Monday, October 3, 2022

Sports-Related Concussion (Part 2): BRAIN-GUT CONNECTION


Introduction

Part 1 of this Brain-Gut Connection was launched by Dr. Michael Gruttadauria's review on sports related concussions and his findings that link the health condition of the GUT with the symptomatology of the head impact injury (see part 1). To continue, imaging diagnostic specialist Dr. Robert Bard concurs with Dr. Gruttadauria's science by presenting current expanded studies on this very connection.  This is recorded by the use of non-invasive imaging called elastography as well as the  3D doppler blood flow ultrasound.  Recognizing the holistic and integrative physiology that comprises our very wellness confirms the link between latency symptoms of past concussions and other culprits to related illnesses that are prompted by metabolic reactions and biological data including antigens, antibodies, electrolytes, enzymes, inhibitors etc. 


GUT IN HEALTH
By: Dr. Robert L. Bard
The intestinal system is now recognized as a major factor in the immune system.  New ultrasound imaging advances allow imaging of the gut wall layers, internal vasculature and areas of inflammation and post inflammatory fibrosis with structure formation. High resolution probes visualize the various segments of digestion for scar formation and the shear wave elastography quantifies the degree of fibrosis. This exam may be performed endoscopically or by transabdominal probes depending on the location of the organ and type of pathologic process. Certain areas, such as the appendix, are quickly evaluated for appendicitis with high accuracy on CT studies. 

Other organs like the pancreas are examined with endoscopic MRI for silent cancers. Inflammatory markers of active disease are studied with Doppler flow hemodynamics including 3D measurements of the inflammatory arteries attacking the swollen bowel wall. Disease such as Crohn’s disease, irritable bowel syndrome (IBS) and diverticulitis are accompanied by an influx of feeding vessels. The more arterial flow in the affected area signifies the likelihood of greater bowel infection leading to exterior wall adhesions which may obstruct or strangulate adjacent healthy small bowel loops. Fistulae, abscess and cancers may be observed with real time sonographic evaluation in quick non invasive scanning sessions. 

ELASTOGRAPHY: ADVANCING ULTRASOUND TO SCAN THE GUT:
Developed in Europe and Japan 20 years ago sonography of the GI tract was slow to be adopted in the US. As of 2 years ago, only one center in New York City was performing outpatient elastography for colitis, IBS and Crohn’s disorder. There are many levels of sophistication in Doppler flow imaging as well as elasticity measurement and the clinical subtype will guide the probe application. Wide usage in cancer detection of the thyroid, breast, prostate and skin has made screening popular worldwide.  Often a biopsy will be avoided by a negative elastogram report.  Cancers are hard and inflammation is soft which are readily observable endpoints on elastographic studies. Elastography is applicable to examining the pediatric brain as sound easily penetrates the younger skull tissue.

ON POST-CONCUSSION SYMPTOMS
The underreported of bowel permeability to toxins in concussion is likewise mostly anecdotal. The possibility of scanning the gut for increased blood flow following brain trauma may be easily performed as followed as a guideline for evaluation of concussion chronicity. As the bowel activity is regulated by the autonomic nervous system we may apply the same diagnostic endpoints as other physiologic norms.  The response of the microvasculature in the retina provides a functional guideline as to the progression of brain trauma and concussion as measured by blood flow. The application of optical devices and sensors for physical (temperature, respiration, heart rate, blood pressure) chemical (pH, pO2, glucose, lipids, oximetry) and biological (antigens, antibodies, electrolytes, enzymes, inhibitors, metabolites, proteins)  data with imaging (endoscopy, optical tomography, confocal microscopy) adds new classifications of metabolism in the altered state. The addition of wearable sensors and portable laser powered LED tools currently used by athletes are applicable to non invasive monitoring of the effect on the body by concussion indirectly.  Surrogate markers are widely used such as analyzing the white blood cells to verify the infection is bacterial rather than viral. Similarly, there exists alternate options with high accuracy to move forward the immediate and long term effects of concussive injury.




Have You Heard of the Term "YOUR SECOND BRAIN"?

Gut-Brain Axis: By Leslie Valle, MD

To heal from chronic conditions, it is essential to approach the gut-brain axis as an integral system.  Some of us don’t know that most of the symptoms we suffer can be reversed by resetting our gut.  Brain fog, fatigue, mental health issues, mood swings, inflammation, short-term memory loss, neurodegenerative diseases, and cognition can result from an imbalance in our gut microbiome (gut bacteria).  

The two-way biochemical communication that takes place between the gastrointestinal tract and the central nervous system, the gut-brain axis (GBA), is influenced by microbiota.  For example, during a stressful event or exciting short-term event one might experience cramping, nausea, or even diarrhea. 

This second brain (our gut), composed by immune, endocrine, and neuronal components, will alert when an imbalance (dysbiosis) in the gut microbiome has been identified.  Constant microbiota fluctuations change our gastro intestinal terrain, and influence our judgment and well-being.  For example, when our good bacteria are out of proportion with the bad bacteria in our gut, there is no production of anti-inflammatory antioxidants to help the body get over trauma.  Thus, bad bacteria begin to flourish, releasing toxins and increasing inflammatory responses in our body which can circulate back through our blood and back to our brains.

Consequent gastrointestinal dysbiosis results in chronic inflammation that leads to brain degeneration. 







MENTAL ISSUES FROM POST CONCUSSIVE DISORDER
Pre-existing mental conditions make the diagnosis and treatment more delicate.  The underlying condition can challenge the client and healthcare provider to meticulously investigate the efficacy of each component of testing and treatment choices, timing, and tolerance. Certain preexisting mental health conditions can be characterized by similar dysfunctions caused by brain injury. On the side of treatment, some of those same conditions and understanding response to treatment can vary, fostering inaccurate expectations when it comes to recovery time. Another issue is the possibility of medications side effects that can also be similar to symptoms of a concussion, adding complication to the prognosis or discharge. Lastly, the availability of treatment choices can be greatly limited as some can be contraindicated- perhaps due to an abundance of precautions affecting clinical decision making. 





CONTRIBUTOR:

LESLIE VALLE, MD - Founder of Biomed Life/ Santa Barbara Longevity Center
After medical school, Dr. Valle focused on managing chronic disease starting with its links to poor nutrition and then introducing them into the world of energy frequencies.  She explores and includes non-invasive modalities such as: frequency therapies (including biofeedback), PEMF, proper detoxification, nutritional guidance and binaural beats as needed. - visit: www.biomedlifesb.com

 



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