Biography/Disclosures
Biography: Hrkal, a board-certified naturopathic doctor, has a special interest in brain health and neurological disorders and maintains a clinical practice at PureBalance Wellness Centre and the Pain and Wellness Centre in Toronto, Ontario.
March 29, 2019
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BLOG: Brain injury may affect sleep, fertility, digestion

Biography/Disclosures
Biography: Hrkal, a board-certified naturopathic doctor, has a special interest in brain health and neurological disorders and maintains a clinical practice at PureBalance Wellness Centre and the Pain and Wellness Centre in Toronto, Ontario.
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Paul Hrkal
Paul Hrkal

by Paul Hrkal, ND

Concussion is typically managed by a family doctor who recommends rest and limited screen time for a few days.

If symptoms don’t resolve, the patient may be sent to see a specialist, such as a physical therapist, chiropractor or a neuro-optometric rehabilitation or vision specialist, to address lingering issues from the traumatic brain injury (TBI).

TBI patients often have vague symptoms that even they struggle to articulate — and what’s going on at the cellular level may help provide an explanation. The latest research confirms that a TBI stimulates a cascade of glutamate and calcium release, which leads to neuroinflammation, excitotoxin production, mitochondrial dysfunction and immune activation.

A TBI, for example, can turn on the microglia cells in the brain. These immune cells are responsible for producing inflammation to protect the brain from infections and invaders. But if they don’t get turned off, the inflammatory signaling mechanisms continue, impeding normal mitochondrial function and energy production.

Mitochondria produce adenosine triphosphate (ATP) molecules that power the cellular functions of every system in the body, including the visual and vestibular systems. In fact, the brain and visual systems are metabolically intense regions of the body. Little wonder then, that TBI patients are easily fatigued.

Depending on which part of the brain is injured, the hormonal center of the brain in the hypothalamus may also be affected. The hypothalamus coordinates the pituitary and autonomic nervous systems, which play a major role in regulating organ function and sleep, among other things. More than 50% of people who suffer a TBI have difficulty sleeping afterwards, sometimes for months or years. Changes (usually reductions) in the release of melatonin, growth hormone, thyroid-stimulating hormone, adrenal-stimulating hormone, prolactin and reproductive hormones are all possible after concussion, according to the latest research.

Additionally, a TBI may unmask pre-existing problems or underlying metabolic weaknesses for which the patient was previously able to compensate but no longer can after an acute injury.

Optometrists who see post-concussion patients who are presenting with persistent symptoms, such as nausea, fatigue, sleep or mood disturbances, should consider a referral to someone with naturopathic or functional medicine expertise so that metabolic and hormonal systems can be addressed, in addition to vision or vestibular therapy, occupational therapy and other services provided by other members of the care team.

In working with TBI patients, I often order advanced bloodwork panels to evaluate hormonal and digestive function. Based on test results and the patient’s symptoms, I will design a highly personalized treatment regimen that may include an anti-inflammatory diet, nutrient supplementation, hormone therapy, acupuncture and/or sleep counseling. There are some simple nutritional supports that any clinician can consider to optimize metabolic function. For example, curcumin, green tea, essential fatty acids, resveratrol and vitamin E are some of the compounds with potential therapeutic benefit in the treatment of TBI (Blaylock et al.).

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Ideally, I would like for every member of the concussion management team to be aware that metabolic and hormonal aspects can play a role in healing, especially in patients who have chronic symptoms that persist long after the TBI.

Reference:

Blaylock R, et al. Surg Neurol Int. 2012;doi:10.4103/2152-7806.92935.

For more information:

Paul Hrkal, ND, is a board-certified naturopathic doctor and an active member of the Canadian Association of Naturopathic Doctors. He has a special interest in brain health and neurological disorders and maintains a clinical practice at PureBalance Wellness Centre and the Pain and Wellness Centre in Toronto, Ontario. For more information, visit www.paulhrkalnd.com/concussions. He will be speaking about the intersection of concussion and endocrine/metabolic function at the NORA annual conference, Sept. 19-22, 2019. in Scottsdale, Ariz. For schedule and registration, visit https://noravisionrehab.org/about-nora/annual-conference.

Disclosure: Hrkal is on the scientific advisory board of Complete Concussion Management – A comprehensive concussion certification program. He also is the medical director for Advanced Orthomolecular Research, which manufactures and sells evidence-based natural health products.

Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.