Nutrition to Support Brain Health & Offset Brain Injuries

the science and practice of enhancing human performance for sport play and life Welcome to perform for the final time this season welcome back friends I'm Dr Andy Galpin I'm a professor of Kinesiology in the center for sport performance at Cal Fullerton so far in the first season of perform we've talked about everything from muscle to the immune system to liver and lungs metabolism genetics sleep blood work and so I thought we have to end this thing on what I hate giving credit to because I'm a muscle guy but probably deserves it and that's the brain

there are obviously many factors that go into getting your brain to perform at its best but today I want to focus specifically on what you can do from a nutrition perspective to reduce your risk of as well as recover faster from brain injuries concussions and tbis I think it's worth reminding you though that if it's good for preventing and returning faster from a brain injury it's probably safe to assume it's also good for brain performance as well as long-term Health now I'm particularly passionate about this subject having dealt with it a lot personally I've had

a concussion or two myself and I've spent much of my career working with athletes prone or at high risk of developing similar injuries this is includes football players wrestlers Fighters boxers and so forth that said those are not the only people at risk of a brain injury in fact those things are quite common and not only in athletes so I'm really excited about this topic because brain injuries are really common they can be completely debilitating and there's actually a lot of evidence that nutrition and supplementation can have a big effect in again both reducing your

risk of getting one as well as coming back faster once they've happened and so I really want to make sure everyone knows what their options are from a supplementation as well as Whole Food perspective on getting back and returning as fast as possible and minimizing the symptoms of brain injuries now as I was saying traumatic brain injuries or what we'll refer to as tbis are really common in fact a lot of people in the field refer to them as the invisible disease because they don't come with a physical appearance there's no cut there's no bruise

or joint sticking the wrong way bone poking out of the skin and so these things can happen and you don't necessarily know that an injury occurred other problems include the fact that the symptoms that are associated with TBI or concussion are really similar to those generally associated with aging so you talk about memory recall issues mood sleep and other things that people don't necessarily know are because of an injury and they may think it's just due to normal aging in fact we'll get into this a lot as the episode progresses but a lot of the

research on brain health with aging Alzheimers dementia and other related topics come from the same data sets that we work on for tbis and concussions and the inverse so there's a huge overlap or vend diagram between the types of research the study design the actual papers themselves the interventions the models whether we're talking about data from humans or animals and rats and ferrets and things like that there's a large overlap between these two bases they're different of course and we'll try to highlight those but these are some of the reasons why I want to get

into today's episode even if you're not an athlete cuz many of you still at risk of getting a TBI in fact the vast majority of concussions and tbis do not come from Sports they come from accidental slips and falls and other problems like that in addition they're still going to tell us a lot of indirect information about overall healthy brain aging so the goal here will be to reduce our risk of course but if it does occur to minimize the symptoms and return back to a healthy brain as fast as possible now before we go

too much further I'd like to take a quick break and thank our sponsors because they make this show possible not only are they on this list because they offer great products and services but because I actually personally love them and use them myself today's episode is brought to you by element element is an electrolyte drink mix that has an ideal ratio of sodium potassium and magnesium but has no sugar electrolytes are critical to proper hydration which I've been harping on for years but you can't do that by only drinking water in fact many of you

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mix again that's drink LM nt.com perform to claim a free sample pack today's episode is also brought to you by Continuum Continuum is a membership only wellness club designed to help high performers reach their Fitness and performance goals Continuum just opened its Flagship Club in Manhattan quickly making it one of the most sought-after memberships in the city its location in Greenwich Village is incredible in fact it's stunning it's a 20 5,000 ft space with state-of-the-art equipment a beautiful design and everything you could possibly want in this unique mix of a gym Wellness Center and Social

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a medical doctor if you think you have any risk of or potentially have had or suffering consequences from any type of brain related injury please see a medical professional in this area I want to focus this episode on nutrition and supplementation related to brain injury but I also don't want anyone to think that I'm suggesting this is all you should do for your brain injury I also don't want anyone to think that I'm suggesting this is enough to stop your chances of ever having a brain injury so that being said the landscape of the research

and many the scientists and they area are on the same page in the fact that there is emerging evidence that several micronutrients and what we'll call biological compounds really do have the ability to reduce the risk I hesitate to say prevent but can help prevent and treat brain injuries concussions tbis and related events now over the course of today's show I'm going to walk you through a bunch of different micronutrient and nutriceutical options you have we'll cover the evidence how much to take the protocol and so on and so forth but before we do that

you have to actually understand a little bit of the terminology because depending on what type of brain injury you have you may want to take a different route with your nutrition so getting going with that point what is a brain injury you've heard me now say concussion TBI brain health and a bunch of different terms like that what is actually the difference in fact do you even know the difference between a TBI and a concussion it's been my experience that most people don't and so we'll maybe just start right there right so a brain injury

can mean a lot of different things honest answer here there's not that much research in humans and randomized control trials on what to do to prevent or reduce an injury in fact if you think about research design that's really hard to do the only way to execute these kinds of studies in humans is to set up an enrollment center say at a hospital probably around an area that has a lot of kids playing in sports wait for people to show up with an injury ask them if you can enroll them in a study and go

on from that we can't go out and give humans head injuries and concussions and so it's really challenging it's hard to get an adequate sample size and you're also relying upon those people coming into the study having the same type of brain injury and we know that that does not happen and so brain injuries themselves there's a lot to learn and there's lots of different types it would be foolish to think that we know how to prevent all of them or recover from all of them some types of injuries we know more about other types

we know way less and so there's not one type which means there's not one solution and this is going to explain why almost always you will see mixed results easy example here we're going to talk about one of the major problems that are associated with brain injuries is sleep so supplements that help with sleep therefore are going to be helpful for folks who are experiencing sleep sleep related problems with the brain injury however if you have a brain injury and we're not suffering symptoms of sleep loss then a sleep aid may or may not actually

work if both those individuals let's say we had two people one having issues with sleep one not both enrolled in the same study you're going to see the magnitude of effect of the supplement or the nutritional Factor gets a little bit washed out so those are common themes you will see I won't bring this up again because honestly I could do that with just about every single stuff but it's something for you to really consider in the back of your mind all right now the goal then is to present to you information that I think

has a strength of evidence I'll explain to you what my C criteria for a strong evidence is a little bit later and things that I think kind of justify what we'll call low risk and high potential reward we'll typically break those down into things you can do before the injury during or immediately after the injury as well as long-term post recovery so you can think about that as pre per or post or simply preventative and then treatments post injury so in terms of terminology I'm going to try to be consistent with three basic phrases so

a brain injury is often broken up into three categories based on the severity there's mild which is the lowest moderate and severe now fortunately mild is by far the most common in fact some papers will indicate that over 90 plus percent of brain injuries are qualified as mild what that means typically is there is a 30 minute or less change in state of consciousness right so if you were unconscious for a couple of minutes you probably had a mild traumatic brain injury right this is often associated with things like confusion or post-traumatic impact Amnesia right

so you you know forgot what happened immediately afterwards or you had a little bit of a time travel as I like to call it and this can occur a couple of hours or even up to one day is the general line that we cross there the overwhelming majority of recreational and Sport related concussions fall into this category therefore almost always though not always but almost always when you hear the word concussion you can generally translate that into a mild TBI now not all TBI are concussions but all concussions are tbis okay so one more time

in case I cost you there concussion is effectively a mild traumatic brain injury based on those categories if you had worse effects so you were unconscious for longer or your Amnesia were lasted longer then you may be actually be considered to being a moderate category so moderate technically is defined as a loss of consciousness or amnesia for somewhere between 30 minutes to up to 24 hours symptoms associated with this are more severe it is headaches confusion dizziness nausea vomiting slurge speech drowsiness difficulty concentrating so on and so forth and so another kind of back of

the envelope way to differentiate between mild and moderate is mild again not always but rough guidelines here mild is fairly acute so in and immediately after the injury you had symptoms but then you're usually back to normal moderate often comes with Downstream problems not the injury themselves so this is when you have beh behavioral changes because of the TBI you've got again difficulty with memory that lasts a long time that's again back of the envelope kind of Distinction if it is worse than that we call it severe that is technically a loss of consciousness or

amnesia for somewhere between 2 24 hours to up to or more than seven days and moderate and severe also have similar dementia like symptoms now I mentioned this earlier but think about this severe tbis oftentimes come with memory and attention problems decision-making problems learning impairments mood Big Sleep disturbances and so you can imagine somebody who's in their 50s 60s or 70s Who start experiencing things like that they may personally just think oh this is I'm getting old family members may think oh Grandma's got you know starting to show dementia signs could be possible could also

be possible that Grandma's simply suffering from a a severe TBI and so this is what I was referring to earlier when I said there is actually a big crossover here it's a bit of a gray area they can actually be the same thing they can clearly be different as well but there is a large crossover between them so hopefully that helps you understand a little bit about what the difference between a concussion and a TBI is what a mild moderate and severe traumatic pain injury R and I started sneaking in some of the physiology about

at least what's the symptoms what are the behavioral and actual consequences that is important to understand because now that'll tell us what we do in terms of a treatment or prevention strategy in order to finally connect that dot though we got to walk through just a touch and I promise this will be just a touch of the physiology or pathophysiology of each one of these categories so we understand what we're trying to do with the nutrition or the micronutrient why they solve those problems and then ultimately how that translates into reduction or of these symptoms

so what's actually happening in the brain when we experience any of these three levels of a brain injury there's a couple of resources I want to give you if you want to learn more about this right now I based a lot of this episode heavily off of these papers so I want to give them their due credit they will of course be linked and PDFs will be available in the show notes you can find those at perform podcast.com but for those of you who want to write it down right now a paper that I found

particularly helpful came out just last year in 2023 and that is titled optimization of nutrition after brain injury mechanistic and therapeutic considerations in addition to that my friend and colleague Dan Garner has a product available for purchase on Amazon called the brain Synergy protocol and I will talk about that a little bit later and then finally I honestly took the vast majority of this episode off of a paper that I co-authored and that's depending on when you're listening to this either in review or potentially published by now called mitigating traumatic brain injury a narrative review

of supplementation and dietary protocols this was led by Tommy wood the Fantastic neuroscientist at the University of Washington and was first authored by Federica kti another tremendous neuroscientist in her own right so they did the bulk of the work here we contribute on this paper together and I thought it was honestly so perfect for a show that I thought I'm just going to take this entire thing and make a whole episode out of it but nonetheless let's get into the paper right now so what's actually happening in your brain when you experience an injury typically

we've been told that when you have some sort of injury you have to go through this Whiplash experience so you have a say a sudden stop your brain inside your skull continues to travel and then smashes up against your skull and then therefore has a bruise on the brain and while that certainly can happen that's actually probably pretty unlikely generally what's going to happen if that occurred is you would see the injury site being on the outside right so you can imagine let's just say the front of of your brain smashes into the front of

your skull you would expect the injury to be right on the front on the outside part of your brain reality of it is that's not where most concussions and tbis occur It generally happens more towards the middle of the brain remember the outside of the brain is where your gray matter is that's mostly where your neurons are on the inside is the white matter that's made of mostly fat and it helps you conduct uh messages more quickly throughout the brain see what typically happens in brain injuries is you get more of what I call the

accordion effect and so you have so much fluid in your brain that if you were to SOS it around a little bit it there's not much room to Sash and so it protects your brain from hitting the skull but what can happen though is an intense pressure inside the tissue because it squeezes together and then gets expanded back out picture the accordion here me taking my two hands putting them closer together smashing it pulling it back apart and so you have this kind of egg looking oval that that is supposed to be your brain and

it gets smashed down into a vertical piece of paper and then extended way back out and stretched and so on and so forth so it's not the actual connection or contact to the skull that is always the issue sometimes it's that stretching and pulling and that pressure wave that caus the damage on the interior or various portions of the brain and so the injuries are highly varied in the brain it can be everything from a capillary or blood flow Supply that is damaged or torn the Axon themselves can be torn this then causes a host

of issues that we'll get into step by step but it's everything from temperature problems energy problems um metabolism problems inflammation and physical structural damage so many different options that can occur but that's basically what happens for most but not all this is obviously a complicated area I don't mean to oversimplify it depending on if you had a single event say a car crash or a single slip and fall or numerous subconcussive events think of blast injuries in folks in the military um small impacts with combat athletes or other people in professions that kind of bang

their head a little bit don't he necessarily get huge symptoms but they have a lot of these stack over time all of it results in different problems I'm just trying to highlight a small example of of what it can look like as a quick overview that being said there are some generalities and commonalities between different forms of tbis and I'll just cover them broadly right now the top of our list here is what's called comprised excitotoxicity I'll explain what that means later but this is arguably one of the bigger problems you will experience there are

ionic disturbances so your positive and negative charges get all messed up there are blood flow to the brain that's called cerebral blood flow edemas and swellings oxidative stress inflammation and then as I mentioned before even damaged or even death in the cells that are directly in in the brain or related to the brain that can actually be going on acutely for weeks or even months to decades throughout life so I can't go over all of this it would take me the entire show if not many but I do want to cover a couple of very

specific examples so you can start to grasp what this could look like the first one is just if you've had capillaries burst so remember you have capillaries that surround all tissue in your body and that's where all of your blood exchanges happen so you have this network in this bed of capillaries that surround your brain when those burst you can't get nutrients and fuel in and you can't get waste products out and so in the most fundamental problem here is you don't get oxygen to the brain so we lose cerebral blood flow we lose energy

production because we're not getting fuel into the brain because we've physically torn capillaries right this if this was on your arm like it is on mine right now you might have a purple and black arm thank you Cam hannes but in your brain you wouldn't see that this goes right back to the invisible disease problem from earlier more detailed example would be the following though often times we'll break up TBI into what we call the initial response and then the delayed or Phase 2 response so let's say you had some sort of Direct Hit again

pick your example it might look something like this your initial response would be an overactivation of the neurons that's right the nerves that are associated with the injury area become overly activated now this initial response is caused in large part by what's called overactivation of neighboring neurons so you remember all the nerves connected one to one to one they're not actually physically connected there's a small space in between them and they communicate by releasing what's called neurotransmitters so what happens in this area is you have a damage to one it overcommunication okay or excitotoxicity because

you're excited so much that it comes to the level of toxicity and excited meaning the neurons being too active now this happens in large part because of a molecule called glutamate you'll see this all over the TP TBI literature supplementation marketing very common to be talked about because it is very real and very important it's the main neurotransmitter that's responsible for this excitatory activity okay now this gets released in response to that we have a whole down Cascade of problems and this starts off as an initial response and then I'll show you how this turns

into that delayed phase response later so we have this overe excitation now if you go back to our episode on muscle you'll learn more about how nerves and cells contract why sodium and calcium and potassium and chloride are responsible for Action potentials and so on and so forth for now sodium and calcium very specifically become overly activated in fact you literally often times have damage to the plasma membrane so the little thing that surrounds your cells gets damaged gets broken and so because of that the things that are supposed to be in the cell and

things that are not supposed to come in the cell start leaking everywhere so sodium and calcium start coming in and out of the cell in inappropriate manners now this causes things that are eventually going to be cell death and degradation because of production of what's called Ross Ross is r a reactive oxygen species so remember oxygen is very reactive it is good and bad you have to have oxygen for fuel allow you to create fuel rather it's a byproduct needed to make aerobic metabolism at the same time excessive amounts of it are going to be

damaging this is how we break down tissue this is how we create and clean out dead and debed cells and so if we're generating way too much of this reactive oxygen species this is almost synonymous every time with oxidative stress these are these are kind of similar terms not the exact same thing but pretty close this also activates several enzymes that damage the cell structure um these are everything from what we'll call proteases so anas is an enzyme that breaks down a protein to lipases these are enzymes that break down fats U Nitric oxides synthesis

and and endonucleases and and other things like that a whole Cask of enzymes that start breaking the thing down you don't know exactly what's happening here but the cell thing thinks that there's problems because there are and so it just starts activating cell death so we're having issues with that okay in addition to that that calcium specificity becomes a problem because it alone harms mitochondrial health and efficiency and so the cells that do stay alive start getting really damaged mitochondria uh this is again because of a membrane damage issue that allows too much permeability of

things in and out and that of course eliminates or drastically reduces mitochondria's ability to work which means your ability to make ATP remember ATP is the cellular currency it's the only way any living cell can create energy and so mitochondri is not the only way we can make ATP hold on to that we're going to come back to that but it is the primary way and it is the exclusive way in which we generate aerobic metabolism so the way that we create fuel with oxygen has to go for mitochondria so damaged or ineffec of mitochondria

is going to directly lead to red reduced ATP production reduced ATP production simply means we have way more cellular energy in our brain this idea of brain fog or fatigue or can't remember things recall exective decision if you don't have energy your brain can't think that's quite literally what's happening and this is why some of the supplements and micronutrients we're going to talk about later have such positive effect is they help you restore what's called that energy balance the damage occurred you weren't able to get transportation of oxygen and things in this allowed permeability of

calcium this allowed too much excitation which means we're burning too much energy at the same time we don't create enough energy and so we end up being in this really catabolic or negative energy State and now we can't think well we're dealing with signs and symptoms and overall more importantly our brain is actually physically unhealthy and so because your brain is measuring energy production at all times it knows this imbalance is occurring it's going to try to alleviate it and the best way to do that is to ramp up energy production but since it can't

do it aerobically it has to turn to anerobic methods and specifically what we're talking about here is Anor robic glycolysis one more time go back to our previous episode I believe it was episode two on muscle and we talk about the physiology and bioenergetics of how we use carbohydrates for fuel it's the same we're in the brain here we're not in muscle but anerobic glycolysis is still anerobic glycolysis it's still the breakdown of carbohydrates for the production of ATP so in this particular case since the ability to store glucose in the brain is quite limited

and the amount that we can get into the brain through the bloodb brain barrier is also somewhat limited if we're only or mostly relying upon anerobic glycolysis you can quickly see we're not going to be able to handle all the supply because not only does the brain take an enormous amount of energy it's in fact depending on the situation our most energy costly organ in the body and now it's injured and it has more energy demands to recover and it has less energy production we're going to be really running into problems with our energy deficit

so to summarize all that effectively What's Happening Here is you've got this disrupted cell homeostasis this leads to all kinds of problems like cell death or apoptosis uh DNA fragmentation necrosis cytoskeletal degradation and a whole host of other things that are short and longterm and that's just the phase one part that's the initial response from there and once we've dealt with that we now have to handle step two or the delayed or second phase which is generally associated with neuroinflammation and prolonged oxidative stress so what we're talking about here is this pervasive inflammatory Cascade that

is in combination with our metabolic changes specifically to the blood brain barrier now remember that's the thing that keeps things out of your brain and in your body and and kind of keeps the separation there if we've got a brain injury we potentially have damage to that membrane as well and so we've got excessive inflammation happening not even talking about the acute response now it's staying there and persisting for days weeks months or potentially even longer this causes uh migration of what's called peripheral immune cells into the brain and releases a whole storm of cyto

kindes these are communication tools that come out of your body from one organ to the next they're not necessarily good or bad but in this case it's so large and it's so extreme that it continues to exacerbate this inflammatory problem uh this also causes activation of things that are called residual neural cells um there's a whole host of these things like astrocytes complement proteins and so on um these things release reactive oxidative species they release AC glutamate again and they release those cyto kindes and so you can see how this circle just sort of perpetuates

itself it's not always a bad response but in this particular case since there's been so much structural damage one more time the cycle just continues this is going to really harm the brain's healing it's going to facilitate formation of what are called membrane attack complexes you could just hear from that term that's probably not a good thing again we're trying to clean out the damage but it's going to come with a lot of problems um this is going to create like very specifically pores in the membranes of the the target cells which means those are

going to often die now in the case of like a skeletal muscle from exercise this is okay it's pretty to repair but when it's happening in your brain it's a problem right so overall we've got that oxidative stress uh response and that's going to start damaging fat protein and DNA remember big portion of your brain is made of fat so while we're typically not concerned about oxidative stress harming all the fat in our rest of our body that represents a serious damage to our brain and one that potentially is not reversible now I know I

got pretty technical there so so if I lost any of you don't worry about it just think about it this way at the highest level uh TBI is going to involve some likelihood of a physical injury or damage this could be your capillaries or any of your vessels your bloodb brain barrier your membranes of your cells your astrocytes your neurons are actually physically torn if you were a house this would mean your windows are smashed your door's broken they got a hole in a wall it's not a functionality issue as it is an actual structure

is broken and has to be repaired now in addition to that we're going to be dealing with a secondary problem which is now because we don't have the physical structure to get in nutrients and get waste out we can't make energy so problem number two is a massive energy deficit your brain's going to try to get around it it's going to start ramping up our less effective methods of producing energy but it's never going to catch up and so physical damage number one one energy deficit number two number three in response to number one and

two is this prolonged inflammatory response and so we're sending in molecules that let the inflammation continue and they exacerbated and they start breaking down and killing and getting rid of actual tissue so the ones that maybe were not injured initially will be injured or removed entirely in the weeks to months because of this inflammatory response so effectively those are our three big problems which means now we can talk about what nutrition options we have to solve or mitigate or at least attenuate slightly reduce some of those issues I'd like to take a quick break and

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old men women kids so on and so forth and there's really very limited side effects if any that have been reported now creatine itself is a naturally occurring derivative of three very specific amino acids methine Glycine and Arginine these are really really common uh creatine itself I typically have talked about how it's stored in muscle and used as a great fuel source but many people don't realize it's actually also stored in your liver testes and brain the last one of course is where we're going to pay our attention to today now it's stored in the

brain so that it can be used as a very quick fuel source your gear should be turning at this point remember one of the primary issues we have with the TBI is that energy demand problem and so it made a ton of sense to scientists very early on to say okay we know that we have energy issues we know that the fast way any of our tissues can make energy is through creting monohydrate and we know it's in stored in the brain already it makes sense to try that to both prevent or reduce the risk

of and then treat brain injuries so it's no surprise when we look at the research here on both TBI as well as aging and normal brain health research to find that monohydrate often improves cognitive function in both brain injury and normal healthy aging folks now it's not the world's most powerful neut tropic I but it is effective and been shown again in many models and many studies across many Laboratories so because it's so effective at giving energy especially in low oxygen situations you'll see evidence across injury in TBI papers but also just normal cognitive function

and healthy individuals uh to see benefit right so creatin is effective in all of those populations and the physiology biochemistry make total sense now specifically regarding tbis and ions one of the things you want to pay attention to a lot is What's called the second impact syndrome many people have not heard of this but this is the basic idea of repeated head blows cause more damage as time goes on and so one of the things that's been shown with creatine is is really effective for that second impact syndrome more specifically it's been shown that the

repeated head blows cause more damage if the creatine is depleted prior to the additional impacts okay so imagine you had an one single impact the more creatine depletion you have the worse damage you get if you have a secondary impact this is any athlete that's going to be in sparring our competitions where we're getting a lot of impacts this is military or special forces or anything like that that is again is getting low impact repeated exposures or blasts okay the more creatine depletion that happens the worse the damage in your brain that occur occurs after

the second or repeated impact so right there we can see that if you've had an injury making sure your creatine stores are replenished as quickly as possible is really important if we're going to continue in that exposure now that's important because many people don't recognize or realize the first injury happened to begin with okay most of them are underreported most don't realize it hard to diagnose and so prophylactically it just maybe makes some sense to make sure that you're taking care of business not necessarily just when you have an injury but if you even think

you're at risk or in high-risk situations or prior to high-risk exposures or or competitions right good example of this there's a pretty famous study I think it was in high school football players high school or college but nonetheless football players American football that is um that did indicate the creatine stores in their brain I think specifically in the motor and prefrontal cortex reduced over the course of the season now this is not a perfect study design but you can see what this is alluding to if you're in a situation again with repeated him head impacts

over the course of his season the number of impacts so in fact maybe I'll back up quickly in this particular study what they did is they filmed the games and so what they they measured is for each individual player how many head contacts they had but there was an association between those players that had more head impacts not even necessarily injuries and the level of creatine reduction in the brain over the course of the season so again we're making some assumptions here but I think it's fair to at least say it's plausible the more impacts

on your brain the more creatine is reduced potentially the higher risk you are for second impact syndrome injuries now before we go any further with the creatine research I need to do a quick pause and explain to you what I mean when I say strong evidence or weak evidence there's no perfect way to do that but an easy way to roughly understand is called the strength of evidence scale okay so I will abbreviate that in the rest of today's episode by just calling it the S OE the strength of evidence okay this takes into account

research design the quality of the relevant studies the applicability to Patient Care and a number of other factors it's up to you ultimately to decide what is an actionable level of evidence or not some people that are may be suffering from a brain injury consider a study in animals to be enough and others want to see a randomized control trial in humans that's not for me to decide that's up to you but I do want to share with you where the level of evidence is and you can make your choice from there so the S

OE is on a scale of one to five a score of one is the best that is the highest score possible this means we see consistent results across multiple studies we've seen it in both randomized control trials as well as systematic reviews and so on and so forth a score of say four four or five would be the opposite that would be our lowest score maybe there's evidence there but it's from case studies or case control studies maybe it's mechanism only or some other model that's close maybe research from aging or demena not the same

as brain injury but it shares some mechanisms you get the idea here so for example the soe for monohydrate is a two my opinion personally that's pretty good summarizing the colle evidence here there's been a lot of research on everything from kids to rugby players to mountain bikers and collectively you're going to see it supports cognitive Health it's been shown actually in psychiatric disorders there's I believe two randomized control trials that I'm aware of that have found five grams of creatine per day um added in addition to anti-depressant treatments improved depressive symptoms right so take

that for what you will and regarding TBI and brain injuries there's an argument we can make here for preventative use specifically for neuronal damage and injury there's been shown to reduce cortical damage following a TBI by anywhere between 35 to 50% that'd be 5 Z pretty substantial amount there should catch your attention they don't know exactly how it works but it's thought to prevent some of that mitochondrial dysfunction I was talking about a few minutes ago uh helps maintain the membrane Health certainly has a role in fending off that Downstream reactive oxygen species ATP calcium

so a lot of those things we just got done covering that's why we covered them creatine probably has a role again we need more information here but likely has a role in in either eliminating or at least drastically reducing some of those issues and finally then what you care more about is the downstream TBI effects have also been documented what I mean here is sleep cognition and actual mood seem to be enhanced with the Crea team furthermore there's actually some studies that specifically been done on kids there's one I'm thinking of in detail here that

was everything from 1 to 18y olds that had severe tbis in this particular paper they gave them 0.4 gram per kilogram of body weight if you do the math there that ends up being a a pretty standard dose but appropriately it was done based on body size you have 2year olds and 18y olds we can't give them all just five gram so dose was given to them within 4 hours post injury and done so for 6 months in that particular study they found improvements in everything from Amnesia to the length of stay in the ICU

improvements in communication Locomotion and social skills and more importantly what I one of the things I loved most about this was this the researchers were clear in the fact that the treatment provided cost significantly less than the standard treatment protocol and this is something I thought was really important because I know supplements are not cheap and many of you can't afford any cost whatsoever but if you can while creatine I know I know I hear this all the time has gotten more expensive in re recent years it's still likely far cheaper than a standard Hospital

protocol so if you can possibly afford it seems to be a pretty good option another thing I want to point out here because it comes up all the time as well in this study again remember Kids 6 months of Crea there were no signs of any kidney liver or heart side effects so overall we would deem creatine as a pretty strong chance of success in both the physiology as well as actual symptoms with a very low likelihood of injury or adverse effects for me personally I wouldn't hesitate to give this to one of my kids

if they have it it's entirely up to you to make your choice I'm not advocating you do anything you don't want to do are uncomfortable with just letting you know for me when I look at the research as a parent myself of two young kids I I would not hesitate at all to use this in my children so how do you actually use creatine well you have a couple of options one you can try to get this from Whole Foods and I'll present to you exactly what that would mean in amounts or you can use

the supplementation route I guess a third option would be to use a combination of both so most of the data on monohydrate for brain injuries they're typically using dosages of about 20 grams per day now that's four times the typical dose you'll see for performance benefits so this is one of our major things we have to pay attention to this is not a dosage that's just your standard five grams five grams five grams it is much higher for the the brain health benefits now often times that's a little bit challenging and so you'll see typical

protocols instead of taking 20 grams at once are things like five GRS administered four times per day right so the the benefits are typically thought of as both acute and chronic I know I have said many many many years now that a is not an acute thing it's not caffeine you don't take right now and feel this big stimulation effects it takes weeks or months to build up however one paper that came out recently kind of shook everyone's World a 2024 paper get just one paper here so temper a little bit I'm tempering my own

expectations but a recent paper suggested that a very high dose I think it was 35 gram per kilogram of body weight was enough to attenuate the drop in cognitive performance after sleep deprivation so you take people through sleep deprivation the next day you give them this giant bullets of creatine and those that took the creatine had less of a cognitive drop from sleep deprivation I actually think the benefit started at about 3 and 1/2 hours and lasted up to 9 hours so potentially say something bad happened happed and you didn't get a great night of

sleep and you could take this maybe 20 G dose in the morning and by noon or so or for the rest of the day you might have some improvements in cognitive function that's the first paper I've ever seen that I'm aware of to show an acute effect of creatine but since that was so dramatic I wanted to make sure I drew it to your attention so to me you have an option there for brain health and now if we consider this in context of the episode of today even getting this creatine in immediately potentially has

a brain impact and that's why I wanted to bring that study up as it relates to the current topic other Studies have found that that 20 grams per day for 7 Days enhances cognitive function um this is specifically the mountain biker study I'm referring to and so generally me personally this is not the studies this is me personally based on the work that I've read I think 5 to 10 gram per day is probably plenty for most people as a prophylactic so kind of an ongoing option to be at that number that said and again

candidly this is what I do for my athletes seven days or so prior to a high-risk situation a competition something like that a race or an event we're going to up that dose to 20 to 30 grams for that seven days all right again one more time when I do that it it is hard to choke down 20 grams at once it's a handful of Scoops and so we will often try to get 5 to 10 gram in the morning 5 to 10 gram at night and split up the dosages throughout the day simply from

my practical perspective now one of my favorite sayings is there are no free passes in physiology creatine is not perfect it's not a Panacea and there are some potential risks the biggest one is GI distress some people have gas or bloating or stomach cramps at even five grams a day so taking them to 20 or 30 may cause some serious issues it's not that frequently reported I've never experienced it I can't think of a situation where I've ever had an athlete or client reported but it is a real thing it is pretty uncommon but is

reported and so you will want to pay attention to that outside of that there isn't really any documented problems associated even with high dosages 20 plus grams a day for years there have been studies in kids elderly various what we'll call risky or unhealthy populations for many many years you can look across all basically all those studies and you just won't find really any other Adverse Events outside of the possible mild or moderate GI distress now if the supplement does give you GI distress or you can't afford it don't have access to it or for

any other reason just don't like supplements you can theoretically get here with food but it is admittedly very challenging especially for those vegans and vegetarians cuz the primary source of creat from food comes from muscle or meat the most common places of and meat are going to be things like beef chicken salmon tuna Cod and they mostly have somewhere between 400 to 600 milligrams of creatine per 100 G of meat now I know in America you're thinking what the hell is 100 gram the rest of the world knows exactly what that means but 100 grams

is about 3 and 1 12 ounces okay a typical serving size at a restaurant is you know 7 o or so and so you can kind of double it in other words beef specifically has 600 milligrams of creatine per 100 gram but a typical serving is 200 gram so you'd be getting 1200 millgram 1200 milligram is also 1.2 gram okay now the average American at least eats about 350 grams or 12 ounces of meat per day so if you did some basic math there which would mean you're at about 2,000 milligrams or 2 gram of

creatine per day so while it is possible theoretically to get all your creatine from food it's honestly quite challenging so supplementation just might be the better option in this case I'd like to take a quick break and thank our sponsors today's episode is brought to you by ag1 ag1 is a foundational nutrition greens supplement that means ag1 provides a variety of vitamins minerals probiotics prebiotics and adaptogens in an easy to drink greens powder initially I was very skeptical of ag1 as I am with all supplement companies frankly but after months of discussions with their lead

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know what I mean after lots of research and development these David protein bars are releasing to the public in September of 2024 the macronutrients one more time are 28 Gams of protein 150 calories and 0 gram of sugar and they do this with excellent ingredients if you're interested in trying these bars for yourself you can go to david.com perform to purchase if possible or be notified when they're available again that's david.com perform to purchase if possible or be notified when they are available our next topic is fish oil more specifically what I mean here is

DHA and EPA DHA is accumulated in the brain in fact it's about 10% of your brain or so so makes a lot of sense that this one's going to be pretty important it's critical for everything from neurological function to injury risk metabolic rate uh prevention of neurod degeneration aging and brain health and Alzheimer's Dimension so on and so forth incredibly important to actual structure EPA is a little bit different it's mainly involved in vascular function inflammation oxygen delivery uh nutrient delivery to the brain and so on and so forth right so these are typically tied

together so I'm not going to really differentiate them as most Omega-3s come with both EPA and D now while I said earlier that creatine is by far the most studied sport supplement because it is Omega-3s are by far the most studied regarding traumatic brain injury there are dozens and dozens of studies systematic reviews randomized control trials on Omega-3s and brain related injuries and various head traumas however you might be surprised to know I'm not aware of any direct evidence of Omega-3s and tbis so this is a great example of me saying hey look there's still

a lot of good tangential or indirect evidence here so much I feel like it's overwhelming but not necessarily that much directly on tbis for the reasons we described earlier they're just hard study to carry out in general what you're going to see is frankly they work they work for both pre and post impacts the soe is technically three here and you generally see main effects and benefits from cerebral profusion so this is getting that blood and oxygen and and flow of nutrients in and out of the brain remember the primary cause of injury there is

that structural that tissue and that axon shearing that that kind of ripping apart and so what that does does is cause that Cascade of secondary insults that mismatch the blood flow and the metabolic demand we talked about that earlier omega-3 is land right on that problem uh for Solutions and the reason is it helps dramatically with what's called arterial pliability and compliance and so when we're having issues getting blood in the arteries can either be broke or damaged or stiff and Omega-3s really help it become more pliable and open and close more itively is one

way to think about it it's also why you see so much evidence in research on Omega thees for heart health and blood pressure and so on and so forth has the same effect essentially in the brain other thing it does that's a huge benefit outside of that cerebral profusion is it modulates inflammation post injury by regulating that Ross reactive auction species it interacts with all kinds of cyto kindes like interlukin one and tnf Alpha if you're familiar with those if not don't worry about it um even actually there's one in particular called nfkb that brain

folks will know exactly what I'm talking about here um this actually functionally it affects a gene expression of a bunch of inflammatory things so it kind of cuts off inflammation at the genetic level so lots of ways that it has an impact to give you a couple specific examples one of the most common issues associated with TBI longterm is called atrophy of the hippocampus now that's associated in one of the areas that's mainly responsible for learning and memory and we know that those are problems right we know that higher omega-3 intake is associated with a

bigger hippocampal volume right so we have cross-sectional studies here longitudinal ones that suggesting in people that consume more tend to have a larger hippo campus and we also see a significant increase in these areas at the dosage of about 2.2 grams per day okay 2.2 grams of fici oil per day associated with a bigger hippocampus therefore potential to improve or enhance our learning in memory similar things have been done with memory specifically in fact one study looked at I think it was a combination of 900 Mig of EPA plus 260 Mig of DHA and that

resulted in greater accuracy and speed of recall tasks so mental recall memory EPA in general is often really associated with cognitive function and the DHA is associated with acdal injuries um works on a thing called neurofilament light or NFL and that's actually been specifically shown in college football players I believe again at that 2 G per day dosage of DHA so in general to get to the end here the dosage for brain related injuries is somewhere between 2 to four grams per day though there's really little risk the only adverse issue you're going to typically

have here is potentially some loose stool again there's not that much evidence of it but if you have a you consume a bunch of oil that can kind of run through you a little bit probably not going to see much happen there very often the time timing of it doesn't matter that much you can you would certainly want to be taking it before the injury as well as after the injury and the timing of the day is honestly totally irrelevant and so pretty easy pretty fast one to go through very effective I personally will be

totally honest I take a lot more than four grams for other benefits but very fairly the available evidence on not necessarily directly TBI rcts but the other Associated areas of brain health and injury and damage pretty consistently show the effect happens at about two or so grams and studies that have looked at higher dosages don't see any additional benefit so I think it's very fair to say two grams a day or so is the effective dose and more than that may not give you additional benefit what's that look like from food another example where vegans

and vegetarians really should honestly strongly consider supplementation here we're going to get fish oil from fish pretty obviously right salmon Herring sardines Macer trout are generally the most highest concentration ones salmon being the most obvious example that's got about 2 gam of fish oil per 100 gram of cooked meat again that' be 3 and a half ounces or so which is not an outrageous dosage at all unfortunately the standard American diet is typically about 100 milligrams of Omega-3s per day and we need you to get to to two all right so you're going to have

to up your an it's totally possible but most people just don't do enough of it this is a really important one to go after I know I just covered information but I want to also highlight the fact you can check what I mean by that is unlike creatine where it's going to be really hard to measure your creatine monohydrate especially in your brain levels you as a preventative strategy should look at your omega-3 index and identify whether you have problems because there's a lot of evidence to suggest if you go into a brain injury with

the better omega-3 the brain injury will be less significant so our starting place here is to actually not go into the injury with a problem I mentioned this but I'll be more clear the omega-3 index is not a perfect way to measure it but it is an effective blood test you can get done and what that's going to effectively tell you is the percentage of EPA and DHA that's in the membrane of your red blood cells and there's been a handful of studies on this that are quite impressive my opinion um studies on football players

and even uh basketball players have found that the mass majority of them have an omega-3 index of less than 5% optimal is like 8 to 10 maybe even 12 the overwhelming majority of these athletes are less than five in fact I think the studies I'm thinking of right now uh the two kind of combined basically none of the athletes had higher than 7% again 8 to 12 is what we're looking for in fact the reason we're doing that is because there's been known and shown documented cognitive benefits at 10% plus even as low as A8

% plus so in these studies no athletes are there in fact most of the over 50% of the athletes in these studies had an omega3 index of less than 4% so it is really really really common in our athletes to see omega-3 status being really insufficient and the same thing has happened in the general population so you can 100% achieve enough for brain health through food if you'd like you just need to make a considered effort for it and you can see and and go back to hear the dose just or you can use supplements

or a combination but you absolutely want to make sure that you're doing this prophylactically as well as if you do experience an injury getting right on the supplementation as quickly as you can next up is what's called vitamin B2 or ribal flavor we're going into ribo Flava next because it is a requirement for proper DHA utilization here's what I mean there's some really nice studies showing that if you give people DHA but they have insufficient B2 B6 B 9 B12 and choline they won't integrate that DHA into their brain so it's really really hard technically

to get the DHA to integrate into the phospholipid membrane without these B vitamins and so part and partial to our appropriate omega-3 status is making sure we're not vitamin B deficient and specifically in this case we're talking about riboflavin so it is a co-enzyme for ATP production it's a part of many of our energy production Cycles it's also High responsible for glutathione you'll hear me bring this up again but glutathione is our chief endogenous antioxidant it's the big Whopper okay so going back to our problems associated with injury riboflavin is going to play a role

in two of those ones energy production as well as inflammation or antioxidant capacity so really helpful from that regard right since we know TBI has metabolic problems it makes sense that these B2 and other B vitamins are going to probably play important role the soe on ribal flaven is a three now personally that's enough for me to take action you're welcome to choose your own level I've AC on a score here but I have utilized and will probably continue to utilize Rial flaven for head related injuries there's great data in Rat studies that have shown

riboflavin helps with some of the behavioral modification issues associated with Downstream TBI problems humans there's not that much research candly again that's why it has an S soe score of three not two or one and what we do know is there's kind of a two studies in particular that are classic and they both used about 400 milligrams per day one of them is a bit older 1998 I think it was published and it was actually in migraines and what it showed is that it was safe and well tolerated now interestingly this was followed up in

2023 and they gave again 400 milligrams I think they actually did it twice per day instead of once per day starting 24 hours after injury I think they had a 50 plus people in the study and they're all about 20 years old now in that they found a significant reduction in the number of days of recovery by about half so the group that did not get the supplement the typical recovery day was 22 days long the supplement group it was cut down to 10 so this was a very very very impressive result and so it

seems to be a somewhat High reward lowrisk option additionally the other B vitamins like b6 and b12 have probably more limited research but they're really plausible they're also really safe they've been studied a lot and a lot of unhealthy or risky populations and they just don't really have that many negative side effects so sounds logical to try these ones um there is a little bit of work here particularly what I'm thinking of as some rat studies in cases of things like folate deficiency when that happens a little bit of a background there when you are

deficient in folate you have higher levels of is called homosysteine and homocysteine is highly associated with additional oxidative stress and a whole host of other negative Health Cascades so really high homocysteine is is bad news right um homosysteine is often also elevated when B vitamins are too low in general that alone is associated with neuropathy of tbis brain atrophy cognitive decline with aging and so on and so forth and so the clinical trials that have been done in this area where they combine these B vitamins and Omega-3s have been shown to reduce homoy and that

has then also been associated with a reduction in cognitive decline so if you can pay attention all those B vitamins try to get them as high as as reasonable or at least not in those danger areas take a look at hosis and pay attention to that and if you do that that will give those Omega-3s a better chance to work more effectively and you should be in a better spot so what's Rial flaven look like in terms of supplementation and food one more time the dosages that have been studied for migraines and headaches and brain

health and things like that or 400 milligrams per day one of the studies did that dosage once per day another did it twice per day but those are really really common now you can look all over the Internet and you will generally find every multivitamin has R flaven but it's not very much so multivitamins are not going to be the place you can go to to get enough B12 or B2 rather for this issue you're going to have to go to companies that make B2 specifically okay in terms of timing again you want to take

this after your brain injury certainly but the better option is just to make sure your B stat status is high enough prior to going in okay but if you didn't do that or don't know you would want to take this post injury time of day doesn't matter at all some people will feel a little bit of an energetic effect so perhaps earlier in the morning others don't but you might want to consider that I'm not aware of any risks associated with it obviously everything has some risk of some dosage and some people but for the

most part there there's very little harm here B vitamins typically don't have many issues if you overc consume them outside of perhaps wasting your money I guess if you want to think about it that way but there's really very little consequences at reasonable dosages so it should be okay there if you want to get this from whole food sources this is where things like liver come in handy or fortified cereals whey protein actually has a decent amount uh beef liver specifically has 3.4 milligram of ribal flaven per 100 gr whey protein is about half that

I think it's about two actually so it's not a terrible source so you can run the math very similar to how we just did it before I won't drag you through it again but if we have to eat something like 15 times is the amount of the serving size I just listed to get to that 400 milligrams per day that's you know going to be a pound a pound and a half sorry a kilo or a kilo and a half of beef liver per day so again theoretically possible but just pretty unlikely or pretty unrealistic

for most people to get these at this dosage through just food now remember these are not daily amounts you have to take we're talking about the dosages specifically for a brain injury and so it's actually not that crazy to think you're taking it if you've experienced something like this it's not something that you need to do every day your entire life next on our list is Coline now this has a handful of functions first it's helpful in preserving that blood brain barrier because it Wards off membrane breakdown it's critical to that cell membrane so it

has a handful of effects there the second big thing it does is it is the primary precursor to the neurotransmitter acetylcholine you may remember that acetylcholine is the primary neurotransmitter that's the signal the molecular signal that goes from one neuron to the next that activates it we talked about this in a little more detail in a previous episode on muscle so you can go back to that to learn more but the third thing it does it is a precursor to that important antioxidant glutathione so a handful of functions here both structural damage cellular communication and

activation as well as antioxidant we also know from a lot of research in the area of brain aging dementia Alzheimer's and so forth that higher dietary intake of choline is strongly associated with decreases in several biomarkers that are associated with that Alzheimer's dementia and other risk factors so from a dietary perspective from a molecular and mechanistic perspective is starting to line up as a pretty important molecule for both TBI as well as long-term brain health to summarize the collective evidence It is Well tolerated and safe it's plausibly helpful like I just described and there's even

some minor benefits in both physiological and cognitive domains following head trauma the most common form of choline in the research is what's called ceto choline or CD P choline as you'll see it sometimes and it's been tested in multiple TBI randomized control trials in fact a recent metaanalysis indicated that there's about a 20% likelihood of success or Effectiveness with acetylcholine for TBI treatment so it's not perfect but 20% is pretty good in my opinion getting into the research just a little bit further there's a handful of animal and human studies that are worth talking about

at a very high level the animal research looked at 100 Mig per kilogram of body body weight per day and I'm bringing up those numbers intentionally I want to put some context behind that honestly because I've just heard people misinterpret this paper a lot so 100 milligrams per kilogram per day immediately after an injury which resulted in significant improvements in what's called spatial memory performance now you can't simply equate body weight here to humans you'll get an absurd number that won't make sense you it doesn't actually work that way for details we don't want to

talk about now but this what this would equate to is something like 60 to 70 milligrams per kilogram in humans and that is high it's about 3 to five times the dosages used in human research but it's not impossible either so I do want to acknowledge that those numbers are again high but it's not completely crazy either in fact some of the studies at 250 milligrams helped with the blood brain barrier breakdown and edema uh were largely reduced in those trials and also had benefits in hippocampal neuronal death for the seven days following injury so

pretty good mechanisms from the rat studies in terms of the human you will see that the studies are mixed okay one gram per day for 30 days has been found to in at least mild TBI to produce statistically significant improvements in recognition memory which is obviously an important Downstream behavioral problem that's associated with t eyes and that study was actually repeated about 20 years after the initial one and they used a pretty similar protocol design and found actually no difference in TPI symptoms I think it was headaches sleepiness dizziness and concentration and things like that

however what's really important to note here is in this study um the majority of the participants had really minor tbis meaning their colc Pathways were probably not affected this is a classic case of something I warned out the beginning or earlier in our conversation if you're not actually giving a supplement or taking a food that the mechanism of effect is not the mechanism of injury then you shouldn't expect a benefit so I think this is really a case of that I actually do feel like the strength of the evidence for coling is okay and reasonable

but that 2023 follow-up study to me is not indication that the original study was flawed or didn't work but simply you had mild injury that didn't result in damage to that pathway so the benef the supplement provided very limited or mixed benefits in addition I know of two meta analyses that reported generally positive benefits here regardless of TBI severity so that's some more information of positive benefit and the probably Landmark study in this area came out fairly recently it was called the cobrit study I think it stands for like cocoline brain injury treatment trial you

know how scientists always like to make these acronyms for our big studies again honestly I feel like this is being misinterpreted in my opinion and so want to touch on this just really briefly but in that they found um no evidence of benefit for cognitive function or cognitive status 90 days post injury with two grams a day of cetola now a lot of people have used that to say we told you it doesn't work it doesn't work and that's fine you can people can interpret how they will my personal opinion on this study though is

that it's highly flawed and I'm saying that because in it they considered adherence to be 75% meaning if the people in the study took their cetto choline 75% of the time they were considered to be adherent only 44% of their participants met that 75% Mark 40% were considered to be non-adherent so that means they took it less than 75% and the rest they don't even know so for me it's it's hard to suggest that it didn't work work when the vast majority of people didn't actually take it most of the time and those that did

was still only 75% of the time so cool study helped a lot add a lot of information in my opinion to the database but I don't think it should be interpreted as saying that Coline then therefore doesn't work or it's a myth or any of those other more extreme interpretations of these data more directly for the context of our show today been done on football players where brain coing and specifically in the primary motor cortex is known to diminish across the season similar to what we saw earlier with creatine probably as a result of those

continuous head impacts so couldn't be inferred directly from this study but you know pretty easy to make a guess that's likely scenario and this actually may contribute to that second impact syndrome and accumulation of damage so similar idea here as creatine to me pretty strong case so based on the different study designs mixed results and other limitations the soe for choline lands at a three so what are we looking at in terms of food and supplements well first of all you're not going to find choline supplements on their own very commonly it's almost always going

to be in the form of what's called Alpha GPC or in the more direct version of phospha choline now Alpha GPC is immediately metabolized into phospholine or PC once you orally ingest it so you can think of these as similar products many companies make either PC straight or Alpha GPC or have a little bit built into oftentimes like B complexes dosages are usually a little bit lower 20 to 30 milligrams if you're getting the alpha GPC directly momentus of course sponsor for the show as well as other companies generally will make dosages 300 to 400

milligram for serving so you need to take you know three or so of those to get to this dosage level but you will find that fairly commonly okay now in terms of timing you're probably want to take something like 500 milligrams per day as a daily dosage prophylactically however if you've had a direct head injury this might be the time to ramp up to 1 to two gr these generally do have a neut Tropic effect and so you would want to take these earlier in the day so you certainly don't have any problems cognitively or

with sleep later on in terms of food if you need to get up to that 1 to two grams after an acute injury you're probably going to want to use supplementation but it's quite easy to get to that 500 that Baseline prophylactic dosage straight out of food a couple of eggs and some turkey will'll almost always get you right there the most common places to get chaned food are meat poultry fish eggs dairy beans cruciferous vegetables beef liver for example has around 400 Mig per 100 G of liver eggs it's about 150 milligrams per egg

and so you can actually see all right three or four eggs in a day get you really close to that 500 number most people a couple of eggs little bit of serving meat you're going to be right there throughout the day which again will put you in a pretty good spot the average person though doesn't get enough choline typical numbers in men is around 400 milligrams women is about 300 or so which is well below the AI or adequate intake which is you know 550 for men and 420 or so for women so you would

have to probably do something in the neighborhood of like 12 eggs to get you to that you know two grams colum per day so like I said totally fine to get this from food as your normal Baseline Health strategy but if you did want to get those upper dosage with an acute injury you're probably going to have an easier time getting a little bit of supplementation rather than trying to eat 14 or 15 eggs in a day all right moving on to our next one we're looking at Branch chain amino acids to clarify when I

say bcas I'm almost always talking about three amino acids in particular isoline Lucine and valine now Lucine is the primary driver of muscle growth or muscle protein synthesis which is why there's so much steam behind BCAAs for muscle growth we'll talk about those details later but in general if you get enough protein bcas are are not really needed for muscle growth that said does something different in the brain the human data do suggest that the severity of your TBI symptoms correlate well with the degree of BCAA suppression in the brain bigger drop in bcas more

symptoms the bcas have two big effects one of them is the fact that they are what's called a nitrogen donor and the other is that they help Transportation interference across the blood brain barrier so let me walk you through what those mean really quickly as it's important to understand why they actually work in this case but perhaps are not so important for muscle growth now when I say nitrogen donor what I mean is they are specifically used as in broken down to give off nitrogen which can be used for glutamate and Gaba I already talked

about glutamate earlier and how that is a primary problem with extreme excitotoxicity so getting too excited turn turning too many neurons on now both Gaba and glutamate are heavily involved in TBI pathology like we just talked about from the transporter perspective when you eat protein the amount or say it's food or supplement the amount of bcas in your blood goes up makes sense but a bunch of proteins in your stomach they get broken down into amino acids amino acids and your blood go up if you ate a complete protein that will come with a bunch

of bcas the amount of those go up in your blood now as the BCA concentration goes up two molecules called tryptophan and tyrosine they happen to share the same Transporters to get through the bloodb brain barrier so if you have this big rise in bcas in your blood the bcas will block up those Transporters which means the uptake of tyrosine and tryptophan are blocked so they're not going to get across the blood rain barrier and not going to get in the brain okay so the amount actually in your brain of TNT tyrosine and tryptophan go

down what that does is cause problems with things like serotonin because TNT act as precursors for serotonin which courses in a precursor for melatonin and various catamin right so this could be contributing to the TBI induced sleep problems and so you can see the basic logic there the current evidence does suggest that actually sleep is not compromised with BCAAs but actually even potentially improved I know of actually a study coming to mind right now that looked at 30 grams of BCAAs administered twice per day found it actually improved insomnia and other latency related issues uh

this was study I think was in veterans with chronic TBI and so we know some about the mechanisms that I just outlined has a potential to be influencing some of our sleep related problems and it seems to be causing a positive and beneficial effect for Sleep which is a huge concern and one of the biggest symptoms associated with the brain injury the S soe on BCAAs is surprisingly a two remember one is best five is worst on this scoring so the data are actually pretty strong here it is pretty clear that it works as much

as we can Define work there is extensive evidence in posst Impact for both mild and severe tbis the benefits range from cognitive deficits so reductions in cognitive deficits to what I just described the some of these sleep wake abnormalities with the main effects probably being a correction of that excitotoxicity issue um and some of the Gaba and other glutamate problems that that we just described probably the most famous study in this area is called the hit heads trial I believe this came out in 2024 actually so pretty recent it was a pilot randomized control trial

they had uh I think like 10 to 35 year olds in there so teens pre-teens all the way up to normal age and they followed them for 3 weeks or 21 days post injury and this was really cool they had I think five arms in the study so some of the participants just got a placebo and then they broke up the rest of the intervention by dosage so they got 15 grams a day 30 grams 45 or even 54 I'm not sure why I 55 but they wanted to see is there effect at all compared

to Placebo and if there is what's the optimal dosage and they gave them five different dosages from low dose to more moderate to to pretty high and scaled all the way up and one of the things that they found was a pretty clear dose response such that the most improvements were found in that 54 gam per day decreased symptoms of concussions a faster and better return to Baseline there weren't not benefits actually in what was called processing speed so that have been shown in some of the earlier studies we talked about but they didn't find

that here for whatever reason but they had all those other benefits one more time highlights the fact that not every supplement not every food not every nutrient fixes every problem okay so benefits here in the concussion symptoms but not necessarily the processing speed but the effects one more time were dose dependent and one more time like we keep bringing up there was no adverse effects reported the data that we currently have suggests up to 55 or 54 G per day more specifically is a dosage you would want to make sure you're at that higher dosage

past injury you can be a much smaller one just honestly make sure your protein intake is high enough you can use whatever number you like we've talked many times though I personally like one gram of protein per pound of body weight if you're at that you're probably getting enough BCAAs at Baseline and then we would go to only this higher dose postbrain injury to break this down foodwise BCAAs it's protein it's dairy product it's meat and poultry most meat's going to be 3 to four gram of bcas per 100 gram of serving and so similar

math the way we've done before okay this is going to result in you having to have like 40 or 50 ounces of meat per day not something you need Baseline but in these small cases again I'm don't want you to feel like I'm pushing you to supplements but it is just significantly easier here for small times and for specific scenarios of a brain injury to go to supplementation here our next micronutrient is magnesium oh my goodness could I go on and on and on about the physiological benefits of magnesium it is involved in well over

600 reactions in your body from cell signaling vascular function ATP production protein synthesis uh neuroplasticity learning memory and I could basically think of anything that happens in your body and magnesium's Central to that I don't have to draw this out then it's pretty easy for you to assume this is going to be a important role in your brain pre and post injury we also have very strong data if you are deficient in magnesium you have associations with a host of comorbidities health conditions type two diabetes metabolic syndrome hypertension headaches is another common one migraines heart

disease so on and so forth we know that it probably inhibits receptors that are directly targets of anti-depressants as well and is a strong contributor to that brain excitotoxicity after injury so you do not want to be deficient in magnesium you can listen to read almost anything in the sports performance realm and you will see magnesium as a top tier supplementation it is really robust and a a strong line of evidence and and recommended by again many people in this field but surprisingly the S soe is only three here there's a well documented drop in

magnesium especially near Central neurons after a TBI and the extent of that drop is associated with the severity of the injury and the level of Behavioral disturbances so not only the injury but your symptoms as well animal and human research here from the animals It's associated with edema brain and blood concentrations calcium problems like we talked about earlier um these are going to result in those behavioral modifications memory cognitive function spatial and working memory and so on and so forth from the actual human stuff couple of studies that are worth drawing attention to here one

looked at acute tbis in kids and so a significant reduction in post concussion severity scores 48 hours after the injury when they used 400 mg of magnesium twice per day now another study was used a similar design and didn't find a benefit but this was actually using magnesium from an IV for 5 days now no one really actually knows why this one trial worked the other one didn't the obvious thought is maybe there's something that happens when you adjust it through your stomach that aids in digestion or makes it more bioavailable but when you took

it with the IV it didn't to me that's honestly not a great answer but I don't have any other reason to think that that happened so really honestly to summarize here it is very very safe it's very little harm it has so many other health and performance related benefits there's so many Health consequences that are associated with magnesium deficiency it helps with symptoms and behaviors that are Hallmarks of TBI like we've talked about so I know the soe is technically three but personally it's it's about as high in the list as I could think one

supplement could be the dosages we described one more time 400 milligrams per day the timing doesn't matter you'll want to have some in their pre as well as post injury and you could take it at any point in the day now depending on the type or form that you use you might want to take it later in the evening some people report and depending on the type magnesium helps you fall asleep I personally feel no effect at all but most people do I still then take my magnesium at night just because just in case there

is all kinds of forms you've heard of magnesium threate at this point bisglycinate malate and right now I don't know of any compelling evidence to suggest one of those forms is any better than another obviously magnesium 38 has become more popular recently and that may turn out to be more effective it may not I'm not sure there's just not enough data for us to have a really an answer at this point and so you can take whatever form sits best with you the obvious risks associated with magnesium are the GI distress bisglycinate malate 3 and8

are generally pretty well handled and so you you shouldn't have too many issues with it if you want to get it strictly from food you're looking now at things like pumpkin seeds chia seeds almonds and spinach uh typically I think pumpkin seeds are about the highest you'll find they've got around 200 milligrams of magnesium per 100 grams roasted again you can do some math there and realize all right that's at least 200 grams of roasted pumpkin seeds I'd have to get to get to my you know 400 milligrams which is honestly quite a lot not

impossible some people eat tons of almonds and spinach and things like that especially vegetarians and vegans but it is quite a bit given how cheap effective and easy to handle and how many other things are benefited with magnesium as a supplement n we use it pretty commonly our final food item to discuss is what's called anthocyans now these come almost always from blueberries so henceforward I'll call these blueberry anthos that's how I refer to it now these are phyto chemicals in the flavonoid family there's over 700 known antho molecules and we're honestly basically just learning

about this stuff so we have a ton of improvements needed a ton more analysis and understanding of mechanisms and so on and so forth but there's enough here to go on at this point we know that anthos are involved in cardiovascular disease metabolic syndrome type 2 diabetes cancers Visions skin Health inflammation neurodegenerative disorders and probably 50 more things really ubiquitous really robust and critical to a bunch of human functions TBI specifically animal research here blueberry supplements or blueberry extracts post injury have been shown to improve what's called brain derived neurotropic factor or what you may

have heard of as bdnf which is inversely correlated with indirect markers of memory performance and cognition now a similar study has found that blueberries also protect against oxidative stress which makes a ton of sense you've all probably heard about the antioxidant properties Associated blueberries and blueberry extracts so this is no surprise for most people the soe for anthos is a three and in terms of human data I don't think there's a single RCT randomized control trial that exists for blueberries and TBI at this point that said there have been studies and many rcts um some

effect fact that are range from developmental to aging to clinical populations on brain health and so this is a classic example of where we can infer some things from General brain health over to TBI at a pretty low risk High reward possibility the collective evidence um indicates that it does help with attention memory executive function there's a lot of evidence specifically we use a handful of papers that have been done looking at blueberries prior to golf and enhancing brain performance in sport context so there's a lot out there we know it works but we also

know we're missing a lot of the details because of what I just described earlier it's pretty new couple of examples one study in kids in particular looked at 15 or 30 grams of freeze dried wild blueberries and saw significant improvements in cognitive function in a dose dependent fashion more blueberries the better uh other work has been done in in older adults looking at things like 100 milligrams blueberry extracts and seeing a better episodic memory performance reduced cardiovascular disease uh and so on and so forth so um what this would look like from a whole food

source you know to get something like 500 millgram of the anthos you need 100 gr of blueberries which is I think a cup has 150 so I'll translate that for you a little bit you have a couple blueberries and you're probably hitting your numbers it's really that easy I would actually say that of all the things we've discussed so far today this is the easiest one to get out of straight food you will be hardpressed to find a program that ever comes out of myself our rapid health and performance company or any other one that

I'm associated with that doesn't have a cup of blueberri in it and it's for these reasons that manymore so it's a pretty easy number to hit pretty consistent and has a lot of benefits right I will also tell you people love to give blueberry all the credit here but it's not the only food item that's got the anthos in it strawberries cranberries they have it too there's not as much data I don't actually know if there's any data but I imagine if they did those studies you'd probably find the same benefit so I'm actually not

as particular on this one I don't have evidence to support myself but I don't think it's that big of a stretch to think the same chemicals in this case that are in blueberries probably also exist in raspberries and strawberries and other similar forms so um we will spread our berries out but if you want to stick to giving all the love to blueberries you're not going to hurt my feelings as far as I understand it that represents all the evidence on food related items one can take for brain health tbis and concussions the only thing

I'm aware of that's actually detrimental for brain healing is caffeine and there's enough evidence here that this is probably pretty bad news when trying to heal from a brain injury it causes neurovascular constriction it leads to less blood flow we know that caffeine consumers are more susceptible uh to to diminished emotional health bad Sleep Quality depression and somatic symptoms with brain injuries and so what my recommendation here would be overc consumption is the problem do not over consume caffeine if you've experienced a brain injury I don't think there's any reason to think caffeine consumption is

giving give you more risk to have a brain injury but if you have one you you want to make sure you're really careful ask your doctor check in there but that's the only one on our list that we have reason to think that you should avoid that concludes today's episode on nutrition for brain injury TBI and concussion I think it's worth reminding you though that if it's good for preventing and returning faster from a brain injury it's probably safe to assume it's also good for prank performance as well as long-term Health my goal of today

as always was to provide you with a ton of information so that you can be excited you can learn you have some things to try but to also be fair with the state of the data and you can make your decision about what you want to do or not do based upon that given this was episode 10 not only are we done with today's discussion but we are done with season one a perform with Dr Andy Galpin I can't thank you all for the support I seriously was overwhelmed with comments from people I know don't

know it it was blew past my expectations and so I really just cannot thank you all enough if you're a new listener this is maybe your first episode you can go back and check out all previous Nine episodes on perform podcast.com you can check out the notes you can go to YouTube and you can see the exact sections of a particular video if you're interested in that and we've made it as easy as possible hopefully for you to go straight to the information you're looking for and not spend time on things you are not I

can also share with you another fun announcement and that is that season two is officially been confirmed it's going to be coming out pretty soon if you want to know more about when that does hit the radio waves you can stay tuned of course on my social media but also I would recommend signing up for our newsletter finishing us up here I I cannot conclude this in season without some very specific thank yous first of all to all the sponsors it was overwhelming your support the people jumped on board quickly and we're really really helpful

so this show would not have existed without them so I know ad reads are a thing but please do me a solid if you enjoyed any part of any of the episodes of the Season go check out the sponsors they really are phenomenal products I got to thank my special man Vin dog you know who you are helped me a ton in preparing for this he's not the front of the camera kind of guy so appreciate it Vince Natasha of course my wife super super supportive and all the time it spent to come up here

and get this stuff done my students former and past and current uh could not have done any of the stuff that allowed me to be up here without all of your support and truly doing all the work in the lab same thing for all of my colleagues and fellow scientists whom helped me directly with this show or indirectly and that I stole your research or read it at least and was able to have information to share with people so science is not easy and a lot of times people don't get the credit for it and

and I thank you all for your contribution all of my teammates and colleagues at my company's rapid health and performance biomolecular athlete absolute rest and vitality again tons and tons of support for everyone so I appreciate that and then finally of course my man here and my boys here at scom and of course Dr Andrew huberman love you all super appreciative of it thank you all so much for joining on this ride and I'll see you next season thank you for joining for today's episode our goal is to share exciting scientific Insight that helps you

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muscle strength how to optimize your sleep for high performance and much more to sign up just go to perform podcast.com click newsletter at the top of the screen and then enter your email address once you sign up you receive access to all of our newsletters I use my Instagram and Twitter also exclusively for scientific communication so those are great places to follow along for more learning my handle is Dr Andy Galpin on both platforms thank you for listening and never forget in the famous words of Bill Bowerman if you have a body you're an athlete