaric oxygen therapy (HBOT), although more research is needed to confirm its benefit.
Treatment Options for Post-Concussion Syndrome
Ninety percent of concussion and mild brain injury symptoms resolve after 7 to 14 days without any treatment, however 10% of people continue to have persistent symptoms (PCS). While there isn’t a defined treatment protocol in the conventional system, we can use the research we do have – combined with clinical experience – to help PCS patients with innovative strategies. In my practice, I use a comprehensive and integrative approach because there are often multiple factors contributing to the persistent symptoms. The following are the key pillars of this strategy.
1) Comprehensive neck assessment – most TBI patients have not been assessed for neck and muscle issues that may be contributing to their symptoms. I work with a group of chiropractors who can identify whether or not the neck also needs to be treated. Muscle release, massage, acupuncture, and natural injection techniques are then used to resolve these issues.
2) Anti-inflammatory diet – I generally ask patients to remove foods that promote inflammation (refined sugars and animal-based saturated fats). At the same time, I recommend increasing good fats (wild fish, flaxseed, coconut oil, etc.) as well as increasing foods rich in antioxidants (berries and veggies). An emerging concept now being explored in the research, that often surprises people, is that reducing the amount of calories in a person’s diet also has a brain protective effect.
3) Intravenous therapies – are a key part of the strategy because it is difficult to deliver nutrients to the brain via the digestive tract. IV therapy bypasses digestion and allows for the delivery of high doses of nutrients directly into the bloodstream. I use a combination of powerful nutrients and antioxidants to restore nerve function. Vitamin C, B-vitamins, and glutathione are central to this therapy.
4) Key Nutrients – are used to reduce inflammation, promote blood flow, and restore mitochondrial function. These supplements (discussed earlier) can be used short term in higher doses to rapidly quench inflammation. Each patient has specific needs, so a unique combination of nutrients is tailored to each individual. It’s essential to target mitochondria to restore the ability of nerve cells to function again.
5) Homeopathic remedies – While this approach is controversial, I find that homeopathy can have a very powerful effect on brain trauma by matching specific symptoms with the appropriate remedy. One of the most well known remedies is called Arnica, which has excellent applications to any type of trauma or injury, even if it has happened in the past. There are many other homeopathics which can be used depending on the key symptoms of each person.
6) Acupuncture – has a powerful effect on relaxing muscles, stimulating blood flow, and promoting healing. In addition to using acupuncture to address tight neck muscles, a special technique called ‘scalp and ear acupuncture’ can have a potent effect on brain recovery by impacting the nervous system.
Reducing the Risk of Brain Trauma
You can never predict when you may sustain a head injury through a car accident or a fall, but people who participate in physical contact activities are at an increased risk of TBI. There are a few practical considerations to always keep in mind:
- Always wear properly fitted head protection during contact or extreme sports and recreational activities. This also includes mouth guards, which minimize the impact on the jaw. While both of these devices can minimize skull and jaw injury, the research doesn’t show that they prevent concussions; they should be worn anyway.
- Avoid activities, maneuvers, and positions that increase the risk of head injuries (helmet-to-helmet hits, racing, high risk combat, etc).
- If you are in a high-risk sport, you should always perform a baseline screening test so your results can be compared to scores right after a concussion.
Many of the natural substances and dietary changes already discussed can be taken preventively. It often takes weeks for substances such as vitamin E and omega 3s to be incorporated into cells, so it makes sense to take them before the injury occurs. Creatine, curcumin, and green tea also could be used preventively. Very few (if any) side effects have been found in trials with natural substances, making their use safe. We can remain cautiously optimistic that more evidence will emerge to support the recovery from TBI and, in the meanwhile, we can use innovative and integrative methods to address the chronic effects of brain trauma.
 Gordon KE, Dooley JM, Wood EP. Descriptive epidemiology of concussion. Pediatr Neurol. 2006 May;34(5):376-8.
 Maroon JC, Lepere DB, Blaylock RL, Bost JW. Postconcussion syndrome: a review of pathophysiology and potential nonpharmacological approaches to treatment. Phys Sportsmed. 2012 Nov;40(4):73-87.
 Blaylock R and Maroon J. Natural plant products and extracts that reduce immunoexcitotoxicity-associated neurodegeneration and promote repair within the central nervous system. Surg Neurol Int. 2012; 3
 Giza CC, Difiori JP. Pathophysiology of sports-related concussion: an update on basic science and translational research. Sports Health. 2011 Jan;3(1):46-51
 McConeghy KW, Hatton J, Hughes L, Cook AM A review of neuroprotection pharmacology and therapies in patients with acute traumatic brain injury. CNS Drugs. 2012 Jul 1;26(7):613-36.
 Bengmark S. Curcumin, an atoxic antioxidant and natural NFkappaB, cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase inhibitor: a shield against acute and chronic diseases. JPEN J Parenter Enteral Nutr. 2006 Jan-Feb; 30(1):45-51.
 Baum et al. Six-month randomized, placebo-controlled, double-blind, pilot clinical trial of curcumin in patients with Alzheimer disease. J Clin Psychopharmacol. 2008 Feb; 28(1):110-3.
 Wu A, Ying Z, Gomez-Pinilla F Dietary curcumin counteracts the outcome of traumatic brain injury on oxidative stress, synaptic plasticity, and cognition. Exp Neurol. 2006 Feb;197(2):309-17. Epub 2005 Dec 20.
 Laird et al. Curcumin attenuates cerebral edema following traumatic brain injury in mice: a possible role for aquaporin-4? J Neurochem. 2010 May;113(3):637-48.
 Wu A, Ying Z, Schubert D, Gomez-Pinilla F Brain and spinal cord interaction: a dietary curcumin derivative counteracts locomotor and cognitive deficits after brain trauma. Neurorehabil Neural Repair. 2011 May;25(4):332-42.
 Sharma S, Ying Z, Gomez-Pinilla F. A pyrazole curcumin derivative restores membrane homeostasis disrupted after brain trauma. Exp Neurol. 2010 Nov;226(1):191-9.
 Begum et al .Curcumin structure-function, bioavailability, and efficacy in models of neuroinflammation and Alzheimer’s disease. J Pharmacol Exp Ther. 2008 Jul; 326(1):196-208.
 DiSilvestro et al 2012. Diverse effects of a low dose supplement of lipidated curcumin in healthy middle aged people. Nutrition Journal 2012, 11:79
 Petraglia AL, Winkler EA, Bailes JE. Stuck at the bench: Potential natural neuroprotective compounds for concussion. Surg Neurol Int. 2011;2:146. doi: 10.4103/2152-7806.85987. Epub 2011 Oct 12.
 Wei IH, Tu HC, Huang CC, Tsai MH, Tseng CY, Shieh JY. (-)-Epigallocatechin gallate attenuates NADPH-d/nNOS expression in motor neurons of rats following peripheral nerve injury BMC Neurosci. 2011 Jun 1; 12():52.
 Itoh et al. Neuroprotective effect of (-)-epigallocatechin-3-gallate in rats when administered pre- or post-traumatic brain injury. J Neural Transm. 2012 Nov 21.
 Park SK, Jung IC, Lee WK, Lee YS, Park HK, Go HJ, Kim K, Lim NK, Hong JT, Ly SY, Rho SS. A combination of green tea extract and l-theanine improves memory and attention in subjects with mild cognitive impairment: a double-blind placebo-controlled study. J Med Food. 2011 Apr; 14(4):334-43.
 Kakuda T. Neuroprotective effects of theanine and its preventive effects on cognitive dysfunction. Pharmacol Res. 2011 Aug;64(2):162-8.
 Ates et al. Neuroprotection by resveratrol against traumatic brain injury in rats. Mol Cell Biochem. 2007 Jan; 294(1-2):137-44.
 Gatson JW, Liu MM, Abdelfattah K, Wigginton JG, Smith S, Wolf S, Minei JP. Resveratrol decreases inflammation in the brain of mice with mild traumatic brain injury. J Trauma Acute Care Surg. 2013 Feb;74(2):470-4.
 Dyall SC, Michael-Titus AT. Neurological benefits of omega-3 fatty acids. Neuromolecular Med. 2008; 10(4):219-35.
[22 Mania et al. Fish and seafood as a source of human exposure to methylmercury. Rocz Panstw Zakl Hig. 2012;63(3):257-64.
 Mills JD, Bailes JE, Sedney CL, Hutchins H, Sears B. Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model. J Neurosurg. 2011 Jan; 114(1):77-84.
 Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acids supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma. 2007 Oct; 24(10):1587-95
 Wu A, Zhe Y, Gomez-Pinilla F. Vitamin E protects against oxidative damage and learning disability after mild traumatic brain injury in rats. Neurorehabil Neural Repair. 2010;24:290–8.
 Conte V, Uryu K, Fujimoto S, Yao Y, Rokach J, Longhi L, et al. Vitamin E reduces amyloidosis and improves cognitive function in Tg2576 mice following repetitive concussive brain injury. J Neurochem. 2004;90:758–64.
 Petraglia AL, Winkler EA, Bailes JE. Stuck at the bench: Potential natural neuroprotective compounds for concussion. Surg Neurol Int. 2011;2:146. doi: 10.4103/2152-7806.85987. Epub 2011 Oct 12
 Sullivan PG, Geiger JD, Mattson MP, Scheff SW Dietary supplement creatine protects against traumatic brain injury. Ann Neurol. 2000 Nov; 48(5):723-9.
 Sakellaris et al. J Trauma. 2006 Aug; 61(2):322-9
 George et al.J Neurotrauma. 2014 Jun 1;31(11):1018-28.
Dr. Paul Hrkal ND
Dr. Paul Hrkal is a board-certified Naturopathic doctor with a clinical practice in the Toronto area at 2 multidisciplinary clinics. He has a special interest in neurological health, chronic pain and brain injuries, writing and lecturing extensively on these topics which includes over 100 webinar, podcast and live presentations to medical professionals, researchers, and public audiences. He is a member of the scientific advisory board of Complete Concussion Management, an international leader in research-based concussion management education and is the co-founder of the Concussion Fix program. He also has extensive experience in the natural health industry where he has been a scientific advisor and medical director for nearly a decade educating clinicians and formulating science-based products including a number of best-selling formulations. Follow Dr Hrkal: Instagram @DrPaulHrkal 7000+ followers Clinical practices: pureBalance Wellness Centre - Cancer Care 219 Lakeshore Road East, Mississauga, Ontario, L5G 1G5 P. (905) 891.3865 www.mypurebalance.ca The Pain and Wellness Centre 2301 Major Mackenzie Dr. West Unit 101 Maple, ON L6A 3Z3 P. 1 (800) 597-5733 Watch the following short video to learn more about Dr Hrkal’s practice: thepwc.ca The Concussion Fix Program concussiondoc.io Complete Concussion Management completeconcussions.com
Dr. Paul Hrkal ND
Dr. Paul Hrkal is a board-certified Naturopathic doctor with a clinical practice in the Toronto area at 2 multidisciplinary clinics. He has a special interest in neurological health, chronic pain and brain injuries, writing and lecturing extensively on these topics which includes over 100 webinar, podcast and live presentations to medical professionals, researchers, and public audiences. He is a member of the scientific advisory board of Complete Concussion Management, an international leader in research-based concussion management education and is the co-founder of the Concussion Fix program. He also has extensive experience in the natural health industry where he has been a scientific advisor and medical director for nearly a decade educating clinicians and formulating science-based products including a number of best-selling formulations. Follow Dr Hrkal: Instagram @DrPaulHrkal 7000+ followers Clinical practices: pureBalance Wellness Centre - Cancer Care 219 Lakeshore Road East, Mississauga, Ontario, L5G 1G5 P. (905) 891.3865 <a href="https://www.mypurebalance.ca/">www.mypurebalance.ca</a> The Pain and Wellness Centre 2301 Major Mackenzie Dr. West Unit 101 Maple, ON L6A 3Z3 P. 1 (800) 597-5733 Watch the following short video to learn more about Dr Hrkal’s practice: <a href="https://thepwc.ca/directory/dr-paul-hrkal-naturopathic-doctor/">thepwc.ca</a> The Concussion Fix Program <a href="https://concussiondoc.io/offer/the-concussion-fix/">concussiondoc.io</a> Complete Concussion Management <a href="https://completeconcussions.com/about-us/medical-advisory-board/">completeconcussions.com</a>
Hi my name is Lydia and I suffer a traumatic brain injury for over 3 years and can’t take it anymore
Dearest Lydia, I know just how you feel. :-(. I am in a similar situation and have felt like I have been fighting for my life for several years. Please remember that You are Worth It! Even when you feel low, keep moving forward. I have other issues as well, so what has begun to work for me, may not work for you, but perhaps it will provide a place to start. Try to find a good naturopathic doctor or certified master herbalist. For me, I found that Ayurvedic (some, not all) was more effective than some of the TCM. Consider a liquid B12 (a nice spray organic liquid B12 can be found on Amazon.com). Also consider Guduchi. As well as a good chiropractor if you can. Stay hydrated – drink lots of water and make sure it is Ph balanced – if unsure, squeeze some lemon in your water (and it helps make it more palatable if you don’t like / have a hard time drinking lots of water).