Andy Galpin - How Concussions Damage Your Brain | Dr. Tommy Wood & Dr. Andy Galpin
The discussion begins by addressing the common misconception about concussions being caused by the brain hitting the skull. Instead, it explains that concussions result from distortions within the brain, particularly at the interfaces between different brain tissues, such as gray and white matter. These distortions cause shearing effects that can lead to axonal injuries. An experiment with an egg in saltwater demonstrates how the brain is cushioned by cerebrospinal fluid, preventing direct impact injuries.
The conversation then shifts to potential treatments for concussions, focusing on ketones and lactate. These substances might help by providing alternative energy sources to the brain, which suffers from energy failure after an injury. Although there is no conclusive evidence yet, ketones and lactate could bypass dysfunctional mitochondria and support brain metabolism. They may also have anti-inflammatory and neurotrophic effects, potentially aiding recovery. The video emphasizes the need for more research to confirm these benefits.
Key Points:
- Concussions are caused by brain distortions, not direct impact with the skull.
- Injuries occur at the interfaces of different brain tissues due to shearing effects.
- Ketones and lactate may help by providing alternative energy sources to the injured brain.
- These substances could have additional anti-inflammatory and neurotrophic benefits.
- More research is needed to confirm the effectiveness of ketones and lactate in treating concussions.
Details:
1. 🔍 Understanding Concussions: Challenges and Misconceptions
- Concussion research struggles with producing consistent therapies due to improper study methods and a lack of comprehensive understanding of the condition.
- The 'slush effect' metaphor inaccurately describes the brain's behavior during concussions, as it implies a simplistic view of the brain moving within the skull.
- The brain's composition of fat and water, surrounded by cerebrospinal fluid within a solid skull, presents a complex biomechanical challenge, complicating treatment approaches.
- Widespread misconceptions about concussion mechanics, such as the idea of a 'contra injury,' hinder the development of effective therapeutic strategies.
- Current research methods fail to account for the intricate biomechanical processes involved, suggesting a need for innovative approaches and deeper understanding.
2. 🥚 Egg Experiment: Demonstrating Brain Protection
- An experiment was conducted using an egg placed in a jar filled with saltwater to demonstrate the protective effect similar to cerebrospinal fluid (CSF) in the brain.
- The egg was shaken vigorously, but the yolk did not break, illustrating how the liquid environment buffers and protects fragile contents from impact.
- The demonstration highlighted the concept that fluids can cushion sensitive objects from damage during rough movements.
3. 🔍 The Reality of Brain Injuries: Distortion and Shearing Effects
- Brain injuries often result from distortions and shearing effects within the brain, rather than direct impact with the skull.
- Concussions are commonly studied using a jar and egg yolk analogy, where shaking the jar without a lid causes the yolk to disperse, mimicking brain distortion.
- Injury accumulation in individuals with concussions, such as those with CTE, is typically found not at the brain's surface but at interfaces between different brain tissues, particularly between gray and white matter.
- These injuries occur due to the shearing effect at interfaces where tissues of different densities meet, such as at the base of the sulci, due to distortions traveling at different rates.
- Severe shearing effects can lead to axonal injury by ripping axons, and blast waves can cause similar damage even without direct shearing, by the energy waves transferring at different rates through the brain.
4. 🧠 Exploring Potential Treatments: Creatine and Lactate
4.1. Potential of Lactate in Treating Brain Injury
4.2. Exploring Creatine as a Treatment Option
5. 💡 Metabolic Substrates and Recovery: Ketones and Lactate
- Ketone esters provide promising benefits for brain recovery after concussions and TBIs, with minimal risks, although further randomized control trials are required to confirm efficacy.
- Ketones and lactate serve as alternative energy sources, bypassing dysfunctional mitochondria to fill the energy gap caused by brain injuries.
- In cases of acute brain injury, while glucose uptake is impaired, ketones and lactate remain usable as they utilize different transporters unaffected by the injury.
- These substrates also have anti-inflammatory and neurotrophic effects, such as boosting Brain Derived Neurotrophic Factor (BDNF), aiding in the recovery process.
- Ketones and lactate are potentially more efficient metabolically, penetrating the brain effectively even during acute injuries, and are less impacted by inflammatory markers.