Concussion Recovery: Takeaways from the Micky Collins & Peter Attia Interview
Concussion as energy crisis, ways to relieve that crisis, and more
Dr. Peter Attia recently interviewed Micky Collins, an expert in sports-related concussions who works at UPMC in Pittsburgh (see video above). I thought there were several valuable takeaways from that interview that I’d like to highlight here.
Peter Attia is an MD who’s become a celebrity doctor. He was interviewed at length on the Huberman Lab podcast and has his own podcast called The Drive.
I think many of us would be utterly thrilled if our primary care physician were someone of Peter Attia’s calibre. That said, this interview highlights just how much an MD (even an excellent one) doesn’t know about concussion recovery.
If a doctor as smart and knowledgeable as Attia knows this little about concussion recovery, well, you can imagine how little the average MD knows. I don’t have to imagine, I know that reality all too well.
Key Takeaway: A Head Injury Creates an Energy Crisis for The Brain, Which Can Linger
Collins describes neurons as a kind of battery. As with a battery, they require the presence of elements like potassium in order to fire and function properly.
A significant blow to the head (whether it produces a concussion or not) pushes potassium and other elements out of neurons.
If the blow is significant enough to create an inflammatory response in the brain, then that inflammation constricts the blood flow that can bring the elements back into the brain.
The brain is then in an energy crisis where it doesn’t have the elements it needs to function, and it can’t get them back due to lingering inflammation.
Collins and Attia briefly discuss the APOE4 genotype as a possible risk factor for post-concussion syndrome, since it can create issues with one’s inflammatory response.
On a related note, I’ve heard Dr. Amen (from the Amen Clinic) say that in his opinion, children should be tested for this genotype and, if they have it, they should be steered far away from sports where head impacts are routine or common. This would include equestrian sports, football, hockey, soccer, volleyball, lacrosse, etc.
I do not have this genotype. Nevertheless, I may still have lingering inflammation in my brain, which could help explain my ANA results and Array 20 blood-brain barrier results.
Creatine
This energy crisis framework could help explain why Creatine has a protective effect and is also helpful post-concussion. It’s an energy input. It reduces the amount of energy required to make your own endogenous creatine on a daily basis. And it supplies one’s brain and body with the energy that one derives from creatine.
Potassium
It also helps explain why Gatorade is a fixture of the NFL sideline—it resupplies potassium after blows to the head have driven it out (but it also supplies sugar, which can be inflammatory). There are options without all the sugar, including LMNT and simply buying your own potassium (which is a far cheaper option).
Ketones
Collins and Attia talk about ketones as an energy source. After watching this interview, I purchased ketones and tried them. I experienced some mental energy lift, but not enough to make me think I should take them on a chronic basis.
I haven’t suffered migraines and headaches the way some post-concussive people do. My wife has had a lifelong history of migraines, so I’ve learned a fair amount about the mechanisms involved, and it seemed to me that migraines could also be considered a kind of energy crisis for the brain. Our son gets ocular migraines.
Both my wife and son have found that taking ketones early in the development of a migraine can either help prevent the migraine from developing or reduce symptoms. So ketones are now an important first line of defence for them.
ADD
If someone has pre-existing ADD, which involves challenges in the dopamine pathway and the activation of the prefrontal cortex, then it’s easy to see how adding an energy crisis to the brain could dramatically worsen one’s ADD, or even create an ADD symptomology. Amen believes there’s a type of ADD caused by head trauma that can be alleviated when one addresses underlying causes like lingering inflammation.
Key Takeaway: A Neurological Decrement Takes Away One’s Superpowers
As Collins explains, the neurological decrements that follow a concussion take away one’s superpowers (one’s highest-level neurological adaptations) first and foremost. He offers the example of athletes who have a mixture of exceptional innate ability and acquired ability.
For someone who spends many hours training up their nervous system to perform at a high level, a neurological deficit is experienced as a massive loss—a loss that produces dizziness and other symptoms—even though that person may appear to perform well on balance tests and other tests that were designed to measure the abilities of an average person.
All of us (whether we’re athletes or not) put in many thousands of hours to train our nervous systems. Think of the difference between a kindergartner using a crayon vs. an adult using a pen.
Still, it’s illuminating to realize that post-concussion looks and feels a lot like Superman draped in Kryptonite.
Key Takeaway: Pre-existing Oculomotor Issues Require Oculomotor and Vestibular Rehab Post-Concussion
Even if you’re not an athlete, if you were born with certain decrements, such as oculomotor challenges due to differences in vision, then your brain had to develop in response to those decrements and make adjustments (over years) to arrive at a functional equilibrium. A concussion disrupts those nervous system adaptations.
Collins says that people who have oculomotor challenges prior to a concussion can expect to need oculomotor rehabilitation.
I was born with an eye that didn’t function very well. I had to wear a patch over my good eye as a child. In seeking out post-concussion care, no doctor had any idea that I might need oculomotor rehab. I only received vision rehab, including syntonic light therapy, in 2021. It made a difference.
To state the obvious, I am not alone—many thousands of people (perhaps millions) are suffering unnecessarily, not knowing they need oculomotor and vestibular rehab specifically.
Onward.
Brainwave is a newsletter about brain health, a personal blog about my own journey, and an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I aim to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve had a lot of sports-related head trauma and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.