Chronic Illness, Brain Trauma, and the Role of Peptides

Eric Gordon, MD

Welcome, welcome everyone. Today I’m speaking to Dr. Chad Prusmack. And Chad is an amazing doctor. Like most of the people that I find amazing, it means that he started off in his case as a neurosurgeon and has gone on to think and realize that everything is connected and accumulate. And he’s going to tell us about how what his his particular way into this world of chronic complex illness, but we’re going to talk a lot about head trauma, but it’s really a lot about all of us and what happens when there’s chronic inflammation going on a little too long. 

We’re to be also touching about peptides and a bunch of other interesting things. So let’s just start off with like, how a neurosurgeon wound up talking to me.

Chad Prusmack, MD

Well, thanks again for having me on, Eric. Yeah, I started a neurosurgery practice in Colorado, and one of the first tasks I had was to be on the sidelines with the Denver Broncos to help with the neurologic injuries. And so from that, I learned about concussion at an early age, and this was before concussions became concussions and so I was able to sort of be curbside and seeing how the evolution of concussive injury occurred both not only in the short term but in the long term. And so my fascination was what really differentiated someone who had a long term injury versus a short term recovery. And as a result of that, I got involved in understanding what the complex chronic illnesses of the brain were.

And although I have a spine surgery practice, as a result, I put together a company that we could spend more time one-on-one looking at these complex chronic injuries of the brain called Resilience Code. And so in that company is where I see these more chronic injury patients. And as you see your chronic injured or ill patients, that’s kind of how me and you got to mesh and think alike.

Eric Gordon, MD

Yeah. So, and how did you wander into the world of tick-borne diseases? Because that’s what makes us even more interesting is you actually have put those two together.

Chad Prusmack, MD

So I grew up in and I grew up with a lot of interesting retrospective symptoms. So I would be hospitalized commonly for muscle cramps. No one in my family has a learning disability. I had dyslexia, which I was diagnosed after I got to college and I had anxiety.

I had some weird fixed false beliefs, but somehow managed to get through all of these schools and sports and so forth and it turns out that I was around 34, 35, I got a really bad illness which they thought I had Dengue fever because I had flown back to the United States from Brazil after giving a neurosurgery lecture and they diagnosed me with Dengue fever and CBID which is Common Variable Immune Deficiency Syndrome. And here I am 34, 35 and they put me on IVIG, and I was chronically ill. so, having experienced that and not really understanding it, I wanted to take it upon myself to understand like, how did I get sick and not be born with it? And I ran into a practitioner named Jill Carnahan, who we spoke, socially for five, 10 minutes. And she’s like, I think you have Lyme disease. And I thought she was crazy.

I went ahead, I did an IGenex test and I was PCR positive for and FISH positive for Bartonella, Babesia and Borrelia. And so I then went to Dr. Kinlener, who is a practitioner in the area who’s wonderful. After two years of antibiotics and the ups and downs, I was amazed where I didn’t cramp anymore.

Chad Prusmack, MD

I could read fluently, my dyslexia was better, my anxiety went away and I was just in a better space. that alongside with this chronic complex brain illness interest, I was like, well, maybe the chronicity is an environmental issue. Maybe the problem is not the injury. Maybe the injury is just what loads the gun and there’s an environmental trigger that makes someone chronic and makes their injury prolonged. And so I became interested in this idea of environmental subconcussion as a result of this personal Lyme spiritual journey, this great blessed journey in NFL sidelines and the everyday rigors of neurosurgery.

Eric Gordon, MD

Okay, that was yeah, I would say not the way I want to learn things, but very effective.

Chad Prusmack, MD

You don’t forget. You don’t forget what it’s like and you can learn. You learn a lot about tick-borne illness and chronic inflammation quick when you get that sick.

Eric Gordon, MD

Okay. And so as you were, you know, seeing this, what, what were the, you know, what were the takeaways? mean, so you started to look at your athletes differently.

Chad Prusmack, MD

I looked at a couple subsets of them first because I do spine surgery. I was looking at long-term outcomes of patients that I operate on and I operate the same way every time, but there are different outcomes. So, you know, I was like, is it diet? Is it physical therapy? Is it performance? And so I think one thing that spirited me was like, why the difference in outcomes when the architect builds the same house. Alongside that, you know, my interest in how athletes had a world that revolved around their health. They had a dietician, they had trainers, they had neurosurgeons, had everyone would revolve around their issue. You took that model, you took the model that you’re starting to identify. There are more variables to outcomes than just a surgeon.

And then you try to apply that model to like, why the heck is this person still sick? And he was had a head injury 10 years ago and he hasn’t left the house since. And so it was that kind of triad of things that made me want to apply these new ideas of like, well, I was sick, maybe it’s an infection. And then I wanted to then learn more about functional medicine. So I got a functional medicine degree at IFM.

And this all sort of put it in this, it’s all about chronic inflammation or lack thereof or, you know, performance and so forth. so then I took it and I started to say, well, why don’t we just study the person, not just like, look at what hardware is broken in their brain. So I always then started thinking, well, maybe there’s a hardware problem that the wiring got disrupted either temporarily or permanently by the injury. But maybe there’s an ongoing software problem. Maybe this person had heavy metals or was infected or had impaired genetically mitochondria as a predisposition. And then say like, why don’t I just study the person and see what inflammatory comes up in these sick patients.

And as you know, Eric, when you do that, you find a lot. You find hormone deficiencies, nutrient deficiencies, high toxicities, impaired immunity, impaired mitochondria. And then you say, well, I don’t know how to rewire the brain. I know how to take out a brain tumor, but I don’t know how to rewire it. But I sure know how to like take away inflammation. And if there’s an infection, I know how to treat that. And so that algorithm is how I started to apply my practice to chronic complex brain injury.

Eric Gordon, MD

And, you know, going along, I mean, did you find a lot of tick-borne illness or is it more predominantly chronic viral stuff?

Chad Prusmack, MD

So I’ll say like in the beginning, some of the usual suspects, so pituitary dysfunction, chronic cortisol problems, hyperpituitaryism, malnourishment, gut brain. So like there was a myriad of that first. I will make a note that there are some hardware problems that can keep people sick. As we’ve talked about before, people who have unknown dysautonomia from a head injury or vestibular ocular impairment, those being what I would consider hardware problems. But to get to your question, you know, after I dove in and you would fix the hormones and you would fix the nutrients and fix the gut and they were still sick. you would find a chronic infection, much more likely a tick-borne or vector-borne illness. But then along came COVID, and then Long COVID, and the injection, the vaccination. That seemed to be another environmental stressor from the viral portfolio.

Eric Gordon, MD

You know, so when you, because you mentioned a few important things here, like the disc, because one of the things we see in some of our sickest patients are the ones hardest to treat is this persistent dysautonomia that seems to develop when there is some neck injuries and that can be very mild, you know, or thoracic injuries that are sometimes, you know, like just mild, you know, like fender benders or, you know, like that, you know, everybody walked away from the accident, but the project, one of them started to have more and more problems. as far as the dysautonomia, other than things that you can fix surgically, what kind of issues are you seeing there?

Chad Prusmack, MD

Yeah, I’d say dysautonomia is probably the most under diagnosed fixable or treatable entity you see in a chronic brain injury or a chronic concussive patient. And so what we first find is there is a dysregulation in how our sensory inputs are coupled together. So for example, for me to feel like I’m in sync with the world,

I need my eyes. I need my vestibular system and I need the proprioceptive system, especially of how my neck muscles, how the Golgi and spindle fibers tell me and give me feedback. I know where how angled my head is. I know where I am in space. After you get a head injury, if you strain a neck or have a tendinopathy of that’s inserting into the skull in conjunction with a desynchronized vestibular ocular system. The body expresses itself as dizzy or nauseous or a visual disturbance. That’s the symptom of the dyssynchrony. In that, if that is not rehabbed properly, the brain then decides, well, I’m not going to live my life sick. Instead, I’m going to remap my brain and I’ll refocus how my brain is so metatopically arranged and I’ll become visually dominant and my neck proprioception and vestibular proprioception will be overtaken by my visual system, which is a slower system.

Eric Gordon, MD

So just for people, the vestibular is your inner ear and your whole sense of balance from that mechanism.

Chad Prusmack, MD

That’s right. We have this system that like an architect would have a leveler with a little bubble and that bubble tells us how angled my head is That has to be in sync with how tight my muscles are in my neck So how loose they are here relative to here and if they don’t match up you get vestibular symptoms or dizziness feeling off this equilibrium But the problem with this autonomia is your body on the inside knows that you’re not synchronized. And so it starts to throw off a danger response. And that danger response is now being dysregulated because you were never rehabbed from the original injury. And now you have a secondary problem.

And once your sympathetic nervous system doesn’t go with the wind of fight or flight, and you have this contradictory life of rest and digest when I’m trying to do more, or I’m trying to sleep and I fight or flight. That’s extremely disorienting. And then people, as you know, get brain fog, palpitations, panic attacks. And by the time they present with that, no one’s thinking of the dysautonomia. They’re thinking there’s something psychologically wrong. And it turns out that you really need to go back, figure out what symptoms are disrupted, try to read program them and try to calm down the dysautonomia.

Eric Gordon, MD

This is music to my ears because it often takes me a very long time to convince patients who’ve been ill a while that their structure is contributing to their symptoms because we live in a place, a world where it’s got to be a disease somewhere that your bony structure, it’s not falling, my head’s not falling off, I’m fine.

Yeah, it’s not a one thing. 

This is definitely, you cannot have a reductionist mentality in trying to approach these patients because it is that complicated. And there is a game of whack-a-mole of multiple problems, which are interdependent on each other. And understanding how you looked at the whole system is sometimes the only way that you could even start to break this down and fix it something that I think is really important that I know that people don’t get is that you can start off with this little, I’m not little problem, but you’re a little dizzy, your bell gets rung, you feel a little off and then you compensate. But that compensation then gets your autonomics to feel like we know that there’s something wrong here. And so you start getting other inappropriate, yeah, other signals that don’t make sense. I mean…

Chad Prusmack, MD

That’s right. So the best analogy I use is to say, let’s say I have a car that drives perfectly. And let’s say I get in a fender bender and my car’s alignment is thrown off. And so my steering wheel veers to the right. And so the first concussion metaphor would be about, my car is out of alignment. Well, I could go get a fix or I could just drive the car by holding the steering wheel straight. But, in that, my arms are getting fatigued because I have to hold it that way. But if I make that my new norm, one, I’m spending more energy. Two, I’m validating that this out of alignment is the way to live and the inside of your body knows it. Now just think if you get just tapped in another car accident, how now you’re already holding on for dear life to keep it straight. How quick it would be to lose the car’s control. And that’s what the sensitivity is of chronic brain injuries or multiple brain injuries. It’s also why we think the people get a glass jaw in MMA or boxing. That the reason is a good boxer who doesn’t get knocked out never has this uncoupling. And then they do. And then their defense mechanism is a millisecond off because they’re depending on how they clinch with their eyes too dominant because they never had the vestibular ocular colic system re-mechanically coupled. And so that millisecond off they are in tightening allows them to get knocked out more quickly.

Eric Gordon, MD

Right, because again, they’re using that slower visual system to know where they are in space. wow, yeah, that’s it. Because where we are in space is really critical for feeling comfortable in the world. I mean, that’s the other part. So you mentioned the anxiety that can then begin to build and you don’t know where it’s from.

Yeah, yeah, because and that neuroinflammatory is because you’ve you’ve you’re now engaging your immune system starts to also be part of this party of like life isn’t safe.

Chad Prusmack, MD

So you now have a software problem because your hardware de-wired itself.

Eric Gordon, MD

Yeah, well, could just, yeah, you can’t fool Mother Nature, I guess. just a simple thing, it’s like having mold and painting over the mold and hoping you took care of the problem. It doesn’t work. when you go back, what’s your way? What are the big signs for you?

Okay, the easy ones, the ones that like, those of us who aren’t neurosurgeons or even especially people who aren’t even physicians, what would be the clear cut hints that, you know, hey, you should take a look at that neck, you should take a look at that visual, you know, like, because I mean, we don’t, many times we have a lot of people who have visual issues, you know, like they can’t focus, they wake up, you some days they can focus and some days they can’t, and they go to the optometrist or the ophthalmologist and everybody looks in the eye and their eyes are fine. Nobody pays attention to the neurologic wiring from your eyes to your brain. So how do you begin to think about that? What tips can you give people to sort of find their way?

Chad Prusmack, MD

Sure. So I would say any person with chronic neurologic unexplained symptoms, the vague ones, I’m persistently dizzy. have brain fog, I’m fatigued. And you get a history of the brain injury. And if we’re talking about mechanical brain injury and the mechanical brain injury involved a whiplash, there was some element where, I got thrown down in hyperflexion and I strained my neck. It’s usually the whiplash part that throws off the coupling of the balance system. And because a lot of brain people aren’t spine people from a doctor’s standpoint, they go right to the looking at how is your memory, how is your cognitive skills? 

They forget that there is a huge component of the neck that could throw things off kind of from a bottom up problem, you know, bottom up being brainstem, brainstem sensory to cortex. And so one length of time since injury with chronicity of symptoms to nebulous types of symptoms, i.e. brain fog, dizziness, feeling off. Again, and this isn’t, we’re talking two, three, four years or six months, sometimes 10 years. And then when you hear about the history, there’s usually history involving neck as part of it.

Eric Gordon, MD

Yeah. And I think, and do you often see that straightened neck? You know, mean, that’s the things that so many of, almost all of our patients, they get a cervical spine and you know, it’s red. It’s normal except for loss of cervical lordosis. You know, it’s, and it’s like, okay, not normal, but you know, everybody’s told you’re fine. Go home, you know, go get a massage.

Chad Prusmack, MD

You bring up a good point. If you have loss of cervical lord doses chronically and no degenerative discs, you definitely have vestibulocervical dysregulation. Sometimes you can get kyphosis when you have degenerative disc disease. And so at C5, C4, five to five, six to six, seven, the degeneration of just wear and tear can do it. But one giveaway is when you have, like a youthful looking disk space throughout and it’s straight as an arrow. Yeah. That’s, that’s, that’s a key.

Eric Gordon, MD

Ramrod.

Chad Prusmack, MD

Okay, well, that’s one important one, because that one, I think, is something that almost all of our patients have and are told that it’s nothing. So I think that’s a good, really good hint out there, because what I’m trying to do is get this information out to people who really don’t believe that there’s anything physically, if you will, wrong with them. It’s all infection, and it’s not. That’s why you’re still sick.

Another thing would be positionality. So like when they lay down and their neck is supported, they’re good. It has to do with when they have to engage their neck muscles. Another thing that sometimes they don’t realize is that it’s at certain angles of where their head is in space. So they may have no symptoms looking straight ahead. But if you ask them to look to their left and do some cognitive tools or look to their right, or do balance testing with head sways and different angles, because that causes the disruption and that evokes the symptoms. So end of the day, the smartest thing to do is get yourself a great vestibular therapist that does a great neurologic exam, does the VOMS and can really deduce what part is proprioceptive, vestibular, what is cervical, what is ocular and then come up with a model of that system. That would be the best advice for anyone who’s seeing a chronic brain injury.

Chad Prusmack, MD

The difficult thing is finding a good vestibular person. mean, I know sometimes the neurologic chiropractors can be helpful there. My issue with them often is that they don’t realize that just because they normalize you when you’re in the office and you go home and it falls apart in an hour that you have underlying infection, they sometimes don’t get that piece. But are there other types of physicians or therapists? I mean, you say vestibular therapists, actually can find that in the yellow pages and nobody has yellow pages anymore on the internet.

So, Eric, what I have found is vestibular therapists associated with the concussion clinic. So instead of one that comes down the vestibular therapist for your tinnitus and through an ENT doctor’s office would be a different balance specialist than it would be someone coming through a trauma. So vestibular therapists associated with trauma hospitals, neurologists, or a chronic brain injury center.

Eric Gordon, MD

Yeah, because one of the things that often, know, most neurologists, know, they’ll, if you can stand on one leg, you know, looking straight, you know, you’re fine. You know, I mean, like if you walk normally, you’re fine. Very few of them really check what happens when you turn your head or move your eyes when you’re standing. You know, they’ll do it when you’re sitting and that’s fine. But what happens when you stand up?

Chad Prusmack, MD

We are our balance exam is two hours long. That’s and it we have pressure treadmills. We have what’s called a proprio machine, which is a machine where you’re standing on a plate and slowly it perturbed. Bates and it can measure your center of mass and how quickly your head writing response. So it requires a very thorough exam to find the fine print. But once you do, it’s fixable.

Eric Gordon, MD

And that’s the thing, and you find that you have to do, I because I get my bias has been that until we get the body inflammation down a bit, I haven’t found it as fixable. But again, I’m not working with people who are as, you know, who are as focused as your folks.

Chad Prusmack, MD

Yeah, Eric, I would say they’re equal. They come to your door through the different door. But like I, when I talk about just the hardware problem, so people, let’s say three months out with post-concussive syndrome, had a normal healthy life that are getting post-concussive syndrome. And let’s say they have dysautonomia and you help treat it. You see the vestibular dysfunction.

You treat it, you treat the neck with whatever the interventions are. They get better because they were just a hardware problem, a true, you need to rewire and you didn’t get out of control. Now, if that same person had a preexisting tick-borne illness or had the vaccine six weeks before and still was feeling inflamed from it, and then they hit their head. Well, now it’s a different story because what happens is the recovery by the rehab does not go as smoothly and people remain ill. And then you start to question yourself, like, is it the vestibular system? Why is the dysautonomia not responding to the Levine protocol, salts, beta blockers? And then you start to have to think of like, this is a software problem. This is an infectious disease, a heavy metal, a psychological trauma whatever would be a perpetuator of chronic inflammation.

Eric Gordon, MD

Right, right, right. Yeah, that’s the thing. if it’s not getting better, there’s something else that’s also feeding it. But just coming back, don’t forget about your neck. And what about, I mean, you see this with, you know, when people have just a thinking of some folks, they have, you know, running injuries or foot injuries. And that seems to then perpetuate. mean, do you ever run across that or does that tend to stay more local?

Chad Prusmack, MD

Same concept. So the brain will adapt to limping and then the brain will start adapting maladaptive movement strategies. If you don’t help the primary problem and you allow inappropriate rehabilitation, asymmetric rehabilitation, yeah, you’ll end up with what we call a motor engram, which is a motor map of your brain, becomes your default map. This is how I move in a default way. And so a limp can do that just like a whiplash injury could do that. The difference is it’s not as closely connected to the brain as the neck is. So you have less likely in the short term to have vestibular ocular problems. But over time, if you are on crutches for a long time, like your vestibular system adapts to being on crutches and getting off that you can get dizzy.

Eric Gordon, MD

Right. And so if you had a preexisting and chronic inflammatory problem, it could begin to, but like I say, your point is it’s that neck that’s the main driver. The main driver, so vestibular rehab is a big part.

When it comes to the autonomics, like when people just have the tachycardias, is there anything in particular that’s done differently if that’s the big system or that chronic nausea that people often get that clearly is not related really to food or what they ate, but it’s that low level, just kind of queasy all the time that I always consider kind of vagal. how do you look at it and do you have any different ways of playing with that?

Chad Prusmack, MD

You bet. Yeah. So again, I’d say dysautonomia is the hardest to deal with. And it’s something that’s critical. So first, what I would say is it’s important for everyone to do 10 minute orthostatic blood pressures in order to diagnose these forms of dysautonomia. And so taking a blood pressure with someone laying down flat, having rested for two minutes, getting a heart rate and blood pressure, standing up slowly, waiting a minute, blood pressure, heart rate, and then doing it at three minutes, five minutes, seven minutes, and 10 minutes. And looking for a differential of 30 beats per more would define someone as having POTS, which is a form of dysautonomia, positional orthostatic tachycardia syndrome, or if they drop their blood pressure 20 points or more on the systolic, 10 points or more on the diastolic, and they get types of symptoms, that’s called orthostatic hypotension.

And so that puts you in the party of saying like, we have to retrain his or her danger response. And if the danger response is persistent, I don’t think you can rehab anything. And the reason is, is because your weather vein of health is not pointed in the direction of the health. Your weather vein of what’s good and bad will fluctuate randomly. So if I’m trying one day to do my vestibular rehab exercises, and my dysautonomia is telling me rest and digest. There is no way I can focus or get through and remember and utilize those skills. And so it’s impossible to rehab if you have dysautonomia.

Well, it’s rehab and any treatments because people generally respond with panic when things change because that panic button is stuck on. So it makes everything very difficult.

It tells you, did I do good or bad? Did I just perform the task correctly? Do I have the right emotional response from like doing my task or am I looking at myself in the mirror and saying negative things and feeling negatively such I don’t even have the feedback loop to say good job because my fight or flight system is fluctuating the entire time. So you get unmotivated, you get brain fog, you can’t attend, and then again, you’re lost.

Eric Gordon, MD

You just get frightened. I mean, that’s the thing is that when people get, you it’s the constant fear that even though you know that you have no reason, quote unquote reason, yeah, your, your limbic system can drive the show quite a bit. And I always remind people is that just remember is that what, what, Dr. Prusmak was, was reciting for those are the numbers, you know, like the, for the POTS, the 30 beats per minute. Those are the numbers to be diagnosed. But if you walk into the kitchen and your pulse is 20 beats higher than it was when you were sitting down, you have a problem.

Chad Prusmack, MD

Dysautonomia is a clinical diagnosis supported by those numbers.

Eric Gordon, MD

Those numbers get you a visit to the specialist easy, but you should pay attention anyway. Something’s going on that shouldn’t be. I know you’ve been interested in the use of the peptides for a long time and for helping people. When do you start to use peptides in your practice?

Chad Prusmack, MD

Yeah, so if we’re talking about the complex brain injury patients, what we do, and when I mean the complex ones, the ones that have been multiple years, we obviously do the hardware evaluation as discussed, the dysautonomia, concussion testing, MRI, vestibular testing. But we also run a biomarker panel of about 5,000 biomarkers of which we find a lot of different abnormalities. We actually published a paper on certain nutrients and micronutrients that are deficient, taurine, vitamin E, omega-3s. But from a peptide standpoint, the pituitary is so closely correlated with chronic brain injury, about 50 % of patients with post-concussive syndrome have an endocrinopathy of some sort.

And usually you see it in the HPA axis with cortisol, either super high or super low, ACTH, super high, super low, or you can see a low IGF-1 or the sex hormone axis. And so in that axis, depending on the age of the patient and the intervention, we do commonly use growth hormone releasing hormone peptides, which GHRHs (Gonadotropin-Releasing Hormone), GHRPs (Growth Hormone Releasing Peptide). Sometimes we use things like kisspeptin, gonadarelin, which are more of the hypothalamic stimulants of the sex hormones, where the GNRHs and GNRPs, these are your tesamorelin, sermorelin, and then your ipamorelin types.

Chad Prusmack, MD

These we find very helpful to fix the endocrine pieces from a peptide standpoint. So I would say that’s one of the first things we do is try to fix the endocrinopathy that’s pituitary based. The second thing that we look at, which I think everyone with chronic inflammation over a long time has to look at is the mitochondrial dysfunction. So I think as you know, like, end of the day, someone’s brain fog, chronic migraines, dizziness, like it’s an energy mismatch. The mitochondria of the brain are zapped. And so by trying to plug in their plug to the outlet, I think is always a place to start. Now it’s hard if they’re too inflamed because you don’t want to turn on their engine, and make their dizziness worse or their dysautonomia worse. So you can’t just go in hot and start lighting and putting the lights on. But in a smart fashion, after we’ve gotten the inflammation down, start to rewire the hardware. We’re very into doing mitochondrial peptides. That’s an area which I’m specifically interested in and have had really good results in.

Eric Gordon, MD

Right. And this is more the MOT-C or the other ones that you’re using?

Chad Prusmack, MD

Sure, sure. So I think subcutaneous NAD is what we use the most of. I have found that to be the most sort of effective short term and long term. It has a short half life. So unfortunately, those injections need to be done once or twice a day. We usually start patients at 50 milligrams three times a week, and we slowly ramp up to sometimes 100 milligrams twice a day, somewhere in between. are side effects and things we could go over, but that to me starts the capacity of the battery to expand. then MOT-C helps a lot with air hunger, endurance issues, exercise and tolerance. It’s an extraordinary endurance peptide. Can increase VO2 max significant percentages, very good for performance. 

So MOT-C is another one. And then the most recent one we’ve been using is SS 31, which seems to be something that by changing the confirmation of that cardiolipin moiety, it gives you more bang for your buck. by the change of how you’re delivering electrons, you’re delivering more ATP for unit transport.

Eric Gordon, MD

No, cardiolipin is critical. We used to measure that from lab in Germany and it was really surprising. So that just gives a more surface area, more little curves in your inner mitochondrial membrane, which is really helpful when you’re trying to generate energy. and these are things that you find that you, but what you’re waiting until people are a little more stable for the mitochondrial approaches.

Chad Prusmack, MD

Yeah, so step one, if we were going through it, vestibular eval, dysautonomia eval, start the rehab exercises for both and control the dysautonomia first. And to do that, propranolol, midodrine, fluids, tights, salt in your food, that’s important. Also, if it’s hyperadrenergic POTS, guanidine, one FSC different foray of things. once those two are. Intact or we see some improvement and the exercise tolerances. Well, we’ll start the peptides pretty quickly. So, you know, two, three months in, drastic improvement in brain fog, exercise tolerance. Those are the two things you see, doesn’t quite help with depression, which you think it would, I just want to make that caveat, but it seems to do with the level of arousal, clarity, cognitive proficiency. I find it to be quite, quite helpful.

Eric Gordon, MD

Yeah, that is, yeah, and I think a really important point that you made is that you don’t want to go throwing a lot of fuel on the fire when the fire is burning out of control.

Chad Prusmack, MD

And Eric, you mentioned, I know this is a topic we hadn’t reached yet, but if that patient also had the spike protein problems or a tick-borne illness, starting that too early without having that under control, I don’t think is a great idea either. So if you kind of get the sense based off of history or lack of emergent response from this hardware rehab, then we go down the whole, you know, Patterson protocol, Patterson panel, the spike proteins, iGenics, T-Labs. And then you look down that lane and then you look down the immune lane, autoimmunity, subclass deficiencies and all that, alongside the gut and the hormones, like I said.

Eric Gordon, MD

Right. But yeah, I think that’s important that you mentioned that because too many people, I mean, we all want to get better fast, but unfortunately, yeah, the mitochondrial peptides are for as your body is beginning to be on that real road to recovery. If you start it while you’re just pulling out of the garage, it’s not going to work well. and just before we finish, I just want to, because you have such an interesting world, you know, like you go across many, many lanes and, and, and something that is that I’ve offered is what are you looking at for, you know, the people you see who are really looking for health optimization? Because as I try to explain to people, almost everything that’s good for health optimization is going to be good for chronically ill people. Just depends on timing and dose, but usually the same thing is needed. where, where, what, what new things are you, are you finding there?

Chad Prusmack, MD

Ironically, they’re the same things I find for illness. what you’ll look at is again, the dissecting mixture, the gut, the hormones, establishing that those are in sync with the patient’s desires, health or health problems, mitochondrial peptides, hormone replacement using peptides. We do commonly use some different peptides, that are more immunostimulant thymus and alpha thymus and beta BCP-157. And again, I don’t want to like jump the gun and say like, as anyone in longevity knows, it’s diet, well-being, exercise, sleep, relationships first, but the unique elements of how you go to help someone sick is almost the same way you help someone perform.

And so someone who wants to run a marathon, MOT-C, someone who is sore in the morning and needs better recovery, a BCP-157, Tesamorelin, Ipamorelin, Sermorelin, you know, any of those things. my, my, I’ve been doing a lot of now is SS 31. NAD are probably two of what I would consider at least in the near term seems to be quite healthy, good responses, again, cognitively, emotionally, and the hormones obviously are important to restore.

Eric Gordon, MD

Right, right, right. Getting the function better. And just one last little thing, because I know this is something that’s near and dear to you, is exercise. Because so many of our patients are so limited, like the post-exertional malaise is a big part of their lives. And I’ve often found that people, repetitive doesn’t work for people, but sometimes, single motions can be good, but what’s been your experience? How do you suggest exercise to the people who can’t exercise because if they push, they feel worse? Do you have any ways in there?

Chad Prusmack, MD

So those that can’t exercise, there are two modalities we recommend starting with. One is called blood flow restriction training, which is restriction training where you’ll wear tourniquets on either your arms or your legs. And you will do non-weighted body weight activities so you don’t have the strain of the joints. And the mechanism with which it works is if you think of the muscle having a supply and demand of oxygen, I can either overwhelm the muscle and make it have a high demand, or I could take the weight off and then I could just suffocate the distal part of the extremity and the supply of oxygen is less. And so then in the absence of an inflammatory response, you actually get very similar hypertrophy responses. So whether I’m doing three sets, three reps of a heavyweight, or doing 30 reps of a blood flow restriction rate, the muscle growth is similar. Now the strength isn’t, but the hypertrophy is, and that’s because it upregulates VEGF and it upregulates vascularity because you’re teaching it how to be hypoxic. So one of the mainstays of people with chronic illness that cannot exert themselves is blood flow restriction training. The other is a type of dynamic heart rate feedback training.

And so the goal is to tell someone, Hey, look, here are your different zones of heart rate. get those zones by doing what’s called a Buffalo test. The Buffalo test is the concussion test that tells us how their symptoms are at different zones of their heart rate. And that, helps us provide what’s called heart rate maxes. And anyway, what we do then is we pick a zone and we say, look, your zone two is 100 to 110, put a chest strap on and you have to stay in that band for 30 minutes. And what this does is it helps teach the dysautonomia patients whose heart rate goes up, down. It teaches them that the oxygen demand based off of what they’re cognitively peddling to stay within a certain range of heart rate. 

And the goal is to sync up oxygen supply and oxygen demand is met by the autonomic nervous system. And so that biofeedback heart rate training where you want to find a zone where someone can maintain that, that’s starting to sync that system up. So I will say for our sick patients, it’s blood flow restriction training, A. B, this heart rate feedback zone training. And then C is isometric, training, not kinetic training. And so people who have your cranial cervical instability issues, earlose, danlose, like isometrics are where they need, they need stiffness. And because these things, as you know, Eric, overlap as EDS, POTS, chronic inflammation, isometric training is where we start there. So those are our three pillars of entry for chronic complex illness.

Eric Gordon, MD

Right, right. And the nice thing about all of them is that they’re controlled and modulated. know, because I, you know, I get lost because I have so many people who basically are at bed rest, but so many people are, do have like those few hours a day that they can function. And if we can get a little tiny bit of training in there, because a muscle that is trained requires less oxygen, effort, produces less lactic acid is going to be able to be more functional for your everyday use. So you’re not going to tire as quickly. we’re not trying to get it so you can run a marathon. We’re getting it so you can actually walk up the stairs and not feel like you ran a marathon.

I just, I want to thank you, Chad, because it’s so much fun to hear like, know, like to look at my world from a different perspective. You know, it’s just so interesting to see and to remember how many things we have to pay attention to and not skip over. I think there’s something about people who have been unfortunately ill for many years that they’ve like, because the body has been so unhelpful, there’s a tendency for them to want to not folk, to not talk about this thing, and not realize. that it’s not just all happening on the inside in this like magic little world, but it has a lot to do with that neck, head, eyes, ears, feet world.

So anyway, thank you so much.

Chad Prusmack, MD

Thank you for having me on, Eric. It’s been a pleasure. I really appreciate you. Thank you so much.