Fatigue After Stroke 2: Energy crisis after stroke

Energy crisis after stroke

Anyone that has experienced a serious brain injury of some sort can vouch for the event that follows the traumatic happening. Your head and body go into lock-down. If you are lucky, and circumstances allow you are one of the happy to get away with minimal side effects after an uncomfortable first couple of weeks. For a significant portion the after-effects last to different degrees, in the form of dizziness, nausea, blurred vision, disorientation, inability to think, oversensitivity to light and sound, fatigue, and/or headaches, To name a few of the side effects.

The main cause for these phenomena is not necessary the impact itself, but the secondary effects of the impact. Researchers indicate one system in particular that has a role in most of the sequela after brain injury: Mitochondria!

Before I explain what mitochondria are and why they have so big an impact on your wellbeing after any brain injury, a quick overview of what you will learn in this article. In section 1, you will learn about an alien system called mitochondria, which are the producers of all of your energy. In section 2, you discover why this energy-producing is so vulnerable and why it can easily continue to cause problems long after the traumatic event has happened, in section 3 I will describe how most other problems that underlie long-lasting side effects after a head injury, will further impact the demise of your energy production system. And in the last part, I will disclose how this knowledge helps, first of all, to prevent this down spiraling cascade in the first place if you happen to have another head injury.

Then in the next article, we will go deeper into natural solutions to resuscitate, repair, and build up the energy production again. I understand that you would like to jump ahead to the next article to find out what you can do to, for example, feel not so tired anymore or to be able to stand light and sound better. I can promise though that sticking to reading this piece will make you understand way better what is underlying your ongoing challenges and make you even more motivated to take up the things you can do to revive your energy system.

Mitochondria, the not so human energy production systems in our cells

Simply said mitochondria are oval-shaped cell inclusions that are responsible for your energy production (when in good doing you harbor hundreds to a couple of thousand in each of your cells). So far so good. Mitochondria, which are non-human bacterial in origin, somehow down the line of evolution or creation (depending on the version you prefer), became locked into your cells as the result of a perfect symbiotic (mutually beneficial) relationship, where our cells provide the protection, food, and environment where mitochondria can thrive and we benefit by getting our energy produced. It goes even further. We are so dependent on mitochondria and the production of energy (on which most of the important cellular activities depend) that if mitochondria were to die or shut off we would immediately cease to exist. Pretty important these mitochondria are. In case you are interested how energy is produced (you most likely got this in school already but were probably not taught that the energy production takes place inside little energy factories):

Energy is made from fuel and O2, fuel in the form of glucose circulating in the bloodstream to the cell areas where it is used by the mitochondria. O2 (oxygen) and Glucose are transported into the mitochondria where they go through several chemical processes, also called oxidative phosphorylation, (In humans, this process occurs in 3 stages: (1) glycolysis, (2) Krebs cycle, also known as the citric acid cycle or transcarboxylic cycle and (3) the electron transport chain (ETC) ) to

produce CO2 (carbon dioxide) and energy in the form of ATP (Adenosine triphosphate) which is used for a variety of processes within all of your cells.

Another interesting fact(and that is what it is, not more than that) about mitochondria is that they come from your mother. Only your mother's DNA determined the quality and quantity of mitochondria you got by birth.

The next thing you have to understand is that under normal circumstances while producing ATP mitochondria will produce byproducts, which normally stay within the confines of the mitochondrion. These byproducts are Reactive Oxide Species (ROS) (such as peroxide H2O2) and reactive nitric oxide species (NOX). Normally the body also produces as a counter measure its antioxidants, of which glutathione is the most powerful. These indigenous antioxidants will under a normal balanced situation eradicate ROS and other reactive species so they cannot harm the cellular environment and mitochondria themselves. Hence: A healthy balance between energy production and antioxidant production will keep everything under control.

Now the interesting part. By now you have learned how vital mitochondria are for your survival. Logically this would mean that these cell inclusions should be pretty robust and can withstand a battering or two. Strangely enough, this is not the case. In contrast, it turns out that mitochondria because of the complexity of other tasks they fulfill (they also play an important role in a variety of other cellular task, even in the preparation of cell death) have to be very flexible and versatile, which does not go well with the biological properties of a very solid, robust and antifragile system. In other words, the energy system we so depend on is more fragile than we would like it to be. It would be a good example to compare mitochondria to canaries in a coal mine. They are the signaling system picking up clues that something is wrong in the body first.

To survive mitochondria do two main things: 1. They either produce energy or 2. They are in cell defense mode (CDM), a state in which they do not produce energy, where they repair and protect themselves.

Now we come to what happens in the case of a traumatic brain injury:

Typically any trauma from the outside to the head (like a head trauma) or in the head (such as a stroke) will produce a certain type of cellular disruption, localized or even widespread cellular death. This event will either locally disrupt energy production and make the mitochondria dump nuclear material (RNA ribonucleic acid) by opening pores in the cell wall. This will release not only messenger particles locally but also into the nearby bloodstream but also ROS and other reactive species that would otherwise be a thread to the mitochondria.

One, the traumatic event causes an imbalance in energy production byproducts (NOX and H2O2 for example) and antioxidants. The trauma leads to anaerobic and inefficient fuel production because of local damage, shutting down of other mitochondria, and disruption of normal blood flow. Two: mitochondria go into cell danger response, shutting down to protect and rebuild oneself. Three: Mitochondria release chemicals, among which RNA or DNA fragments, signaling locally and throughout the body that things are wrong and causing other areas to go into cell danger response mode as well. The result: An energy crisis! To illustrate the following; Even traumatic stress events will cause mitochondria to release these signaling messenger particles. That is how sensitive mitochondria are. Thus the impact or event itself is often not the biggest problem, the sequence of events involving your energy-producing system is.

Unfortunately, these effects can last for a long time, especially when circumstances are not optimal.

Many factors play a role in how well mitochondria recover and resume normal balanced ATP (energy) production. It is in these factors and other circumstances though that we find the possible solutions for recovery from the energy crisis that results after a brain injury.

Of course, the force and extent of the injury play a major role as well as the previous state of the brain and health of the energy production system. Research shows also a direct relation to how healthy and abundant your mitochondria are before an incident and the effect of brain injury on the energy production after. Factors as how much chronic or acute stress you were exposed to, being a smoker, heavy drinker, bad eating habits, the use of medication, gut health, systemic, heart, lung, and vascular health, exposure to toxins in the environment, all play a determining role in this. Mitochondria are extremely sensitive to all of these factors (we will take a closer look at these factors and what to do to help mitochondria to thrive again in the next blog).

Other major themes that come about after brain injury, such as brain inflammation, neurovascular uncoupling, autonomic dysfunction, actually enhance the disruption of normal mitochondrial function even further, because either there is an increase of inflammation, a disruption or inefficient fuel, or oxygen delivery, all factors that will cause mitochondria to go into CDR even further.

This is the reason why it is logical to see the crisis that comes about in the energy-producing system as the key to what happens after a traumatic head injury. The more factors are present at the time of the injury that will make energy production difficult (eg. preexisting heart or lung disease) and the more factors and mechanisms are present after the injury (eg. Brain inflammation because the immune system in the head is, and stays activated) the more difficult it will be to recover from the energy crisis. Anything that will help the mitochondria to start producing energy again (such as well-regulated physical exercise!) will help in the recovery from a brain injury.

And there is a positive side to this story about what happens to the mitochondria. Even though they are more vulnerable than we would wish they are, they can regenerate and even multiply (Mitochondria have their DNA and RNA to replicate). In contrast to popular belief (even from scientists) the number of mitochondria, their effectiveness in energy production and regeneration can increase. Not just after an accident but throughout life. This is information that is supported by a lot of recent research. There is a catch to this though, you will have to create the right circumstances and do the right things for this to happen.

Before we reveal what these things are, that can help you to recover better after a brain injury in the next blog, I will show some things that you can do immediately after, or even before preventatively, a head injury that will greatly improve the outcome and reduce the negative effects of a brain injury.

- Make sure that natural levels of Glutathione (the most powerful human antioxidant) are high at all times. Products such as Gotu Kola, L-glutamine, N-Acetyl Cysteine (the most powerful precursor of glutathione), and Alpha lipoic acid are known to raise levels of glutathione. After a head injury, you can apply generous amounts of Glutathione gel or cream on or around the spot (not on a wound of course), or just directly on the skin. Since most forms of Glutathione are not readily absorbed into the bloodstream, it is better to ingest precursors or topically apply them.

- Take loads of bioflavonoids. Bioflavonoids are free radical scavengers that can assist with cellular homeostasis, thus reducing inflammation and cell toxicity after brain injury.

Bioflavonoids can be readily found in everyday food sources, famous examples are quercetin and luteolin found in onion, apigenin found in chamomile, and catechin found in green tea.

- Also, provide the body with enough magnesium. Magnesium is tremendously important for hundreds of processes in the body. Especially at a cellular level, it plays among others a role in pain management, muscular contraction, and the energy production process. It is very abundant in nature, but also one of the first substances to disappear from your body because of its high demand. In the event of a brain injury flooding, the body with high-quality magnesium becomes mandatory. Why? One of the detrimental byproducts of brain injury is the chemical glutamate. A very powerful destructive substance that can disrupt the influx of minerals in and out of cells. Cells lose their charge and become ineffective and start to blow themselves up. This disastrous effect can be undone by having enough Magnesium in your body. Magnesium binds to so-called NMDA receptors in the cell wall and thereby prevents glutamate to bind thereby preventing a flood gate of negative after-effects.

In this article, you have learned the important role of mitochondria in the energy crisis after any brain injury. You have also seen that energy production and the demise thereof after injury are also key to what happens after the initial event. Other mechanisms, such as a disruption of blood flow, and an activated immune system in the brain can further enhance the energy crisis. In the last part, I described some preventative and curative mechanisms to mitigate or greatly reduce the detrimental immediate effect of brain injury on the mitochondria. In the sequel to this article, we will investigate what you can do to reduce and turn around the energy crisis, making more recovery after brain injury possible.

Arjan Kuipers

Diplomatic status with the American Chiropractic Neurology Board (ACNB) since 1997

Official member of the International Association for Functional Neurology (IAFNR)

DC, BSc, DACNB, FACFN, spFEAC, CPN, CPE Specialized Chiropractor

Consultant Applied Clinical Neuroscience