Tips for beginners…..and possibly experts too

If you’re considering using intermittent fasting, exogeneous ketones or the ketogenic diet to treat concussion symptoms then prepare yourself. It’s not an easy ride. I don’t want to turn anyone off but it’s important you manage your expectations – there’s a lot to learn, results may take time and they may not even be obvious.

If you’re not familiar with keto, then that in itself is a steep learning curve.  The science behind it (high fat low carb) goes against the mainstream, plus you are processing this information under the cloud of concussion and any other symptoms – which means you won’t be at your best.  My advice here is to relax. There is zero pressure on you to get this ‘right’ first go. Start small with any changes to your diet and continue building on your successes. It’s ok to make mistakes – that’s simply part of the trial and error process as you work out what suits you best before you make the changes permanent. Your rehabilitation from the symptoms does not include adding more anxiety. Taking an active role through the diet means introducing more fats, not stress. If weight management is one of your goals then that’s another matter, you’ll probably see a more immediate return on your efforts.

If it’s your first experience with either keto or concussion then I found it helps to build a basic understanding of both. It’s quite empowering to get a handle on the science as I felt like I could own the solution more if I understood it more. It seems to be much easier to get quality information on keto than TBI (Traumatic Brain Injury). We’ve no doubt come a long way with tbi but the science is still in its infancy. Not to say the effect of keto isn’t, but there’s definitely alot more material out there to work with.

You will come across people who are opinionated on keto or diets in general. They will want to tell you in any number of polite or not so polite ways that what you’re doing is wrong. That’s fine. Your job is not to convince them. Your focus is on contributing towards your well-being. If it helps, let them know that ‘the research suggests I’ll get a better energy supply throughout the day’ if you’re not comfortable sharing your tbi experience,  or ‘the research suggests it will support my rehab’ if you are.

The effect keto will have on your concussion symptoms is hard to understand and indeed, measure. I never sat a baseline memory, anxiety, head pressure or fatigue test prior to the concussions so it’s going to come down to self assessments. Do I feel better across any of the symptoms? If so, how would I describe it? Would the benefits have come with the passage of time anyway? Are other variables at play? It’s easy to doubt yourself along the way especially if others are questioning you. My experience was to push on. The knowledge I was doing something proactive was enough to help mitigate the symptoms even if I didn’t have a recorded measurable difference. If you think taking an active role in your rehab through keto has created a chance for you to get better, then so be it. You lose nothing by taking an interest in looking after yourself.

You’ve heard the cliche ‘it’s a marathon not a sprint’? I think that applies here too. Focus your energy inward on helping yourself by slowly building your knowledge base as you make incremental changes. Take note of what’s working for you and consider ditching the rest. Keep a daily diary of what you’re doing and track your symptoms – it doesn’t have to be a novel but something you can reference later. I’ve found this incredibly powerful (as the days and months can blend into one) so now I have an accurate record of what happened, instead of relying on my concussion tainted memory.

Lastly, this paper is a little dated but worth reading as you continue to build your understanding. It speaks directly to nutrition and TBI https://www.ncbi.nlm.nih.gov/books/NBK209323/

As always, good luck with the keto, the concussion rehab or both.

Eddie

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I don’t like the drugs but the drugs (sort of) like me.

Whether you’re a professional athlete, ,stay at home mum, red tape bureaucrat or a serial blogger we should watch what we put into our bodies. The reality is often different. Convenience, cost,taste,knowledge etc. are all factors.
The same shouldn’t be said for medicines. Ideally we only put the very best, fit for purpose drugs into our bodies and nothing else. The problem is that the drugs available arent prescribed in that manner, especially when it comes to TBI. It’s more a “try this drug which is known to treat this symptom, which is kind of similar to what you’ve described”. That can mean a lot of unnecessary trial and error for you to go through.

Ive been asked a lot about the medications I was prescribed so here goes. Before I do, here’s my disclaimer – I’m not a doctor and what you’re reading is my opinion based on my experience. Make sure you speak with a health professional to get their advice.

So anyway, some were for the headaches, pressure, the all important sleep or a combination of them.  A quick google search should show you local brand names if you need them.  You’ll see that many of them are ‘catch all’ drugs. Designed for one purpose and prescribed in the hope it would help with my symptoms. I’ve also commented on measurable differences and any side effects as I’m super sensitive to some drugs and not others.

Amitryiptyline hydrochloride 10mg
Nortyptiline 10mg
To help with migraine type symptoms and sleep.  The Amitryiptyline left me feeling stupified and zombielielike for the following day, so we tried nortyptiline – same result.  Keep an eye on this if you intend to operate machinery, play contact sports, look after small children etc. Not only that, I get a crawling sensation over my skin like when youre coming down with the flu. This branch of drugs are prescribed for so many ailments and issues, don’t be surprised if half a dozen people around you are on it as well.

Melatonin 2mg. Melatonin to assist with the ice pick head aches but also doubles as a sleeping aid. Your body naturally creates melatonin so this seems pretty safe. I found it a useful sleeping aid to get me to sleep, not as useful for keeping me asleep during the night.

Zopiclone 7.5mg tab. This is something you want to get your hands on but be careful, it can pack a punch and its addictive.  The important thing to remember is that sleep is critical, you must have it, and it is an essential part of your rehabilitation. Theres a balance to be had of course so when you’re using this stuff or melatonin or anything else to assist with sleep, be very open about it with your doctor/ health specialist or significant other.

Magnesium amino acid chelate 250mg. Magnesium (not so much a drug as a vitamin) is easy enough to get off the shelf but you wouldnt believe how many differing opinions there are on this when oxidiation is discussed.

Topiramate which is normally prescribed for migraines, 12.5 mg a night and the dose up titrated (a fancy term i learned along the way) to 100mg twice daily.

My approach to taking meds during my rehab is probably described as best intentions, at times poorly executed.  Regularly taking pills x times per day before or after food, 1-2 hours before bed or whatever just doesnt fit my lifestyle. When I’m disciplined I’m really disciplined,  when I’m not, well……I’m not. My daily diary (which I can share in a later blog if there’s interest) has helped highlight the effects of this.

So that covers the medicines I’ve been prescribed and, with the exception of the amytriptiline and nortyptiline, continue to take.

In the next blog I’ll cover some of the challenges I think you’ll face trying to treat concussion symptoms with intermittent fasting and the ketogenic diet.

Thats probably about enough for now,take care and good luck with the rehab

Cheers,

Eddie

The word is getting out there….

So a lot has been happening since my last blog. Rather than overwhelm you in a single post I’ll chunk it up into useful bite sized topics that should also prove easier for future reference.

In this one you’ll find podcast and YouTube links to an interview I gave recently after my blog caught the attention of Ryan O’connor. Ryan follows one of the world leaders of ketogenic research, Dominic d’agostino, who kindly tweeted about my journey using ketosis as a means of treatment for TBI.

We cover a range of topics including sleep, anxiety and keto food ideas so something in there for everyone.

The podcast can be found at https://itunes.apple.com/nz/podcast/the-stag-roar/id1257836237?mt=2

And on YouTube at https://youtu.be/I0QdBQVJHZY

In my next blog I’ll respond to some questions I’ve fielded about the medications I was prescribed and the dosages – including how my body reacted to them. For those of you in a professional sport or work environment, perhaps you operate machinery or look after children, then I think this is something you want to be mindful of.

Take care and good luck with your keto diet, concussion rehab, or both.

Cheers

Eddie

Keto & Concussion. Why you should do one and not the other – and my experiences with both.

Here you’ll find some anecdotes and data on one mans journey with using the ketogenic diet to manage concussion symptoms. There seems to be a shortage of info on this kind of thing so I’ve also included a bunch of links to research, podcasts, videos & other interesting stuff to help you along.

I have two young kids with another on the way, played rugby union and rugby league for 30 years, have tried to drink all the world’s alcohol, enjoy Brazilian jiu jitsu and yoga, high adrenaline activities and travel, and all while living on a high carb eat-everything-in-sight diet.

In that time I guestimate I’ve had around 10 or 11 ‘concussion level’ knocks to the head. I can’t give an exact figure, because honestly, I don’t know and I’m not sure anyone (medical professional or otherwise) would know either. In my completely unscientific definition, it’s been where the impact has been so severe that I’ve lost my bearings and balance in a sea of stars for a sustained period of time, or had my vision badly affected/haven’t been able to see for a few minutes, or I’ve completely lost consciousness.

In 2016 I had 3 concussions in quick succession and the impact – pun intended – is still being felt today. Shortly after the third and probably the worst episode (I was knocked out cold for about a minute) I started to get symptoms those of you familiar with the fog of concussion will readily identify with – dizziness, pressure headaches, loss of sleep, anxiety and fatigue. My favourites though would have to be struggling with stress, hyperacusis and pulsatile tinnitus. I know there’s a lot of problems in the world but when you’re beyond tired and the thing stopping you from sleeping is the sound of your heartbeat, sleep becomes the only problem in the world.

All of this was followed up by multiple trips to the GP (in New Zealand that’s your local family doctor – someone who knows a little about everything, but not a lot about anything) to get a better handle on how to manage the issues. I was referred to the specialists in brain trauma injuries, ABI, who helped me develop a plan for addressing the symptoms I was experiencing. If there’s an interest out there, I can let you know the meds, rehabilitation plan and how it targeted my work environment.

Anyway, after following the determined course of action, by and large the symptoms began to ease off over a period of time until I felt like I was free of them for a couple of months. Then, problems. Some of the symptoms had come back. The stress and how my body responds to it plus my old friend pulsatile tinnitus had made an unwelcome return.

Why the hell would I starve myself?

Some time around all of this a good friend (I’ll call him Bob) messaged me about intermittent fasting and the “benefits” of it. Even though Bob’s a genuine guy with an eye for science, my initial response was to rubbish the idea and write it off as a fad. I come from a world where healthy people eat lots of food so why the hell would I starve myself? True to form, he followed up with links to research and podcasts on intermittent fasting, what it does to your body and why it’s more widespread than I thought. There were these things called ketones and macro nutrients, something about epilepsy and brain injury (brain injury?, that’s me!!), the blood brain barrier and blood sugar levels. I’ve always been a huge believer in living life and not being a bystander. The idea of concussion telling me how I can live that life, doesn’t sit well at all. As I dug a little deeper I saw research that suggested ketones had a positive influence (notice the vague words) on brain injuries and synaptic function.

This was like being in a foreign place with foreign road signs, but this is exactly where my journey into ketosis began….

Ketones, Ketosis, and Dominic D’agostino

My first foray into the world of ketosis looked like intermittent fasting for a 16 hour period, once a week, followed by unadulterated carb bingeing for the rest of the week. This was under the impression I was able to get the benefits of these ketone things released into my body – the same thing cavemen benefitted from during times of food scarcity, allowing their brains to function at peak performance. Sounds reasonable.

Bob was also fasting and doing a much better job of it. Regularly doing longer fasts and for more days of the week. The problem for me though came down to sustainability. Not in a saving the planet kind of way – but in how long I could keep starving myself, then eating as much food as possible, then anxiously waiting until the next time I starved again.

The more I learned about ketosis, the more I came to understand that I needed to be in it for longer than a couple of hours if I wanted to draw any benefit from it. The other thing I learned about ketosis, is that you can’t learn about it without coming across the name Dominic D’agostino.

When the big guns do podcasts about keto – Tim Ferris, Dave Asprey, Joe Rogan etc. – they get this guy. If you want to know more about Keto then you’ll want to find out more about him and the work he’s done. Aside from being near the top of the keto ladder, he has an ability to translate the science of keto into a language that non scientists and boffins alike can engage with. He’s also the one that encouraged me to write this blog in the hope it will contribute to the global understanding of how keto can benefit people managing their way through concussion.

If you ever read this Dominic, my thanks. Writing this blog has added a different dimension to my rehab.

By the numbers

Fast forward in time and my current state of ketosis reflects my full blown ketogenic diet. Less than 30 grams of carbs per day and my macro levels are around 75% fat / 20% protein / 5% carbs. Bulletproof coffee gets me started and I try to have two meals loaded with all the calories I need at lunch and dinner times. I’m 181cms & 81 kgs, blood pressure around 104/70 heart rate 60. I have been in varying levels of ketosis for 3 and a half months now (kicked out a bit) and at times it’s been a battle, others, super easy. Meal plans can be challenging but honestly, just google and you’ll soon find a method that suits your lifestyle. I know mine doesn’t venture into eating oysters and sardines like Dom, but there will definitely be a way out there that meets your needs.

When I made the commitment to going full keto, I stopped all physical activity. I had an appointment with a neurologist lined up and I didn’t want to do anything that might compromise my concussion recovery. My previous recovery plan had included light aerobic activity, but since I was back at square one, I figured this would be my new baseline and I could grow from here.

Coincidentally, my GP also recommended me for a cardiovascular trial that was gathering data for people in my demographic who were potentially ‘at risk’. Perfect. This meant I could now measure what full keto and zero exercise was doing to my cholesterol levels and likelihood of diabetes. Assuming I got the clearance from the neurologist, I could go back to Brazilian Jiu Jitsu (BJJ being my favourite addiction) and measure the changes. Tweaks to my diet could also be measured.

I now have recent blood tests to compare with previous years. If you’re looking for reasons to start a keto diet, it doesn’t make for great reading so I’ll put my caveat in here (Dom also references this type of change in the Asprey podcast). Prior to the 2016 concussions, I’d always been super active with rugby and league, tai chi, running, swimming etc plus I’m a non smoker. The latest results give some insight into a period of zero exercise, and the introduction and testing of a completely new way of eating for me. The transition from eating carbs to mainly eating fats, meant eating all fats – good and bad.

Averages from 2012-2016 (pre keto)

Cholesterol 4.4 mmol/L

Triglyceride 0.7 mmol/L

HDL Cholesterol 1.43 mmol/L

LDL Cholesterol 2.6 mmol/L

Chol/HDL Ratio 3.1

December 2017 (2.5 mths in ketosis)

Cholesterol 8.4 mmol/L

Triglyceride 0.5 mmol/L

HDL Cholesterol 1.77 mmol/L

LDL Cholesterol 6.4 mmol/L

Chol/HDL Ratio 4.7 Ratio

If you want to know how to read cholesterol results try this.  Basically, it suggests my diet isn’t good and I’m at risk of death as my bad cholesterol (LDL) is too high.

The neurological assessment and where to from here

The Neurology Registrar and Consultant believe there are a couple of red flags such as the ongoing pulsatile tinnitus and all day ‘pressure’ headaches I had on a few occassions. I’ve been sent for an MRI in a few months which will help fill in some of the puzzle and prescribed Topiramate to go with the melatonin and magnesium. I’m gradually building my exercise program and I even got sign off to return to BJJ.

I have follow up blood tests in 3 months which will help measure the effects of the diet and exercise. The biggest test of all though, the hardest to measure, has been ‘how do I feel’?

Honestly, there were times in the very early days when I thought I could feel a difference but that was just wishful thinking. At its worst, the symptoms made my memory something akin to a sieve or colander and I could barely retain information throughout a day. The concussion fog (not to be confused with low blood sugar fog ive heard about) felt like it made everything so much harder. Harder to hear, think, process, respond, do. This is no longer the rule, more the exception, and only really happens during times of stress like when I’m having an emotional or deep conversation.  Also, I don’t believe my memory or ability to focus on a task is as sharp as it was prior to the recent concussions. I think the ketogenic diet, coupled with daily yoga and BJJ has given me an opportunity to feel like I’m playing an active role in my rehabilitation, and for now, that’s enough. I will want to see more tangible results in the future though and I would also like to see more hard evidence that confirms (or otherwise) links between ketones and brain injury rehabilitation.

In the meantime, I’ll create another blog after my next neuro appointment, MRI and cholesterol tests to track my progress and respond to any ideas generated in the comments.

Thanks and good luck with your ketogenic diet, managing your recovery from concussion, or both.

Cheers, Eddie

P. S If you know of other tests to measure the changes keto might be having, please let me know. I’m happy to submit any results. I’ve also reached out to WCSG to see what can be done to measure changes. I’m super interested in anything that can be measured in this space.

If you want to know more about concussion, the science is still a bit fuzzy but I really enjoyed this ted talk. It wasn’t recommended by my specialists, rather, popped up on my research travels. Let me know if you come across others.