--- title: "Hydrate & Elevate" entity: "blog" canonical_url: "https://www.andreaproulxnd.com/blog/hydrate-elevate" markdown_url: "https://www.andreaproulxnd.com/llms/blog/hydrate-elevate" lastmod: "2023-06-09T02:36:46.000Z" --- Hydrate & Elevate - Unlock the Power of a Well-Hydrated Brain Coaching session - June 08, 2023 00:01 Hi, hello, hello, hello, hello, welcome to hydrate and elevate where we are going to talk hydration hormones concussion brains. Let's talk brain and brain health. 00:14 I'm Andrea Proukx, I'm a naturopathic doctor and I'm lucky to report I have never had a concussion, but I work with so many women and athletes who have had concussions and they're seen me because of the concussion issues or because of other things in and around, but it's such an important factor that 00:33 we need to be mindful of over and above or kind of beyond this idea of opose concussion syndrome. And I sort of say that rule my eyes a little bit because there's so much that I think we could put under that umbrella that as medical professionals were not always assessing as well as we can. 00:53 So please feel free to drop your comments in the comment box. I hopefully I will see them and if I don't, I apologize, send them to me in other ways or I will get to you. 01:06 So let's talk, let's talk concussions and hormones and all of the things. So I really wanted to kind of focus on this idea of brain health around injury, like brain injury or what's called traumatic brain injury, TBIs, concussions are part of that. 01:27 So I was looking at that, that then diagram of brain injury, brain health, hydration and things that we need to be aware of as active women in terms of how our hormones may or may not be affecting some of those pieces. 01:43 And so I wanted to pull all of that together for you so that we can, you know, have a good discussion and understanding of what's happening over and above. 01:54 Oh, I hit my head. I now lights bother me, noise bothers me. I'm going to talk about it. I'm going to take some time off work if you have that, that luxury or that opportunity. 02:05 Because there's so much more that we need to talk about and address, especially as active women. And we're seeing more and more women participate in sport and high level sport and competitive sport, which is wonderful. 02:21 But of course, with more and more of us participating, that just means there's going to be more of us suffering from some of these brain injuries. 02:30 Just by nature. There's more of us doing this. And, and sadly, I have to preface today's discussion with, you know, this a similar preface I've said before is that yes, there's like I'm quoting some research and giving you some stats. 02:47 But sadly, the world of women's health is not sufficiently researched. And the world of women in sport, women's sports performance is also definitely not sufficiently researched. 03:01 In terms of women in sport and sport performance, we're looking at somewhere between three and maybe 30% of studies. I think 30 is being quite generous. 03:14 And again, a lot of, and as I was digging into the literature around concussions or brain injuries, more of that research was focused on teenage girls or young 20 year olds, possibly because we're seeing more of them and in terms of their accessing the medical health system because of changes in school 03:37 or not being able to go to school. We're not getting that research or those research numbers in terms of women in their 30s, 40s or 50s, us adult ladies. 03:49 And our concussion aspects in sport in life, this hormone hydration kind of, he's saying then diagram like we're all these things. 04:01 Come together. And I also want to kind of highlight, yes, I'm going to be focusing more on the context or the slant of concussion or brain injury that happens in the context of sport. 04:14 But to be honest, it's about 15% of concussions occur in the realm of sport. So the vast majority of these brain injuries are not happening within the sport context. 04:27 And I applaud right now the YWCA among other groups are rallying right now in terms of a wonderful media campaign during these 2023 NHL playoffs where they're really trying to highlight and tie in some money donation to, you know, bringing awareness to the idea that for every one concussion in the NHL, we're seeing over 7,000 women in Canada suffer from concussions due to domestic violence. That aspect is outside of today's discussion today's coaching call because I kind of want to focus more on the context around the sport, but fundamentally when we're talking about concussion, regardless of the mechanism of injury or the location, the circumstances, I think we need to be mindful that concussion and brain health is not a discussion reserved simply for female athletes. 05:28 So let's talk. Let's talk about, you know, our brains around this idea of hydration. Hydration definitely affects so many cells in our body and perhaps you've heard me say that before. 05:47 But specifically around brain stuff, we know that a dehydrated person dehydrated brain has changes in memory and not the good kind. 06:00 Reduced reaction time again measured in sport. There's some controversial evidence suggesting perhaps there's impaired balance again in sport context when we're dehydrated. 06:14 We do know that hydration, altars are protective structures in our cerebral cortex as well as impacts the actual cellular structures of the neurons, so the neurofilaments. 06:29 What does this basically mean? Well, if we're dehydrated, then those protective mechanisms around fluid and inflammation balance are significantly impaired. 06:42 Right, our brain is sitting in this skull in this cavity with cerebral spinal fluid brain juice. It's a fluid where there's a lot of water in that fluid. 06:53 And like anything, if there's enough fluid, we can help absorb shock a lot better when we're in some sort of impact scenario. 07:04 And we want that fluid to be able to absorb so that the brain isn't being jostled quite as much. Because part of what's happening is that a concussion occurs because again, the brain is moving within the skull. Perhaps from contact with something else or the ground or another person, or it could be like from whiplash in a car accident, where there's the neck moves so quickly that the brain shifts very quickly within the skull cavity. 07:32 And the neurons, so those long, long cells in our brains and their little finger like projections are being broken. These small neurofilaments are being stressed. 07:47 The sheer force of the movement is pulling, tearing, stressing these neurofilaments and causing them damage or possibly even to break or to disconnect. 07:58 These long, little skinny wires, these delicate wires, and we want to try to absorb the shock so they don't suffer or break quite as badly. 08:10 There's also this idea around this inflammation, and for a long time we talked about concussion and inflammation. That discussion is still very relevant. In some circles, I find we've turned down the volume maybe a bit too much on the impact of inflammation around concussion and post concussion syndrome because it is still very much a part of the story. 08:33 It is not the only part of the story, but when we're dehydrated, we have more trouble buffering some of those inflammatory reactions within us. 08:43 We also have that reduced blood volume, making it all much more difficult to deal with. So typically with concussion, we think about those more immediate symptoms. 08:56 That could be, and I mean, be on the immediate of possible loss of consciousness, possible memory lapses about the moment sensitivity to light sensitivity to sound. 09:07 Maybe there's headaches, migraine components, there could be some dizziness, some gut stuff like nausea, vomiting. It may be a difficulty to concentrate in the moment and even in for several days or weeks after the concussion. 09:26 But what we do know from doing autopsies is that even 52 weeks after a major brain injury, we still, sorry, these are autopsies, sorry, 52 weeks, we see that the neurons can still be in this high alert stage. So we have to think of concussion, see what's happening in that moment, the brain moving around, the shearing forces on the neurons. 09:53 But also, let's look at like, what's going on in that context? What is the health going in, what is the health of the person going into that concussion? 10:01 And what is it afterwards? Because we're seeing a lot of symptoms come about that are related to this ongoing high stress state. 10:14 We could call that also a pro-inflammatory state. We'll get into the nitty-gritties. Because whenever we have any kind of injury, brain or otherwise, right, our body shows up and tries to help solve the problem. 10:30 Right? Maybe that's about scar tissue, that's about inflammation, it's bringing about fluid or white blood cells to the area to try to heal. 10:39 Like, there's all these things our body tries to do in the case of an injury. What often becomes problematic is when the body can't move from that initial stage of acute injury inflammation. 10:53 And we move into a chronic inflammatory state. And, or possibly, into this chronic stress state, where the body's always kind of on edge, because it still feels like it's stuck in this moment of injury and hasn't moved beyond that. 11:12 Where sometimes you might feel that also emotionally, where we're stuck in this high alert stage. I find a classic symptom of that is where you make that quick turn. Did I see something? I thought I saw something out of the corner of my eye. It was nothing. It was nothing. 11:30 I know when I first moved into my house, we had mice in the house. And for four months afterwards, after we got rid of all the mice, I still like, Did I see something? Did I see a mouse? There was a part of me that was still in this high alert from the stress of the mice and moving into my first home and the renos and all the things. 11:51 I'm not saying you're seeing invisible mice, but that's just a classic sign of this being on high alert aspect. And so because of that, our typical goals of concussion treatment are around reducing inflammation, increasing your neurons' growth abilities, reducing any oxidant stress that's on the brain , but also to stimulate BDNF. So BDNF is called, it will, it's brain-derived neurotropic factor, so it's basically like brain fertilizer. We know that exercise in general increases BDNF. It's one of the beautiful side effects of exercise, and why people who exercise regularly, their brains work better in old age. 12:43 So we're starting to incorporate this, this information into our concussion recovery protocols, where we're looking at low levels of steady state exercise. Now then of course follow up with your healthcare provider who's overseeing your concussion recovery protocol, because different amounts of low level steady state exercise can mean different things, based on your underlying sport level training level, but also in terms of how your body recovers in stress. And that's where wearables can be really handy, whether that's your, or a ring, your whoop, your Apple Watch, your Fitbit, your garment, whatever the thing, because if the thing measures broadly recovery body battery body energy, they all have different names that can help you gauge how well are you recovering based on all of the things that you're doing. So if you do have those wearables, you can use those and not simply use the, oh, does my head hurt again around this low level steady state exercise, but that's the logic there is we're using low level exercise to stimulate our natural ability to make BDMF that brain fertilizer. But I really want to highlight when we're looking at the goals of concussion treatment is what was the state of your health before this brain injury. 14:25 So what was the state of your health before? And that's often overlooked. When we look at the bigger picture around concussion and brain health here, so I'm tying in the hydration is what, what have we done to our brains? And it's a tricky thing to study. However, we're seeing two kind of bigger pieces I want to highlight for you. One is around digestive dysfunction or gut symptoms. And the other one's around hormones and a variety of hormones. So you want to take a look or have a better assessed that gut piece because it's not uncommon after having a concussion that the gut starts, I'll say misbehaving. All right, so digestive dysfunction can look like reflux or heartburn, bloating nausea, poop changes, cramps around poops. People will say they're, I just don't digest my foods the same. So take a look like where those gut things there before the concussion or could they have possibly been triggered by the concussion. 15:52 The other one is around hormones because we know that concussions and again traumatic brain injuries can exacerbate pituitary deficiencies and instigate many hormone deficiencies. Our pituitary gland is in our skull and it's part of one of our kind of master glands that sends out a variety of hormones to the rest of the body to either do stuff or to tell other glands to turn on and do stuff. That's why it's the master hormone or the master gland. And we know that concussions can exacerbate pituitary deficiencies that already exist but can potentially also trigger some and we see that in terms of hormone deficiencies. And we tend as humans to often look at the most immediate area of a problem. We don't always do a great job of looking multiple steps upstream. We tend to look at what was right there. Oup, PMS, let's look at your ovaries. Let's look at your uterus. 17:07 Let's look right there. We don't always ask the question of, yeah, but who or what hormones are sending the messages to the ovaries or to the uterus? Or that upstream piece. And because men and women can show concussion symptoms differently, you know where I'm going with this, and you combine that with not enough research on women specifically, maybe sometimes you're being overlooked or kind of shrugged in terms of when we have some of these hormone related concerns. Because women may present with more drowsiness, more sensitivity to noise compared to men. But I mean drowsiness, right? That could be due to so many things. Oh, well, you're a busy mom. You're a busy woman playing sports, training hard. 18:07 You have a job. Like of course you're going to feel drowsy or sleepy or tired or low energy, whatever you want to call it. Again, could it be related to that brain injury? Because it's not always obvious to us or to people that were our medical professionals. So let's look at these pituitary potential deficiencies. So the pituitary gland, like I said, is in the skull. Right? You have this brain injury. The skull is moving around and the pituitary gland can suffer. It makes a variety of hormones. Phyroid stimulating hormone, TSH. Hypothyroid stuff. It makes prolactin. That is more familiar with breastfeeding, but also affects fertility. It makes FSH and LH. Two major hormones when we're talking about the menstrual cycle. And it makes ACTH, which then tells the adrenal glands to stimulate cortisol. Hmm. Are we getting so caught up in talking about cortisol estrogen progesterone? Not always, where did this stuff come from? Who triggered these things? And these pituitary hormone issues can be vast, right? Because you could have some cortisol concerns as well as some PMS, menstrual concerns. Maybe we'd treat those separately, but are we looking at, is there a pituitary gland issue? 19:41 That's part of this story. All right, this gland is just in this perpetual stress response. That's also why we see those gut issues. Because the vagus nerve, the biggest nerve of the parasympathetic rest digest have sex recovery system, it's turned off when we're in that stress mode. So if you turn off your rest digest, have sex and recover, guess what? You're gonna probably see some gut issues. 20:15 Maybe some nutritional deficiencies. Right? Maybe that drowsiness, that's sleeplessness, sleep issues, fatigue. And it's interesting because when I was getting my information together to speak to you on this topic, the very first thing on my Google search said menstrual cycles do not affect concussion. And I was like, I disagree. You scroll down a little bit further on that Google page and you see all sorts of studies. And I said, yeah, yeah, they are related. Oh, Dr. Google. We do know through multiple studies that menstrual cycle disruptions are not uncommon in post concussions. What could that mean? That could look like heavier flow, more painful periods, irregular periods. In fact, in one particular study of over 100 women, it's not a huge study, but still show that 68% of the post concussion women had irregular periods, along some mental health changes in the two to three months after having the concussion. So take notes. Again, a lot of these studies are on teenagers. If that one was done on adult women, but one particular study on teens showed 23% of teenagers had abnormal cycles, surely after having a concussion. Another one looked at, this one showed 12%. So we've got these different percentages. Again, I think we need more studies. 21:56 We need to look at a broader range of age. What's interesting about one particular study, a very small study, though done in 2019, where they looked at phase of menstrual cycle. Does phase of menstrual cycle affect concussion risks, recoveries, etc.? And I know that many groups in Australia, including the Australian Institute for Sport, are investigating this even further. So I suspect we'll see more coming out of them in the next couple of years. But right now, we're seeing preliminary suggestion that in the late-luteal phase, so that week before our period, and the first two days of our period, this study showed those nine days, that about two-thirds of the people who had concussions had them within that phase of their menstrual cycle. Should we stop playing sports the week before our period? No. But we need to be aware that our risk may be increased in that week before our period. I think what's interesting as well is that in that week before our period, that late-luteal phase, our hydration needs actually change, actually increase. Worse is that we don't feel quite as thirsty. So we need more water and we have less thirst. That is a tough, tough combo. 23:30 So we have to remind ourselves using our brains, I have to drink water, even though I'm not feeling as thirsty. So maybe that's part of why we're seeing more concussions in there, is maybe the hydration or the dehydration aspect. Again, this was an early preliminary study, just released just over three years ago now. So hopefully we'll see more information coming out there. But menstrual cycle disruptions is not an uncommon side effect of concussions. And it can happen right after the concussion or the first few months actor. Or sometimes it sort of happens like you have a couple of period cycles that are normal and then they start getting bit disrupted. You know, potentially years later we're seeing like women will say that just these PMS. Like I've had this bad PMS and then we ask ourselves, okay, well when did it really start? And what's worse is we're not great at taking notes about these things. Well, I don't know exactly when when would tend to my brother that PMS kick in on trying to, where was I living with job did I have? 24:34 We're never good at remembering these things. Humans just aren't. We're going to remember what happened yesterday, but not great at happening what happened a year ago, let alone the details around that. And in in chronic concussion syndrome, we know that 15% of those people have low gonadal hormone, you know, it's like your estrogen progesterone testosterone 15% of people with chronic concussion syndrome have low hormones of that nature. So absolutely we have to look at this, right? 25:08 Absolutely. And it can be difficult, it can be very diff…