Brain Injury Breakthroughs: Dr. Mark Allen on Healing Post-Concussion Syndrome

Lisa: Hey everyone, and welcome into Pushing the Limits. Today I'm super excited to have Dr Mark Allen with me, who is one of the world's leading experts in brain rehabilitation, and has a PhD in this, and runs Cognitive FX in Utah, amongst other things. Can you give us a little bit of background about yourself, Dr Allen, and how did you get here? Give us the two-minute version.

Dr Mark Allen: Yeah, there are a lot of twists and turns to it, but it all started back, like you say, with my PhD at Johns Hopkins. We were one of the first places to get our MRI machine outfitted to be able to do functional MRI. So this is back around '98 or so, so it was really in the infancy of fMRI. And I just had to do it. It seemed like science fiction at the time, to be able to see the brain doing things in real time. So I got right into it, and that's driven, not the direction, but it's been the basis of every opportunity that I've had.

Dr Mark Allen: So I was in academics for a while as a professor, and one of my graduate students, my first PhD student, ended up being my partner in business in doing this concussion rehab. For her PhD we did the early version of the assessment that we do to be able to do the treatment that we do. And then through a lot of opportunities, we were able to befriend very high-level athletes that are very famous, like Tom Brady. He's an American football player who's probably the most famous — everybody knows him. And so that opened up a lot of doors. Legitimate or not, people would say, "Oh, you work with him, you must be good," which isn't necessarily true, but we'll take it.

Dr Mark Allen: So that led to more and more opportunities, and I left academics in order to pursue actually helping people. That was what my partner Dr Alina Fong, who's fantastic and should be on this podcast as well — she kept pushing me: get out of your comfortable ivory tower, whatever, and let's do things that can actually help people. And it's a lot more fun. I enjoy it. It's so gratifying to actually do things that no one else can do for people, when they're stuck, when they've been everywhere and nothing else works, and then you have a solution for them and it works. It's incredibly satisfying. So I've kind of skipped around a lot of my history, back and forth, but it really is centred around that power of functional MRI to, instead of guessing what's going on in somebody's brain, to actually see what it is and then be able to effectively treat it.

Lisa: Can you explain to lay people who don't know the difference — but in New Zealand we don't have a lot of functional MRI, we've got a lot of standard MRIs — can you explain the difference between the two, and why you don't see a heck of a lot in a normal MRI?

Dr Mark Allen: So an MRI works by magnetising tissue and then sending radio waves through, and that's how you're able to — because the radio waves interact differently with the way that the tissue has been magnetised, it allows you to distinguish different tissues within the body. Well, it turns out that the oxygen in the blood, the iron properties to it that change when it gets oxygenated, that disrupts the magnetic signal in a specific way.

Dr Mark Allen: Now, the second kind of fortunate thing about physiology is that brain cells are really anxious about oxygen, so they're very proactive in getting themselves oxygen. They're actually competitive, and they do it very quickly and precisely. What that means is that when you see changes in oxygen in the brain, that is very, very likely to be tied to neural activity. And when you do the statistics correctly, you can distinguish other rises and falls in oxygen from those that are coming from activated neurons.

Dr Mark Allen: And so you give somebody a task to do and it will light up, so to speak, different areas of the brain. And that's been mapped out for the last few decades, what kinds of tasks engage different brain areas. That's allowed us to learn so much about how the brain works. But then when it comes to using this on the medical side in treatment, then you have to have norms. Brain cells will become active to some degree, might become deactivated, and it's all relative, so you have to have a context. That's why we've collected hundreds and hundreds of data points from hundreds and hundreds of people that don't have any history of brain injury. And then you can compare any individual who gets scanned to those norms, can see how far away they are from normal, and then address that. So that's the basics of how we use functional MRI. That's sort of the magic of it.

Lisa: So when we go to the hospital, say we land up in the ED and we've had a hit to the head, they do an MRI, we don't see anything, they tell you, "Fine, go home and rest for a couple of days in a dark closet somewhere." What's wrong with that picture, and why is that type of MRI not going to tell us — it doesn't show us?

Dr Mark Allen: Okay, so you really ask just the right questions, because the normal MRI, or structural MRI, won't show any problems. A CT probably won't either, unless you've had something really severe. But if you've just had a concussion, and even a really bad concussion, even something bordering on what we'd call moderate to severe brain injury, the brain cells don't die. And this is where the whole post-concussion symptom problem comes from. So brain cells don't die, but they get damaged, they get roughed up a bit. So a normal scan will show that they're still alive, that no tissue has gone away, so it looks normal, so you're sent home. Resting, by the way, is absolutely the worst thing you can do.

Lisa: Yeah, you've got to keep your heart rate up, those brain cells active.

Dr Mark Allen: Because what happens in about a third of people, around there, is that the brain doesn't heal properly after a concussion — and also after different viral infections as well, like COVID, and West Nile virus, Lyme disease, so a similar thing happens. So the brain cells get damaged, they repair themselves, and they can repair themselves quite well, but they take a long time to do that. They take days, maybe weeks, to do that. In the meantime, the brain gets impatient, so it reorganises its network. So you have these brain cells that were responsible for doing some function, they get ignored, and some less adequate brain cells get picked up and integrated into the network. The brain wants to keep going. And so it locks down on this solution of network organisation, and once it gets there, it wants to stay there, because it's keeping you alive, you're eating, you're breathing, so it's not really motivated to change.

Lisa: Wow.

Dr Mark Allen: Now, this is where some things that are mysterious about concussion happen. And I enjoy speaking to wider audiences, because most of the time when I speak to people who aren't necessarily looking for information about concussions, they realise that they have post-concussion syndrome. People out there talk, and they'll come up and say, "I think that's what I have." And they don't think they have post-concussion syndrome a lot of times because it's been a while since they had the concussion. So that's where this — and again, this is getting back to your question, why the normal scan doesn't pick it up — because you've got this reorganisation, the brain has improperly healed, and that could be kind of a ticking time bomb.

Lisa: So this could have happened years ago?

Dr Mark Allen: Yep. And you keep plugging away, you can compensate for it, but you'll get to a point where either there are some new life stressors, or you're getting older, or just the fuse on that ticking time bomb — your brain runs out of the ability to compensate. And so you start getting these symptoms like headache, fatigue, irritability, your autonomic nervous system — and it's almost always in the direction of the sympathetic, so being overdriven. So you feel kind of irritable and edgy and amped up, so you can be both fatigued and kind of wired at the same time. It's kind of that gross feeling. And so that's why your concussion can be a culprit even though it was years ago, for how you feel.

Lisa: Yep, that's a lot of information. Yeah, I've got a hundred questions, because that sort of blows my mind, right? Like, the fact that we have this initial injury, we have the tearing of the axons, or whatever's in the brain, right, that initial thing. So that's what they're looking for in an MRI, that you haven't got a big dead part of the brain or some major bleed going on, and they might be able to pick that up. But they're not picking up, unless it's a functional MRI and unless you've got someone who knows how to read all that stuff, they're not picking up that the cell might be alive but it's sort of — I sort of picture them as not functioning properly, they're not firing properly.

Lisa: And so the reorganisation of that network — this is where, this was a key moment for me when I was listening to one of your lectures, and I'm like, okay, that's the problem then, that we're having to overcome. The brain's adapted, and when we know, like as humans, when we create a habit or a ritual or a routine, it's very hard to break routine, right? Because we've done it over and over and over again and we've practised it. And that's sort of what's happening with this network, isn't it? It's reorganised itself, it's brought in the reserve players off the bench who aren't as good as the top players. They're not the Tom Bradys of the world, right, they're second-rate players, to do the job that the top-rate players were doing. And then you don't get those top-rate players back in the game unless you really have a concerted effort, a multifaceted, integrated approach. And this is where the magic lies in what you guys do. Is that correct?

Dr Mark Allen: That's correct, because it's about engaging neuroplasticity, and the brain doesn't like to do that. It does it at the time of injury — it's a maladaptive plasticity. Anytime you reorganise networks, you have to induce neuroplasticity. The brain doesn't like to do that, so you have to convince it to do that. And that's where the trick is. So now, what do we do about it? That's the tricky part, is engaging that neuroplasticity, which takes a lot of effort and a lot of tricks in how you time what you're doing physically and cognitively, how you layer those therapies.

Dr Mark Allen: And one thing that you mentioned is intensity, but it's the sustained — what we call the sustained principle — where you have to go at it all day for many days in a row, so like maybe a week or two weeks. You might have some talented therapists who are good at brain rehabilitation, so whether it's insurance or however it works in your country pays for maybe so many sessions so many times a month, so you go do one session a day, and that perturbs the brain a little bit, but then when you're done with that therapy it just wants to go back to the way it's been doing things.

Dr Mark Allen: You get a little bit of progress, but when you go at it all day for several days in a row, then you get to a point where the brain is sort of forced to adapt to what you're demanding it to do. You're not letting it get away with going back to being lazy. You're overcoming the laziness of the brain, basically.

Lisa: Yeah, the same old, same old, right? You're making it adapt to you, instead of you accommodating and changing your lifestyle so you don't get symptoms. This is so key. When Mum had her aneurysm and stroke 10 years ago, I would have the arguments — the doctors would go, "She's got massive neural fatigue, you can't train her for more than a few seconds at a time, because she just hasn't got any focus whatsoever." And my approach, because I'm an ultramarathon runner, that's my history, right, professional ultra-endurance athlete — I just knew that with an ultra-endurance training background, you just had to train your ass off and you had to find a way around the fatigue. You had to walk, you had to crawl, you had to stretch for a bit, you had to change.

Lisa: So what I did with Mum, unknowingly at the time — I just changed the impetus of what I was putting in. She would not be able to focus. Say we were six months in, at the very beginning she had bugger all of anything, so it was really me moving her limbs, me trying to talk to her, trying to engage her, trying to get her eyes...

Dr Mark Allen: You were moving her limbs. That's okay, keep going. This is really interesting.

Lisa: My sort of thinking was, she's atrophying. Things like drop foot, I didn't catch, and so she ended up with a drop foot, because nobody told me that lying in bed with your feet like this — which ended up being a major. But I tried to move her every hour of every day in some way, shape or form. And then as her brain started to have— and I used some hyperbaric oxygen therapy. I don't know what you know about that or think about that, but that was for me a cornerstone of it.

Lisa: But it was the training, the eight hours a day that I put into training her in different facets, changing up her training as much as I could, because the neural fatigue was real. If I would get her to focus, and we're focusing on doing a little basic task like wiping the pan with her hands, so she's using her right hand because she was paralysed on the right side — very basic, sitting there doing something like that, she doesn't know what she's doing really, but I'm making her do something — and then I would change it, and then I'd be working her feet, and then I'd be doing something else, and then I'd have her in the hyperbaric. And so the whole day was an eight-hour programme, basically, of input, in between rest — lots of rest as well. But that push and pull, push and pull, push and pull, month after month after month, thousands and thousands and thousands of hours, retrained her brain.

Lisa: And I didn't have the expertise that you and your team obviously have, so I didn't do it nearly as efficiently. Things like vestibular, your eyes — once she was able to stand and balance, because she had no vestibular system whatsoever, so she couldn't even sit, she'd fall over. To get her to actually stand without a support took me a year. It took me a year and a half to get her to be able to walk without supports. So it was a massive, massive undertaking, but we did it. She got her driver's licence back, for crying out loud, in two and a half years.

Dr Mark Allen: That is amazing. I think it's really cool that you had that insight from your background as an ultra runner, of not giving up on your body. People give up too easily on brains, way too easily. But notice what you had to do, how much effort it took, how much time, how much consistency, day after day, hour after hour. And that's why it doesn't happen in the medical world, because the medical community is not set up with that kind of dedication for one patient, that kind of time. And most caretakers don't really — they give up as well. A lot of caretakers, they'll do it, it's hard, it's bloody hard for a while, and then they're like, "Okay, this is just the way they're going to be."

Dr Mark Allen: Any time I see somebody in a coma, it's a real tragedy just to see, they're in this quiet room with — I mean, dead quiet. People come in and they whisper. My brother was in a coma recently, and I told his daughters, "Go in there, turn on the TV, make a lot of noise, move his limbs, simulate walking with him, open his eyes, force them to be open. You'll get kicked out of the intensive care, but do it anyway. Force his eyes open and try and make them move." Olfactory stimuli, everything, to tell his brain that it's not dead. Otherwise, if the brain thinks it's dead, it will die. But nobody does that.

Dr Mark Allen: I did this with my wife — I don't want to get into it too much — she was in a coma, so we did that, and I did get kicked out several times.

Lisa: Being kicked out of many hospitals, "What are you doing?"

Dr Mark Allen: We were doing all kinds of stimulation. "This is dangerous." No, she'll die if we don't do this. So we had nurses on our side who would help us get away with it, but she would have died if I hadn't.

Lisa: Yeah, and your mother as well, her brain would just—

Lisa: Fight after fight after fight in the hospital, because I was wanting to bring in supplements, and I'm wanting to bring in her food, because I wanted her to be on a keto diet, I wanted her to have good fats, I didn't want her to have the shitty Ensure products.

Dr Mark Allen: I know that battle as well.

Lisa: Yeah, that's just — I sometimes feel like it's an alternate universe in our hospitals, especially over here. It's like 30 years out of date. And you're just battling the whole time against not only the situation that you're in, but the staff and the medical system. Without going off on a rant, because I could — I just would do things around it as best I possibly could, and then fought like hell to get her home.

Dr Mark Allen: Likewise. I just — we've got to get her out of here.

Lisa: "She's not ready." Yes she is, she needs—

Dr Mark Allen: "Well, she's got a feeding tube." Take that thing out, that's pumping her full of all kinds of horrible stuff. And sure enough, she could eat. And yeah, it was a fight just to get her out of there, and to sign away all kinds of things. That's fine.

Lisa: Oh yeah. And you know this stuff, you're a professor who's studied this stuff. You can imagine the average person going up against the system, and what chance have they got, because they've got the guys in the white coats coming and telling them they know better. And you've got a background that they can't really argue with, your qualifications. But when you're not that person, it's really tough.

Lisa: And the exercise piece of this puzzle is a big one, isn't it, the HIIT training?

Dr Mark Allen: Well, with your mother, in some sense, yes, brains can't be pushed when they hit some limit. So you work around that limit, you increase that capacity, like you would with any other kind of training. So we have a special kind of cardio that we do, and it has to be tailored to the individual, because one of the main symptoms of post-concussion is exercise intolerance. So we have to have tricks to get around the intolerance, to get those people to be able to do some pretty extreme cardio. And I have a special kind of high-intensity interval that would sound kind of crazy, the way it's done, but doing it that way then gives the brain some neurotrophins and other neurotransmitters that are hanging around for a while that allow the brain to be pushed harder than normal. So you get these little windows that give different neurochemicals available for either an hour, or several hours, or a whole day, depending on what substance it is. And so that's one way that we get around the limits of fatigue that you'd normally have.

Lisa: Yeah, and I think you always have to tailor it, obviously. I'm like that with Mum — she's sitting on an exercycle in the room next door to me while I'm doing this, so that she's at least moving her legs. She's not moving them fast enough, I could go and yell at her for a second, but she's moving something while I'm working. And this is the thing as a caregiver, you've got to juggle multiple things, right? So my whole day is set up around here. I run a number of companies, and so I'm running between Mum, company, Mum, company, just backwards and forwards, backwards and forwards, 24/7, 24/7. And I've been doing that now for 10 years. It takes massive, inhuman efforts. But when you love someone, and you can see— the other thing was that people give up way too early, don't they? This takes consistent, persistent training over long periods of time. And I know people come to you for one or two weeks and get this intensive, but I bet they go home with a big programme of continuing.

Dr Mark Allen: They do. And we do get a lot done in that short amount of time. Now, we're just talking about something that's very fixable. Post-concussion is very fixable, it's relatively easy compared to something like what's happened to your mother or what happened to my wife. That's where — okay, so we have this expertise, but it comes down to what you learn from being an ultra athlete: it's the consistency and the grind. And now that this has been personal for me, not just with patients, now this is a family member — it's just day after day after day, just keeping at it, in the drudgery of it.

Lisa: Oh yeah.

Dr Mark Allen: I guess the best word I can use is grind. It's, okay, here we go again, we're starting our morning routine, okay, let's run through all that. Okay, now it's noon, let's start with the noon routine. And then all the way up to bedtime, here's our routine, bed. And then the next day is the same thing.

Lisa: Yep. And there were no holidays, and there were no breaks, and there were no timeouts.

Dr Mark Allen: Right. And so I think there's medical expertise, but I think that your background with that kind of mindset—

Lisa: Yeah, it is a mindset piece. I think that's probably what I can bring to the party when I'm trying to help people get even from this conversation — is the mindset piece.

Lisa: I think this goes not just for post-concussion or for brain injuries like this, but for every disease. I talked to Dr Dan Goodenowe, who's an expert in plasmalogens, last week — fabulous man. I don't know if you know his work, but awesome.

Dr Mark Allen: Oh, I sure do. Yeah, I did the ProdromeScan panel. So yeah, I'm very familiar.

Lisa: Yeah, he's brilliant. And a piece of the MS rehab too is plasmalogens and all of that. But where was I going? It's the mindset of whatever disease you are facing and you're told there is no way out — whether it's the stuff that Dr Dan works with, like ALS and Parkinson's and multiple sclerosis or Alzheimer's, it's a one-way street to dead. And he said, life is binary: you're either alive or you're dead, and if you're alive, you've got a chance. And I subscribe to that approach. Life is precious, let's throw everything at it to get as much function back as we can, get as much life quality back as we can, and ignore the statistics sometimes. Because the statistics are based on the system that is failing. And there's not enough time, but if you're willing to put in the hard work, the time, the money, the effort, and everything else, then you can have a chance at beating the odds. And that's the message: are you willing, as a caregiver or as the person, to go through that? That is the question here, not whether it can be done.

Lisa: I just watched a documentary on our TV here and it was about ALS, and the people were saying there is absolutely nothing you can do and this is what we have to accept. And I'm just going, that's not true, that's not true. Have you done this and this and this and this and this? No, you went and took a drug and that didn't work. There's more to this than that — it's multifaceted. And that's what I loved about your approach, and it's a hard work approach.

Lisa: Tell us a bit about your team and what parts make up a good post-concussion programme — because not everybody's going to be able to go to Utah and hang out with you guys. Is there anything that we can take away, with their limited ability to access everything, but what can we take away?

Dr Mark Allen: The active part of it is very active therapy. You know, therapists engaging one-on-one. A lot of the alternatives, at least in the US besides our clinic, are places where they have a lot of devices, so you get light therapy, you get something passive, you go sit in a hyperbaric chamber, you go sit in a room, somebody sets you up and they leave. That's more cost-effective for a clinic to do those kinds of things, where they don't have to have so much expensive types of personnel to do these one-on-one therapies. So it is that active piece, and guided by an expert. And unfortunately, that's one of the things that you can't do so much at home. But you can educate yourself and learn a lot.

Dr Mark Allen: The other trick to it, though, is that there's a trick to the way that you proceed with therapies that are different from one another. So vision therapy, vestibular, cervical therapy, working on the cognitive stuff, sensory things — if you go, especially with vision, if you go too far in one direction, you can kind of undo progress in other areas. So we have a very parallel, iterative approach where you do a little bit in one domain, then you circle, the therapists all talk together, they say, okay, this is the progress we made here, let's see how it's affecting this domain, then they work on that a little bit and circle back. So there is some trickiness to it. Now, this is again for post-concussion, but there's a basic formula to it, which is we call the PAR cycle: prepare, activate and rest.

Dr Mark Allen: So the prepare is some physical activity that should be fairly intense — you should really get your heart rate up. And then that gives you that window when you can push things cognitively a little harder, and then rest, recover, and then go through that cycle again.

Dr Mark Allen: For post-concussion recovery specifically, I could give a little away that people can try. It's a high-intensity interval with an accelerated cool-down. So it sounds kind of pretty, but what you do is you warm up, and then you do some activity that's going to really get your heart rate up fast, like an elliptical or doing burpees will do — something where you're using a lot of muscles.

Lisa: Yeah, body pump.

Dr Mark Allen: Now, if you do something that uses your quads, that's good, because a lot of BDNF is generated from your quads.

Lisa: Interesting. Wow. That's for your brain.

Dr Mark Allen: But okay, so back to this regimen. You go all out to your wall, you go a minute or whatever it is on the machine, until you reach that point where you have to stop. And then you immediately stop, you get off the machine, you lie down, you sit down, you relax every muscle in your body. You're fighting for breath, that's fine, you try to get your breathing back. You even meditate, whatever you can do to cool down.

Lisa: Dropping fast, yeah.

Dr Mark Allen: Drop fast. Try to even psychologically pretend like you're not going to do another cycle. That's what I do. I'm like, okay, I'm done, that's it, I'm not getting back on.

Lisa: Wow, okay. Kind of fooling your brain.

Dr Mark Allen: That it's in that stage where now it thinks you're done, it's going to start doing some different things with the blood vessels, with the chemicals. And you surprise it, you get back on and you do it again. Because there's something special that happens at the beginning of a workout, when you go from — because you're in a more parasympathetic-dominant state and then you start pushing. Notice that the most miserable part of a workout is always the beginning, right? And that's because your parasympathetic system kind of doesn't want to disengage. It's like, okay, you sure you want to do this? We could just sit on the couch, watch something. And then it lets go and lets the sympathetic kick in.

Lisa: Wow.

Dr Mark Allen: And then you start feeling better, and then you can push the sympathetic more. So what this does, by going through those cycles of extreme rest and then back up to the high activity, the extreme rest — you're giving more opportunity, you don't quite get down to that baseline, but you are giving more of those startup opportunities for those startup mechanisms. There's an interesting little fight that goes on in the autonomic nervous system between the sympathetic and parasympathetic, where they fight it out as you're starting the next cycle. That strengthens that relationship. So that's another benefit of doing these accelerated cool-down HIITs: it strengthens the autonomic nervous system, but then it also is a quick way to get a lot of these great brain chemicals.

Dr Mark Allen: Something also very special happens when you are really at your limit, when you're going all out and you hit that wall where your muscles are just saying, nope, we've got half the oxygen, you've got to stop. And your brain — you literally would die if you kept going, right? But there are really great things that happen at that point as well.

Dr Mark Allen: And again, that can be difficult with people who are struggling with exercise intolerance, so we have little tricks to get around that with breathing and cooling and different things, to keep those — the nausea, usually nausea, headache, pounding that they'll get. And we have some tricks with CO2 therapy as well. But just in general, that's something people can try, maybe under guidance of at least a PT or something.

Dr Mark Allen: And this is hard when you've got people who have had post-concussion for a long time. Maybe they're not trained, they're maybe overweight, or they're disabled, or they're elderly, like Mom — you can't push physically too far. So you've got to tailor it to the person, obviously. But then the thing is, the less fit they are, sometimes the sooner you get the goodies. And so to whatever degree you're able to work out as intensely as you can, and safely — you've got to worry about your cardiovascular factors as well — then that's an opportunity to get what's called the post-exercise cognitive boost. A lot of people feel sharpest right after a workout.

Lisa: I know, yeah.

Dr Mark Allen: So that's when I kind of prioritise the stuff that I least want to do, that takes the most hard work. I schedule it to do right after I've worked out. That's when I feel my best and brightest. And it's the same thing with your rehab. So right after that, then do some brain games or whatever challenging things you can find to do.

Lisa: Now, you have a lot of vestibular work, I believe. Explain to people why does using your eyes, refocusing, training your eyes in certain ways, help the vestibular system? How does that interact with it all?

Dr Mark Allen: Yeah, and that's again where it takes a specialist. But one of the basic breakdowns, the most common thing that we see, is the vestibulo-ocular reflex. So you have circuitry in your brain that computes how your head is, how your body is moving, and it immediately tells your eyes how to adjust. So your eyes are constantly adjusting for head movement. When that computation breaks down, you get really miserable, because your eyes are always lagging behind, your eyes aren't keeping up, they're not moving with your head and your body, and you get dizzy, you get nausea, you get headachy, those kinds of things.

Dr Mark Allen: So there's an exercise that you do, and you have to do it in the right direction. So you find that people have a problem in one head direction and not the other. You want to rehabilitate only the one that's not good and not rehabilitate the one that's good, otherwise everything keeps the same and we don't end up getting any benefit. So that's one of the things that takes some guidance, right?

Dr Mark Allen: But then we also work on people's necks. Most people with head injuries will have neck injuries, and you need to get the musculature of the neck in place. And then there's the balance part to it. So we find that when people have vestibular problems, a lot of it is the eyes, but there's also something with breathing that's going on that can be part of the vestibular problem. And then the otolith bones — they're sensitive to gravity and they can become injured, so there's

Dr Mark Allen: something about the connection with the brain — the fibres that connect to those bones that respond to gravity can become worn or broken. You can rehabilitate those with a special device that stimulates those at a certain frequency on a certain side. Again, you have to kind of go through some testing, and you can get those fibres to re-engage and become attached and responsive again to the otolith bones. About half of our patients respond to that therapy and need that therapy. If you do it and it doesn't do anything for you, then you know that's not your problem — you've got problems with the canals maybe instead. And then you address that through, kind of, whatever makes you dizzy. You find the motion that makes you dizzy and then you keep doing it.

Lisa: Wow. So it's a symptom aggravation?

Dr Mark Allen: It's a symptom aggravation. The brain, under a lot of circumstances, can adapt from failure. So you move a certain way, you get dizzy — that's a failure. In a lot of cases the brain can learn from that failure and make adjustments. So you let it fail, you let it fail, and then now it doesn't work — it doesn't always work for everybody, but people should at least try it. If you find, like, I lean back in my chair and get dizzy, well, do that some more. Or you stand up and you get dizzy, you've got more of a static issue, like some POTS kind of thing. Do it again — safely, being in a place where you can fall down. If you get light-headed, stand up again, stand up again, and you might find that you're training it. So that's kind of a symptom aggravation approach.

Lisa: So you're creating this adaptation in the network at all times. And ideally you have a specialist who knows how to do all this vestibular or balance training, or working out which areas. But for the person who can't get to your incredible clinic, just putting in stimulus every day, consistency, exercise, challenging the body in many different ways, and safely, obviously.

Dr Mark Allen: That's right. And you have time. I mean, you don't have an expert, but this is kind of the biohacking world, I guess, where you have yourself and time to try. So you try, and you eventually stumble across something that works for you, and it's not too dangerous. These things either work or they don't work. There's not much you can do to make things worse. There's nothing that you can do to make a concussion worse other than another hit to the head, or where your brain gets jostled by being on an ATV with a bad rider, or in a car where you're not the driver and you can't brace. So aside from rapid head movements or another injury, pushing your brain isn't making it worse. A lot of injuries to our bodies, you can overwork, and the pain — so you have a knee injury and you push too hard, and the pain tells you you're causing more damage. Well, it's not the same with the brain. The brain is different. When you push your post-concussion brain and you get symptoms, you're just getting the symptoms, it's not causing more damage.

Lisa: Not damaging. That's important that people know — it might actually be doing a little bit of adjustment and rehabilitation. So don't be afraid of the symptoms coming from what you're doing. You're not making it worse. That's really important, I think, for people to hear, so that they're not scared of the thing. I mean, obviously, if you're standing up and you're dizzy, you need to make sure you're not going to fall over, you need someone there with you or whatever, your mattress on the floor or whatever the case may be. So be sensible with this. But you're not actually going to damage yourself by stimulating your brain in many different ways, and constantly doing that, and changing it up, and being persistent with it is the thing.

Lisa: In Mum's case it was a combination of hyperbaric, plasmalogens, exogenous ketones, supplements up the wazoo, a really good strict diet, exercise constantly, vestibular system work, eye work as best as I could do, chiropractic work. There's a lot that goes into this, but by having that multifaceted approach, then you can get sometimes extraordinary results, if you're willing to hang in there for the long term. Unfortunately most people don't, they give up.

Dr Mark Allen: They definitely do. I kind of like this direction that we're going, where if you come to our clinic we can do this, and the advantage is that we can do it very quickly. We can get right through the problem, we can do it in a very super-efficient way, we can go through all this. Whereas if you can't come to this clinic, then you're going to have to experiment yourself. You're going to have to stumble on what the right formula is. But you can, if you're consistent. And sitting in a dark room is not the answer.

Lisa: And I think a lot of people stop working, stop training, stop doing all of this because they think they need to rest. Rest is the worst thing that you can do. Our bodies are made to move, our bodies are made to train. We need that blood flow, we need that oxygen, we need the delivery of the nutrients.

Dr Mark Allen: Yeah, especially right after a concussion. I get several calls a week because people know what I do, so there's always somebody who's got a concussion, and they call me and say, this happened today, what do I do? And they say they told them to go home and rest. And I know — no, you need to get on the exercise bike, or something that keeps your head... it's not, you don't want to keep your eyes fixed, your eyes are going to be kind of wonky for a while, you're going to get nauseous, but keep your heart rate up. So I always have them immediately get on an exercise bike and try to engage in as much cognitive stuff as they can, try to go about their normal day. They may get a lot of symptoms, they may get terrible headaches, but that's what you need to do to stave off that initial maladaptive reorganisation.

Dr Mark Allen: And there's even more to it than that. There's some protective mechanisms that rush in and they try to shield those neurons from further damage. They can be a little overprotective, and so if you keep blood flow and you keep those brain cells firing... what they do is they kind of lock down the brain cell trying to protect it, but they also lock down its functionality. And so if you can get some sparks out of those, they kind of tell those protective mechanisms, I'm okay, you don't need to be so protective, back off a little bit. So blood flow will do that, and then firing it both keeps those overprotective mechanisms backing off, and it tells the brain network that it's got viable brain cells there — don't give up on those, don't reorganise, just hang in there and wait for those. So that immediately after is really important.

Lisa: What's your take on — we've got rugby as our national game over here, and we have our guys, when they get hit in the head on the rugby paddock, they might get taken off for an HIA. What do you think of an HIA?

Dr Mark Allen: Provocatively, they're pretty useless. I mean, yes, I'm all for being very conservative with getting out of the game.

Lisa: Oh yeah. And they go back on...

Dr Mark Allen: The few Americans out there playing rugby played American football.

Lisa: Yeah, so you're very familiar.

Dr Mark Allen: I grew up with Polynesians, so in the community I played a very rough version of rugby as well. But I'm all for being very conservative, because you don't want to get hit more, you don't want your head moving a lot, you've got to deal with the visual problems that are most likely going to come — let that calm down. But it's more just the get off the pitch, but then get on an exercise bike and try to keep your heart rate up, even right after the concussion.

Lisa: Wow. That alone is great. Keep moving. And don't — a lot of them just get sent back on the paddock, and even if you've had a small knock to the head, that second hit that comes later in the rugby game...

Dr Mark Allen: There's that, and so it's just a matter of how conservative we want to be. It's hard, because when I worked a lot with the National Football League, in their careers, depending on their position, they might only have a couple of opportunities per game to show that they're worth their contract. So it may be a receiver that only gets the ball to them maybe two times a game, and they've got to come through then so they can keep their career going. So there is that to take into consideration. But if it were only a matter of your health, then yeah, conservative.

Lisa: Yeah, and the consequences. When you've had repetitive brain injuries over and over again, the consequences 20 years later, 30 years later — the Alzheimer's, the MS, the Parkinson's, the mood changes, the personality changes, all of that sort of stuff that happens later. I had a brother who's a professional rugby player, got hit in the head so many times, and he's got problems now in his 50s, and a lot of his friends as well, because back then there was no HIAs, they just said harden up and keep going. And yeah, it's tough now, because it's a lot of damage.

Dr Mark Allen: That's all avoidable, too. The problem is that you finish your career and then you don't get treatment for — basically what's going on is they have post-concussion syndrome. They have these inefficiencies, these metabolic inefficiencies. Their brain is using this inefficient way of doing things, kicking out all kinds of bad byproducts that eventually culminates in CTE or dementia. But it's avoidable, that if you reregulate your system, if you do these things that re-engage normal blood flow, get the brain efficient, get a nice clean... You could have had many, many concussions, there's still hope. It's still in that state of kind of limbo of being fixable, because you don't have cell death. So you take somebody at the end of a very rough career, they've had many concussions, you scan the brain, you may not see a lot of problems at all. It might look totally normal, because those brain cells are still alive. So that shows you you can do something about it.

Lisa: Even if you've had many, many concussions, you can still fix your brain and avoid... There is hope. And be proactive and go out and take the right supplements, eat the right diet, do the right exercise, do the training, do the hyperbaric, all of those aspects that you can be proactive with, so that you don't end up with Alzheimer's or dementia or something horrible happening to you later on, because you are predisposed more

to those things. I mean, this is a message — I might be overstating it — but you don't just have to sit and wait for "oh no, am I going to get..."

Dr Mark Allen: No, no, definitely not. You have agency, you have control over it.

Lisa: Yeah, and we've done lots of episodes on various aspects. I've interviewed Dr Mark Gordon and of course Dr Diane and Dr Dale Bredesen and all these people that have their proactive plans, if you like, that you can take, and yours as well. And if we listen to all of that and say, what can I do, my loved one, what can I afford, what can I get access to, what can I take away from that conversation — there's nuggets in every one of those, because then there's things that we can be proactively doing. And prevention and proactiveness is, I think, absolutely key. Not waiting for the problem to arise before we do something about it, which seems to be the sort of standard medical model. We wait till you have diabetes before we treat the diabetes, even though we can see it coming 10 years before.

Dr Mark Allen: Right, yeah.

Lisa: It's crazy. Why are we not going, okay, you've been a rugby player for 15 years, you've had a hundred different concussions, maybe we want to be proactive, maybe we want to go and do some hyperbaric and some HIIT training and some saunas and get some BDNF going, and whatever the case may be. There's a lot of things we can do.

Lisa: Dr Mark, thank you so much for sharing your brilliance and your wisdom. I know you've been doing this a long time. The functional MRI — I hope that people all around the world start getting access to functional MRI. We don't have it here. There's one place that I know of in New Zealand that's doing it, and it's way over the other side of the country. It's not sort of standard, and I'd love to see that sort of technology, and like your wisdom on how. And I know that's why our mutual friend Dr Elizabeth Harris is sort of working on a brain centre down here. But we need these advanced sort of technologies as well, so we can actually see what's going on in the brain.

Dr Mark Allen: Yeah, yeah. So it's not too hard to set up a place to be able to do fMRI. It's just, then what do you do with it? So we can generate the report, people can do their own version, then it's kind of like, what?

Lisa: Yeah, then how do you use it? Yeah, that expertise.

Dr Mark Allen: But it's all — yeah, we did it and other people can too. You just have to break out of the structures of the medical system that you're in.

Lisa: Or convince them to change the way that... yeah, it's probably easier to set up your own. But it's always, like, these are things that are not then paid for, they're not funded by insurance and so on and so forth. We have to understand, I think, that the insurance system or the social health system that we've got in New Zealand is very much limited in what it can actually offer you. So I always try and get people to start putting some of their money away. They can put 10% of their paycheck away every week, or 5%, or whatever they can manage, for future health-related plans, to have that nest egg for when you need something that's not offered by the standard medical system. And there will be, if you want the things that are actually going to help you, then that's the way that it has to probably be in the future.

Dr Mark Allen: Yeah, it's a pay-to-play system, unfortunately. Unfortunately these things are expensive. I wish they weren't. We've made so many efforts to try to make things as cheap as possible, and you just hit some limit where you have to pay all the therapists.

Lisa: Yeah, yeah. You've all got to make a living, right? Everyone's got to eat. It is difficult. But as the more we scale these things, the more people are aware of it, then we slowly may change the actual system. And that too has its validity. So we just got to keep going.

Lisa: Yeah, absolutely. So it's been wonderful to interview you today. I thank you so much, Dr Mark. And I'm very grateful to Elizabeth for connecting us, and learning so much from you. So thank you so much. And where can people find you if they are wanting to come to Utah and they're wanting to work with your team, or reach out to you? How do they do that?

Dr Mark Allen: Well, if you Google Cognitive FX, you'll get there.

Lisa: Cognitive FX. I'll put the link in the show notes.

Dr Mark Allen: Cognitive FX. You Google it, it'll come up. All kinds of contact information, all kinds of information in general, so you can read, watch videos, educate yourself.

Lisa: So much information you can educate yourself with, both about coming to the clinic or, if you can't, what you can do.

Dr Mark Allen: Yeah, a lot of what we've talked about.

Lisa: Absolutely brilliant. That's a service to humanity. So thank you very much, Dr Mark. You're absolutely wonderful.

Dr Mark Allen: Well, you're welcome.

Lisa: Thanks so much for watching, and we hope you enjoyed this video. Please like, comment, hit the notification bell and subscribe, and of course share it with just one person who you think could really benefit from this content. Click here to watch last week's episode, and click here for my website, and click here to watch a video you may not have seen.