How BDNF and high-intensity exercise drive targeted neuroplasticity

This is session number 45 of the Performance Place Sports Care Podcast. It's fishing time, y'all. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Okay, before we go into the show, just like we did last week, this is actually the day before the end of my Kickstarter campaign. And if you don't know what Kickstarter is, it is mainly a trial period, an uncreated product that I put on there. And the product is the 4-Step Healthy Back System.

I've been working on it for actually a couple months now, and I thought, you know what, boom, I should probably validate the idea. I should make sure that everybody wants what I'm going to create before I create it fully. So what I'm looking to do is actually create something that's a really quick daily ritual you can do every single day that doesn't take any more than 10 minutes of your time. Ideally, I'll probably make it six minutes of your time. And it's going to make it so our backs are really, really healthy, so we're not avoiding activities such as deadlifting, running, baseball, pickup basketball, picking up kids.

You know, these are the things that I think everybody should be able to do because that is life. We might as well get really, really good at these movements. And so I wanted to create a product or a system like this. And what it's going to be is an exercise library, a worksheet to get over all the, we call them ya-butts. So when someone says, well, I want to get a healthy back, but, you know, ya-butt, they always have these ya-butts, which are barriers to their success. So I'm trying to mitigate those risks for everybody. And I'm also going to have an e-book, which has a lot of education in it.

So that is, this is the last, it's going to end tomorrow on 27th. I don't know what time, I forget what time, but go on there right now, go to the show notes. So p2sportscare.com slash podcast. I'll put a link right there to get to the Kickstarter. You just have to pre-buy it basically. And I can't stress it enough. I don't want the support of people just to be nice. And I'm really, really grateful for people wanting to do that because I have had a lot of people who have already tried to do that with this product. And it's great. And thank you for supporting me. But realistically, this is a test to see if anyone will use it.

If you'll use it, your friend, your wife, your husband, your teammate. These are what I'm looking, this is what I'm looking to create. Something that somebody will actually use, not just a novelty to put on their bookshelf. So that is the pitch. Go to Kickstarter today, go to the show notes, and it'll take you right there. Let's get on with the show. Hey, everyone. It's Dr. Sebastian Gonzales with Performance Play Sports Care. Again, we have, I think, a really, really good podcast. And I venture to say I told my guest before we actually recorded this that I think it's going to be the best one we've had so far.

And we're up to around the mid-40s now. And I was actually introduced to Dr. Michael Lovitch by Dr. Eric Ries, which we spoke with on session 42 about concussions and basically new brain software or what we call neurology. So what I wanted to speak with Dr. Lovitch about was let's break down that process a little bit further. And I will have Dr. Ries back on again, and we'll probably go back and forth on this concept, on these concepts. But what we're going to go down through here is basically the idea that how your brain is speaking to your muscles, your tendons, and all the rest of your body and how the software of the brain really dictates function.

Okay. I'm going to say that again. So we have a computer, then the software, if the software is corrupt, then we can't do anything on the keyboard. It has nothing to do with the keyboard or if it's plugged in or not plugged in. It just has to do whether they're communicating or working or they're syncing up well. So Dr. Michael Lovitch is actually someone that, again, I met through Dr. Ries. And when I spoke with him, like in person, we had a really, really good conversation and we flowed back and forth really well. And then we started getting deep into the terminology of functional neurology.

And I told him, as we were talking about what we're going to speak about on this podcast, and I was like, well, you know, we better break some of these things down. And if you listen to session 42 again, I stopped him really quickly and I said, okay, explain neuroplasticity. Explain these terms because these are ones that actually, I mean, I venture to say a lot of sports chiropractors, a lot of physical therapists, a lot of massage therapists, a lot of doctors don't really remember from school. And we did go through neurology classes, but not to the degree that someone like Dr. Lovitch has. So I asked him to make this a very simple one, as simple as we can make these complex ideas and break it down for us.

Because really how, again, the software dictates the function of the entire computer. So the topic we're going into today is how BDNF and exercise creates targeted neuroplasticity. So again, I'll say it again and I'll break these down. So BDNF and exercise creates targeted neuroplasticity. And he will go into all this as well, but just to make sure you guys don't shut off already and realize that we will go into each term. So BDNF is basically brain-derived neurotrophic factor. And neuroplasticity is the brain's ability to basically change in response to an external stimulus. And this could be good, it could be bad, and so on.

So without further ado, let's go in and hear what Dr. Michael Lovitch has to say. And we'll try to make this as simple as we can, but I think you guys are going to get a lot, a lot out of it. Because these are conversations you might not get when you go to the doctor's PTs. And certainly you won't get them, a lot of them, when you're searching on the internet and everything. Because even, actually, I'm even going to ask him if we can post some of these notes. Or he can write a little something for us. Because it's something you're going to want to dive into a couple times to really understand.

So without further ado, Dr. Michael Lovitch. And here he is, everybody. We are talking with Dr. Michael Lovitch right now. And I want you to tell us a little bit about yourself and kind of how you got started on this path of neurology and functional neurology. And tell me why it all makes sense to you. Yeah, thanks for having me on here. Yeah, no problem. I'm a board-certified chiropractor. I'm also a board-certified chiropractic functional neurologist. I have a CCSP, so a certified chiropractic sports physician. Let me tell you a little bit about how I got to where I am. I was working my way through the chiropractic curriculum and felt like some of the lines used to connect the dots may have been a bit zealous.

I felt like there was something missing. I loved neuroanatomy and neurophysiology while I was going through it. And I was working with Dr. Rich Gillette, who unfortunately retired the year that I had that class. So my only experience with him was in neuroanatomy lab, but we were talking about part of the brain in the front, the bottom of the frontal lobe called the orbital frontal cortex, and how research showed that negative emotions are associated with that area. And then how the prefrontal cortex, which is above that, like forehead level straight back, is sometimes associated with positive emotions.

And I asked him, why couldn't we just activate one area and inhibit the other? And he slightly, definitely can see that there was some history going on there. But he mentioned that there was a group of people out there who were doing just that. And through that small lead, I found the clinical neuroscience program at the Carrick Institute. And I ended up finding a local doctor, Dr. Glenn Zielinski in Lake Oswego, Oregon, who teaches for that program and figured the best way to learn would be a patient. And what was your so did you what did you give him like a whole bunch of like real symptoms when he went in or did you go for fake ones?

So personally, I actually so I fell on my head when I was four years old. If you have a conversation or get to know me, you'll probably be like, yeah, this kid definitely fell on his head. And when when I so I mean, four years old, I fell on my head five years old. I was diagnosed with AAD and I was medicated by five and a half. And I'd been on that medication all my life. And this was I maybe and then 22 years later, I I was like, oh, OK, well, now I'm learning this stuff. And according to some of my reading, this can help with AAD, ADHD. So I went in and I was like, all right, I'm coming in for this.

The funny part was I didn't even connect those dots when I was there. I was like IADD. And during my initial evaluation, he looks at me point blank. And he's got a personality that that I can't replicate a matter of how hard I try. And but the way he said he was like, sure, you didn't have a concussion, dude. And I was like, I know I never had a concussion. He didn't get like two inches from your face and try to get like the truth out of you. No, but I mean, if you ever meet him, that that look he gives, it doesn't need to be too much from your face. He could be on the other side of the street, but you're like, yeah, I don't know.

You question all reality when he asks you a second time? Yeah, you can. He definitely makes a question of reality when you when you start hearing some of the some of the things he puts together. But so what ended up happening is I skeptically went away as a patient. So I was like, you know what, let's see what happens. If nothing happens, whatever, he takes my insurance. And I ended up seeing results that allowed me to function without my ADD medications for the first time in 22 years. And all my grades went up 10 points, which was pretty awesome. And it was a great unexpected experience. I figured that learning about functional neurology and brain chemistry was something I couldn't afford to miss out on.

There was that was the missing piece of the puzzle that everybody was saying was there, but didn't really explain it. Well enough. So they didn't go through that much at school like they didn't go this deep in school like so most chiros and PTs will probably won't get this education talking about. Right. So to be honest, I would say the first half of the program you get most of the first half of the neurology graduate program that I did, you get most of it in your classes. We had a great professor at University of Western States, Dr. Schull, and his notes, everything was in there. It was amazing.

However, we just didn't apply it the same way. We didn't apply it to the nerve. We didn't apply central nervous system to peripheral nervous system. We didn't put all these things together in a way that you can actually observe it in a patient. You just said, hey, this is what it looks like if you do your neuros, and I would call it a neuroscreen at this point. When you do your neuro exam, these are things, these are what it's called, but how does it affect your treatment? More on that later. So the – but here's the thing. Just the knowledge base to learn this stuff is rigorous and intense, let alone the clinical applications and actually recognizing the subtleties that you see in clinical practice.

There are so many pathways and loops that it's understandable why people don't want to learn it. Like in school, they asked me to start the neurology club, or fellow students did. And I tried. I taught what I could, but most of the students are like, I like it. I think it's useful, but I think I'm going to focus on the musculoskeletal system or something like that. Or they would do some sort of rehab-based specialty and just claim they're treating the neurology. Well, in essence, they are. I mean, I'm one of those people who I'm always looking to see how I can fine-tune what I'm currently doing and make it even more effective the next day.

And anyway, currently I'm a board-certified chiropractic functional neurologist with a master's in sports medicine at my Boston-based clinic, Delta S Performance Functional Neurology and Sports Medicine. I work with neurologically-based pathophysiology, like post-concussion syndrome and vertigo, where I use neurorehabilitation in the form of a complex combination of visual, vestibular, and proprioceptive rehabilitation. Yeah, that's a lot right there. Yeah. I mean, the whole thing is we're trying to target brain pathways and structures to improve functionality. It's a little bit of a mouthful, right?

Yeah. So let me ask you this because I know that probably after everyone's listened to that, they're like, how does this apply to me? You know, like they might say, well, how does this apply to an ACL injury? How does this apply to a back injury I sustained while I was exercising or, you know, playing my sport? So how does that all apply? When you're playing a sport, you have to learn a skill. Think about when you start playing your sport versus at the end. If you take a dancer who's – a child is going to have all the connections in their brain. They're going to have a ton more neurons than an adult.

But the adult is still the better dancer, right? Mm-hmm. The idea is it's neuroplasticity. It's your brain constantly adapts to the environment that it's put in in order to get to a goal. And if you are a baseball player, you only hit right-handed. You only throw right-handed. You are going to create neurological asymmetries only – by only training that one way. But those neurological asymmetries are what makes those players great. So what I do is I try to figure out how can I make the brain grow and the brain become more efficient and effective in their goals? Mm-hmm. And that enters into something called neuroplasticity, which is a term most people have heard of.

But what exactly is it? It's actually a pretty simple concept. Mm-hmm. It's the brain's ability to change in response to an external stimulus. And this can be for better or worse. Neuroplasticity can be positive or negative. It is a combination of two processes called – one is called long-term potentiation, and the other one is called long-term depression. So when you say depression there – because earlier you said emotion too. So are we talking about like depression, like crying and upset? Are we talking about actually emotions, emotions, or are these different terms? Unfortunately, it's more of a scientific jargon term, which is as opposed to elevation depression.

You're going to be – you're going to have a decrease in amount of connectivity in the brain through long-term depression. Mm-hmm. So don't think of this as an emotional term. Got it. All right. So you went through chiropractic school. Do you remember what long-term potentiation is? You know, I actually don't. I mean, I'm not going to say I fell asleep during neurology class. I mean, but I was actually – I was a lot more interested in the musculoskeletal, like – because I'm a very visual learner. Like even like patients that come in now, like I remember that like when we had paper files, like I would – I would only remember their name if I looked at their file multiple times.

But if like whenever they say it and they say – they tell me and I say it right back, I still don't remember. And same thing goes with like things like neurology. It's like they're so small and all you get is these little pictures, you can't touch it, you know. So I guess you could touch it if you want to. But yeah, so I do remember parts of it but not all of it. So yeah, so you're – but you get the general gist of it, which is – I mean it's the more you practice specific activity, whether it's a sport or work or anything you do, writing papers. The more you practice a specific activity, the more resources and proteins are going to be put towards that pathway.

Over time, that pathway becomes more efficient or it does not – also known as it does not need as much energy to get the same activation. Now, this can be positive or negative. Yeah. There's a great book out there called Why Isn't My Brain Working by Datis Karazian. And in it, he gives a great example about negative plasticity where take a – and this can be even better or worse. I'm not pro-violent video games or anti-violent video games. And to me, it's a different topic of discussion. But he talks about if you are – if you take a kid who six hours a day, every day of the week, plays – without naming specific games, some sort of military game where you have a lot of loud noises, a lot of surprise things, a lot of flashing lights, a lot of things that put you in a sympathetic state because you're tricking your brain to think that you are in that sort of situation.

You're going to plasticize or create more connections in the systems in your brain that allow you to cope in that environment and respond to that environment. So this is the concept of – so we said long-term potentiation and depression. So this is potentiation but in the wrong direction. Exactly. Now, you can also do it in the right direction too. Like you want to be a better, quicker, faster reader. You start slow and you start reading more and more and you can do – I think there's companies out there that you can go to and they will get you to being a speed reader. But this is a potentiation.

Long-term potentiation just means that you're training your brain to act in a certain way and it's going to become better at doing that. Long-term depression, in essence, is the opposite. It's how your body prunes the neurons that aren't really in use and recycles those proteins for other functions. In other words, I mean, you can quickly say if you don't use it, you lose it. But also, it's how – I mean, you don't need to remember how to – Ride a bike? Yeah. I mean, you don't really need to remember how to ride a bike because – or all the little things you do if you never ride a bike again. So you're still going to have that memory, but it's not going to be your most efficient thing that you do.

So I know that – so I was talking actually this weekend with – he was a veteran. He was – he had – so it was a charity. It was a charity event and a veteran was there and they were talking about PTSD. And you made me think of it because you're talking about the video game thing. So if we have long-term potentiation or growth of neuropathways in a certain – to adapt to a certain situation, would this then be – if you're just not exposed anymore, say the kid just doesn't play the video games anymore, does it eventually, like, come back and does it depress automatically or do you have to reverse that with some type of correction?

That's a complicated question to ask, mainly because PTSD is a very complicated situation. There are some studies out there that talk about PTSD as atrophy of the hippocampus. And from my perspective, let's say there was a person with PTSD sitting in front of me, I would probably try to use my ancillary therapies to target – I guess to target certain parts of the brain that will – I mean, we start basic. Yeah, yeah, yeah. Sorry, I think I jumped a large question because I was thinking about it. Yeah, no, it's a great question. And there's actually a paper that came out – I mean, it's a great pilot study.

I would love to see reproducibility and more and more things. It came out by Dr. Brandon Brock and Dr. Carrick about using pretty much functional neurology to work with patients with PTSD. That would be something definitely to check out. I think it's in Frontier's journal, so it's open access. Anybody can have access to it. Read that if you want a little more information about if PTSD can see some sort of benefit. Okay, I'll try to find a link on that one, and I'll put it in the notes. Sounds great. But the thing is, PTSD and long-term potentiation and long-term depression, it all has to do with what, I guess, you wanted me to come here and talk about, which is BDNS.

So we're going to actually title this one, BDNS and Exercise Creating Targeted Neuroplasticity. So explain BDNS, and we're going to go into some ways that people can potentially make it better or improve it so they can improve their conditions, right? Yeah, exactly. So BDNS is brain-derived neurotrophic factor. BDNS is also the mature factor of pro-BDNS. So this is something that's very important to know because a lot of times in the body, and I can't say for all of them, I'm not sure, but a lot of times in the body, the precursor doesn't really have an effect at the same order of magnitude as the actual mature factor.

So the interesting part about this is that pro-BDNS actually has an effect. We're going to get to that in a second, though. Let's first talk about mature BDNS. It activates something called the TREC-B receptor and is associated with long-term potentiation that now everybody knows. It promotes enlargement of dendritic spines. So when you look at a picture of the neurons, imagine a head with a long stalk going down. That long stalk is the axon. The head is the cell body. And the dendritic spines is the hair on the head. The long axon that comes down connects to the dendritic spines of the adjacent or the neuron that's close to it.

All right? So when you promote enlargement of those dendritic spines, which is the part of the nerve that receives information from other nerves, it also promotes the development of neuromuscular synapses. Synapse is something that a lot of people have heard of. It's how neurons connect to each other and communicate to each other. Now, what's cool, for better or worse, I think it's cool. ProBDNS actually acts as an independent signal molecule. So it activates something called neuronal apoptosis or the exact opposite effect of mature BDNF. It actually, instead of promoting synapses and promoting enlargement of dendritic spines, it reduces the size of dendritic spines.

It promotes the breakup of neuromuscular synapses at long-term depression. So therefore, pro-BDNF is actually turned a synaptotoxin, while mature BDNF is known as a synaptotrophin. So going back to the idea that we were kind of talking about earlier, so although it's a synaptotoxin, is this positive in some instances or always bad? Oh, it's great, because that means you aren't wasting protein on pathways that you don't use. It's how your body recycles and maintains efficiency, because efficiency is the name of the game. You don't want to waste energy. Then you get those things like chronic fatigue that are no fun at all.

Okay, makes sense. Now, most of the studies measure BDNF through the rate of activation of that TREC-B receptor. So if you decide to go and read on in the publications in scientific literature, you can safely assume that the studies are referring to the mature BDNF, not the pro-BDNF. And through the remainder of this podcast, if I refer to BDNF, please assume that I'm talking about the mature component, just to keep it simple. Just in case everyone does their own research, or we get some grad school students on the listener end? Mm-hmm, exactly. Now, BDNF is produced by the postsynaptic membrane of dendrites.

This means that BDNF is not produced by the axon coming down to connect. It's produced by those dendrites of the adjacent cell. So think about it like this. Two brain neurons sit in a salty soup. Neuron A is constantly flickering its axons out like fingers, trying to feel around the surrounding soup for BDNF. Once BDNF is released from the dendrite of neuron B, neuron A finds said BDNF. All the proteins come together in an instant to form the axon and connect these two neurons together, forming a synapse. So how long does a process like this take? Does it find it and it kind of slowly migrates towards it, or is it quickly attached?

Oh, we're about to talk on that. That's the best part. It's quick. There's actually a great video that I wish I had access to where it's just a black and white – I think it's – to be honest, I'm not even sure if it's an electron microscope or not. It's just a black and white video. And it shows the flickering of the axons. And then all of a sudden, it just strikes out like lightning. Like when you think of – when you watch like a slow-mo video of lightning, it just goes shoom right to the ground. The neuron goes shoom right into the adjacent neuron and creates a synapse. I was thinking kind of like a rattlesnake.

Yeah, like a quick bite. And it's really cool to see how fast this stuff happens. And however, just to warn you, I'm about to go off on a tangent, but I promise it's going to come back to make a great point. So what we've been talking about here is important because your body will not create BDNF just for fun. It needs a reason. There's a paper called Perot et al. 2013. It talks about the D5 receptor of dopamine being a regulator of BDNF. And this is really cool stuff, so get ready. People usually think about dopamine as a reward system. Like if you want cake, you eat cake. You get dopamine saying cake is good.

It's a reward system. They even had a joke about it on South Park. Great episode. I didn't see that one. It's the one with premium gaming. Yeah, you can look it up. I will. I'll watch it tonight. But there's some new evidence from people like Wolfram Schultz, Paul Glimcher, Steinberg et al. 2013, and Nasser et al. 2017. They all talk about dopamine not as a reward system but a form of prediction error. In other words, when you get what you're expecting, you actually get a lull in the dopamine. But when you get something that your brain is not expecting, you get a huge boost of dopamine. So in other words, dopamine is more produced when what your brain predicts will happen is wrong.

And this actually ties directly into the best ways to boost BDNF. It makes me feel like playing a lottery ticket but then assuming you're not going to win, but then you do. Exactly. So is it a mindset thing? Like if you thought you were going to win and you won, it wouldn't produce dopamine? Well, there's always – you can always bring in the limbic system or the cognitive aspect. I find that it becomes a lot more complicated because it's – that saying you can think your way to better health, which some people argue. But for me, I find it a lot simpler just to follow the neurophysiology as complicated as it is.

Yeah, it seems like a much harder way. Exactly. But when you're doing it like this, but let's just say that we look at that as a – like the lottery ticket example. You're going to buy a lottery ticket because you're expecting – because you're thinking about the what if I win. When you don't win, if you're expecting not to win, you're not going to have any change of dopamine. But if you win anything whatsoever, then you get a little reward saying, hey, I just won two bucks. And then that makes them want to do it again. Exactly, because then you're training your brain to get a huge spike. So that's – this is – I mean this is a relatively new theory that came out.

Not a hypothesis. There is evidence to support it. But it is still pretty new. I'd love to see as things progress with that to see if it continues. I'll put links in there, by the way, for – I see you should probably – you gave me a couple of references, so I'll find them too. Great. So moving back to BDNF, because I promised I would. That is the topic. You've got to stick it. Right? You actually can boost BDNF. So there's a paper, Ferris et al., 2007. I highly recommend getting this paper for everybody. It showed that BDNF levels in humans are significantly elevated in response to exercise, and the magnitude of increase is exercise intensity dependent, not time.

This means that the highest spike in BDNF production occurs after one to three minutes maximum of high-intensity exercise. Maximum. So if it goes beyond three minutes, there's less increase or elevation. Exactly. You're not getting the same rate of increase. So if you're looking to be most efficient with your time or when I'm looking to be most efficient with my time, what I would do clinically is I would preface all my brain-based therapies and exercises to induce neuroplastic change with some sort of high-intensity exercise. So you know with high-intensity if the patient is breathing too heavy to talk.

So does it matter what type of exercise or...? Not necessarily. There are some papers out there, Bekenstein et al., 2011, and soon et al., 2010. They both talked about inducing BDNF expression through spontaneous physical activity, environmental enrichment. And based on reading these papers, you can reasonably assume that you can further augment BDNF with exercise that requires you to respond to a stimulus. I'm thinking of tennis, not golf. High sprint, hit a ball for power and accuracy. Then high sprint, do it again. I would love to see a study showing if BDNF spikes during tennis matches. So it's the reaction to an object and the sprinting to it, which is the double positive on that rather than, say, golf, you're reacting to or the ball is static and you're not sprinting.

Exactly. Now, if there's ways to make this more fun, like just spitballing right now, if I wanted to do this, maybe I'll have them do sprints or do a wingate test on a bike or have them do what is it called, the chop feet, the fast feet, and then have them stop. What I would do is I would then go right into the exercise that I'm looking to improve. Got it. So you're trying to get their heart rate up some and then you go into the exercise you're trying to. Yeah, so you get that BDNF spike and then you use that BDNF to create pathways with whatever exercise you're doing. So I know that you met Richard Hanson at the symposium this year when we were talking, right?

Yes. Okay. So he actually, we were talking about, so he actually, he did a presentation later. I think you went to the training center, but he did a presentation later that he was talking about how to improve running injuries or decrease the potential running injuries based upon partially how you like, kind of like this, the sequence of exercises you give them. And the idea was to decrease neuromuscular fatigue or basically keeping correct form during the exercise that is the important one, such as single leg stance and so on, because form starts to degrade. So would that then be like the same concept where you're talking about you, you fatigue them out a little bit, but then you're trying to improve a movement pattern while you have that synaptic change?

Yes. And actually I did catch his talk and it blew my mind a couple of times because it was really, really good. It definitely made me rethink how I approach certain situations. I'd like to use actually a different example. So I was an orchestra when I was in high school and my teacher, doctor, I mean, not doctor, uh, Gordon Tedeschi. He always gave the example when he used to teach marching band that you practice the way you're supposed to do it. If you practice, like if you're a sax, uh, let's say a trumpet player and when you're practicing and everything and you have the trumpet facing down, no matter, no matter how much you mean it, when you say, no, when I'm doing it, when we're in competition, I'm going to play it right.

I'm going to hold it up. They never do that because they practice, they made muscle memory, they made, uh, they train themselves to do things in a certain way and they're training their body to react. It takes a lot more, uh, don't talk about like, uh, back stabilization to hold an instrument up versus hold an instrument down. So that's exactly it. You, you'd want to train the way you're going to perform so you can make that motion the most efficient. Yeah. It makes sense. Makes sense. Especially when you're under fatigue too. I mean, that would be, um, totally. It's much, much harder. You guys didn't sprint, you guys didn't sprint in band and then, then go into formation.

Uh, no, I wasn't in band. I was, I don't think they, uh, wasn't that a Woody Allen thing where you carry around the cello in the marching band? That's what I've learned. Did you, did you really? Yeah. That, uh, that'd be tough. I don't know. Do they have a strap for a cello? They don't have a strap for a cello. No, they don't. No, let's just say I work, I work in neuroscience now. I'm not a professional cellist. So you, you remind me like you could pay the cello though. I'm going to try to find it. The most cello like picture of you and try to put it on this podcast somewhere or put it, put it on it.

I appreciate it. Thank you. Uh-huh. Anytime. Um, so do you, do you have other ways to, to increase, uh, BDNF that, uh, you know about? Yeah. You can always support it nutritionally. So D. Nicolo et al 2013, they showed that there's an increased consumption, that increase in consumption of olive oil can elevate BDNF in the hippocampus and the olfactory bulb, which is smell. Well, your nose, but it also, but it also decreased BDNF in the frontal cortex. Thought. So, and I say, I'm assuming that's how you say it, I say it all 2015 showed a similar effect as well. So typically when I'm trying to boost BDNF, I usually recommend increased consumption of raw extra virgin olive oil, alpha linoleic acid, and green tea.

There's some research behind intermittent fasting and increasing BDNF as well. But that's generally known as very neuroprotective on its own. Neuroprotective. Explain that to me. Uh, neuroprotective means that when you do it, it supports brain health. Uh. Oh, duh. An example. Yeah. An example of intermittent fasting that, that is recommended would be every four days you do like an 18 hour fast. So you stop eating at eight o'clock the night before. You don't eat anything until two o'clock the next day. Brush your teeth, take your medications. Like that should go, that's, you still do that, but you're trying to do these mini fasts every four days.

And that helps your brain clean out the, clean out some of the garbage that's, that's been building up. I get it. I get a feeling that would be a topic of a whole different podcast. Yes. Uh, yeah. We, I'd be happy to talk about that. That's a, it's a lot of fun too. Okay. Um, also. Um, yeah, I guess intermittent fasting works. Um, I find using the, uh, the exercise actually is more effective. At least when I'm looking at my neurological, like objective markers. Yeah. I find that the exercise creates from what I'm assuming, I mean, there's no way to prove it without some pretty expensive equipment and blood labs.

Uh, but I'm assuming that, um, we're actually going to be, I'm assuming that, uh, the exercise is going to be a little more effective. Yeah. I, I, one more way, uh, with the nutrition or at nutrition and exercise, you got another way. Yeah. Social enrichment also boosts BDNF. So as hypocritical, as hypocritical as it may be to hear from a millennial, it's important to put the phone or iPad down and have a face-to-face conversation with other people as often as possible. So I think we could, I think we can set up, there'll be a social group like meetup.com where you're just eating olive oil and sprinting between it.

I think it's going to be great. I think that's called CrossFit. Yeah, you're right. Nothing, nothing has CrossFit. I actually think it's great, but that was a joke. No, no, it's, I think it's good. I actually, I mean, I've, I've noticed that like, um, actually some of the people I have come in for, for rehab here, um, when we do it one-on-one, like, so if I'm like, cause a lot of times during the day, like if there's already a one-on-one person earlier, I'll do it with them. Cause I kind of want to do like, if, if, especially if like what I prescribe for them, like if I think it's gonna be helpful to me, I just do it.

Cause why not just get it done? Um, but then later on, I don't want to really do it twice. So that second person, if there's another one-on-one person, I don't feel like they get as much out of it as if there's someone else in the building doing it too, or if I'm doing it with them. So, oh, totally. It could be a little bit of competition. It could be mirror neurons. It could be a ton of things. And, but anyway, it really does help out when there's somebody else doing it with you. Yeah. I think there, I don't remember if I was listening to a podcast or I was do, uh, it was on one of them, but they were talking about how depressed people are with, uh, not neurological depression, but like how antisocial they are with, although there's so many validation styles of like social media out there now, it's just not the same.

You know, you need to be able to visualize other people. You got to use more senses than just cognitively knowing who you're talking to. Yeah. I would imagine it's always like a one way, just one way conversation, you know, kind of like email. Yeah. But you'll see that in people with a decrease in BDNF too. Um, it's, I'm just going to disclaimer right now. It is definitely outside of my scope to talk about psychiatric conditions. So unfortunately I will not be able to comment much on those, but there are some studies that link a decrease in low BDNF with, depression, schizophrenia, bipolar disorders, and autism.

There's also a high link between, there's also a link between high BDNF and epilepsy. Okay. I think they should, so we should get them to exercise then if they theoretically have that. So, I mean, you can always say exercise is the answer. I like to say, how can we find two things? Because sometimes when you have other things going on, exercise feels like a chore and it shouldn't be. And there, that actually may be why, that's actually why I brought up the dopamine before, because there are some things about if you have decreased dopamine going on that you actually have decreased motivation and you're not able to actually get up and exercise, even if you know what's good for you, even if you have time, you'd rather sit there for 30 minutes because you just can't get yourself up and go.

So, it's a little more complicated than you need exercise. Yeah, yeah. It's definitely other motivation and psychological factors. Oh, totally. So, is there any other, is there ways actually to identify, I know we talked a little about blood tests, but is there ways that someone that's listening to the podcast says, I don't know if I have decreased BDNF, like how do I know? And how do I know the doctor's testing me for this stuff? So, there are ways to measure serum BDNF using a blood test. Well, Polacini et al. 2015 specifically recommends the biosensus kit as the most reproducible, with the ability to measure both pro-BDNF and mature BDNF.

However, the overall reproducibility is still poor, so however important BDNF may potentially be as a biomarker, the variability from minute to minute may actually prevent us from getting real clinical use out of measuring it at this point in time. That being said, there's still no substitute for a properly performed neurological evaluation. So, how do we know? Go ahead, go ahead. I don't want to interrupt you. You're flowing. Yeah, thank you. Most important is to have keen observation skills. You can memorize a textbook, but if you can't recognize things as they happen when they're in front of you, that may be counterproductive.

So, is there certain, at least three, four tests that you would at least baseline? I know you said that, like, in school you learned mainly a screen, now you call it. Is there a couple tests you start with and then kind of tangent from there? Yeah. So, when I do my neuro exam, it's pretty in-depth and rigorous, and so my new patient evaluations are 90 minutes. But when you're, let's say you're doing this, you can, I would look at cerebellar coordination tests, like rapid alternating movements, finger-to-nose is a good one. Romburg test is a great one because it integrates, even though clinically it's for dorsal column systems, which means you're trying to see if they have proprioception coming from their legs.

When you throw them on a foam pad and look for just sway patterns, you can actually determine the functionality of their cerebellum and their vestibular systems as well. So, it's, so I like using those as tests, as neurological tests to see if I'm improving neurological function. Again, BDNF isn't really something that I look at where I can measure it and say, my goal is to increase BDNF. My goal is to do things that support BDNF while I increase neurological function. So, just to bring it back again to make sure that we're, that everyone's kind of understanding the pathway. So, the point of increasing BDNF is in relationship to a peripheral injury like a knee or a hip or an ankle.

Just recap that real fast. So, let's say you roll your ankle. And you have a decreased proprioception in your ankle now, so it stiffens up. So, what you want to do is you want to increase BDNF in your brain, so that way you can appropriately remap the ankle and rehab it to a point where it's back to full function. On some level, we're talking about shades of gray, of course, but on some level, this is happening whether or not you do all these little things I said. Because your brain is constantly producing BDNF and producing pro-BDNF to balance it out and seesaw back and forth. But if you were, let's say, if I had a sprained ankle sitting in front of me, what I'd probably do is once we start doing just general range of motion stuff, once we get back to the actual sports-specific conditioning, I'd probably do that high-intensity exercise for two minutes, and then I'd have them follow up with some sort of ankle-specific proprioception.

Got it. So, just to brainstorm a little bit more, too. So, say we have that ankle as well, because there's probably people listening. They're like, well, I got an ankle sprain. I can't run. I cannot do that high-intensity thing. I can't jump and so on. So, just to clarify again, it doesn't matter what will increase the heart rate. It just has to increase, right? Yeah. You need to get a high-intensity exercise. You know it's high-intensity if they can't talk. Got it. So, it may be a little harder if they can't run, if their ankle hurts. If you've got a pool, you can have them sprint in a pool. If you have maybe just a ton of push-ups.

Yeah. Just something where they're working so hard that they can't carry a conversation, let alone put a couple words together. I was thinking before, and I never followed up on this idea, but you know how when you get scared, your heart rate increases? Mm-hmm. Or you hold your breath, your heart rate will increase as well? Like, so, could you almost psychologically scare, like, not even, like, make them do anything, but get them to the point where they have a really high heart rate in that manner, and then you do it, and then you do the ankle-specific, in theory. So, you keep coming back to heart rate.

It's not a heart rate thing. Okay. It's the physiological effect of high-intensity exercise. It's not that heart rate, when that goes up, that you get increased BDNF. It's that when you start requiring metabolic, when you start increasing your metabolic demand from high-intensity exercise, besides your heart rate going up, you also have BDNF going up. Got it. So, there's other parts to it. Yes. So, you can't just hold your breath, and you can't just target on, okay, I've got to get the heart rate up. The idea is you've got to do something high-intensity where they are 100% focused on it, because they can't talk while doing it is another way to say that they're doing something so intense that they have to focus on it because they have to focus on it, because they have to put all their resources towards it.

Got it. Okay. I just want to make sure to clarify. I was going to have people hold their breaths all week here at the office. No, I don't recommend that. Oh, good. Well, cool. Remember, this is only for two minutes, three minutes max. One to three minutes is typically what is said. So, you can do it for one minute with a person, just get their heart rate up. I mean, I shouldn't have said that. You just get their BDN up for one minute, and that should have an effect. Yeah. Well, I always tell people, too, with, like, I know that the, like, I've had people with, like, shoulder conditions and ankles and knees.

I have a bunch of them. But let's just say with ankle, like, they, the reason why I asked the question about with, you know, they might not say they can do, like, burpees or run or sprint, and they're like, well, I can't, you know, create that high demand. I would think you can just do something like a Tabata squat, you know, and I'm like, if we're not jumping and we're not impacting the area, probably the risk of irritating that actual structural issue is really low. I mean, it could irritate a little bit, but most of the time it doesn't. So, I would probably venture to that a little bit, I guess, if in your treatment scheme.

Well, that's the best part. It's neuroscience. You're talking about inputs into a system and what the outputs look like afterwards. You can do anything as long as you're hitting the right spots. So, you have to be creative with it. Tabata squat sounds like a great way. Maybe even do, what's that called, a split squat. So, that way you get the ankle out of the picture completely, but you have to just keep pounding those squats out until they're like, okay, I need a rest. Yeah, they're going to hate all this, but it's going to be so fun to do. Kettlebell swings. That may help. That may be pretty low impact on the ankle.

Oh, you're right. Yeah, kettlebell swings would be great. You get that thing up probably within a minute. Yeah, totally. That's a ton of work. Yeah, I got to stop saying getting the heart rate up. Yeah, right? It's tough because you're trained to think peripherally. Everybody's trained to think peripherally and just completely ignore the central nervous system, which I would argue is most of it. Yeah. Well, we were talking before with the, like before we actually started the podcast that so, I mean, I came from the standpoint of when I first started, we treated very structurally. So, in the analogy of the ankle, we would assume that, and this is years and years ago I started this way, but like we'd say, oh, well, you hit a pothole.

You turned it. Okay, so there's a ligament tear. We have to stabilize it for X amount of time. Then we have to work on the scar tissue. Then we have to improve the function of the muscles around it. And, you know, we really came from that point of view that the structure was just unlucky. And after that, you just have to fix the structure or stabilize it or whatever. And I remember I was telling you about the concept of, so when I was first starting to, we had the concept of glute amnesia where you just didn't have the glutes working for X, Y, and Z reasons. But we didn't really question the reason why, you know, higher up into the brain or into the neuropathway, how we can actually improve that.

It was more of just, if you use it, it'll come back. Exactly. But, yeah, so that was our thinking process. And I like this one much better because rather than just thinking that, oh, that's too bad. You got glute amnesia. You know, it's just more like this gives you a little bit more power of things that you actually can't do. Exactly. Now, I had a great conversation, a local doctor up here, Dr. Thomas Michaud, who actually wrote the book on ankle issues that I think a lot of PT schools and chiropractic schools, it's called Human Locomotion. You've probably heard of it. We were chatting about this, and we were talking about how you can predict injuries in lower extremities using some various tests that were published in literature.

And so I broke my right knee. I have a PCL tear. And when we did this test on me, even with the injury to my knee, I still had a much better balance and proprioception on my right leg to my left. And that comes to think that maybe neurologically, I have deficits on the left side of my body, which turned out to be true. And by having left-sided deficits, I put more emphasis on the right side of my body. This is more than just being right knee dominant or right-hand dominant. But by putting more emphasis on that, that put me at more risk because I was essentially doing everything on one leg. When you talk about what my current aches and pains are right now, it's my right knee and my right shoulder.

And it's interesting to think that by not having a balanced nervous system, to grossly oversimplify it, that you can put yourself at risk for an overuse injury or a more traumatic injury like happened to me on the leg or on the arm that is better functioning. Yeah, that makes sense. That was like actually the second route that we ended up taking or that I ended up thinking it was more of like, are you overusing or loading a certain side because of a deficit on the other? But, you know, I was thinking too that actually as you were talking about exercise and BDNF and the need to stimulate that system or the BDNF to increase while you're going to repattern or improve a region.

And I was thinking about it because there's actually someone I follow on Instagram who likes to use the hashtag, not your grandmother's PT. And I started thinking about like all these clinics that the people don't sweat in rehab, you know. So, I mean, in theory, I would imagine if we're going to improve, you know, the way that you're saying, then you kind of got to sweat a little bit there, right? So, again, I don't like to be the proponent of more exercise is always better and more intense exercise is always better. But it depends on what you're targeting. Yeah. So, because I do functional neurology, it's not just, hey, you need to move more, so we're going to get you moving more.

We're going to figure out how to be as focal and as specific as possible in how we get them move more to target the areas that need to be improved. So, for that example where my left side just doesn't work as well as my right side, we're going to do left-sided biased exercises. So, that way I improve my proprioception and strength in that area. So, if I start doing squats all day, then I may not, I'm going to be doing everything bilaterally. I'm going to have everything symmetrically. I'm going to have to do single leg squats. I'm going to have to do side planks. I'm going to have to really bias things in a way that are going to activate those areas of my brain and target the structures that my neurological exam has shown made me a little bit of exercise.

Yeah. I haven't asked you before, but you haven't done any kettlebell certifications or anything, right? I have not. I think I've got to get through it. I use the example of kettlebell swings for a minute. Yeah. I can't even get through a minute of kettlebell swings. It's okay. I was going to ask you a couple of questions, but I won't venture too far down that route. But the reason why I brought it up was because, so I use kettlebells in the office here and I use a lot for unilateral loading or single-sided loads, you know, rack carries, suitcase carries. Even the other day, there was someone that came in that we did an exercise called a kettlebell arm bar.

And then he was like, is a getup okay? Is a Turkish getup okay? Yeah, sure. Do it. You know, because it's a lot of single-sided loading patterns. And I didn't know if he had used any of it at all. I have done those. I was working on a guy with a shoulder issue that he just kind of fell on it. Like, there wasn't any trauma. There wasn't anything crazy to it other than he just fell down. And so we ended up going after some vestibular issues and rehabbing the shoulder. And all the rehab I did for the shoulder was also targeting the appropriate neurological structure. So we ended up building him up from an arm bar all the way up to a Turkish getup.

But you don't even have to get that complicated. You can do things like an overhand press and just have him walk back and forth. There's some vestibular integration with unilateral strength building or unilateral cerebellar activation. So there's a lot of fun ways that you can integrate the vestibular system with the proprioceptive system and get people to a goal by targeting their training. Yeah, I like it. So many doors open right now. Yeah, right? Isn't that the cool part? I mean, again, this stuff, it took me like three years to learn what I know, and I still feel like I know nothing. I'm working through some textbooks right now that, I mean, I get through three pages every four days.

You just have to read them a couple times because they're that kind of book. Yeah, I know. Some people think, like, I'm not speaking English. I have no idea what they're saying. Yeah. It's funny. I've come to the point right now, like, not that I have tried to stop learning. I'm learning new stuff, but they're, like, I'm learning new stuff on this podcast all the time, just in talking with other providers. But there's something about, like, something I need to learn to do better is to break down the information that I know to a patient. Because if they don't understand the reasons why and they don't understand what we're doing or what's wrong with them, then I'm not really helping anybody.

So, my focal point, I'll definitely still read some articles and whatnot, but I'm trying to improve the way I translate, which is kind of the point of this podcast. What I do is I draw a ton of pictures. Stick men? Well, to be honest, yeah. I draw a brain. I draw lines and arrows, and I give it to them. Because, to be honest, you're not going to – I mean, going through a 45-minute review of findings with them and saying this is what's going on, they're not going to grasp it. They're going to understand, okay, generally he knows what's going on or he's got a decent idea of what's going on. And these exercises can improve this if this is the cause.

But when you're going through this, when you're explaining it to people, you've got to have pictures. Because otherwise, like I tried for a while to just explain things with like using my hands. But people don't grasp it. People – you yourself are a visual learner, you told me. And just think about it like let's say you didn't know what was going on. How – what is the simplest way to explain it? What is the most amount of pictures you can use that are the simplest pictures? I like thick drawings for that reason because, I mean, when I was learning – when I was going through chiropractic school, I would open up netters.

And I would look at the anatomy textbook, and there was so much detail there. That was amazing once I learned it because then I can go to it and see how everything was. When I was first learning everything, it wasn't good because I didn't – I couldn't grasp big picture versus small picture. And by drawing out individual structures of my own sketches, which are – will never be seen because they are really only legible to me. I was able to start grasping some of the basic concepts and then move into the more complex concepts. And then move from there into the real complex concepts, which then if I didn't learn it like that and didn't start slow, which is okay, I'd probably never be able to grasp some of these neurological concepts that I'm grasping now or I think I'm grasping.

Yeah, yeah. It's funny. Yeah, well, probably our perception of what we know to be true right now will probably change over the next couple of years anyways. I think it should. That means we're learning new stuff. Yeah. Well, I think – gosh, I don't know. Oh, I know one more question for you actually. And I don't know if you can answer this or not, but it's something I've been researching. And I'm actually going to put – I'm going to make a poster or a graphic for my site about parts of this. So it was on the concept of running injuries and improving running mechanics and time and so on. And it was actually based upon that lecture that we heard by Dr. Hanson.

So I took a bunch of notes on it, and he explained the – so he talked about heart rate variability. So you remember that part? Yes. Okay. So the reason why I'm asking you is because you talked about the sympathetic versus parasympathetic nervous system and basically like a recovery. Is there anything from the neurology side that you have to say about it or – because I'm still learning actually about it more, and I'm trying to break it down really easy for people. That is an incomplete graphic and article at this point because I want to make sure I get all the parts to it. So when you're talking about heart rate variability, from what I understand, the more variability you have, the more parasympathetic you are.

The less you have, the more sympathetic you are. That's correct, right? So as the more – I'm working on this. I know as heart rate decreases, variability increases. And that puts you in a more parasympathetic state, right? Yeah. So yeah, more parasympathetic. So the idea is – think about it like this. Your autonomic system really has a hand in everything, from your conscious processes to your unconscious or your subconscious processes. If your heart rate variability is high and you have a high parasympathetic state, that's good. That means that you're able to function more. So you're able to be more clear-headed as you're working on things.

If you have low heart rate variability and you're in a more sympathetic state, a lot of things that are going to be driven, without getting into all the neuroanatomy, but that will affect oxygen perfusion to your hands, feet, and brain. That will affect your digestion of nutrients and minerals because you're talking about motility of the stomach. So remember, the motility of the large intestine. So remember, the last two-thirds from the splenic flexor or the left side of your large intestine down through the sigmoid colon and out the rectum is controlled by your parasympathetic nervous system.

And if you're in a sympathetic state, you have what's called dysmotility. So you can talk about irritable bowel syndrome as a function of brain function as well, based on that. So I would say if we're talking about the autonomic nervous system, that itself is an entire new lecture or an entire new conversation. Because I would say by talking, just touching on it right now, that would just give you just enough information to be dangerous. Okay, I can agree with that. Because as you're learning, you can see how complex it is. Imagine taking it into neurotransmitters after that. Yeah, it's a whole realm that like, you know, as I started reading more into it, I know I probably should have known more a long time ago.

And as I was talking to someone else I interviewed on here, his name was Tim Fleischer. He's on a, I think about 10 episodes ago. I called him and I was like, hey, you heard about this? He's like, man, you're like five years behind, man. So easy. Oh, totally. So, yeah, I just, I never focus on that stuff of it. I feel like I shouldn't be the jack of all trades. So how would everybody reach you if they want to speak with you? So I mentioned earlier, my practice is Delta's Performance in Boston, Massachusetts, right in Brookline. But I also have another service that my friend, Dr. Mahul Parekh out in Portland, Oregon, and I have created.

It's a consulting service called NMS Consulting. It's for practitioners who feel like they may be in over their head with a patient or would like to refer, but are unsure of who to refer to. Please feel free to reach out to me at info at neurologymadesimple.com. We offer a service to assist you with neurological pathophysiology. They may still be challenging or help guide your referral to the appropriate member of the health care team. Our mission is really solely for the good of the patient. So definitely reach out to me through email. I'd be happy to talk, to talk shop, and I'm always looking to learn new things.

Oh, cool. So I guess before we close up, I want to make sure that we recap one more time since this is a really complex topic probably for a lot of people, even me. What's the reason for BDNF in regards to sports injuries? What are three things they can do today to help themselves out in the right process other than going to a doc? BDNF is something that you use and is a concept, at this point in time, is a concept that you use to help get more effective with your treatment strategy. Second question is give us three things we can do to improve our BDNF levels, just in theory. I know that everyone should go to a doc probably, but everyone's looking for an idea of, hey, this can improve.

All right. First one is anti-inflammatory diet, adding some olive oil and alpha-linoleic acid. Second one is going to be high-intensity exercise for one to three minutes, followed by whatever skill you'd like to improve on. And the third thing, get out there and socialize. Oh, I like it. That's a good recap. Well, cool. So if there's nothing else you'd like to add, I'll close up the podcast and let everyone know where all the notes are and all the links you talked about. Anything else you'd like to add? No, thank you very much for having me on. I really appreciate it. I've enjoyed my time here.

Yeah, it was a good time. I learned a lot, too. So just stay on. We'll talk right after the podcast, okay? Great. Okay, everyone, that was Dr. Michael Lavich. Again, you can reach him at info at neurologymadesimple.com. Also, I'll put all the links onto the show notes, which you can find on p2sportscare.com slash podcast. And remember, if you're listening to this on someone else's site, because a lot of times the guests do post this as a link in their site, feel free to click all the way through to iTunes or go to the show notes because on iTunes is the only spot where you can actually subscribe and get these every day.

They come out every Wednesday. And actually, I would be very, very thankful if you gave me a review and suggested another topic that you want to hear. So you can only review on iTunes and, again, suggest the topic that you want to hear because I want to be able to talk about what you guys want to hear about. So I possibly might, we'll see where this goes with it, but this topic being so complex that I spoke about with Dr. Lavich, I might see if he can write a couple of guest things onto the p2sportscare page to write things down. Because, again, a very complex topic, but I think super, super important.

And if there's any chiro students or PT students out there who want to contact him about his services, I do highly, highly suggest it because we don't get this kind of stuff in school. So, all right. So, everybody, thanks for listening, and I'll speak with you next week. Talk to you later.