How to Recover From a Concussion | Dr. Tommy Wood & Dr. Andrew Huberman

Immediate Post-Concussion Care

00:00Are there anything that people should do and or take in the immediate aftermath of a head hit? Now, I'm not talking about uh hopefully people are getting checked out for brain bleeds and things like that. So, I'm I'm talking about moderate concussion.

00:16Someone got their quote unquote bell rung. Uh they slipped and fell. Uh they got clipped in soccer practice. Um their kids a little dizzy. Now, of course, somebody young or old is vomiting or, you know, not able to sleep or real issues. I mean, everyone should probably be checked out in in the first case, but I get asked this question all the time.

00:36Is there anything that people can take to kind of get over mild concussion or moderate concussion? The evidence base on this is a little shaky, but I think for most things, it it kind of fits into this idea of positive asymmetry, right? Low risk, high potential for benefit.

00:53And there have been lots of you there have been randomized control trials that kind of look at some of these things. So we a couple years ago we published a paper looking at different nutritional supplements after concussion that you know we have some reasonably good evidence for.

01:06So um yes you should be seen by a doctor. You should get whatever scans and you know immediate medical care that you need. Absolutely right. That's we're assuming all of that is done or will be done. Yeah.

Managing Body Temperature

01:19Immediately. There are a couple of things that I think we know um from sort of um animal studies that translate fairly well onto onto humans but also some you maybe some observational studies in humans but a couple of things are important. So one is temp temperature management temperature regulation.

01:35There have been this is what my PhD was actually in hypothermia after acute brain injury. Hyperthermia hypothermia yeah so cooling down although I did do some studies where we you know heat it up and that makes things worse. So this kind of pertains to what I can imagine.

01:50Brain doesn't like to get too hot. That's essentially what I'm about to say. So there have been lots of studies where they've done cooling hypothermia in people after traumatic brain injuries and concussions hasn't really shown much of an effect.

02:02What seems to be important is preventing hyperothermia. So um one of the effects of cooling somebody down is that they don't get hot. So that's probably something that's really important. So often concussions happen in a heat stressed environment.

02:18You're on a football pitch. It's August in Alabama, it's 40°, right? Get inside, get cool as quickly as you can because there are there are studies that and that doesn't mean you have to get in an ice bath. Just don't be really hot. If

Blood Sugar & Stimulants

02:32you get a fever, which you might might do after a more significant injury, you know, Tylenol or something like that to help maintain thermmore regulation will be really important. The next is uh blood sugar regulation. So we know that after a significant brain injury, you have increases in in blood sugar.

02:46That's associated with worse outcomes. Some of it's like what's caused? What's consequence? Is the injury driving the blood sugar? Is the blood sugar driving the injury? I think an easy thing to just say is I would avoid any super sugary refined carbohydrates that might just sort of, you know, uh kind of pile on for one of a better word.

03:05Right. What about alcohol? So alcohol um I would avoid as well mainly because it impairs sleep and we know that sleep is going to be critical to recovery. Some people would say something similar about caffeine acutely after injury because it's a it's a stimulant.

03:18Um one thing that the reason why hyperothermia or getting too hot makes the injury worse is because it um you know simply speaking increases the gap between energy requirements and energy production. So like one of the hallmarks of these acute brain injuries is a deficit in energy production with you know mitochondrial failure or mitochondrial dysfunction.

03:39And so if you get too hot or you stimulate the brain you're asking for more energy when the when the when your neurons can't produce it. And that is a trigger that kind of deficit in energy production is a trigger for cell death and neuroinflammation and some of these other processes that then may happen.

03:55So

Creatine Dosing & Protocols

03:58avoid alcohol, avoid caffeine. Both of those potentially related to improving sleep. Then uh things that we have some you know reasonable evidence for um immediately after concussion are creatine. At what dosage? The best trial was actually done um in a p like pediatric group although very broad.

04:16It was like one year old to 18 years old. Um but they gave 4 g per kilo per day. So Whoa. Yeah. So it's it's a pretty it's it's like double a traditional loading dose if you're a 100 kilo person. But like if you're 7 if you're 70 kilos um you know 155 lbs or something like that then that's 28 grams of creatine.

04:35So like it's a lot but extra trips to the bathroom could be expected but you may just spread it out across the day right. Yes. So well one thing I'll say about that is um the most recent meta analyses show that you actually don't get is actually quite rare to get more GI side effects uh with creatine compared to placebo.

04:55Some of it is probably related to the quality of the supplement. So poor quality creatine supplements have more adulterance that may cause some of those GI side effects. Some of it is can be due to high um um you can saturate the creatine transporters.

05:08It doesn't get absorbed. Water gets drawn into the gut that can that can then write cause diarrhea or something. Um but some of the GI issues that people experience are probably due to poor quality products that they're taking. For the non uh head injured individual, is there any reason to go back to the old loading protocols of taking 20 grams per day, putting it in a little bit of grape juice or something else to spike blood sugar for this very reason that it could um augment the the passage of creatine into your cells as opposed to drawing water into the gut?

05:42In the '9s, we would take five grams of creatine four times a day in an ounce or two of pure grape juice. Um, and you draw a lot of water into your muscle cells. You put on, you know, it varies, but for me, anywhere from 5 to 8 pounds of it's water weight, but it's mostly in the muscles.

06:02It's not insignificant. Translates to big strength increases. I don't take nearly that much now. I just do the 10 grams per day. But is there any reason to go back to those traditional loading? So, if you're just like long like long-term creatine supplementation, pro probably not.

06:17um in this kind of setting I think a a you know the the evidence is for a loading style protocol right so for most people it might be 20 to 30 grams of of creatine spread spread across the day you know for if anybody's just like taking creatine for other reasons you know this a standard dosing protocol I think is fine I thought you were going to tell me I could get it to work that way so so like the the some of the studies that use traditional like creatine monohydrate and look at creatine levels in the brain they did use the loading protocol for for a week and then you see

06:50significant increases in brain creatine. But creatine having other effects on the brain, you know, potentially improving mood, improving uh memory and in older adults. Um some of those benefits happen at just like a traditional creatine doses.

07:03So you don't need to take massive doses, you know, think load loading doses. You can actually see some benefits of like 5 to 10 grams. So that's creatine. So magnesium, so 400

Magnesium & Omega-3 Fats

07:11milligrams once or twice a day. There've been some trials that shown um what form those studies actually use magnesium oxide. surprisingly. Um, but I would probably use magnesium glycinate. Um, the it's very bioavailable. Um, athletes usually need a bit more glycine anyway, but any bioavailable form will will be fine than omega-3 fatty acids.

07:32Um the evidence is is is a little bit better for like um there are now several studies in like America in like collegiate American football players where they take a couple of grams of omega-3s every day and across a season you see um less accumulation of uh biomarkers of of injury like neuropilament light that are circulating in the blood.

07:55So that's something that I would just take long like longitudinally. If you're somebody who's at risk of a concussion uh because of your sport or your job, I would just, you know, take a reasonable omega-3 supplement just long term because we have some reasonable evidence for that.

Sleep & BCAA Support

08:10Then other things might become a little bit specific to uh the symptoms that you're experiencing. So if you have sleep issues, then uh there's studies that have used melatonin and that's that's shown improvements. Branch chain amino acids at high doses uh for sleep.

08:24And that's interesting because outside of TBI, high doses of branch chain amino acids may actually impair sleep because they compete for tryptophan uptake into the brain, decreasing potentially decreasing serotonin, melatonin uh production.

08:38But in TBI, there are two studies that suggest improvements in sleep with high doses of branch chain amino acids. If somebody's going to take branch chain amino acids, presumably they're going to look at how much leucine is there for a variety of reasons.

08:51Um, so do you recall how much leucine to get this effect post TBI? So I I don't think they at least I don't remember the leucine dose, but they were taking up to 60 g of branches. 6. Okay. Cuz a typical kind of suggested supplement bottle gym dose would be 3 to five grams.

09:12That's usually about six capsules. Yeah. So Okay. So like one study they did in veterans they had um [snorts] I think it was three doses of 20 grams AC spread across the day. Are you curious about um these uh Ibagain studies that are looking at uh you know TBI and brain recovery?

09:33I mean Iane is a it's a a whole other thing because it's a the the most powerful long-lasting psychedelic at least that I'm aware of. But it seems like there's

Psychedelics & Choline Research

09:44some interesting data coming out. Absolutely. Um and then you know in people with a history of brain trauma and PTSD and I think some of these other psychedelics are going to be um very interesting um there as well potentially due to their neuroplastic um effects that tend to particularly happen in like macro doses right in in um in the psychedelic doses.

10:07I think that there's a lot more to come there, but certainly the trials that have been done so far are quite compelling, but that's obviously in in a very controlled kind of clinical heart rate monitor. Again, it's not legal in the United States, although things things are shifting, but choline is another thing, particularly aceticoline.

10:23So, um uh best evidence is for 1 to two grams a day um of choline of choline, you know, in the form of CDP choline or citoline, which is which is the same thing. Um those are the main ones. Then there's some other like Nisha supplements that do have some evidence.

10:40The one that's probably has the most evidence for it is Boswellia. Boswellia. Yeah. Which is Frank Indian frankincense, but there's an extract of Boswellia that's been tested in I think three different clinical trials after TBI showed some benefit.

10:50Enzogenol, which I think is a pine extract, slightly less evidence than Boswellia. I typically would recommend people stick to the first group of kind of nutritional type supplements. um but in very specific um use cases based on specific symptoms some of those other things might be beneficial.

11:07Then beyond that we know that phys return to physical activity as soon as possible is really important after without getting another head injury.

Returning to Physical Activity

11:15Without getting another head injury and you know so so this really changed over the last few years. You know maybe 5 10 years ago people like you know rest is what you need to do. Go lie in a dark room. If you got a concussion in sports, you you would expect the team to have a rigorous return to play protocol that included lowlevel aerobic activity as soon as you're able to tolerate it u two or three times a week at a level just below what might make your symptoms worse.

11:43And then first you do sort of like non-specific aerobic exercise and then you start to bring back skill specific exercises, sports exercises, then go back into full training and then um go back into into playing kind of in that order and that should be quite systematized now.

11:57So I would expect sports teams to kind of have have that in place. So like the standard of care is generally phys physical therapy. if you have any ongoing cognitive or physical symptoms sort of a month plus after uh any kind of traumatic brain injury.

12:12Um there's some evidence that like virtual reality or augmented reality uh physical uh activity uh might improve cognitive symptoms. uh vestibular therapy for balance and dizziness issues. And then increasingly uh you know there's um a focus on sort of ocular motor training for like convergence or other eye like um eye issues that are very common after concussions but aren't picked up as often as as people might like.

12:44increasingly kind of eye tracking and these kinds of things are done particularly in professional sports or other arenas after brain injuries to kind of ideally you'd have a baseline you figure out what's changed and then you would track that over time and you can you can train that depending on the deficit [music] [music]