Episode Transcript
[00:00:00]
Jill Brook: Hello, fellow POTS patients and most appreciated people who care about POTS patients. I'm Jill Brook and today we are interviewing Dr.
Eric Reis about nutrition for brain health and healing. You may recall he spoke about spoke to us just a few weeks ago about concussions and brain injury and how they relate to dysautonomia. Dr. Reis, thank you so much for being here today.
Dr. Erik Reis: Jill, thank you for having me and having me back.
Jill Brook: Well, you were awesome and you told us so much good stuff about brain injury and concussion. And I guess just to remind people, you are a doctor of chiropractic medicine, you're board certified in chiropractic neurology, you are the Chiropractic Neurologist at the Neural Connection in Minneapolis, Minnesota.
You specialize in helping people with traumatic brain injuries and concussions and vestibular disorders. I recall you're a Certified Brain Injury Specialist through the American Brain Injury Alliance. You educate [00:01:00] other practitioners. You have so much impressive stuff, and I guess people can see your website, but I really want to let you talk but I just wanted to remind people that that's kind of who you are.
Am I missing anything else people should know about who you are?
Dr. Erik Reis: I think the easiest way to sum that up is I'm just a massive nerd and I'm completely, completely okay with that. So yes, I think you did it justice.
Jill Brook: And you've experienced concussion and brain injury in your own past. So, you know firsthand what it's like.
Dr. Erik Reis: Yeah, you know, playing contact sports has really been educational. We kind of left off our last episode with you asking a quite thought provoking question about if there would be sports that I would allow my kids to play, specifically contact sports, right? And so, you know, I had time to think about it a bit after our last recording about what sports I would let my children play, but I wouldn't let them play.
The hardest part with that is you never know when or where a concussion is going to occur. Right? So I have patients who have concussions while they were playing tennis or while they were doing things that were [00:02:00] supposed to be the lowest, lowest hanging fruit or opportunity we'll say to have a concussion.
And so it's a really difficult question to ask and really give an answer to because I learned so much playing sports, winning as a team, losing as a team, winning individually, losing individually, leadership, overcoming adversity. And so I don't know if I will have an answer to that question. I think when I'm a parent, maybe I will have a bit more of a stronger opinion, but you know, concussions to me are a bit elusive.
They're, they're a bit of an enigma because I think so many people think, Oh, that won't happen to me. Or that's never, you know, that's not my story or this isn't it. And then unfortunately they look back to their history and they're like, Oh gosh, I, you know, I guess I did have a car accident in high school that I never really felt the same after, but you know, I didn't really think too much of it.
Or oh yeah, you know, I slipped on the ice shoveling snow a couple of years ago, but you know, I didn't hit my head. So I thought that I was okay. And I can't tell you how many patients come to the clinic where now it's days, weeks, months, [00:03:00] years, sometimes decades later. And they're like, gosh, like things have changed.
It's just, it's been so slow or they didn't realize it right away and they thought everything would get better. And so, treating in this space has been interesting and educational, and I'll always come back to this, that there's a reason they call it practice, is because you're always learning what works and what doesn't, and we just really, at the end of the day, have to treat every person individually like the individual that they are, so I'm always learning just as much as my patients are.
Jill Brook: Well, and we appreciate that you are familiar with so many different ways to heal a brain, cause it sounds like you can't necessarily avoid hurting it. So being able to heal it is valuable.
Dr. Erik Reis: Yeah, well, and you only get one brain, right? So you may want to take care of it as well as you can. And, you know, for those who are listening, I think in a lot of situations, patients, unfortunately, sometimes have to go through a series of visits or providers to learn and figure out what works and what doesn't.
And my whole goal [00:04:00] and the whole goal of our, of our clinic at The Neural Connection is to accelerate the process of finding answers, helping you improve your quality of life. And the most enjoyable part about that is, in all respects, kicking people out of our office when they are doing better. That's, that's really the end goal for us is to get people in, get them assessed, get them diagnosed, get them treated, and then send them off into the world so that they can live their life.
The quality of life component is a massive aspect and I hope somebody would do that for me if I needed help and needed to kind of get my situation figured out. So I just believe that that's the best that you can use those for, for medicine.
Jill Brook: So last time we spoke, you discussed why and how brain injuries can trigger POTS or dysautonomia. And you spoke about a number of different treatment approaches that you use, but we didn't have time to go deep on nutrition. And you had kind of mentioned that that would be a good thing for us to go into because I'm guessing you see that as a major strategy for the brain healing, right?
So, yeah. [00:05:00] And if so, okay, where do we start?
Dr. Erik Reis: Yeah, that's a really good question. So maybe I'll just give a quick recap for people whether you did listen to the last episode or you didn't. When you talk about a concussion or a brain injury, a concussion really is a mild form of a traumatic brain injury. You can have, you know, moderate and more severe and we base those off of different monikers of loss of consciousness and if there's, you know, injury to the brain that can be seen on an MRI or a CT, if there's bleeding, stuff like that.
So we're really talking specifically about mild traumatic brain injury concussion. As you get up on the severity of scales, a lot of these things will apply. And what I would say is the lens that I'm looking through specifically is for concussion and mild traumatic brain injury for this discussion, which can probably be extrapolated to just general brain health, to be honest with you.
A lot of the data would support that. There isn't always like systematic or meta reviews to be able to, you know, validate that. But in some cases as well, too, it's kind of hard to run a study and say, hey, we're going to show how [00:06:00] impactful the study is. this protocol or procedure is because you can't just have some people sign up to actually get traumatic brain injuries to be the cohort that has the intervention or not, right?
So there is a limitation in this space, but as long as we understand that, then we can at least have that discussion. Just as a kind of overall view, you know, when you're suffering from a concussion or brain injury, essentially what happened is your brain, in some way, shape, or form, had some sort of injury occur to it.
I don't think that that is super surprising. But what really happens to the brain is that it twists and shears and rotates on itself. And so the analogy I used last time is kind of taking those spaghetti strands, those hard spaghetti strands, and twisting and rotating them. What happens is they break and they shear, and that's what happens to neurons.
There can be injuries to soft tissues in the cervical spine or even the upper body. And then we also have this disconnect between these different areas that communicate. So, the analogy that I give patients is, you know, getting a concussion is kind of like pouring water on my laptop. I can't exactly tell you what is going to happen or what isn't going to happen.[00:07:00]
But my goal is to take a look and see what's working and what isn't working. And then, at some point, find ways to help that patient update their software in those areas that are perceived weak or not as functional. So that's pretty much it. probably just a good place for us to start from a standpoint of neurology.
When we talk about nutrition, the caveat comes in to say, well, interesting, well, we want to use nutrients. We want to use food as a medicine, and that's always a great program to adapt and utilize. But what does that actually look like? Why does the brain How does the brain become affected by foods we eat or how does the brain benefit from the foods we eat and the supplements we take?
And there's a lot to be said about that because you know, you have a lot of neurology that's involved with digestion and regulation of basic things that you shouldn't have to think about that are actually going on in the background. So, Jill you and I sitting here together today, neither of us are thinking about regulating our blood pressure, you know.
We're not thinking about [00:08:00] regulating our heart rate. We're not processing anything with regards to our digestion or what kind of enzymes need to be secreted from our liver to digest the food that we just ate, right? Like, there's nothing really that is needed from that standpoint to, you know, process for us.
Yet after a concussion or brain injury, these lower areas of the brain that are doing their job for the most part become affected and digestion is one of them. The absorb sort of nutrients can also be affected. And this is via this kind of gut brain brain gut connection that we alluded to last time called your vagus nerve.
And that's where nutrition really comes into play is how do we actually help the brain get the nutrients it needs to repair itself? How do we help the nervous system go back to functioning at a standard state? And then what can we do you know, supportive on that side of things from structural and neurological rehabilitation to help people get back to where they used to be at?
So I hope, I just wanted to give a little caveat so people understood kind of where we're talking and kind of what we covered at least a little bit last time.[00:09:00]
Jill Brook: Well, and that's really interesting because what I think I hear you saying is that it's not the same as healing your finger because if you hurt your finger, presumably that doesn't affect your digestion, right? So you
can eat healthy to, to heal your finger, but in your brain, you have a little bit of this vicious cycle thing going on
potentially for some people, where the brain injury is making it harder to digest or absorb nutrients in the first place, which makes it a little more complicated to get the nutrition you need to heal the brain to make your digestion better to heal the brain and on and on and on.
Dr. Erik Reis: It's an interesting feedback cycle, right? So, I challenge everyone listening to this to go and try and have an in depth conversation with a cadaver that has all the muscles, all the tissues, all the organs, right? And you won't get very far. In fact, you won't be able to have a conversation because there's no intact nervous system there to help you have that feedback and actually be able to process what's being said.
And it's a bit of a cheeky analogy, but it genuinely holds true is the fact that the brain really controls everything. And it allows [00:10:00] us to be alive and to think, to navigate our world and to digest things. And so when the brain or the master controller, the computer becomes injured, then nearly everything can become affected.
And that does involve digestion and the absorption of nutrients. As a result of, like, the physical, it's shearing traumatic experience that happens to the brain, there are parts of the brain that physically become damaged, right? So cellular membranes, neurons, connections, different, you know, interactions, and neurological wiring of systems in the feedback.
Those things can become affected. More importantly too, you have a massive inflammatory cascade that occurs as well. You have alterations in neurotransmitters. There's this whole kind of glutamate excitotoxicity aspect in the literature where you essentially have these really excitatory neurotransmitters that get released and they kind of wreak havoc on neighboring neurons, which send a signal to neighboring neurons as well to be like, Hey, the brain is, kind of a bit on fire.
And so not only do you have altered communication between neurons, but you have physical damage between those neurons as well, [00:11:00] too. And they produce these inflammatory mediators like tumor necrosis factor alpha, interleukin 1 beta reactive oxygen species. And you don't need to understand what those are or what their impact is.
You just need to know that they're not necessarily good in long term chronic situations. Cause not all inflammation is bad. Acute bouts of it are important, right? So, Jill, to heal your finger, you need to have white blood cells go to the site and be able to actually bring neutrophils and macrophages in to take out and clear the damage, but then also to bring, you know, different types of cells to help you heal and repair that.
With a brain injury, it's a bit different, and the neurological wiring can become affected. Structurally, things can become affected, and then metabolically, they can also be affected, and that's why, from a treatment protocol standpoint for our clinic, we look at people structurally, we assess them neurologically, we absolutely need to understand them nutritionally and metabolically.
And it's not because we want to, it's really because I feel as though we have to. Because we don't get to see people for their first visit after an injury, sometimes we're their 10th doctor they've seen. I talked to a woman months ago. I was her [00:12:00] 26th doctor she's seen. That is way too many providers to be seen before she gets answers, and so we really have to challenge the thinking of this space, and that's why nutrition is a relevant component to this.
Jill Brook: Okay, yeah, and I get it that nutrition is something you probably are doing as part of a bigger plan and approaching this from numerous sides at once, but if we were just to go deep on the nutrition, okay, so, like, what are some of the big first things that you would either look for or have somebody do.
Dr. Erik Reis: What I usually like to do, I love data. I think data is important. I really enjoy the NASA quote, like, in God we trust, all others bring data, right? And that got them in trouble with the Challenger, you know, crash and things like that. But I really think data is important because it allows me as a provider to track things and track progress.
It allows me to educate patients and empower them, and then a lot of patients want to see their data as well too. But it really gives me a [00:13:00] chance to kind of start at ground zero and take a basic inventory of what's going on. So I love running labs. I think labs are important. You know, people can run labs through our office or they bring in labs from other providers.
I really don't care where the labs come from or where they're ran. I care what they tell me and what they can inform me. So labs are a great place to start. And those can be you know, serum blood tests. They can be different labs that can be like, we'll even look at stool samples, right? So there are labs that can tell us about the gut microbiome and the health of the bacteria living in your intestinal tract.
There are a lot of different labs to assess, like a Dutch test, which is a really in depth test to look at hormones and hormonal metabolites. I like data because it can give me a great place to start and a great place to assess progress. So I usually start with that. If patients are coming in and let's say they can't afford it, or they don't want to do that, or they're like, listen, I just want to get started, then we take those resources and hopefully we apply them to dietary and lifestyle changes.
So with that being said, you know, the question always comes up like, what should we be eating [00:14:00] or what should we be supplementing with in order to, you know, improve our brain and improve our neurological function overall? And I'm a massive advocate of getting as much of your nutrition from whole foods as possible, right?
So if it was alive at some point, you know, I would prefer to have you eat it than have it be something that's shelf stable for days, weeks, months, years. I think that's a pretty good question. easy thing to take to the bank. For those who have modified food diets, like if you're vegan or if you're vegetarian, those are obviously different conversations to have, but they all kind of range through overall from the standpoint of what the literature shows about relatively healthy eating habits.
So I'm a big fan of that, but there are some really well researched supplements that can be very impactful for brain health, and I'm happy to run through those for people if they have an interest or if that's something that you would like to cover, Jill.
Jill Brook: Yeah, definitely.
Dr. Erik Reis: Sure. I hope to give you some good things to digest.
So first and foremost, just with any caveat of this, right? So I'm obviously not anyone's doctor on this call. And so this is just educational information for sure. Before anybody [00:15:00] starts a new program or protocol, obviously you should have a conversation with your healthcare provider or primary care physician.
But once they're past that and they kind of have an idea of what they're looking for, then there are some really interesting molecules out there. So I think the first one that is kind of pretty high on my list at this point that hasn't always been very high on my list is creatine monohydrate. So creatine, statistically speaking, has really been viewed by a lot of people like in the bodybuilding or like exercise space as this molecule that can help you like lift more weights and put on mass.
And while that is true and it's really well researched, really well established, and very safe, what we're also finding out is that creatine can actually be very beneficial for cognitive health and brain health. So, as far as like dosing is concerned, most people on average should be consuming about five grams of creatine monohydrate per day.
That's a pretty standard dose for most supplements out on the market today. Some of the literature for the cognitive and brain health [00:16:00] benefits can actually have dosing anywhere up for like 15 to 20 grams per day. Now that's quite difficult to get from a dietary perspective because that will come from meats and fish and, you know, things along those lines.
Anything that really has a hard protein base, but mostly if it's from muscle, right? Because creatine is stored in muscle. So you're talking, you know, about a lot of beef or meat based products. If you're a vegan or vegetarian, you're probably not getting much creatine, and so supplementation would really be ideal in that situation.
The only caveat you have to consider is that in some research and on some we'll say just self reporting, like, outcomes, some people do have digestive or indigestion problems creatine. I've never personally experienced that, but I also haven't been dosing at 20 grams per day for days, weeks, months.
So that's something that people need to watch for. But creatine is something that is becoming quite prominent and there's a lot of interesting research coming out supporting the use of creatine [00:17:00] before head injuries or before preventative, you know, measures and during or even after an injury as well.
And whether that's with a concussion or even a POTS patient or somebody just looking to optimize their brain health in general, creatine would be something that would be on the top of my list just because it's so beneficial for mitochondrial health and brain health and allowing you to be able to just kind of enhance energy use.
Jill Brook: Great. Fantastic.
Dr. Erik Reis: Yeah, so number two on my list is fish oil. So, I think most people when they think of fish oil, they think of you know, a rotten fish smell or they're like, gosh, are we, do we really have to take it? And so, what I'm going to tell you is that most quality fish oils will not have that rancid smell because if you do have that smell, so this is kind of a litmus test, if you have a fish oil at home and you bite into the capsule and it smells fishy, you should probably throw it out.
Unfortunately, fish oils are quite unstable, meaning that they don't have a long shelf life. You can get fish oils, from exactly what it sounds like, from fish based products. So that's [00:18:00] salmon, that's tuna, that's cod, I mean, anything that is fish based you can get fish oil from, but it's, it's really the concentrations and the doses that really makes the difference.
So, for fish oil, you know, anywhere from 2 to 2. 5 grams is shown to be very beneficial for most people. That's a combination of EPA and DHA. Now those are two different molecules that are usually put together in fish oil that both have a bit of a different benefit or property for the brain and the nervous system.
So the EPA portion is the part that you learn about for like heart health and cardiovascular health specifically because the EPA aspect is really the anti inflammatory component. And these fish oils get implanted into the cell walls that give them the flexibility and the viability or dynamicism to allow to be able to flex and move.
That's really healthy for our cells to have. The bad fats, like the trans fats or the omega 6 fats, are the ones that make our cell walls quite rigid. And as we know, right, a bouncy ball [00:19:00] is bouncy and flexible and malleable so it can bounce and absorb force. If it's rigid, it would probably shatter like a glass.
And so that's where you start running into trouble with bad fats versus good fats. And so the EPA is a really big component for the anti inflammatory and the arterial benefits. The DHA is really important for the brain because I think 10 percent of the brain is pretty healthy. DHA specifically, and most of your neurons in your central nervous system are covered by fat.
Your brain is a majority of it is fat. So that's the really important aspect of helping you to rebuild the fatty covering the myelin sheaths around your neurons. It's important for kind of rebuilding the house as I would tell my patients about what we're trying to do with therapy. So EPA and DHA are really important for people to gather.
And most of the time in a supplement form, it can come either in a capsule or you can get it in a liquid. So, you know, I love taking EPA, DHA, fish oil is a staple for me. A lot of benefits for cardiovascular health, brain health, [00:20:00] Alzheimer's, traumatic brain injury, concussion. Just in general, once again, fish oil is a really, really well researched topic and , the best part about it is that it comes, it's such a nice supplement form.
You shouldn't have any issues getting that 2 to 2. 5 grams per day. So, that's a usually a pretty low hanging fruit for me right away is to look at that omega 3 to omega 6 fatty acid ratio. I can also run a blood test to determine if somebody's ratio is off. And so we can use that as a marker to say, are you taking enough?
Are you absorbing it? And kind of move forward with care from there.
Jill Brook: Can I ask a question about that one?
So, I know a lot of us do try to get what we can from the actual food so we don't have to supplement, but for people who hate fish or who are just hearing so much about contamination in fish, is this one where you feel like as much as possible, someone should try to actually eat the salmon.
And I guess, by the way, that gets expensive by the time you have the wild salmon from [00:21:00] Alaska shipped. And aye yi yi. So is this one where the supplement seems good enough? Or how hard do we have to try to eat fish?
Dr. Erik Reis: This is a great question. There's always trade offs with everything in life, right? So, I, in an ideal world, you'd be getting fish that was wild caught and it didn't break your bank and you're able to eat it regularly to, you know, you were able to eat it on a regular basis. doing it on a frequent basis and you're able to absorb it and, take it and utilize it.
Fish oils in the supplement form are, are really important to consider from a standpoint that with any supplement that we talk about today or any supplement on the market in general, you want to make sure that it's 3rd party tested. And especially with fish oil, you want to make sure that every batch is tested for mercury, like lead, like these toxic chemicals that can be caught and found in there, because you forget that when you're looking at fish oil or larger fish, they eat smaller fish, which eat smaller fish, which, you know, can have a whole contamination kind of build up.
And the longer a [00:22:00] fish is in the ocean, the more toxins that builds up. Same for human bodies, right? The longer we're on Earth and the planet, the more toxins build up and thank goodness for fat cells because fat cells help buffer the the outside world and our arterial and intestinal tract from the inside world, which is what fat can actually be to do to be, you know, protective on that.
So you have to be careful with the supplement that you take. I am always looking for third party testing. I'm always looking for independent research studies. I'm always looking for tests that they'll do with different batches for purity and content. So you do have to be careful with fish oil. I would argue for every other supplement you're taking and putting in your body or on your body, you should have the same standards as well.
Jill Brook: Okay, perfect. Sorry, one more question. And do you know anything about the algae based fish oils where supposedly they don't have to get involved with all the mercury and other potential contaminants because they make it in a vat just directly from algae, like Nordic Naturals has one of those. And so [00:23:00] sometimes like the vegans like taking that and do you, I don't expect you to know the answer to this, but on the off chance that you do...
Dr. Erik Reis: That's a great question. So what I know about algae is that they one, from an algae standpoint, if they can do it in an artificial environment that's cleaner and safer, the argument is that there's less toxicity, right? So there's the benefit for that. There's also the discussion, too, because I was taking an algae based fish oil, Omega 3, for a while as well, too.
The question is, is there more bioavailability, more absorption for it than standard fish oil? My understanding is you actually need some B vitamins to actually absorb the EPA, DHA in fish oil. And so while you might be still be getting some of those, there's other types of free fatty acids that are beneficial for the brain.
I don't fully know the full story on that algae. What I will say is Nordic Naturals is a great company, and I thoroughly enjoy taking their products as well. Momentous has a really good fish oil that they've produced as well. And these are kind of, you know, companies that are gaining a lot of market share from a standpoint that you [00:24:00] can get them on Amazon, you can get them through providers offices, things like that.
I will only take things that I would put in my body and I will only suggest supplements that I would put in my body to my patients. So I'm usually the test dummy before I do anything for my patients as well. So those are the two that I have tried and taken and really am comfortable taking to the bank on that.
But you know, something that you get at like Costco or Target, you must be very wary and very careful. You don't know how long it's been sitting on the shelf. Like I said, your litmus test is biting into that capsule to see if it's most efficient. If it does, unfortunately, you either have to throw the whole batch out or you send it back and say you want a refund in a different product.
Jill Brook: Great. That is fabulous info. And I would just say, don't, don't cut it open indoors. Do it outdoors. Cause if it does smell bad and it gets on stuff, that smell is hard to get rid of.
Dr. Erik Reis: And you know, you're dealing with an oil, so it can stain as well too. So there's always that caveat as well. So, great questions though.
Jill Brook: Okay. Oh, that's fantastic. Okay. So, so creatine and fish oil.
Dr. Erik Reis: [00:25:00] Yep, so the other ones that I would put into that batch as well are another great one that has so many different benefits is Magnesium. So a lot of discussion about Magnesium. Magnesium itself is involved in like 600 different enzymatic processes. It's a really important cofactor for so many things for cellular signaling, brain function, allowing just membrane stability with neurons and within the brain.
Magnesium is important for like muscle cramping. There's different forms of it that can cross the blood brain barrier to affect central processes. You know, majority of people who have migraines are magnesium deficient, and majority of the world, in some way, shape, or form, is actually deficient in magnesium.
So, I simply using that as a statistic and a, an example, you can kind of say, well, magnesium is probably one of the easiest, quickest things you can do to supplement with. Now, once again, not all magnesiums are created equally, but there are different forms. So like magnesium glycinate and malate. They're great for like digestion, [00:26:00] muscle cramping, things along those lines.
Magnesium threonate is touted to cross the blood brain barrier, which is the most tightly regulated barrier in your entire brain and body. Unfortunately, that becomes compromised with a concussion and a brain injury, as does your gut barrier. And so you want to heal these barriers as quick as possible, but you still also want to get nutrients into the brain.
And so magnesium is a really important aspect for that. Naturally, you can get magnesium from like nuts and seeds. I think pumpkin seeds are like the highest concentration of magnesium. But with this, you're going to get somewhere like 400 to 800 milligrams of magnesium a day. What you need to watch out for though, is that magnesium in higher concentrations can become a laxative.
And so, when you take a look at like MiraLAX, or different types of, you know, supplements that are on the market today, Magnesium is one of the compounds in there to help increase digestion, and so, while there's touted standards for how much you should take, really at the end of the day, it's kind of up to how you experience it, and what you experience taking it.
You know, taking [00:27:00] Magnesium malate and glycinate during the day might be a good idea. Taking threonate at night to help you sleep better and calm the brain down before you go to bed might be a great protocol too. Just kind of depends on how you sleep, how you absorb it, and how you deal with it. But magnesium without a doubt is one of the quickest, simplest, and easiest things for me to suggest to patients.
Because I know that most patients will benefit from it. The hardest part about magnesium is that like 98 or like 99 percent of it is stored in bone. So I can't just run a quick blood test or do a biopsy and say, Hey, here's your magnesium profile. We can make assumptions with serum blood tests, but until proven otherwise, I think magnesium is a pretty simple thing for me to suggest to people as well.
Jill Brook: Awesome. We like simple and easy.
Dr. Erik Reis: We do, yeah. So, so we have creatine, right? So we talked about creatine. We have fish oils, which I'm a massive fan of, and I think just general brain health that will benefit anybody. We have magnesium, which is really important, really powerful. We also have just the next supplement that [00:28:00] I have on my list, which is B vitamins.
Now, there are different types of B vitamins, right? So, we don't have to go into detail with every single one of them, but B2 and B6 are important for neurons and just the neuropathies, things along those lines for neural health. But B9 B10 and B12 are really important for like the methylation of you know, different processes that go on in your body.
And homocysteine is a, is an intermediary molecule where if you have too high levels of homocysteine, they can become, you know, put you at more risk for cardiovascular events so that's a marker you want to keep within range especially. And so I usually just suggest for patients to take a B vitamin complex so it has all the B vitamins.
There's that synergistic effect for the B vitamin absorption and what's great about it is it's water soluble, so you're just going to pee out what you don't use, right? So if anyone's taken a B vitamin before and they've, you know, gone to the bathroom afterwards, they'll see that their urine [00:29:00] is probably a bright yellow color.
Well, that's a lot of those B vitamins coming out that you haven't used. And so I'm not saying that's a good thing or a bad thing, but what I'm saying is that you will most likely get more bang for your buck by taking a B complex. A lot of mechanisms for brain health, neurological health, neuronal health, some for cognitive health potentially as well too.
Research is still a bit early on that. But B vitamins are a staple and for me, you know, I've taken some genetic tests and I know that I'm a poor methylator. So, you know, I started getting gray hairs a bit earlier than everyone else my age. Like there were things that started to occur and I started looking into this thing, what's going on.
I found out that I have a MTHFR, a genetic mutation. So, you don't need to know what MTHFR means, but I will give it to those who want to know it. So it's methyl tetrahydrofolate reductase. It's an enzyme that's involved in methylation and methylation is kind of like turning a gene on and off, right? So it's kind of like a light switch.
You flick it up or you flick it down. So methylation are these [00:30:00] tags we put on the different molecules that activate them or deactivate them. And so for me, I'm, you know, trying to live a lifestyle of not trying to produce too much inflammation by eating well, sleeping well, moving well, all the things that we know we should do.
But I take B vitamins as well to support that methylation process. And I'm always looking at my homocysteine levels with labs. So, a B complex is also just a really good general idea. You can get a lot of that through things like meat, fish, poultry, dairy, you know, things along those lines. Cruciferous vegetables.
There's no you know, kind of right or wrong on that. Once again, I would prefer for you to get it through food. But if you can't, or if you feel like that's too much of a you know, burden on you, then you can go get it in the supplement form. And they're pretty easily tolerated by most people.
Jill Brook: Okay, great. Yeah. And it sounds like that's the one that if you're a vegan, you're not getting much from your diet. And so...
Dr. Erik Reis: Yeah. You know, there's, it depends on the type of vegan you are and what you're eating and what you're not eating. But I would say for a lot of those that occur [00:31:00] naturally, and if you're not eating the foods that I had mentioned previously, you can also just do a quick Google search as well to find out, you know, what is, or what isn't these foods you're going after.
You can kind of make an assumption that you're probably going to be supplementing in some way, shape, or form for vegans, and then especially for vegetarians, right? Vegetarians aren't getting much any meat at all. And so B12 is a very big limiting factor for them. They absolutely, without a doubt, should be supplementing with B12.
And then my argument is, well, why not just take all of them? Because the B12 you know, B6, kind of methylation recycling of the homocysteine is a big factor. So you may as well try and do anything that you can to support that system.
Jill Brook: Fantastic. Excellent. All right. Good stuff. Good stuff. Anything more?
Dr. Erik Reis: Well, you know, here's what I would say is, it's not just about supplementation, but like the way that you live your lifestyle and the foods you eat, right? So, we know the blueberries are a massive kind of brain food, for the lack of a better term. These anthocyanins that they have, there's, there's hundreds of them.
And they're really important for brain health, [00:32:00] cognition, memory, controlling inflammation. There's a lot of really interesting benefits from blueberries and not just blueberries, but most likely blackberries, raspberries, strawberries. So the berry family is just always a really good idea to be consuming.
And you know, what's great about berries as well too, people are talking about fruits and sugar and the, you know, the sugar that naturally is contained in there. Well, it's also wrapped in fiber and phytonutrients and vitamins and minerals. And so it's very different than like the table sugar that you're getting in like a can of soda, right?
So, you know, not all sugars are created equally, 100%, just like not all calories are. You know, there's the, the law of thermodynamics with, you know, calories in calories out, which matters, but the food component and the content matters just as much too. And so berries are a great example of like a staple.
Like I have a handful of berries every day. I also have three eggs in the morning every day for like good choline, good B vitamins, good proteins. You know, there's, there's some great ways to eat well for the brain. What I would also say too is [00:33:00] one of the biggest factors that people can really control, for the lack of a better term, is their blood sugar.
So, you know, it's no surprise that so many people these days are dealing with type 2 diabetes, which really, if you look at the literature, is quite a lifestyle disease. And it's reversible, which is really cool to think about, and should be empowering for those if you are dealing with that. And I'm not saying that it's your fault.
But at some point it does become a responsibility to try and figure out like what we actually can do to lower blood sugar levels. And I can run things like fasting glucose levels, HbA1c. I have a lot of patients that are on like continuous glucose monitors to look at that. Some of them have diabetes and some of them don't.
Well, why would people who don't have diabetes have a CGM? Well, what we're looking at is we're looking at their utilization of energy. Some of them have had concussions or head injuries, or maybe they have like an autoimmune condition. And what we're looking at is we're looking at the metabolic profile, specifically the inflammatory profile, that [00:34:00] occurs with spikes in blood sugar.
The sensitivity of insulin and how all that plays a role. Because what we're understanding now is that there are some really strong theories that, you know, Alzheimer's and dementia really is like a type 3 diabetes. And blood sugars, when they're left inside the arterial vessels, are quite reactive. And unfortunately what that means is that they can promote inflammation.
There's a reason that people have a well known neuropathy with diabetes, a diabetic neuropathy. Well, there's also a diabetic retinopathy, right? So what do you think the blood sugar is doing to those vessels? It's poking holes in those vessels, causing gradual, chronic, long term inflammatory responses. If you have a neuropathy in the most distal area away from your brain or away from your heart, we'll say in your toes and feet and fingers, and you're getting it also in the eyes.
Well, where else do you think you're going to probably get it? Probably in the cortex, probably in the brain at some point, right? So all of these things are connected. Your brain chews up a ton of energy and [00:35:00] is very, very sensitive to oxygen, blood flow, and metabolites. And so, balancing blood sugar is a big deal in my office too.
Some patients I have fasting, some patients I don't. Some patients, I'm like, hey, let's talk about getting your HbA1c and your blood sugar under control. Some are doing a great job with it. It just, it depends on the person in front of me, but that's why I like running labs and looking at nutrition and the metabolic profile is because it can give me a lot of information and it can be very informative for patients because once they see the numbers, those numbers don't lie for lack of a better term. So I'm really keen not just on brain health, but general health, because all of that plays a role and manifests in the brain in some way, shape, or form.
And that's relevant for patients with POTS, right? So looking at metabolites, looking at different types of electrolytes, looking at blood volume you know, functionality of the brain, things like that. So all that's really important...
Jill Brook: Yeah, yeah, absolutely. I've never met anybody who felt good when their blood [00:36:00] sugar was all over the place, whether they had a POTS diagnosis or any other diagnosis or not. I think everybody feels crappy when their blood sugar's on a roller coaster. So...
Dr. Erik Reis: yeah, it's a real thing. And what's beautiful about it is we're learning a lot more about it. I think there's a growing trend in people really understanding their blood glucose levels. I, you know, whenever I see somebody with a CGM, I'm always intrigued to learn why they're using it. But more importantly too, I love that they're using that data to make informed decisions.
So, I think we'll be seeing that as an emerging trend over the next couple of years. You know, most people today know their, their waist size, most people know their shoe size. What if you knew your average blood glucose levels? Or what if you knew your average HbA1c? I think people should know their vitamin D levels on a relatively often basis.
So I hope to see those trends moving forward because we can learn a lot about that.
Jill Brook: So a lot of people talk about a ketogenic diet, i. e. you know, a diet where you're primarily burning fat for fuel, not too much carbohydrate, and even the protein is limited, and [00:37:00] there is talk that that can be anti inflammatory to the brain. Do you have a lot of people who try that, and do they get good results?
Or, like, the other side of that coin that at least I hear about is that it, you know, can be, it can, it can be stressful or, or increase your cortisol or adrenaline to be so low carbohydrate. So maybe that's not great. I like, I have not heard a definitive answer or seen any data, but do you see good or bad things with ketogenic diets?
Do you recommend them?
Dr. Erik Reis: Well, I think once again, I don't think you will see a consensus on this, because every person is different. Right? So, what I will say is that there are different conditions that I'm more apt to get somebody doing more ketosis based. So, for instance, if I have somebody who is dealing with blood sugar instability, and they have no insulin sensitivity, and they are type 2 diabetic.
Fasting can be one of the most effective ways to start utilizing [00:38:00] and deploying free fatty acids from fat cells, optimizing glucose levels, increasing insulin sensitivity, and helping people not only lose weight, but improve their metabolic profile. Sometimes that can help. Once again, everything comes with a trade off, right?
In the metabolic kind of neurological world I live in, everything comes with a trade off. And so you do have to be careful because when you're fasting or when you're in ketosis, specifically with fasting, what you're utilizing is utilizing cortisol levels, which you already use at night when you're sleeping, right?
You're not eating when you're asleep, so cortisol slowly rises throughout the night to maintain your blood glucose levels. Your liver produces, you know, you have gluconeogenesis, which produces more glucose in that pathway. And in the morning when you wake up and you break your fast, then, you know, cortisol levels drop, and then you have that rush of blood sugar in from the food you just ate.
Now, fasting can be a really effective way to help people, but not everybody does well with it. Especially females. I've seen [00:39:00] females who are close to menopause and post menopausal sometimes really struggling with that. I've had a couple who've done really well with it. I would also say too, it just kind of depends on the metabolic profile you have, but I use fasting with some of my patients.
Some of my patients, I try it with them, and it just doesn't work out well. Some of the patients I try it with, it works out extremely well, and so it just depends. Some of them are like, hey, let's do a long term ketosis or let's go for like 20 or 30 days with ketosis. It just depends on the patient. And, and that's once again where I run labs and look at that.
Some patients are better off where like they need carbs, right? So if you're somebody who wants to go walk a lot, or if you want to go work out, like you're going to need carbohydrates to be stored and replenish glycogen stores in your liver and your muscles. You absolutely need that. So I don't think all carbs are bad.
I think you need every single metabolite and nutrient for the movement in the kind of life that you want to live, but you're never going to go wrong with making sure that you're balancing calories in, calories out. That's a really big factor. And that just, the [00:40:00] first law of thermodynamics just kind of states like matter and energy is neither created nor destroyed, it's converted.
That's a big factor for us. And I think a lot of people have tried to gamify that or cheat their way or use a supplement or find some sort of mechanism for that. And we just, we haven't found one yet. Sometimes it does just take a little bit of work to overcome that. The coolest part about your metabolic system is that it can change and adapt and grow.
I used to be such a hangry eater at night. And now, I am done eating at 7 o'clock at night. I'm fasting throughout the night. My sleep is better. My mood is better. And even when I wake up in the morning, like, I don't eat for a couple hours. Sometimes I'll do a 16 18 hour fast. When I get that hit of ketosis, I just get this surge of like, oh my gosh, my brain's on.
Now, I don't usually struggle with brain fog, but there are benefits to switching back and forth between those different metabolic processes. It just depends on the type of metabolic system you've got and what you're dealing with. So, there's no one size fits all, Jill, and I'm going to put that to rest.
You don't have to worry about that. It's really trial and error [00:41:00] and making educated guesses.
Jill Brook: Okay, fantastic. So, if there's anything else you want to say about brain nutrition, fabulous. If not, I was hoping maybe you could leave us with a few more ideas of tasty foods that are really good with the brain. Like you gave the example of blueberries and I just, I thought it would be nice to leave people feeling hungry for the good, healthy things.
Dr. Erik Reis: Yeah. Well, so here's, here's what I will say in the decade that I've been in practice, what I've realized is that it's, I think we've really failed as a society from a medical standpoint of educating people and empowering them to own their health. And I'm not saying that you need to be on your own and there's no one else there to support you, but health really happens outside of the office and outside of the clinic.
And I empower my patients every single day to not only consider what we've talked about, but to make those changes, to spend less time in my office. Like, I think I'm cool, but I'm not that cool. I don't want anybody to spend any more time than they need to in my clinic because I really want to get them back out living their [00:42:00] life.
And so building that trust, building that relationship, and then empowering people to be able to make those changes is really where I really see healthcare moving forward. That kind of integrative, more holistic health is, is really powerful and it can help. prevent and treat a lot of really interesting things that have kind of been demonized and labeled as disease and we're stuck with this forever.
So I would say one of the hardest parts for me seeing patients has been most patients don't even have the fundamental knowledge to actually ask the basic questions to truly get the answers they're actually looking for. And I think that right there is one of the reasons why we find ourself in the current state of medicine that we do today.
Unfortunately, you can find so many resources and references for so many different health topics. But what I'm going to tell you is that we really haven't taught patients how to be good patients. And most doctors don't have the time to do that, right? And so with platforms like yours, I love that people are learning about their condition.
[00:43:00] They're finding out different questions to ask. I love when patients come to me and they're like, I have this question, or I want to know about this, because the more that they know, the better they're going to be able to take care of themselves. And so, I love that there's platforms like yours that are going above and beyond to educate people, to empower them, and then to get patients to realize that they should be asking those questions.
So, you are allowed to hire your doctor, you are allowed to fire your doctor, you are allowed to, you know, find somebody who's going to treat you the way that you want to be treated, and go from there. I continue to get messages from patients who continue to feel like they're gaslit or they're not listened to.
And I don't think anything about that is medicinal or beneficial whatsoever. So I just want to put that caveat out there that there may be a lot of people that are still struggling and just because you've struggled for however long you've been struggling, it doesn't mean you need to continue to be that way.
Jill Brook: Oh, that's great. That's great. And it's good to be reminded by a doctor that you can hire and fire your doctor.
You're the first doctor to ever say that here.
Dr. Erik Reis: I tell my patients all the time they're allowed to do that. [00:44:00] So, yeah. Yeah. So you asked about, you asked about some food, right? So other foods to kind of get into, to be fair, you know, we can go down the rabbit hole with this and, and try and pick apart so many different discussions about keto versus you know, going vegan or vegetarian or going carnivore.
And so I don't think that there's one diet that fits all. Yeah. I do think that the Mediterranean diet probably has some of the most compelling evidence, but once again, that doesn't mean you can go just drink wine and hang out and just have, you know, olives and some sort of like meat on a daily basis.
There are other things that come with that lifestyle. What I would say is what I tell patients is you have to do what you're capable of doing. Like, I have to meet my patients at the crossroads of where they're at, regardless of what I think for a treatment plan. If you're not willing to do any of it, then I've just wasted your time and mine, right?
So, that's why it's important to have that dialogue, that give and take, and say, What are you willing to change or modify? Let's start with those baby steps. Let's slowly work our way towards the goal that we're [00:45:00] trying to achieve. And then over time, we can start taking some educated guesses on benefits.
Data doesn't lie, so I can always run blood tests on that, but I want people feeling better, and I want people really understanding the benefits of how impactful food can be. And then at that point, they have enough conviction to probably continue that journey themselves. And I'll always be there as a reference and resource, but hopefully we can get them on their way.
Jill Brook: Excellent. Beautiful. Well, Dr. Reis, thank you so much for all this wonderful information. And it's, it's really helpful to hear what somebody like you thinks about the food and the supplements. And we just appreciate you so much.
Dr. Erik Reis: Yeah, thanks Jill. I appreciate you having me on. And this is what's always exciting, right? These are things that we know that are true today. And something that I say today could be wrong tomorrow or next week or next month or next year, right? So we're always learning, we're always growing, we're always adapting.
And that's the best part about medicine is that we'll never fully know the answer. It's truly the most exciting form of science because we get to help people in the process. And [00:46:00] I'm just grateful to be trusted by my patients to try and help and serve them. And it's always fun to come on podcast platforms like this to share knowledge.
And I learn, you know, just as much as I feel like I probably educate people as well. So thank you for giving me the opportunity to come join you today.
Jill Brook: Awesome all around. Well, hey listeners, that's all for today, but we'll be back again next week. In the meantime, thank you for listening. Remember you're not alone, and please join us again soon.
