Fatigue After Stroke 3: stress in little doses can be beneficial

Good stress (hormesis) changes energy after a brain injury

When dealing with the aftermath of a concussion, or stroke, you probably know by experience that stress is one of your worst enemies when recovering from the (long term) effects of a brain injury. The type of stress that can worsen your situation often comes in the form of negative thoughts such as worrying, physical overexertion (often not much activity is needed), chemical (like cleaning agents), toxic (alcohol, smoke), viral (like the flu) stress to name some that you are probably all too familiar with.

There are however also good forms of stress. Stress in little doses can be beneficial and raise your overall energy levels.

In this article low-level stressors are introduced that you can implement to increase energy levels (such as heat, cold, low oxygen levels, and calory restriction). A second article will deal with nutrition, chemicals in the form of nutraceuticals (natural components that have drug-like effects), avoidance of environmental stressors like toxins in your kitchen, and sleep all of which will have an energy-enhancing effect and complement what you will learn here.

In a previous blog, I wrote about the energy crisis after a brain injury and the energy factories (also called mitochondria) in your cells. Most of the things that are listed in this article will have a positive effect on your mitochondria and energy production. When applied mitochondria will be stronger, produce more energy, fewer waste products, and even multiply.

Before starting to present the list of good stressors (and some things you can do to benefit from them) I will explain a few things about hormesis, a word that is inseparable from the good effect that low levels of stress can have.

What is hormesis? (you can skip to the section where the activities you can do are listed if you do not like the technical stuff)

Hormesis is a technical term used by toxicologists which refers to a biphasic (working in two phases) dose-response to an environmental agent characterized by a low dose stimulation or beneficial effect and a high dose inhibitory or toxic effect.

Sorry, If I lost you there. What it means in simple words is that a low dose of activity or substance (such as exposure to radiation, potential toxin, or oxygen deprivation) can be good for you and that when the dose is increased it can have the opposite, toxic or braking effect, which of course is negative.

To put it another way: “what doesn’t kill you makes you stronger” Exposing yourself to potentially unpleasant experiences can make you feel better.

The so-called hermetic effect (low dose beneficial, high dose harmful) can be obtained in several ways:

· Calory restriction

· Exercise-induced

· Heat exposure

· Cold exposure

· Light exposure

· Oxygen depletion

· Toxins/ radiation

· Phytochemicals

All of which will have a profound effect on your mitochondria.

Calory restriction and exercise will initially deplete the energy available (like the glycogen stores in your liver) and will cause the energy production to lean more towards efficient use of ketones that are freed by using fat stores as fuel. The result is a more clean and efficient production of energy (see also the last article on how mitochondria produce energy). Most of the other ways inducing hormesis potentially cause the energy production initially to fail in some part because of depletion of oxygen, toxicity, or physical damage to the mitochondria. In low dose form, this will have a secondary upregulation effect on the protective mechanisms built in the energy production, for example, an enhancement of glutathione (the body’s own strongest antioxidant) output to counteract reactive oxygen species (ROS) produced by unbalanced energy production. Also, the repair and reproductive mechanisms of the mitochondria will be enhanced when the energy factories are exposed to low levels of stress. All of these mechanisms will as a result improve the efficiency of energy production.

For simplicity and safety sake we will cover the first six (calory restriction, exercise, heat, cold, oxygen depletion, and light exposure) from now on, sort of skip the toxin and radiation part (although I will give some interesting facts on these too) and leave the phytochemicals to be covered in part two (the next article).

One word of warning though before proceeding. Although implementing low levels of stress is harmless, if done correctly it will require some level of discomfort, especially at first (think about the first time you started running or went to the gym). As a precaution, you should of course consult your physician if it is alright to apply in the first place.

Low-level stressors that you can use to have more energy production daily:

Exercise

Probably the best-known form of hormesis and also your number one resource to tap into when you want to recover energy levels. Research shows that moderate and more intense exercise will cause real (micro)damage in muscle fibers, which is what gives you the soreness after having worked out. When training beyond your oxygen uptake capacity (anaerobic training) you will in addition produce lactic acid (which gives the burning sensation) both effects will trigger a multitude of beneficial effects in the mitochondria in your muscle. More is produced, energy production goes up and repair of your energy factories is upgraded. Low levels of graded activity, such as walking or pedaling on a stationary bike will improve circulation and thus increase fuel and oxygen delivery throughout your body (most importantly your brain).

As mentioned before the opposite happens with more intense forms of exercise (like weight training and high-intensity interval training), less fuel and oxygen will reach the energy production chain and mitochondrial mechanisms are forced to upregulate and improve the increased demand for fuel. Implementing this into your daily life when you are dealing with a brain injury will of course depend on the level of recovery you are at and the amount of temporary exacerbation you can handle on a short-term basis. Having said that, no matter where you are in your recovery, there is some form of exercise that will fit your situation. Stronger said if you are not already doing so, you have to start moving again, it is one of the strongest tools for repairing your energy levels.

As mentioned in most cases starting to increase your exercise level can have a temporary negative effect to avoid too many side effects, you will have to build this up slowly. This of course is where a personal trainer, physiotherapist, or ergo therapist can be of great help to get you going.

As with all the following items, I want you to be aware of the fact that at all times you will have to address more than one aspect. For example, research has shown that neuroinflammation will cause you not to want to move, as a protective mechanism (more on that when we cover neuroinflammation and its role in fatigue after brain injury), so for you to get into an exercise routine you will also have to address neuroinflammation.

Calory restriction and intermittent fasting

At first glance, you may think that restricting calory intake is contradictory to having more energy. In real life, though it is one of the strongest things you can do to upregulate mitochondrial energy production (repair and reproduction!). Many researchers have shown the multiple benefits restricting calories (especially cutting refined carbs out of your diet) has on health: Prolonging life expectancy, restoring glucose levels, preventing inflammation in your body and even cancer, next to improving function energy production, to name a few.

Fasting or intermittent fasting is by far the easiest way to accomplish this. Since intermittent is the least complicated to weave into your daily life we will focus on that. Intermittent fast just means that you extend the period not eating for 14-16 hours (which is, unless you have problems regulating drops in blood sugar levels, not that hard). Of course, you can build this up gradually, and I can tell from personal experience, it is not that hard (especially when you think about all the health benefits (-: ). In daily life it may look like this: You stop eating at 19.00 and start eating at 10.00-12.00 am.

What happens is that you start running out of glucose (the fast energy source) and start upregulating the energy process to run more efficiently, with fewer waste products, by running on ketones which are taken from your fat reserves. Leaner and more efficient energy production is the result. If you want to enhance this process even further you cut most carbs out of your diet (meaning bread, pasta’s, potatoes, rice, and all flour products soda’s etcetera.) other than the more than enough carbohydrates you get in through your main staple of vegetables (more on this in part II) and replace them with good fats (wild fatty

fish, game, avocado’s, nuts, olive oil, coconut oil). As you will learn in part II of the series good fats enhance health, decrease inflammation and make for way better energy production. Increased fats and decreased sugars (read carbs) make that you start producing more ketones (remember the body's source for leaner and more energy without excess waste products).

Heat and cold exposure

Both are known to have a strong (up) regulatory effect on mitochondrial energy production and even replication. Researchers have shown that one of the easiest ways to upregulate mitochondrial function is cold exposure. Terms that you will often come by when talking about the heat or cold exposure and its beneficial effects are heat shock and cold shock proteins which are released when the body is exposed to extremer high or low temperatures. Scientists believe that the release of these shock proteins upregulates mitochondrial energy production through several mechanisms. Some of the effects are that beneficial nitric oxide is released, which makes the blood vessels work better so more oxygen and fuel is delivered, and internal household mechanisms clean up any damage inside the mitochondria.

So what are the easiest and best ways to gain benefits from heat or cold exposure?

Let me start with heat. One of the most extensively researched ways to produce shock wave proteins is taking a sauna regularly. The best thing is that regular heat exposure over short periods has many health benefits ranging from, life extension, detoxification, quicker recovery time, better sleep to better energy production. If you want to enhance the effect of heat exposure an infrared/ red light sauna will even have more effect. The heat penetrates deeper and mitochondria react favorably to red/ infrared light exposure. In case you do not have access to a sauna but are in the fortunate circumstance to live in a sunny environment, then short bouts of sunbathing can have a similar effect, although it is not the same (see also sun exposure)

Although cold may seem less tempting to most, I would read on and start investing time and effort into it, since it is together with exercise one of the best ways to increase energy production and resiliency. There is a reason why Wim Hof (also known as the iceman) receives a lot of continuing attention in the media, researchers find that the health claims made in the media are not a myth or just a one-man miracle, they are real. Taking a cold shower or bathing year-round in cold water (the effect is already reached after one and a half minutes) is the easiest way to release the so-called cold shock proteins. Out of practical use you can, for example, start with walking outside in the morning in nothing more than a T-shirt and shorts, when living in a temperate or cold climate, and stand outside for some time drinking your morning coffee or tea. Now, this may seem a little over the top since you most likely learned that you have to dress up avoiding things like colds, but new insights from research back up the practice of short periods of cold exposure. Interestingly enough I had the same idea for most of my life, at least two layers of clothing to prevent the cold (my mum was insisting firmly) to get a grip. Now I think the opposite, after practicing cold showers, bathing outside in cold water for some years I have noticed that my body handles

cold way better and I have no, or hardly any colds anymore (one of the other effects of short periods of cold exposure is upregulation of the immune system)

As with all practices, whether that is increasing exercise, sauna, or taking cold showers, build things up slowly, so your body gets used to it. This will avoid a strong stress response which you will get when too much exposure is done.

Hypoxia (reducing the available oxygen)

I already talked about this more or less when covering the effects of exercise. Anaerobic exercise (where the effort exceeds the available oxygen and you go into anaerobic energy production with side products such as lactic acid).

Any practice where you temporarily reduce the available oxygen will have a profound effect on the efficiency of your energy factories.

You do not have to spend time at a high altitude where there is less oxygen available. One of the easiest ways to practice hormesis through hypoxia is breathing exercises where you teach yourself to have more time in between your breaths. Interestingly this is also one of the easiest and best practices to increase your focus. For example, navy Seals practice a breathing technique called boxed breathing to get super focused. I mention this here since I found this breathing technique very helpful. A side effect of this one simple technique is that you practice hypoxia full-on. The periods where less oxygen is available to increase as compared to regular (unconscious) breathing. The technique goes as follows: depending on your level of familiarity with breathing techniques, you can start with 2-3 seconds intervals and build this out to 4-second intervals. 3 (or 2 if you want to start easy) seconds inhale through the nose – 3 seconds holding the breath – 3 seconds out through the mouth – 3 seconds hold. Hence a box with 3-second sides (-;. You can do this for a couple of minutes once you have mastered this technique. Do this a couple of times a day.

Of course, you can change your breathing more subtly if this proves too challenging. For example, breathing out longer than in, most people do not do this, so it will pay off to breathe in for say 3 seconds, hold your breath (to optimize gas exchange in the lungs) for one or two seconds, and the breath out through the mouth for at least 4-7 seconds, and do this for some rounds.

Now if you know you cannot keep yourself to regular practice. You may choose to swim instead or increase physical activities where you naturally will cause states of hypoxia and upregulated energy production.

For more explanation about breathing oxygen and advanced breathing techniques where hypoxia is induced I refer to training on this that I made before (see breathing, O2 video)

Light (sun) exposure

Light is one of the most essential sources for energy production, that you have. Yet it is perhaps also one of the least understood or utilized ways to gain energy from (more on blue and red light qualities in subsequent blogs). Most of us know how good it can feel to sit for some time in the sun. This already gives a clue to the beneficial effect of sun (light) exposure.

Although sunlight exposure has gotten a lot of bad press, you should never underestimate the beneficial effect short exposures will have on your overall health (that is beside the hugely important role sunlight exposure has on the formation of vitamin D3, one of the most important hormones you have). Of course, always keep in mind that too much exposure will never be good (the toxic end of the hermetic effect) and can eventually lead to lethal conditions such as skin cancer. The relatively short periods in the sun should preferably be without any sunscreen (be also aware that most sunscreens have potentially very negative toxic consequences on mitochondrial and hormonal function because of their ingredients)

The hermetic effect of sunlight can be explained by two main effects, one is somewhat like when you train muscles, sunlight will cause mini lesions in skin tissue which demand repair mechanisms to come into play (this is beneficial damage, unlike what happens when you get burned by the sun). One of these mechanisms will upregulate energy production. The other effect will come from heat shock proteins that will be activated by the heat of sunlight. We already discussed this in the hormetic effects of heat exposure. Another very strong effect will be that of the red wavelengths of light (which are also stronger in the morning and evening) on your mitochondria, energy production goes up because of red light exposure.

Short periods in the sun (how long will of course depend on your skin type and overall health condition) especially in the morning and after three in the afternoon can thus be a very effective and safe way to not only boost energy but also morale, overall wellbeing, hormone levels, and thus should not be avoided!

This concludes the first major ways that you can implement daily to help energy production be raised to better levels. What I did not discuss is the hormetic effect of small doses of radiation, on which I am 1. not an expert, and 2. The irreversible damaging effects of too high doses of radiation are not something you should be playing with. To learn more about this I suggest digging into the longevity project where centenarians are traced around the world. In one of the places where there are statistically significant more persons over a hundred (In Greece) one of the reasons that are given, next to lots of physical activity until old age, healthy food, close-knit community, is the presence of natural wells where low levels of natural (not being background radiation) radiation (which can come from certain rock formations) are present. This apparently might also have an up regulatory role in the antioxidant formation and cellular energy production and be a safe source of beneficial hormesis through radiation.

So to safely increase energy production through upregulating mitochondrial function, you can start daily to add some beneficial stressors into your daily routines, next to increasing exercise levels, intermittent fasting (calorie restriction) some cold, heat, and light exposure can help to overcome the energy crisis after brain injury. Keywords here are consistency, slow build-up, and perseverance until small doses of beneficial stress have become a habit for you (this usually takes 60 plus days of consistent action)

In the next article I will discuss the hormetic effect of food, and other specific natural components (so-called nutraceuticals) that can raise energy levels even more. In later

articles, we will discuss other crucial items such as stress reduction, forgiveness, and learning all of which have a big effect on your energy levels.

Arjan Kuipers

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