TBI/traumatic brain injury

Multiple areas of the brain are involved in TBI and concussion.

Concussion, or traumatic brain injury is common among contact sports participants. Concussion has been defined as a condition in which there is a traumatically induced alteration in mental status, with or without an associated loss of consciousness. In reviewing the scope of symptoms of actual concussion patients, further specificity can be discussed. Dizziness or vertigo is an erroneous perception of self motion or perception of environmental motion and of gravitational orientation. Most patients who have suffered a concussion experience this phenomena of symptomatology. Typically this perception is created through a mismatch between the vestibular, visual and proprioceptive, (sensation of the earth under your feet), systems. Because of the overlap of these systems, they each tend to compensate for deficiencies of the others by design. This is why when the lights suddenly go out, or you suddenly step onto a soft spongy surface such as wet sod from a hard surface such as concrete, the normal brain can quickly compensate by changing between these three systems to prevent falling. TBI does not produce a specific disease entity, rather, it causes a syndrome of mismatches of the stabilizing systems described above, in addition to headache and other symptoms. There is no evidence that medication improves recovery after concussion. Further, research has found that overuse of analgesics following injury may exacerbate concussion-related headaches or make them chronic. The most common treatment recommendations for concussion are rest. But this too has not met with satisfactory results as concussion symptoms commonly continue or worsen. An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion. The first ten days following a concussion appear to be the greatest risk for being diagnosed with another concussion. Second concussions are bad for several reasons. The brain has not yet recovered from the first concussion, so the damage becomes cumulative. Second impact syndromes are often the cause of fatalities in concussions, sports related, (adolescent and pro), or other causes. Although rest initially following a concussion is often advisable, it is not solely the best treatment for concussions. Our office uses the most contemporary and proactive treatment methods in the management of concussion brain injuries. We do this by directly affecting the aforementioned systems of balance for as long as these systems continue to be mismatched, there can be no recovery, and as long as these systems remain mismatched, they will perseverate the other concomitant symptoms associated with concussion and traumatic brain injury. More information on traumatic brain injury and treatment can be found on my website at



The main causes of concussions are typically anything that involves a head injury. This can include sports activities, and all too frequently, automobile accidents. Severe concussions, because of the immediate symptoms, are often followed up upon with medical care. It is however the less severe impacts that can become more problematic as these are not always brought to the attention of a medical person. In addition to neurologic symptoms which can develop following even a mild concussion, even more serious is something called second impact syndrome, whereby an individual with a concussion has a second one and has not yet recovered from the first. This can be so severe that it can actually be life threatening. For these reasons any suspect concussion, i.e. any head trauma, should be followed up for appropriate examination by a medical person well trained in post concussive injuries. The most common symptoms following a concussion include sensitivity to lights and sounds, and often altered sense of smell and difficulty reading. The latter is often inappropriately thought to be due to age related deterioration in vision, but is in fact due to an inability to properly place the eyes in the correct position and keep them there while viewing a target, or while moving the eyes from one target to another, or while following a target, as occurs with reading. My office is used to seeing patients who have had an untreated concussion years ago only to find worsening symptoms now. Naturally these are much easier to treat earlier on.

Things that you can do if you believe you may have had a concussion: The simplest thing you can do is come in to our office for a balance test. The test takes less than one minute to perform and yields an extraordinary amount of data relative to you postural systems and your brains ability to resist the earth’s gravitational pull properly, i.e. risk of fall. Our office does not charge for this service as we offer it as a free community service. Our office is additionally equipped with a complete balance center, including infrared video goggles which allow us to record and watch your eyes while following targets on a computer screen in real time. This information is essential to properly treat someone whose brain has been injured.



In the United States, sports-related head injuries occur frequently. The Centers for Disease Control, (CDC), estimates more than 300,000 sports-related concussions occur each year just in the US. There are a number of myths and misunderstandings among health care professionals regarding concussions.  Many physicians serve as the team doctor for their community high schools. The demands of clinical practice may preclude them for staying abreast of the latest evidence-based information regarding management of concussions in their student athletes. From 1982 through 1996, only 101 articles had appeared in the literature on concussion whereas recently this number has more than tripled.  The following new findings have all been demonstrated in recent research: 1. High school athletes are more vulnerable to concussions than older athletes and may take longer to recover.  2. Failure to properly manage concussion may lead to long-term cumulative consequences.  3. Loss of consciousness is not an appropriate marker for the presence or absence of concussion.  4. High school athletes are 3 times more likely to experience a second concussion if concussed once during a season.  5. More than 5% of high school athletes are concussed each year while participating in contact sports. There are a number of myths and misunderstandings among health care professionals regarding concussions.  Failure to recognize that a concussion has occurred increases the susceptibility of the student athlete in three ways: 1. A rare but fatal event, second impact syndrome, can occur in which there is massive brain swelling. Typically, this can occur when the student athlete receives a second blow to the head while still experiencing symptoms from the initial concussion.  2. A less serious, but nevertheless debilitating, sequelae is the development of a post-concussion syndrome in which headaches, dizziness, irritability, and eventually depression continue to persist for more than 6 weeks. The activities of daily living for the student athlete become disrupted secondary to their symptoms. Both academic performance and social interactions are impacted, primarily because no explanation for these symptoms has been offered to the athlete, family, or teachers. If an understanding is gained of the changes observed in the athlete being secondary to neurophysiologic mechanisms, support and accommodations are more likely to be offered.  3. There is now clear evidence that effects of concussions are cumulative.  It is, therefore, important to know the concussion history of the athlete when formulating a return to play decision. More information on concussion/traumatic brain injury can be found on my TBI/concussion page.



Various 2012 studies further clarified how excessively sweet, unhealthy foods affect the brain. An animal study out of UCLA found that diets high in fructose can impair cognitive function, which is reversible with omega-3 fatty acid supplementation. High fructose consumption can induce some signs of metabolic syndrome in the brain and can disrupt the signaling of the insulin receptors and reduce the action of insulin in the brain. Other work published in JAMA suggests that fructose consumption modulates the neurophysiologic pathways involved in appetite regulation and encourages overeating. An October 2012 study published in the Journal of Alzheimer’s Disease reported that a diet high in carbohydrates and sugar raises the risk for mild cognitive impairment in the elderly, while a diet high in fat and protein may reduce this risk. Logical yet simple enough, an “optimal balance” of carbohydrates, fat, and protein may help maintain neuronal integrity and optimal cognitive function, particularly in the elderly.

Mounting evidence in 2012 reinforces that high consumption of red meat increases stroke risk. The largest meta-analysis to date looking at the atherogenic effects of red meat found that the risk for total stroke increased by up to 13% for each increase in a single serving of fresh, processed, and total amount of red meat consumed per day. Earlier in the year another study found that processed and unprocessed red meat is associated with a higher risk for stroke, while poultry was associated with a reduced risk. One study found that a diet high in fruits, vegetables, grains, and fish led to a 30% lower depression risk compared with a meat based diet. But, as pointed out last year, meat quality is a factor: Moderate consumption of unprocessed, free-range antibiotic free red meat may actually protect against depression and anxiety. Much of the livestock in the United States is raised on industrial feedlots, which increases saturated fat and decreases very important good fatty acids, whereas pasture-raised animals have a much healthier fatty acid profile.

Information derived from Medscape.




A study conducted in Spain reported that consumption of both polyunsaturated fatty acids, (found in nuts, seeds, fish, and leafy green vegetables), and monounsaturated fatty acids, (found in olive oil, avocados, and nuts), decreases the risk for depression over time. However, there were clear dose-response relationships between dietary intake of trans fats and depression risk, whereas other data support an association between trans fats and ischemic stroke risk. Trans fats are found extensively in processed foods, including many commercial chocolates, (hence, check that label when considering dietary intake of chocolate. Also, only the highest levels of dark cocoa contain healthy antioxidants, not milk chocolate). A deficiency in polyunsaturated fatty acids has been linked to attention deficit/hyperactivity disorder in children. Thanks to their high levels of polyunsaturated fatty acids, namely omega-3 fatty acids, fish can help fend off numerous diseases of the brain. A 2010 study correlated fish consumption with a lower risk for psychotic symptoms, and concurrent work suggested that fish oil may help prevent psychosis in high-risk individuals. Although data are conflicting, new research shows that the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid are beneficial in depression and postpartum depression, respectively, and other research suggests that omega-3 deficiency may be a risk factor for suicide. Oily, cold-water fish, such as salmon, herring, and mackerel, have the highest omega-3 levels. Keep in mind that Atlantic fish have elevated levels of mercury and PCB’s compared to Alaskan/Pacific fish, and that farm raised fish contain very little healthy omega 3 fatty acids, due to the confined breeding of farm raised fish.



2012 Neurology Game Changers, Which Foods Are Best for the Brain?

Dietary advice is common practice in cardiology and primary care, but recently food and drink have become important considerations for neurologists, too. Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. 2012 saw coffee and berries warding off dementia, caffeine supplements improving motor function in Parkinson’s and the Mediterranean diet reducing the odds of developing Parkinson’s. Lycopene-rich tomatoes and the flavanones in citrus fruits were found to protect against ischemic stroke. As for what not to eat, a study published in January in Stroke supported previous work linking red meat consumption with higher stroke risk, while diets high in carbohydrates and sugar reportedly raise the risk for mild cognitive impairment and dementia in the elderly. A 2009 study published in the Archives of General Psychiatry found that people who follow Mediterranean dietary patterns — that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat, (common in olive oil and other plant oils) — are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare. The olive oil-inclined also show a lower risk for ischemic stroke and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.

All data derived from Medscape, 2012.



This week I would like to talk about exercise.  For the most part the word exercise appears to be a foreign word lately. I started exercising when I was 13, and I haven’t stopped since.  At the gym each day I see a myriad of individuals trying to stay fit, but in reality this is only a small minority of the population at large.  Our society has now become so obtuse in their habits that getting an extra fifteen minutes of sleep trumps an exercise regimen.  I hear excuses in my office all day long, from “I have kids”, to “my job doesn’t allow me the time”, and on and on.  I have yet to hear a reason that is not merely an excuse to not have to exercise. Quite simply, these excuses are in reality a way of stating that exercise is just not a priority.  The simple truth is that by not getting needed exercise, in effect, you are pretty much agreeing to a shorter life expectancy, which by the way, is predicted to be shorter for the first time in history with the upcoming generation associated with diabetes, hypertension and all of the syndromes associated with lethargy and poor eating habits.  Humans were not put on this earth to sit and watch television and eat yodels.  Genetically and historically, we essentially were out chasing food, or being chased as food.  Because of technology, it is now quite easy to not have to move much during the day, and even easier to eat pre-made stuff full of preservatives and chemicals with no real nutritional value whatsoever.  If you have already lost your health because of poor eating habits and lack of exercise, you should probably discuss any upcoming exercise plans with your doctor first.  However, if you still have your health, doing anything is better than doing nothing. And the more fit you are, the higher the intensity should be your exercise. As an example of light exercise, when going to the market, rather than driving around stalking that close parking space, take a far one and walk. If you are able, jogging in place for several minutes is great exercise.  Doing so in say 8 intervals of 20s of jogging with 10s of rest is extraordinary.  Just three days per week of this would actually change your health as well as your body. If you do the math, that is 4 minutes, three days per week.  Can you still honestly say that you do not have the time? Not if you are truly honest. For those interested in maximizing their fitness regimens, I have already published several articles on that topic which are readily available, (search word: HIIT), on the fitness page and in the articles section of my website.



Over the years I have authored several articles on vertigo, dizziness and imbalance, mostly pertaining to treatment, as treating these disorders is my specialty.  So how do you avoid getting them in the first place? Well, not so easily for some, quite easily for others.  Lets first talk about vertigo.  The most common causes of vertigo simply cannot be volitionally avoided outside of recommending that you do not bang your head.  Vertigo seems to attack everyone at some point or another, some being more predisposed to having repeat attacks.  The good news however is that the disorder is quickly remedied, at least in my office.  If you do get vertigo you do want to come in and get it treated quickly as it typically only gets worse, and more importantly it invariably leads to imbalance, which causes falls, which are much more difficult to recover from and often times you do not.  So the longer you wait to get vertigo treated the more a fall becomes imminent.  As some types of vertigo can be caused by swimming, particularly in lakes, cautions should be taken to avoid getting water in the ear canals. Dizziness, is actually different than vertigo, the latter having a rotary type feeling.  Causes of dizziness are vast.  It is the main side affect from any drug.  High or low blood pressure can cause dizziness as can variations high or low in blood sugar.  If you are taking drugs for high blood pressure, it is always a good idea to have a home unit so that you can monitor your pressure and maintain a log, which you can share with your doctor.  If you gain or lose weight and your daily recordings start to change, you need to inform your prescribing doctor immediately as the drug dosages may require titrating upward or downwards. Similarly, changes in blood sugar are associated with diabetes, which if not kept in check will cause dizziness. Alternatively, a pre-diabetic state where there is simply too much sugar in the diet, hypoglycemia, (low blood sugar), which many people are susceptible to from skipping meals too long or eating poor quality, (low nutritional value), foods can also cause dizziness.  If you do not have any of these conditions, it is a good idea to continue to do things in your best interest to keep it that way.  Eat healthy and exercise regularly.  See a doctor regularly to have your blood pressure checked and have blood work done annually.  It would be appropriate to mention eye exams as well as changes in vision as well as ocular diseases are a cause of dizziness. Imbalance, is usually a side effect of vertigo or dizziness.  However, it can occur without and typically does as we age although this needn’t be the case.  Imbalance is typically associated with aging primarily because the eyes and spine work differently together as the spine becomes arthritic, which is inevitable as we age.  If this is not corrected imbalance is the result.  My office offers free screening exams for imbalance and the test only takes twenty seconds, and it is the standard in the industry for fall risk analysis currently.  As with blood pressure and blood tests, fall risk analysis should be performed routinely every few months.  There is no downside as there is no prep required for the test and results are immediately available.  And if it means averting a fall the service is invaluable.



This article is a great find by my office manager Debbie.  It concurs with what I have been saying all along.  If you have high cholesterol or are already on cholesterol lowering drugs, this should be cause for you to do your own research.  Similar information is available at Dr. Mercola’s website, which I have referenced many times in the past.  Readers may intuitively ask why I would be writing so many articles on cholesterol when my specialty is in neurology?  Well, quite honestly two reasons.  The main reason is that heart disease is the leading cause of death in this country.  The second?  Because I too have fallen victim to the “take these cholesterol meds or else…” story.  Cholesterol has become an incredibly hot topic in recent years as well as a financial gravy train for the pharmaceutical companies who manufacture the drugs.  Virtually no one who has been to see a doctor in the last 20 years cannot tell you their cholesterol number as quickly as how many children they have.  However, routine screening exams performed by the vast majority of primary care doctors, are next to useless with respect to predicting heart disease.  They are useful to give you a cholesterol number which will then be used to determine whether or not you will receive a prescription for cholesterol lowering drugs.  If having a low number is your goal, then this is appropriate.  However, if preventing heart disease is your goal, then this formula requires rethinking.  With the number of people taking these drugs, why has the rate of heart disease gone up? One of the main side effect of cholesterol lowering drugs is muscle fatigue and weakness.  Clinically, I hear this all of the time simply from the large number of people taking these drugs.  One must ask the question, isn’t the heart made of muscle?  Again, not sensible.  The first thing that needs to change is our screening process.  The focus of blood work needs to be on inflammatory markers rather than on total cholesterol.  There are several lab panels now available which are much more useful than simple total cholesterol screening.  If you are determined to be at elevated risk, this is most always correctable with diet and exercise.  You should be working with someone skilled specifically in this area, or, your doctor should be working directly with a lipidologist.  If you are currently taking cholesterol lowering drugs, you should not stop taking them without an alternative plan and you should always be working with a trained professional.  As always, there is a multitude of information available on my website fitness and healthy eating pages with respect to health, which is really what we all strive towards, rather than just boasting the lowest “number”.



Metabolic syndrome, (obesity, hypertension, dyslipidemia and hyperglycemia AKA diabetes), remains a concern in regards to increasing health risk within the United States population.  For the first time in recorded history, our current generation is projected to have a shorter life expectancy than the prior generation.  This is a projection from the New England Journal of Medicine in 2005 based on the current epidemic.  And things have only gotten worse since then.  Metabolic syndrome with its associated cardiovascular disease, stroke, blindness, amputations, etc., accounts for the majority of healthcare dollars currently being spent.  Still worse, current medical treatments focus only on symptoms, which actually make the syndrome worse.  Hyperinsulinemia causes the pancreas to secrete increased amounts of insulin in response to elevated blood glucose.  However, practitioners typically focus on glucose levels or hemoglobin A1c, and prescribe drugs which actually increase insulin levels even further.  In a typical case, a patient would present with obesity, hypertension, diabetes and elevated blood lipids.  The patient would be told to lose weight by eating more fruits and vegetables and to cut down on fats and cholesterol and to do some light exercise as a standard first-line therapy of lifestyle changes.  This certainly stands the test of reason.  The problem is that under this regimen, the syndrome actually worsens.  Eventually antihypertensive medication is prescribed as are drugs for diabetes.  Soon the patient finds themselves on 6 or more drugs with no improvement in their status.  The underlying problem is that nothing has been done to address their insulin resistance.  A more appropriate course of treatment in this scenario would be the use of a muscle sparing protein diet and more importantly carbohydrate restriction, consisting mainly of fiber and vegetables, keeping in mind that all carbohydrate, with the exception of fiber, will eventually be turned into blood glucose either quickly or slowly.  By restricted carbohydrate intake, insulin secretion can be reduced and thus reducing insulin sensitivity/resistance.  In doing this, weight loss can occur and the patient’s syndrome can actually reverse.  If you suffer from any of the symptoms associated with metabolic syndrome, you should consult with myself and/or your family physician before undertaking any therapeutic regimen as in extreme cases drug therapies may be appropriate to reduce risk of stroke and/or other consequential risks.



Over the years I have written several articles on headaches.  This is because there are so many types and causes of head pain that there is much to write about.  Headaches remain one of the top three reasons why people go to the doctor.  The most common types of headaches are tension headaches and migraine headaches.  Tension headaches are typically a constant squeezing-like pain around the head whereas a migraine headache has a throbbing or pulsating component.  Many people believe the term migraine headache is used simply to describe a very severe headache.  This is not the case.  Migraines are a specific group of headaches which have a vascular cause and thus have a throbbing component.  Compounding diagnosis, headaches of the same type can have many different causes.  In my office we address many migraine causes as well as tension headaches which are caused by brain based inabilities to perform appropriate eye movements.  This becomes confusing for many patients as once you mention the eyes as a cause of headaches you inherently think to see an optometrist.  In reality, optometrists are interested in the focusing ability of the eyes and in diseases of the eyes.  Movement of the eyes to targets however is brain based and not typically assessed by eye doctors.  This is an extremely overlooked cause of headaches as few practitioners have appropriate diagnostic equipment to evaluate brain based eye movements.  Additionally, many headaches are perpetuated through poor eating habits and deficient nutritional needs.  This can easily be addressed by changing poor dietary habits in favor of better eating habits and thus augmenting nutrition.  It is most unfortunate however that the vast majority of headaches are managed through inappropriate drug therapies, most all of which do not fix the underlying cause of headaches but rather are typically an opiate based drug prescribed to deal with symptoms.  Recent studies are uncovering more and more deficits associated with these-type drugs which can be extremely addictive and require increasing dosage to maintain any level of symptom control.  If you suffer from headaches you would be well served to contact my office to schedule an appointment for a complete neurologic examination.  For many, it is their last headache consult.



Each week I see patients who have recently been examined by their primary doctors and are told that have findings of high blood pressure, elevated blood sugar or both. They are ill advised to return for followup in 8 weeks for a second test. I am not suggesting that it is wrong to followup when you have such finings. It is however foolish to make no management recommendations and expect a different outcome on a subsequent visit. Often on the next visit medication will be prescribed as now there is a trend and not just a single visit finding which may have been just coincidence. It is necessary to show a trend vs. a single visit reading to prescribe drug therapies unless hypertension is severe. It is reasonable that if someone is found to have high blood pressure, or, blood work reflects elevation in blood glucose, that rather than simply recording such data for record keeping that lifestyle modifications would be immediately discussed and proposed as being not only appropriate but necessary. Again, it could be argued that simply having an elevation in blood glucose does not mean that you are diabetic. Currently the diagnosis of diabetes is based on a blood test called the Hemoglobin A1c. However, if your blood test is demonstrating elevation in glucose, you are currently in a prediabetic state that needs to be addressed, not just monitored until such point that you definitely have diabetes, as is the case with an enormous number of Americans. If you have either elevated blood glucose or high blood pressure there are definitive lifestyle changes that you need to be making, now, not later. These changes do not merely mean kicking back and awaiting a drug therapy. It is this combination of blood glucose elevation and hypertension that constitutes the metabolic syndrome, a leading cause of disabilities, stroke, heart disease and death in this country, and it is getting worse each year despite drug therapies. When I meet with my patients I routinely discuss all aspects of their health. Most patients come to see me for dizziness and balance problems as well as other brain based disorders, but this doesn’t mean that I can’t help them get their life back if they are dangerously hypertense or prediabetic. In fact, I believe it is my job.



Over the last few years it has become such that you cannot watch one television show without seeing at least a few commercials for drugs.  Not surprisingly, during the part where they list the adverse side affects attributed to the drugs, there is a very attractive young lady smiling and dancing and throwing rose pedals.  Drugs have become more accepted than breakfast in our “better living through chemistry” society.  Well, a recent study published in the archives of internal medicine, depicts a disturbing picture of our societies interpretation of these ads.  Of the thousands of individuals involved in the study, thirty-nine percent mistakenly believed that the FDA approves only “extremely effective” drugs; 25% mistakenly believed that the FDA approves only drugs without serious side effects.   In conclusion this study found that a substantial proportion of the public mistakenly believes that the FDA approves only extremely effective drugs and drugs lacking serious side effects.  This is hard to believe as the side effects are indeed mentioned at the end of each commercial.  It would seem that no one is paying attention for this part.

When I meet with new patients as part of my initial history taking process I ask each patient which drugs they are taking and why. I find that about 20% of my patients on initial consultation do not know why they are taking their drugs, and, many are taking more than six different drugs.   If you are taking prescription medication, you should be aware as to what you are taking and why you are taking it.  Learn the side affects of drugs which you may be taking as well, should you experience any of them. If you are on high blood pressure medication, buy a home blood pressure unit and check your own blood pressure daily.  It is not uncommon for me to meet with a new patient suffering with dizziness only to find out that they are on high blood pressure medication, have lost weight, and are still taking a high dose from before their weight loss and that this is causing there dizziness from low blood pressure.  Drug therapies are still drugs, and they should be used with diligence and with prudence.  Act responsibly and know all of your options before blindly going on drug therapies, as ultimately, you are the one taking the drug.




Statin drugs are being prescribed like candy for tens of millions of Americans, but you need to seriously consider statin therapy before deciding to take your physician up on this prescription, as their use has serious and significant consequential side affects and risks, and, their use is clearly not appropriate for everyone.

The majority of people using statin cholesterol-lowering drugs do so because they believe that lowering their cholesterol will prevent heart attacks and strokes. How many of these people do you think would continue to take them if they knew that their drugs have been linked to increased risk of heart attack and increased risk of stroke?  Probably no one!

Until recently, statin use has been generally accepted based on studies primarily put together by the drug company selling the drugs.  However, recently these drugs are falling under increased scrutiny. A recent study in Clinical Cardiology found that heart muscle function was “significantly better” in the control group than in those taking statin drugs.  Weakened heart muscle function is the cause of heart failure.

Statin therapy is very effective in lowering total cholesterol levels rather significantly.  The real question however is why would you want to do this?  Lowering cholesterol, the “buzz” of the millennium, makes it appear as though you are benefiting from the drug therapy and thus improving your overall health.  Further, as your health deteriorates from the drugs, other problems which manifest later in life are often misinterpreted as being  separate and distinct conditions brought on for alternative reasons rather that affiliated with the statin therapy which was truly responsible.

It is and has been my medical opinion that for certain individuals who have high risk factors for heart disease, and/or have familial hypercholesterolemia, (about 1 in 500), statin drugs may be useful. Unfortunately, the vast majority of statin users does not fit this criterion and are taking them merely to lower cholesterol.  This equation needs serious rethinking.  More information on healthy eating and lowering cholesterol though diet is available on my healthy eating page.



Over 40 million Americans – 1 in every 7- suffer with a movement disorder.  That’s more than double the number of people who suffer with diabetes, which, is in itself a staggering number.  A person who has a movement disorder will typically see on average 15 different doctors, over the course of 5 years before one of them actually recognizes and properly identifies the problem.  To those individuals suffering with movement disorders this is a very real problem and as such those suffering are very much underserved.  Making matters worse, movement disorders, once recognized, are typically treated by drugs which were not necessarily developed for the treatment of any particular movement disorders.  And if this is not bad enough, most of these drugs are actually known to cause movement disorders, such as tremors.  Surprisingly, one can develop these tremor side affects, (called tardive dyskinesias), from a single dose of prescribed medication.  Most people think that you have to take a lot of a drug before it will inflict side affects, though in actuality, this is clearly not the case.   So is there a better approach to this?  Well, actually in a word, yes.  As a functional neurologist, I routinely spend my day seeing patients with movement disorders, most of whom have been referred to me to ascertain what is going on with them what is causing them to move the way they do.  Many of these movement disorders can actually be treated better without drugs using neurologic rehabilitation, whereby we restructure the brains neurologic connections using simple exercises and activities, affording the brain appropriate integration of the many neuronal pools which all have to work synergistically together at all times.  The trick to this is that the diagnosis needs to be extraordinarily precise, as no two patients, even with the same movement parameters, are typically going to be managed the same. Because of the simplicity of this approach as well as the lack of harmful side affects, there is little sense in utilizing alternative drug therapies in favor of appropriate neurologic rehabilitation.  Another problem with the drug approach lies in the fact that since the drugs are not treating anything at all and at best hoping to ameliorate some symptoms, the underlying cause continues to worsen.  Often times as this goes on for a long time, the movement disorder becomes difficult or even impossible to entirely correct due to the vast reorganizational changes that have now occurred in the brains many interconnections.  This is particularly frustrating for me as a clinician as well as for a patient suffering with a movement disorder as had they presented years earlier the problem would have been much easier to treat successfully.



Dizziness and vertigo are among the top three reasons why patients visit a physician. Back pain and headaches comprise the other two reasons. Symptoms such as dizziness, vertigo and imbalance actually are estimated to affect 40% of patients 40 years of age and older. Of those age 65 years or older, 25% are estimated to suffer a fall and thus a fall related injury. Falling is typically a direct consequence of dizziness, primarily in this group of elder individuals and risk of falling can increase considerably when those individuals have other problems such as high blood pressure or diabetes, or any of the gamut of neurologic defects such as Parkinson’s. A sample report of US emergency room visits, from 1995-2004, confirmed that vertigo and dizziness were indeed high on the list of reported presenting complaints as reason for reporting to the emergency room. Data from the National Health and Nutrition Examination Survey demonstrated that individuals with symptomatic vestibular dysfunction have a 12-fold increase in the probability of incurring a fall. It has also been associated that more frequent medical consultation, sick leave, and interruption of daily activities in general, have been related to dizziness symptoms, particularly vestibular vertigo. Medical research on ill health is commonly disease focused as opposed to symptoms related. This generalized approach may actually underestimate the reality of such common symptoms as vertigo and dizziness, which as mentioned, rank high as patient complaints in primary care, yet evade accurate diagnosis and remain unexplained in 80% of cases. Making matters worse, even though symptoms of vertigo and dizziness can be associated with a wide variety of other conditions, all of which necessitate a multidisciplinary approach to management, said dizziness symptoms rarely prompt appropriate referral to a qualified specialist for proper evaluation. The most frequent conditions which cause such symptoms as vertigo and dizziness for the most part remain largely undiagnosed outside of specialty clinics such as my own. Because of the substantial risk of injury and the resultant decline in independence and/or quality of life following a fall, predicting who is at risk is most helpful, and for those who reduce that risk through a fall prevention program such as ours, falls and otherwise impending fall related injuries may be prevented. Our office does just that using computerized technology, which ironically, only takes seconds to perform. Balance is not a single physiologic function. The sensory inputs for balance include vision, vestibular, and proprioceptive feedback. While a person is walking, the brain must instantaneously integrate this information and execute appropriate motor planning. This function must be supported by an adequate neuromusculoskeletal system. All of these factors change with age. Further, any disease related decline in any of these systems further impairs balance. Bilateral vestibular loss is a significant contributor in 25% of elderly patients with imbalance. Untreated vertigo is a severe risk factor for falling as well. Our office, as a community service, does not charge for balance/risk-of-fall analysis. Call my office (below) to be screened.



Diabetes mellitus is a chronic metabolic disorder affecting about 6% of the population worldwide with its complications, and is rapidly reaching epidemic scale. Diabetes mellitus has long been known to be a cause of dizziness, associated with sudden changes in blood sugar levels too high or too low.  Metabolic syndrome is associated with insulin resistance, elevated glucose and lipids, inflammation, decreased antioxidant activity, increased weight gain, and increased glycation of proteins. Cinnamon has been shown to improve all of these variables in both animal and human studies. In addition, cinnamon has been shown to alleviate factors associated with Alzheimer’s, ischemic stroke and studies also show that components of cinnamon control new blood vessel formation associated with the proliferation of cancer cells. Human studies involving control subjects and subjects with metabolic syndrome, type 2 diabetes mellitus, and polycystic ovary syndrome all show beneficial effects of whole cinnamon and/or liquid extracts of cinnamon on glucose, insulin, insulin sensitivity, lipids, antioxidant status, blood pressure and on lean body mass. However, not all studies have shown these positive effects of cinnamon, and type and amount of cinnamon, as well as the type of subjects and drugs subjects are taking, are likely to affect the response to cinnamon use. There are however no studies suggesting adverse affects of cinnamon use. In one study, the median lethal dose of cinnamon could not be obtained even at 20 times (0.4 g/kg body weight) its effective dose. With the high margin of safety of cinnamon, it appears useful as a potential therapeutic candidate for the management of diabetes.  As such, the use of cinnamon may be important in the alleviation and prevention of the signs and symptoms of metabolic syndrome, type 2 diabetes, and cardiovascular and related diseases.  I have been recommending its place in the diet for years to my patients, particularly those whom are diabetic or suffering with the aforementioned disorders.

Extensive research within the past two decades has revealed that obesity, a major risk factor for type 2 diabetes, atherosclerosis, cancer, and other chronic diseases, is a pro-inflammatory disease. Several spices have been shown to exhibit activity against obesity through antioxidant and anti-inflammatory mechanisms. Among them, curcumin, a yellow pigment derived from the spice turmeric (the main ingredient in curry powder), has been investigated most extensively as a treatment for obesity and obesity-related metabolic diseases. These curcumin-induced alterations reverse insulin resistance, hyperglycemia, hyperlipidemia, and other symptoms linked to obesity. Other structurally homologous nutraceuticals, derived from red chili, cinnamon, cloves, black pepper, and ginger, also exhibit effects against obesity and insulin resistance.



So what is vestibular rehabilitation therapy, a.k.a.VRT?  Think about it like this.  Suppose you just had shoulder surgery.  Would you be all better, or would you now need to do physical therapy to rehabilitate your shoulder back to normal function?  Without rehab such as this, I can tell you that you will never regain normal use of your shoulder.  Well the same is rue of the vestibular labyrinth.  Whenever you have any affliction that causes any type of dizziness or vertigo, without vestibular rehabilitation therapy exercises, it is highly unlikely that you will just return to normal function.

Is There a Difference Between Physical Therapy and Vestibular Rehabilitation Therapy?

Yes.  Physical therapy involves exercise therapy primarily for the trunk and limbs.  This can oftentimes be useful for individuals with increased fall risk and imbalance.   However, it should not be confused with vestibular rehabilitation therapy which concerns itself with rehabilitation of the vestibular labyrinth, brain and oculomotor system.

How Does Vestibular Rehabilitation Therapy Work?

Just like physical therapy makes muscles grow stronger and more coordinated, vestibular rehabilitation therapy is a method of habituating neurons of the central nervous system, (primarily the brain), and the vestibular system so that neurologic function  may be enhanced thus improving the function of the balance systems. Because neurons respond and grow very differently than does muscle tissue however, vestibular rehabilitation therapy must be done very specific to your needs.  This is to say that a canned approach will not work.  Two individuals with the same exact problem may respond very differently to vestibular rehabilitation therapy depending on the extent of involvement of their disorder, their overall health going into treatment, and their level of stamina in their ability to perform the exercises in the first place. If this is not taken into consideration in the therapy plan, the treatment is destined to fail and will in all likelihood even worsen the patients status.  I see this all of the time in my own practice as it is a common occurrence and reason for referral to my office in the first place.



Dizziness and vertigo are among the most common symptoms causing patients to visit a physician (as common as back pain and headaches). The overall incidence of dizziness, vertigo, and imbalance is 5-10%, and it quickly reaches 40% in patients older than 40 years of age. The incidence of falling is 25% in people older than 65 years of age. Falling can be a direct consequence of dizziness in this group, and the risk is increased considerably in those suffering with other neurologic deficits. A report reviewing presentation to US emergency room departments from 1995-2004 indicated that vertigo and dizziness were quite prevalent and thus high on the list of presenting complaints.

These symptoms, particularly vestibular vertigo, are associated with more frequent medical consultation, sick leave, and interruption of daily activities in general.

Research into the burden of ill health usually focuses on specific diseases rather than symptoms. This diagnosis-based approach, however, may underestimate the burden of common symptoms such as dizziness and vertigo, which rank among the most frequent complaints in primary care but remain unexplained in as many as 80% of cases.

In addition, although dizziness and vertigo may be caused by a variety of conditions that often require a multidisciplinary approach, these symptoms rarely prompt referral to a specialist or hospital admission for investigation.  In example, the most frequent conditions which cause such symptoms as vertigo and dizziness remain largely undiagnosed outside of specialty clinics, (such as my own).

Data from the National Health and Nutrition Examination Survey found that those with symptomatic vestibular dysfunction have a 12-fold increase in the odds of falling.

Because of the substantial risk of injury and the resultant decline in independence and/or quality of life after a fall, predicting who is at risk is most helpful. Our office does just this using computerized technology, which ironically, only takes seconds to perform.   Balance is not a single physiologic function. The sensory inputs for balance include vision, vestibular, and proprioceptive feedback. While a person is walking, the brain must instantaneously integrate this information and execute appropriate motor planning.

This function must be supported by an adequate neuromusculoskeletal system. All of these factors change with age. Further, any disease related decline in any of these systems further impairs balance. Bilateral vestibular loss is a contributor in 25% of elderly patients with imbalance. Untreated vertigo can be a risk factor for falling as well.

Our office, as a community service, does not charge for balance/risk-of-fall analysis.  Call my office (below) to be screened.



The only thing worse than someone who suffers with fall risk and not doing anything about it, is someone who does do something about it but waits too long and winds up suffering the consequences of a fall.  This is so disheartening to see as we help so many people with severe risk of fall to improve their lives, their safety and their ability to live normally again.  Why I am I telling you this? Because I saw a new patient last week for the first time, who was referred to my clinic for dizziness and imbalance.  Unfortunately for several years up to this point nothing had been done for this patient with respect to her imbalance. By the time I saw her she had already been suffering for years, and steadily worsening.  You might say that I had my work cut out for me, however, I was confident that I could help this woman.  Well, I received a telephone call earlier this week from a family member of this patient, informing me that over the weekend she had fallen, fracturing her hip.  She is currently hospitalized, where she will likely remain for quite some time, awaiting surgery for her fractured hip, which, may never even be performed depending on whether or not she is determined to be of adequate health or not to even be a surgical candidate.  If she does not have the surgery, the likelihood of her waking again is not good, and if she does, it will be quite some time and effort, as well as much pain, before she may ever walk again.

Obviously the unfortunate circumstances here are that we could have prevented this fall had I seen this patient sooner.  There are so many people waking around that have increased fall risk, some who realize it as their imbalance has already gotten severe, and some who have a false sense of confidence because they don’t yet know that their balance is deteriorating.

My office tests individuals for risk of fall daily.  The test takes seconds to perform and is done without charge. It is extremely accurate at predicting fall likelihood based on overall stability, and is in accordance with hospital mandates requiring front line providers to have some methodology for screening individual patients for risk of fall.  For these reasons, everyone, without exception, should be screened.  If you pass, you go on with your life.  If you do not pass, wouldn’t you like to know that before you fall and break a hip?



Diabetes is becoming more common and more of a medical problem than ever before.  I am specifically referring to type 2 diabetes, which is invariably brought on entirely by ones eating habits.  This is why it has earned the designation “adult onset diabetes”.  The “juvenile” type, or type 1, occurs at an early age for other reasons entirely.  So let’s discuss type 2, since that is the big problem and since it is entirely in your control to remedy.  Quite simply, type 2 diabetes occurs associated with obesity.  For each pound of “extra” weight one carries, risk of diabetes rises, exponentially.  As an example, someone 30 pounds overweight has a 4000% increased risk in becoming diabetic.  (This is not a typo).

Heart disease and peripheral artery disease are the biggest complications that people face with uncontrolled diabetes. Approximately 65% of death from diabetes is due to heart disease and stroke.  Peripheral artery damage or nerve damage, also from uncontrolled diabetes, can lead to foot problems that can lead to amputations. More than 60% of leg and foot amputations not related to an injury are due to diabetes.  Diabetes is the leading cause of blindness in this country. Other problems include glaucoma, cataracts and diabetic retinopathy.  Studies show that regular eye exams and timely treatment of diabetes-related eye problems could prevent up to 90% of diabetes-related blindness. Recent studies correlate metabolic syndrome with marked increase in total fructose intake in the form of high-fructose corn syrup, beverage and table sugar.  Metabolic syndrome is a name given to a group of risk factors including heart disease.  If you learn to read labels, you will find that many products now contain high fructose corn syrup.

Dizziness, a common problem in and of itself, is often associated with deregulation of sugar.  Sugar levels, both too high, and too low, will lead to dizziness. Your body does a delicate balancing act trying to maintain as steady a level of blood sugar as possible.  You can help this cause  by maintaining a healthy diet that does not cause blood sugar levels to suddenly go through the roof, or conversely, waiting all day to eat causing them to plummet.  More information on healthy eating tips can be found on my website.  Much of the dizziness which I see clinically is ether caused by or complicated by extreme variations in blood sugar levels.

Of equal importance is exercise.  Humans were not meant to be sedentary, which unfortunately, is how many Americans spend their day. Exercise should be performed at the highest level of your ability.  If you are unsure of your ability, you should discuss it with your doctor.



High blood pressure affects about 1 in 4 American adults and is one of the most common worldwide diseases afflicting humans.  It increases the risk of heart disease and stroke for those afflicted, so it’s important to know how to lower high blood pressure. High blood pressure, aka hypertension risk factors include obesity, drinking too much alcohol, smoking, and family history of hypertension.  Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease.

Normal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg, (however, unusually low readings should be evaluated for clinical significance as well).  Prehypertension is a new category emphasizing that patients with prehypertension are at risk for progression to hypertension and that lifestyle modifications are important preventive strategies.  Home blood pressure predicts cardiovascular events much better than do office readings and can be a useful clinical tool. Anyone with hypertension should be monitoring their own BP at home.  BP kits are available everywhere, and they are inexpensive.  If your BP readings suddenly become low, you should tell your doctor to titrate downwards your medication so that you do not become syncopal, (passing out).  The following are the ranges of BP:

Normal – Systolic, (top number) lower than 120, diastolic, (bottom number) lower than 80.

Prehypertension – Systolic 120-139, diastolic 80-99.

Stage 1 hypertension- Systolic 140-159, diastolic 90-99.

Stage 2 hypertension- Systolic equal to or more than 160, diastolic equal to or more than 100

Recommendations to lower blood pressure and thus decrease cardiovascular disease risk include the following:

  • Lose weight if overweight. Even a few extra pounds will raise blood pressure.
  • Google DASH (Dietary Approaches to Stop Hypertension) for a reasonable diet, which is rich in fruits and vegetables.
  • Limit alcohol intake to no more than 1-2 drinks/day.
  • Increase aerobic activity (30-45 min most days of the week).
  • Reduce sodium intake, learn to read nutritional information labels on products you purchase.
  • Maintain adequate intake of dietary potassium, calcium and magnesium for general health.
  • Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health.



So why is it that one can go to ten different specialists, get no diagnosis or effective treatment , and that same individual can then come to see me and get better in a few days?  Am I just very lucky?  Is it the power of suggestion?  Well, I can tell you, that’s not it.

Here is why.  Most specialists do what they do very well.  They excel in and have vast studies preparing for their particular area of expertise.  However, most human suffering is not always textbook.  That is to say that when a doctor studies disorders, they do not always match up with what we might see in our offices.  Further, most doctors tend to be trained such that they are examining you with a goal of matching up your symptoms with illnesses that are referenceable in a medical textbook.  Many disorders can be diagnosed in this manner; however, the vast majority of human suffering is not from these “named” diseases.  It is from “shades of grey” symptoms that do not typically match up well with any disorder, yet are real symptoms for the patient.  Since the doctor cannot find any disease that matches your conditions symptoms, you are simply told to “learn to live with it”, or worse, “it’s all in your head.”  Few doctors examine patients cumulatively just trying to get a grasp of what might be realistically happening with that person rather than just trying to find the matching diagnosis code to send to the insurance carrier.  Well when you think about this, you can see how easy it is to have no idea of what may be happening to explain your symptoms.  It is easy to see how all of the individuals with disorders that fall into the “shades of grey” area are just going to be brushed off as being odd or unrealistic problems.

The reason why my office has so much success in this area, is because when I examine patients, I do not have a predisposed opinion of what disease I am trying to rule out.  I look at them for what they are, a human being with symptoms, and I use logic to rationalize what neurophysiology is not working properly, and more importantly, what could be done to fix it.  My office has had great success treating patients with difficult disorders in this regard.  Because of our success, we routinely see patients who come from other states and spend a week with me so that they may get better.

So if you have been told to “learn to live with it”, or have been going from doctor to doctor without answers, you are my best patient.  We always offer a complementary consultation if you prefer one prior to examination as we understand that you may have many questions simply out of years of frustration in dealing with the medical system.



As a rule, the main types of disturbances that we feel as humans that present to the clinician as one form of dizzy feeling or another, are vertigo: a sense of spinning; disequilibrium: a sense of imbalance; or dizziness: a feeling of being off, or disoriented.  Dizziness is the vaguest of the symptoms.  Let’s talk about it this week.

Dizziness is in the top three reasons why individuals present to their doctors office.  It is often a confusing constellation of symptoms which patients find difficult to describe, and clinicians find difficult to diagnose.

Oftentimes, vertigo and disequilibrium will manifest such that the patient would complain to the clinician about dizziness.  It is up to the clinician to ask the right questions to discern between them to correctly diagnose the patient and refer to the appropriate specialist for neurologic or vestibular rehabilitation therapy, (what I do), vs. to an ENT for a sinus infection or similar.

So what then is Presyncope?  Well, syncope, means in medical terminology to pass out.  So presyncope is the sensation just before passing out, without progressing into actually passing out.  Most patients with presyncope will be referred to a cardiologist, assuming of course that they were even correctly diagnosed in the first place, which is not necessarily always the case.  This is not a bad plan as it rules out any cardiac problems as being causative, however, the patient gets cleared from cardiology and is still symptomatic.

Well here’s the deal.  Syncope/presyncope is almost always a neurologic condition.  Yes, it is caused by the heart, however, the heart only does what the brain is telling it to do.  To make some sense of this, imagine you are standing up.  Your heart has to pump blood up to your head sort of like a small water tower.  Now imagine lying down.  As blood gushes into your head, baroreceptors in the carotid vessels tell your brain to tell you heart to slow down so you don’t shoot your head off.  Conversely, when you arise from lying down, your carotid baroreceptors tell your brain to tell your heart it had better pick up and fast to get blood back up to your brain, (like a water tower again).  When there is a problem with this regulatory system, you are going to experience presyncope.  As this problem worsens, you will actually experience syncope, (actually passing out).  The irony to all of this is that this is actually very easily fixed more often than not; these are the types of problems that I spend much of my day fixing for people. As syncopal problems worsen, it is not uncommon for simple head movements or turns, or visual stimulus from driving to provoke an attack.  This also often precipitates into panic disorder and panic attacks, not only because of the fear and anxiety associated with the symptoms, but also because of the sympathetic nervous system and its hard wiring.  (The whole “fight-fright-flight thing you learned in school).

Again, there are many causes of dizziness and presyncope is just one of them, but it is a fairly common problem and finding the right specialist early on can make a big difference in how far your symptoms will progress and whether or not they will progress into other conditions over time until properly treated.



Over the past several months, we have been discussing imbalance, dizziness, vertigo, disequilibrium, etc., how to find out if you are at risk, etc.  We know that as part of the natural aging process individuals will become more prone to imbalance associated with changes in the spinal joints from degenerative joint disease, and the disturbances in the ocular reflexes which are preprogrammed to the spinal movements.  These disturbances can also lead to anxiety, changes in respiratory dynamics and changes in the digestive system as these systems are all hard wired and linked together, thus changes in one system affect the others systems as well.  Changes in breathing dynamics alone are probably responsible for half of the dizziness in society.  These changes not only create anxiety and panic disorder, but will eventually lead to a permanent change in your systemic pH, which can lead to all sorts of problems.

The good news is that these disturbances are not only reversible, but are actually quite easy to fix.  Inappropriate ocular reflexes are corrected through appropriate eye exercises, which are orchestrated to strengthen the specific ocular weaknesses, which need to be addressed.  This alone typically improves imbalance and disequilibrium immediately.  Breathing dynamics can easily be corrected by increasing rib excursion and thus increasing lung vital capacity.  This will immediately reverse aberrant changes in systemic pH, any panic disorder induced from such, gastric problems, which may be associated, etc.

Inasmuch as these problems are quite reversible and easily fixed, it is certainly with an understanding that treatment is provided under the guidance of a health care provider adequately trained in treating problems associated with imbalance and postural and gait abnormalities.

It is unfortunate that the vast majority of balance problems go unnoticed and untreated when they are easiest to correct, as most individuals don’t appreciate that they even have a problem because they do not take the time to get screened.  Society has been trained over time to obtain routine blood work, and other “routine” and “preventative” screening procedures, because we know that if we do not have them, we may miss something that would have been easy to fix had it been diagnosed early on but was ignored because no screening was ever done. Balance screening is no exception to this.  Simply put, the longer you wait, the longer it will take to fix, and the more likely you will incur a fall and thus have a serious injury to overcome. I have mentioned several times in my column that you cannot tell if your balance is impaired without screening.  If you can tell, it is only because it has already gotten so severe that it becomes apparent just standing or while walking about. If this is the case, not doing anything about it is like being diabetic and not taking your medication and not changing your diet.  It will just be a matter of time