Brain Health

Concussion Connection to Heart Seen in Research Testing

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Twitter is great. It feeds me all sorts of new, sometimes even relevant scientific or medical news.


“Their research shows that autonomic reflex testing, which measures automatic changes in heart rate and blood pressure, consistently shows changes in people who suffer concussions.” (Ashik Siddique, Medical Daily, 20 Mar 2013)

Neurologists at the Mayo Clinic in Arizona were looking for a biological marker for concussion and found this connection. But what is an autonomic reflex?

Reflexes are like neuronal loops. Stimulus of your knee, for example, sends an impulse up a bunch of nerves to your spinal cord and brain, and they send a signal back, and your leg jerks or not. One reason it may not jerk is because you’ve used your brain to over-ride that reflex. You control it. But an autonomic reflex is a loop through your autonomic nervous system, which controls your heart and blood circulation. Just as you cannot tell your heart to beat or your blood pressure to drop, you cannot control the reflex. Plus it’s all internal. You can’t stick a reflex hammer inside and tap your heart. And so it’s a bit difficult to test it.

According to the Cleveland Clinic’s description of cardiovascular autonomic testing, testing includes four activities:

  1. Blow air into a small tube. This is called a Valsalva test.
  2. Put your hand in ice water for two minutes. This is called the Cold Pressor Test.
  3. You are given phenylephrine to increase blood pressure, and your heart rate and blood pressure will be recorded.
  4. You are given amyl nitrite to lower blood pressure, and your heart rate and blood pressure will be recorded.

I had a variation of this test back in 1989/90. Mine included a tilt table (which from what the doc says in the video below sounds like was also done in the research testing). I had it done because I had blood pressure that would drop like a stone under stress and was chronically low. The brilliant woman who tested me and diagnosed what I had died a few years later. Unfortunately, after my brain injury — and even though I was chronically complaining of a permanently racing heart and a yo-yoing blood pressure — I never met anyone as brilliant as she was. And so I didn’t have this kind of test done (not that I would’ve volunteered for it again, as having a needle stuck in your arm for two hours, blood pressure cuff going off all the time for 2 hours, having ECG leads on, putting your hand in ice, and being tilted is awful).

If I had, I wonder what my results would have shown?

The researchers in their video talk about the assumption that post-concussion dizziness is due to vestibular issues. I did have ear and vestibular testing to see if that was the reason for my dizziness. Nope. All peachy keen, and my hearing was excellent too. The researchers dispute vestibular causation and suggest that the symptoms are due to an hyperadrenergic state — basically, too much adrenaline — which I think is a different way of saying the sympathetic system is on overdrive cause of the injury. Yup, that’s me, even 13 years post-injury. Gah! Oh, hey, lookee what they also mention: tachycardia!!! Yup, that’s me. And considerable blood pressure variability!! Oh gee, what a surprise.

They postulate a centrally-located impairment of the adrenergic nervous system (um, I believe that’s the sympathetic nervous system) caused by the brain injury, aka, concussion. And they postulate that the dizziness represents autonomic nervous system impairment, whose symptoms include — wait for it — exercise intolerance!!!! And only a trainer was able to recognize and tell me that people with brain injury can have exercise intolerance. Now neurologists are figuring this out. Double gah!

They suggest autonomic nervous system impairment is common in “these patients” — that includes me. OMG. I’m about to have a heart attack that mainstream brain doctors are actually recognizing what to date only the psychologists and psychiatrist at the ADD Centre and the trainer I met in 2009 have recognized!

Of course, being researchers, they’re only interested in this finding as a biomarker for brain injury. What I want to know is: what now? How does one treat this, FFS?

*Crickets* Sigh. Well, at least a major US centre now recognizes it. Next step is to duplicate the findings with a larger sample size (cause 21 is rather small) and then, you know, work on a remedy.

Brain Health

What Doctors Don’t Know: Brain Injury Equals Weight Gain

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Weight loss. The entirety of North American society is grappling with weight loss. With diet. With exercise. With staying at a healthy weight.

But believe it or not, people with brain injuries struggle even more than the typical North American. We struggle more because we may no longer be able to perceive that one’s stomach is painfully full as long as there is still food on the plate. We struggle more because doctors don’t acknowledge that mental work may preclude exercise. We struggle more because our metabolism has changed, is no longer the one we know, have lived with our whole lives — and again the doctors don’t even notice the change and thus cannot help.

And so when we suffer a brain injury, we have huge fatigue and understandably feel great pain and stress as a result and suddenly begin (or if did it before, increase greatly) ravenous emotional eating because our usual ways of coping with stress are gone, vamoosed with the injury. I used to read, to lose myself in a book, when stressed. Sometimes I’d eat chocolate or ice cream, but small amounts because I had such strong self-control and knew pain in the stomach meant it was very, very full. I also walked, whether to shop at my local stores or just to process what was stressing me. No more. My brain injury kiboshed my reading, my self-control, my local shopping, and my walks. Oh, I tried to read but I’d crack open a book and read and reread the same page and never get lost in it. I tried to walk but fatigue stopped me cold. Because I had so much trouble cooking, a certain someone took over and served me as much as he ate. No more did my plate hold the smaller amount I habitually ate pre-injury. And no more could I stop eating, perceive my stomach was full — not until the plate was clean. I never cleaned my plate pre-injury, much to my mother’s annoyance. And then on top of all this, my pain, physical, emotional, and mental, was great; chocolate offered relief. Good-quality large bars of chocolate. My favourites were Green & Black’s bars, and these days, I vary between them and Camino’s 80% Panama bar (but now I eat only 4 to 6g in a day).

I gained weight.

For whatever reason, I noticed yet didn’t. No doctor noticed enough to guide me back to my normal weight. Friends and family, well, all I’ll say is thank goodness for Oprah.

One could count on Oprah beginning the year with a weight loss push. She filled her January shows with practical advice on how to eat better, exercise well. She was such a cheerleader that her inspirational motivation penetrated even the thick cotton batting surrounding my mind.

I lost weight.

I came close to a decent weight but not my old, lifelong weight. And then I began brain biofeedback. No one, but perhaps fellow people with brain injury and trainers whom I wasn’t in contact with at the time, knew that intense mental work equals no energy left for exercise equals brain screaming for glucose, more than even a university student — because not only does the brain require food for the increased learning but also to keep repairing the brain, to redo the connections the mental work is demanding.

Mental work equals weight gain.

Brain biofeedback was, in a way more intense than studying at university, for it was not only repairing or creating new pathways while I was learning but it was also forcing me to learn a new way to control a computer. I mean, who has controlled a computer game with their brain before? Not me!

I gained weight.

A lot of weight.

I also gained more water. Brain repair is stressful after all, and I also didn’t know that I had exercise intolerance. I looked like the Michelin Man, like a sick person on steroids.

I felt lost. I had no idea how to lose weight. I was eating well, exercising properly, staggering home exhausted after biofeedback, yet gaining weight.

Then biofeedback ended. I had more energy, a much better functioning brain. I got a new GP. He introduced me to his trainer, who told me about brain injury, heart, and exercise intolerance. He cut my exercise down to ten minutes three times a week, and I lost water and weight. The new GP reminded me of the GI Diet. I began counting calories, not only to lose weight but to retrain my brain to eat as much as my stomach can handle not what is on the plate. And I created, refined, and stuck with my hypothalamus fix.

My weight loss is so slow, frozen molasses could move faster. I still have a tendency to gain weight, well, water, if I exercise too much (e.g., walking partway between appointments because, again, the TTC isn’t working) or think too much or, worse of all for me, am subjected to emotional stress. I try to avoid the latter like the plague but sometimes tis impossible.

Health

The Core of The GI Diet by Gallop: The Glycemic Index

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Aside from my rebellious first impressions of The GI Diet by Rick Gallop, I have to admit that this book does one thing very well: makes the glycemic index intelligible and practical.

Dr David Jenkins* at the University of Toronto developed the glycemic index as a way to measure how a particular food affects glucose levels in the blood and its attendant insulin response. Huh? Basically, a food will either make your blood sugar skyrocket or not. Those that do are bad bad bad for you. Those foods cause your pancreas to pump out large doses of insulin rapidly that suck up the blood sugar and then stuff the excess into your fat cells. The sugar becomes stored fuel, not used fuel. Gallop calls them red light foods. Those foods that cause your blood sugar to soar quickly but not too quickly, Gallop calls yellow light foods, like the amber light at an intersection that warns you to look before proceeding. In this case, think do you really want to eat this, is the transient pleasure worth the rise in blood sugar and all that will lead to, primarily weight gain and blood glucose results your GP will tsk tsk over? Then there are foods that cause a slow, long-lasting rise and fall of blood sugar like a slow, warm wave that washes over you langurously. Those foods Gallop calls green light foods because you can eat as much as you want when you want — within reason of course. Because the blood sugar rises slowly, it’s used as fuel for the body as you go about your life; there is no excess the body sees as storage potential and thus you don’t grow your fat cells. (Gallop explains it differently: red light foods give you a sugar high then a sugar low that leads you to look for more to eat, and that’s how you get fat.)

Gallop makes the index even more understandable by creating a small table of basic, everyday foods that you can eat but in strict moderation if you want to lose weight. My only gripe with this table is you got to remember the page it’s on and to keep looking at it else you’ll forget that no, it’s not 2 slices of bread at a meal but 1 that you can eat. What would’ve been nice is a pull-out card listing these foods that you could stick on your fridge or bread box where it’s always visible.

Gallop makes his traffic light analogy even more followable by listing at the back almost every food in colour-coded columns under category headings so that it’s easy to find out if what you want to eat is green lighted. And right at the beginning where he talks about starting Phase I of the GI Diet, the weight loss phase, he lists them under breakfast, lunch, dinner, and snack, which makes it even easier when starting this diet.

Some people think it’s easy to follow a GI diet cause you just eat more fibre. I’ve had one rather obese person say she doesn’t need to get the book because she eats healthy, no white bread, no white sugar. Uh huh. Clearly, losing weight and keeping it off is more than just switching one’s bread to whole wheat. First off, in Canada, whole wheat does not mean whole grain, and only whole grains give you the complete nutrition and fibre content of the wheat. Also, did you know that how the wheat is milled will change its glycemic index rating? If it’s milled the conventional way it’ll cause a much faster, higher blood sugar rise than if it’s stoneground.

I was in the mood for a sandwich the other day — a no-no as a sandwich is 2 slices and I’m supposed to have only 1 slice per meal, but what the hey, I was in the mood, and a Herbivore sandwich for me is 2 meals anyway. So I went there, and as she was preparing my yummy, huge sandwich, I noticed all these goodies. Several used spelt flour, so being mindful of what Gallop had said about stoneground wheat only, I asked, “Is the spelt flour you use stoneground?” I got a blank look, the kind that screams I’ve never heard that question before. She asked someone in back; that person said she had no idea but now was so intrigued just had to find out. Several minutes later, she replied, it’s stoneground. Whoo hoo! I bought a chocolate chip “cookie.” Yum, yum, yum. OK the bananas in it were not the most GI friendly but the flour was as were the rest of the ingredients, so I figured I was good. I continued to lose weight after indulging in that anyway.

The problems I had with converting my diet to The GI Diet were in finding the kinds of crackers and breads and snacks I could eat. I discovered that many so-called high-fibre breads and crackers were not, despite what the labels said. I would buy a package of what I thought was the good stuff, take it home, compare the fibre grams in it to what Gallop said it should be and find it sadly lacking. I finally wrote down the nutritional requirements to take with me to the store and spent hours poring over labels. As Jane Haddam is so fond of saying in her Demarkian mysteries, it made my head hurt. I would say it took me about a half dozen trips plus a couple by my mother to the grocery store for me to finally get my snacks and breads in order.

Gallop recommends Wasa brand crispbreads; the store clerk told me they fly off the shelves. I don’t know why. They made my gums hurt (and I’ve never had problems with seeds before), feel like sawdust, and taste so-so. Back to the cracker aisle. I had the added problem of trying to find an organic product as I prefer my diet to be as close to 100% organic as possible, at least at home anyway. I finally settled on Holland Organic and Ryvita. The latter is not organic, and the former, after I did the math, I realised didn’t have enough fibre in it. Ryvita seemed very familiar to me. Turns out my maternal grandmother insisted on my mother keeping it in stock for her. It’s a lot tastier than Wasa, and my gums are OK too. But the Holland cracker is absolutely terrific with cream cheese and strawberry jam. So I may treat myself to those every once in awhile.

Bread was a bear to find. First off, I guess I’m fussy. I like slightly sweet — sweet from the grain, not sugar — chewy, flavourful whole wheat bread. I tried multigrain, and although it’s OK, I much prefer whole wheat. Plus multigrain breads are not all made the same. Most don’t have enough fibre in them. Then I had to figure out which whole wheat was stoneground. What a pain in the you-know-what. Most breads don’t list that on the label. I had to go surfing their websites and, in the end, just go in to the wholesale-retail outlet and ask. The St John’s Bakery Integral and Red Fife breads are made with stoneground flour. They’re pretty darn good too. Tough to keep to the 1-slice-per-meal rule.

And lastly, I hadn’t eaten protein bars before but after reading and rereading Gallop’s 3 meals, 3 snacks plan of green-light foods for weight loss, I decided that would be the easiest way to fulfill at least 1 snack requirement. Ha! I went to 3 different stores, stood in front of 3 different protein bar aisles, compared the nutrition labels of all these bars to what Gallop recommends, and wanted to give up right then and there. Too much fat, not enough protein, too much sugar, way too many calories, ingredients that sound like a pharmacy aisle, ingredients that make me gag, not organic. The ones I settled on were closest to his requirements but were too caloric and had too much fat. And then my mother remembered that my father Dr. Khursheed Jeejeebhoy works with a woman who has developed an entire line of low-calorie, low-fat protein bars that triathletes love. The Simply Bar. And they exceed Gallop’s recommendations too. So now I got my snacks sorted.

Next, his fat rules.

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*I worked in Dr. Jenkins lab one summer as a student. It was nice to work with human diets for a change instead of rats, and I may actually have been there when he was developing the glycemic index. I remember being fascinated with his work and regretting that I spent such a short time there. Most summers I worked in Dr. Harvey Anderson’s nutrition labs at the other end of the building and learnt a lot from his staff.

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Related Articles:

Type 2 Diabetes Plays Gotcha

First Impressions of The GI Diet by Rick Gallop

The Three-Month Type 2 Diabetes Followup

The GI Diet: Could I Stick it in the Long Run?

Health

First Impressions of The GI Diet by Rick Gallop

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It’s been almost 4 weeks since I started The GI Diet by Rick Gallop after my Type 2 Diabetes diagnosis. Before my brain injury I had been following a low-glycemic index (GI) diet; but not being able to cook for many years and the other changes wrought by the injury resulted in me having strayed and forgotten many aspects of this diet. This book is one of the easiest to follow in terms of figuring out what is low GI and what is high, but there is a lot to learn.

Gallop divides foods into red light — foods with a high GI and are verboten — yellow light foods — mid-range GI foods that should be eaten with caution when maintaining weight or not at all when losing weight — and green light foods — low GI foods that can be eaten at will. This was good. But then he went on to say that one must cut out all sugar, coffee, and chocolate. Um, yeah, OK.

He recommends replacing sugar with Splenda or some other artificial sweetener. Now having studied sweeteners in nutrition when at the University of Toronto, I knew one thing: I wasn’t going to touch them with a barge pole. As well, as one who loves to bake, I’m prepared to make substitutions, like apple sauce for some butter and some of the sugar, but I’m not prepared to use Splenda instead of sugar. If I had Type 1 diabetes, I would of course make different choices, but I have marginal Type 2, and because of my brain injury I’ve already had to cut out a whack of stuff that result in either my body temperature going even higher than it is or bloating. Also, the brain eats glucose for energy, and after heavy mental work, my sugar need rises like you wouldn’t believe. If I don’t have something with sugar in it, my brain doesn’t work so good. So the idea that I can’t have sugar on top of not having salt, pepper, cinnamon, ginger, spices, etc. etc. does not sit well with me, to say the least.

The other aspect of the nothing sweet rule, unless it’s artificial, is that eliminates natural sweeteners like honey and molasses that do have nutritional value. Certain kinds of manuka honey are said to have immune enhancing properties; blackstrap molasses contains iron (the organic kind is the only tasty version). Maple syrup of course is Canuck to the core, so how many real Canadians are going to give that up?

And then he says no more coffee and chocolate:

“The trouble with coffee is caffeine [actually that’s also it’s benefit]. It’s not a health problem in itself, but it does stimulate the production of insulin….insulin reduces blood sugar levels [good reason to have that teaspoon of sugar in it then, eh?], which then increases your appetite [not mine, but then I’m odd]. Have you ever ordered a venti from Starbucks and then felt positively shaky an hour later? That’s your blood sugar hitting bottom. You cure it by eating a bagel — which isn’t helpful when you’re trying to lose weight.”

That’s actually never happened to me. If you’re getting the shakes, then you’re drinking more coffee than your body can handle — so don’t drink that much! — and the caffeine has probably overstimulated your central nervous system, which it’s wont to do, being a stimulant and all. Again, note that not all the population responds physiologically the same to the same substance. I asked around and apparently diabetics do drink coffee without any ill effects; in fact research is saying it may help with Type 2. So one must pay attention to one’s body and balance out one’s priorities. For me, being alert is the most important thing.

It seems to me diet gurus reflexively frown down upon coffee and chocolate. Yet they have beneficial effects. Coffee helps with ADD; it can help with mild asthma also. Decaff, which Gallop says is OK, does neither. Regular coffee, not decaff, also increases mental alertness, and it can help with exercise tolerance, allowing a person to exercise longer. Cocoa can do the same thing even more effectively. I’ve written before about all the good things about chocolate. It seems to me that diet gurus talk about coffee and chocolate as if everyone is swilling down 7 or more cups of coffee and gorging on an English grocery aisle of candy bars masking themselves as chocolate. I don’t believe that’s the case. Gallop allows that if one must, one can drink one cup of coffee a day. I have mine black with a teaspoon of sugar, and I rarely finish it. I also vary the time I drink it so that I will not develop a tolerance to it (something I learned at university) and thus don’t need to up the number of cups I drink to get the same effect. Apparently, the experts are saying up to 2 to 3 cups a day is fine.

As for chocolate, I ain’t giving it up. I am heartily tired of everyone frowning down upon it, and to be quite frank, how many dieters stay off chocolate once they get to their target weight? I bet none. Once you add it back in, you’re adding in calories you haven’t learnt to accommodate in a healthy diet and you’re probably eating the same kind you did before you went on a diet instead of adjusting your taste buds to good quality, dark chocolate. So is it any wonder your weight creeps back up once the diet is over. Far better to lose weight while still eating chocolate, I say. I call it the chocolate variation.

Gallop also divides nuts up into those that are OK within limits and those that should not be eaten when losing weight. One of those in the latter category are walnuts. Yet walnuts are very good for the brain and body with all those omega fats in them.

I started to wonder at that point that with the emphasis on the glycemic index and little fat, if the nutritional and functional side of food was being totally ignored. Now if you’re overweight but otherwise healthy, you could probably knock out walnuts and not notice any change in your mental acuity, or knock out chocolate and not have any pain or energy repercussions. But for those of us with chronic illnesses or injuries, these diets really need to be modified to include the fact that some foods are necessary to keeping problems at bay or at least not so bad. Brain injuries in particular are hardly understood (despite what over-confident docs say) yet are affected by what you eat, as I’ve learnt over the years. As well, trauma always increases nutritional needs, and too many brain injuries happen because of trauma. Yet doctors know little about that side of nutrition, and the diet books are aimed at the general public, not the injured one. There is a great, gaping hole in this side of losing weight while trying to regain health.

So I continue to add a teaspoon of sugar to my small cup of instant coffee. I still have my up-to-but-no-more-than 10g per day of Green & Black’s 34% milk chocolate every so often and my cup of hot chocolate with skim milk at the end of the day. I currently use Green & Black’s hot chocolate mix but will be switching over when the jar is finished to Cocoa Camino’s dark chocolate mix. I rarely ate store-bought cookies anyway, preferring to bust stress by baking my own. I haven’t had the energy to bake in awhile, as does happen, so my cookie consumption is pretty low right now. It goes in phases anyway. And when I do bake, I’ve been using whole wheat cake and pastry flour for years and years — a low-GI flour — and when I remember I substitute unsweetened (organic) applesauce — also low GI — for half the butter. I recently tried butter-free half-the-sugar double-chocolate cookies. They were good but more like mini muffins than cookies.

So far, I have steadily but slowly lost weight, except for a recent 600g abrupt drop in 2 days. Next time, I’ll talk about the point of the book: changing my diet to the low-GI way. What a kerfuffle that has been!

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Related Articles:

Type 2 Diabetes Plays Gotcha

The Core of The GI Diet by Gallop: The Glycemic Index

The Three-Month Type 2 Diabetes Followup

The GI Diet: Could I Stick it in the Long Run?