Convincing Evidence that Gut Restoration is Needed After a Concussion or TBI

Alterations to the gut microbiome after sport-related concussion in a collegiate football players cohort

Six months into my gut barrier restoration protocol, this week marked the transition from Phase II “the kill phase” (taking things that kill off certain bacteria) to Phase III, the restoration phase (taking specific probiotics plus other essential nutrients that help restore the gut and brain barriers). More about that in a moment.

As I made the transition this week, an interesting and related news item hit the wire—the results of a pilot study called “Alterations to the gut microbiome after sport-related concussion in a collegiate football players cohort”.

I believe the results point to some very clear and actionable takeaways.

The study designers wondered if measurable changes to one’s gut microbiome might serve as a biomarker for concussion severity. The aim was to add another diagnostic tool to the toolkit.

But if you’ve been struggling to recover after a concussion or repeated sub-concussive blows, this study points to the essential importance of getting your own microbiome test (such as the GI360 test from Doctor’s Data), and taking appropriate action to restore your gut barrier and microbiome with the guidance of a naturopathic doctor.

As I read the abstract of this study, I reached for my GI360 results from six months ago and scrolled down the alphabetized list of bacteria and checked their levels. Sure enough, my results lined up with the results of this study in terms of the specific changes to specific bacterial species. This study illuminates what these changes could mean.

Illuminating quotes from the study

As you read these quotes, you might feel a combination of exasperation and relief. With one exception (my new naturopathic doctor) none of the medical doctors or specialists I’ve seen had any clue about this.

Head trauma leads to both the acute and chronic disruption of the intestinal barrier and the subsequent appearance of bacterial endotoxins in the blood (Mazarati et al., 2021). The gastrointestinal and metabolic disruptions that often accompany brain trauma can be explained by the bidirectional link between the central nervous system (CNS) and the enteric nervous system (e.g., the brain-gut axis). Patients with moderate to severe brain injury often show neurogenic gut dysfunction due to a lack of CNS control over the gastrointestinal tract (Grande et al., 1997), suggesting a possible involvement of the gut microbiota in head injury outcomes. The gut microbiota is an essential neuromodulator of brain-gut signaling and can affect brain inflammation resulting from brain injury (Benakis et al., 2016).

So head trauma can cause chronic changes to the gut and the collapse of your intestinal barrier, exposing your brain and body to the open sewer of your gut, and chronically inflaming your brain and body. And:

Severe TBI patients treated with Lactobacillus-rich probiotic supplementation have decreased gastrointestinal dysfunction and a shortened time spent in intensive care (Tan et al., 2011). These observed benefits are commonly attributed to probiotic-induced reductions in systemic and central inflammation (Brenner et al., 2017). Similarly, thinking about a post-concussion clinical treatment, novel preventive and therapeutic strategies, including nutritional diets, microbiota manipulations with probiotics or prebiotics, or strengthening the enteric barrier could be applied to modulate the intestinal microbiota and ultimately improve both cognitive and functional TBI health outcomes. In addition, changes in the gut microbiota (or dysbiosis) have previously been correlated with developing certain diseases, including neuropsychiatric disease (Cenit et al., 2017). Dysbiosis of the intestinal microbiota has been described in patients with chronic severe TBI (Arciniegas and McAllister, 2008; McAllister, 2008) and is related to alterations in the permeability of the blood-brain barrier and microglia activation (Hoban et al., 2018), as well as changes in the microbiome composition (Treangen et al., 2018).

If you have chronic post-concussion symptoms or mTBI symptoms, it’s very likely that you’ll need some level of gut barrier repair and restoration, without which you may be unable to fully heal.

If the intestinal barrier is compromised, what about the blood-brain barrier?

The intestinal barrier and the brain barrier are made from the same type of cell. And these barriers are one cell thick.

This study demonstrates that once the gut barrier is compromised, one’s blood is also compromised.

As we know, the brain is mostly vascular tissue, with huge quantities of blood flowing in and out every minute.

Although this study didn’t look at the blood-brain barrier, based on my understanding, the implications are clear.

When I took the GI360 test, I also took the Blood-Brain Barrier Permeability Test from Cyrex Labs, which revealed that my blood-brain barrier was also compromised.

All of this points to a kind of vicious circle where healing isn’t really possible without directly addressing the restoration of these barriers. The “chicken or egg” question of which barrier breaks first is interesting, but for those of us with chronic longer term symptoms, we likely need to address the restoration of both.

Back in 2008, my MD told me to simply let time heal everything. First I was told that I’d feel better in a couple of weeks. Then a couple of months. Then a year, tops. All the while, I was regressing, each month getting worse and worse, not better and better. The compromise of these barriers would help explain that regression.

In hindsight, one of the things I find remarkable about this sequence of medical malfeasance is that the prescription to let time heal everything included a tacit admission that the brain and body’s own healing mechanisms are essential and the prime driver of healing. But without a corresponding approach—knowing exactly how to help and support the brain and body’s healing processes in a systemic way—my doctor was completely out of his depth. It was as if I showed up with a broken arm and he knew the first part, that my body was capable of healing this injury over time (true), but he had no idea what the “cast” was for a combined brain and gut barrier injury. So I didn’t receive one.

The Restoration Phase Begins

This week, with the guidance of my naturopathic doctor, I began taking four things, which I will continue to take multiple times a day for the next three months.

These products are specific to me personally, based on my test results, and they would not be effective if I had not already done six months of the Phase I and II. In other words, I wouldn’t tell anyone to just start taking these things.

They include a specific probiotic, a butyrate complex, a combination of several things in a product called GI Resolve from Biotic Research, and alpha lipoic acid.

Butyrate is mentioned in the microbiota study on concussed athletes. Here’s the section that mentions it under Pathway analysis, emphasis my own.

Prediction of the pathway abundances associated with the fecal microbiota changes from the post to off-season indicated that processes related to the synthesis and degradation of sugars and aromatic compounds were among those showing the most significant fold changes. Interestingly, both bacteria species significantly decreased in abundance in players diagnosed with a concussion, E. rectale, and A. hadrus are major butyrate producers, with the former associated with insulin metabolism (Venkataraman et al., 2016). Butyrate producers are garnering renewed attention as “next-generation” probiotics for increasing colon butyrate production and their role in countering disease-associated alterations to the microbiome (Boesmans et al., 2018). Metabolomic analysis of the fecal samples in future studies will help characterize these changes further and elucidate their role in brain damage.

Note the mention above of “synthesis and degradation of sugars” and “insulin metabolism”. About a decade ago I eliminated sugars from my daily diet, and saw major improvements in my quality of life. This might help explain why.

Going into Phase III, I was forewarned that I would experience some level of brain fog, which I have, although it appears to be waning each day. It occurs mostly in the morning in the hours after I take the probiotic.

Interestingly, I am also experiencing some level of dizziness, which was my primary complaint to the doctors and neurologists and physical therapists and vision therapists I saw over many years.

On the subject of vision, one of the cryptic and intriguing elements of this study was the unexplained mention of eye-related testing in the section: “Optic nerve sheath diameter and velocities with breath-holding”. I find this particularly fascinating since I’ve done syntonic light therapy and vision therapy (in the past two years) and for the past two years I’ve also done daily bouts of Wim Hof cyclical hyperventilation with breath holding. I would love to know more about why they looked at the optic nerve during breath holds in this study.

Speaking of which, it’s now that time of the morning when I do the breathing and take the cold shower.

Onward.

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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.