Interview with Matthew Galati, Founder of Brain Changes Initiative.

Matthew Galati founded the Brain Changes Initiative in 2019 to primarily focus on Traumatic Brain Injury (TBI). Dr. Galati thinks the possibilities are endless because traumatic brain injury is such an untapped and ignored field of medicine. After exchanging a couple of emails, we met at St Clair and Runnymede Starbucks on October 6, 2020 (Tuesday @0830) for this interview. The duration of this interview was 32 minutes and 50 seconds.

Urgen Kuyee (UK): Hi Matt, thanks for making the time to do this.

Matthew Galati (MG): Yeah, no problem.

UK: Why don’t you let my readers know a little about yourself? Which school did you go to? What made you want to be a doctor? How long have you been a doctor for?

MG: I went to Western University for everything. I did my undergrad, medical school and then, residency at Western. I kind of always wanted to be a doctor. I don’t have a good answer for that. I guess, growing up, I know it sounds cliche but I always wanted to be a doctor. I always gravitated to the sciences in school. I actually had a friend who passed away from a ruptured brain aneurysm in grade school which was my first time experiencing how fragile life can be. This tragedy combined with my aptitude for science kind of set me down the path of medicine, a field where I could use my strengths to help others.

UK: Got it but I thought you wanted to be a soccer player.

MG: Hahaha. I did as well. I was torn between soccer and medicine.  And when I couldn’t make it in soccer, I had to go with my back-up plan – medicine. Haha Just kidding, I am very passionate about my job and am so happy I took the path towards medicine.

UK: Not a bad plan B. How long have you been a doctor for?

MG: I have been practicing since 2018, but I graduated from residency in 2019. I went back for one extra year of training in something called environmental medicine and was working concurrently. Have you heard of environmental medicine?

UK: Nop.

MG: It’s like, have you heard of functional medicine?

UK: No, what is that?

MG: It’s basically more of a holistic approach to care. It’s like Western medicine and you know everything else. You are treating the body as a whole. You are treating the body at the root cause of disease versus putting a bandaid on symptoms.

UK: Got it. Where do you work currently?

MG: I do hospitalist on-call work at Runnymede Healthcare Centre, as you know and I have a family practice in Scarborough at Ellesmere Medical Clinic. I also do research at Toronto rehab around the brain in relation to how to rehabilitate from Traumatic Brain Injury (TBI).

UK: The family practice in Scarborough. Is it like a family doctor clinic?

MG: Yeah, it’s a family clinic.

UK: I spent quite some time on brainchanges.org as I was doing some homework for this conversation, can you tell us how the Brain Changes Initiative start? When did it start?

MG: In order to tell this story, I kind of have to get into the background of everything.

UK: Please do.

MG: So in 2013, it was actually January 28th, 2013. I was back home visiting family for the weekend from my med school. I went to med school at Western, Windsor, Campus. I was back home in Toronto visiting family for the weekend and there was a massive snow storm. I had to be back to school on Monday morning for a small group session and I was going to leave Sunday night but the weather was terrible. So I was like, you know what, I will leave tomorrow morning, maybe the weather will be better.

I woke up in the morning and the weather was even worse. I started driving. I had a passenger with me and we are on the 401. This is like really, really early in the morning. And the weather was so bad that there was a detour route off the highway in Woodstock. So, I got onto the detour route, hit black ice, the car spun out of control, hit a tree, rolled up the tree, down the tree and I was knocked unconscious. I had like multiple skull fractures, broke almost every rib, collapsed both of my lungs and severed a nerve in my face. For months it actually looked like I suffered a stroke because I couldn’t move half of my face, but thankfully the nerve regrew 1mm/day and I regained full motor control of my facial muscles.

Luckily, my side of the car absorbed all the impact so my passenger was able to get out of the car and call an ambulance. When the ambulance came, they had to remove me with the jaws of life. They intubated me at the scene and I was rushed to the nearest hospital. I was knocked into a three day coma and when I woke up, I couldn’t walk, I couldn’t talk.

I basically had to relearn everything from scratch. And this was in the midst of med school. So, my recovery began at Toronto rehab. Well, it actually started before that, just stuff that I was doing on my own with my family, in the acute care hospital, learning how to tell the time again, learning how to read basic words etc. It was like being a child all over again. The first few weeks after emerging from the coma, I spent in acute care in London, ON and then a step-down neuro unit at Sunnybrook hospital. Eventually, when I was strong enough, my family advocated for me to be admitted to Toronto Rehab Hospital. It was there that I worked with all the allied health care professionals (physiotherapy, occupational therapy, speech language pathology), but I was also enrolled in a research study to intensify my rehab. So, I was doing double the therapy that all other patients were doing in hopes of improving my recovery. Also as part of this research study, I had to write a series of neuropsych evaluations. Do you know what a neuropsych is?

UK: Nop.

MG: Basically it’s a big, long battery of tests that takes around six hours in total to complete. It tests all your baseline functions like memory, attention and speed of processing. The first one I wrote was when I was still a patient at Toronto rehab, nothing was severely impaired as it had been a few months post-accident, but it was clear that there was no way I was going to be able to return back to med school at that point.

I was discharged from Toronto rehab and I went home. This was eight years ago and the medical community still didn’t know a whole lot about the brain/recovery at the time. The common dogma of thought was still that what you are born with in terms of brain cells is what you die with- that there’s no real room to create brain cells or to recover from severe brain injury and return back to a highly demanding life such as professional school.

Luckily, I was already in the medical field and I knew where to look for information. I wasn’t ready to just take the doctors’ words as the word of god and forfeit my dreams and aspirations. I started doing all my own research to give myself the best possible chance of recovery. I was at rock bottom. I had nowhere to go but up, right?

I started doing all this research and what it all pointed to was five different pillars that are absolutely vital to heal a brain. One of them being physical exercise and this was my main pillar. I learned about how achieving a certain threshold of aerobic exercise can upregulate levels of something called brain derived neurotrophic factor which is a protein that creates brain cells. So, essentially exercise creates brain cells. And, not just that, it also upregulates all the hormones in your brain, like dopamine, serotonin and norepinephrine that help with cognitive processing.

I started running five kilometers every morning. I learned that it’s not enough just to create brain cells, you have to fill them with meaningful information. And, there were other pillars too that I learned about and incorporated into my recovery like diets and mindfulness meditation which have positive effects on the brain. Anyhow, after six months, I returned to Toronto rehab to write my second neuropsych evaluation and everything was through the roof. I was above the brain injured and the standardized population for the same age and education level. So I told myself, you know what? I think I am ready to return back to med school. This was six months later. I returned back to med school, but there were some doubts amongst the heads of the medical school as to whether I could perform up to standard.

I am so thankful to Dr Green, Canada Chair of Traumatic Brain Injury, who was in charge of the study at Toronto Rehab that intensified my rehabilitation. She vouched for me and basically told the heads of the medical school, “I have never seen a recovery like this. If anybody is ready to return to something like medicine, it’s Matt.” They were pretty much telling me that I had to rewrite every single exam in order to get back into med school. I agreed to rewrite one exam just to show them that I was back and ready. I chose to rewrite the hardest exam for that semester which I had already passed prior to my accident. To my own amazement, my mark improved by 10-15% from the year before! After that I returned to successfully complete my medical schooling and then residency and all the while, I kept in touch with Toronto rehab and Dr Robin Green.

Over the years, professionals who treated me at Toronto Rehab would ask: what is it that you did that made you have such an incredible recovery? We don’t see recoveries like this – seeing people return back to a medical profession. So I would tell them about my research around aerobic exercise and the brain and how this was a huge part of the rehabilitation protocol that I developed for myself as an outpatient. When I graduated from residency in 2018, Dr Green and I were talking and she said to me something along the lines of, “Why don’t we research some of the things that you did to recover and try to change the standard of care for traumatic brain injury moving forward.”

That’s what our research is on right now. We are researching the dose of intensive aerobic exercise in combination with intensive cognitive exercise necessary to best heal a brain after traumatic brain injury. Sure, there’s already evidence in the literature that exercise creates brain cells and improves mental processing, but nobody knows the exact dose.

So, I started the non-profit organization, Brain Changes Initiative, in 2019; originally, as a way to fund our research because any research being done to change standard care is very expensive. That’s how we started, but we have kind of evolved into a larger beast. Now, we serve as an avenue of awareness, education and support for traumatic brain injury patients, their families, healthcare providers and people who just want to live a brain healthy lifestyle.

UK:  Your story is very VERY inspiring. My follow up question would be how were you able to overcome everything and be who you are today?

MG: I have always been an intense person. I have never been the type of the person who just gives up. The way I was thinking was why would I not give myself the best possible chance of recovery? I have one shot at this life. They give you a two year window to recover from Traumatic Brain Injury, which I don’t think is true either. I don’t think that the brain ever stops recovering or changing. It doesn’t make sense that it stops because your brain is always creating connections and shedding others. But at that point in time, I thought to myself, I am going to make it back to my dreams, goals and aspirations and the fact that there were all these people doubting me just fuelled my fire.

UK: Fuck those doubters man.

MG: Haha but at the same time, I can’t sit here and lie to you and say that I didn’t suffer things like depression and anxiety. There were a lot of moments where I doubted myself, but I had to push through those negative thoughts.

UK: You got a lot of help from your family members and your friends, correct? Did that make your recovery a little easier?

MG: Yeah, absolutely. So, I have a very supportive family and that’s known to be one of the positive prognostic factors for recovery from something like a traumatic brain injury. For example, my older sister works for Loblaws head office. She manages natural products for all of Canada. She was always looking at the supplements and nutraceuticals for me to take that would help with my recovery; I began taking Omega-3s, B vitamins etc.. My family was constantly looking for information and resources to help me recover in addition to helping me relearn how to be independent.

There is no streamlined path for traumatic brain injury. Once you leave acute care, if you don’t have a very supportive family, you are kind of left in the abyss because there’s no direction. It’s not like, this is what you do after you hit your head, then you go here, then you do this. You and your family are left to sail uncharted waters and figure everything out. That’s a solution that we are trying to create through Brain Changes – a complete, seamless, navigation pathway from acute care to inpatient rehab to the outpatient rehab setting and back to independent living. We want Brain Changes to be the one stop shop for traumatic brain injury. When you get into a car accident or suffer a brain injury we want people to feel like they have a guiding light. We want survivors to say: “I am going to look to Brain Changes because they can help steer me down the path to recovery.”

UK: I love that. You mentioned aerobic exercise and running so let’s talk about Brain Gains. Every Sunday, a group of runners meet up at 9 in the morning and run through High Park, correct? Tell me more about brain gains and if someone wants to join the run, where do they sign up?

MG: Yeah, originally Brain Gains started as just a way to spread awareness around the positive effects of aerobic exercise on the brain. I have always loved running. And, I have a good friend who is now our VP of Public Relations at Brain Changes.

He was a childhood friend growing up and we have been running together since the development of my own outpatient rehab regimen 8 years ago. Early 2020, we started filming some of our runs on weekends and we would post these cool, fun videos on the Brain Changes instagram page as a way to spread awareness around the effects of aerobic exercise on the brain. Because our videos on Instagram were so fire, it drove other like-minded intense people to join our runs and Sunday Brain Grains was born.

UK: The videos are fire for sure.

MG: Yeah, the videos caught fire and people started reaching out and wanting to come out. Our numbers kept growing week to week and now it’s this big thing where we do a weekly run through High Park. So, it’s a run which is aerobic exercise and then we sprinkle in some plyometric strength training exercises which are all aerobic and elevate the heart rate as well. Basically all these exercises are designed to create brain cells in addition to helping with cardiovascular fitness and strength.

UK: Got it. Where do people sign up?

MG: If you want to join, you just reach out to us. Either DM us on Instagram or you can email us at info@ brainchanges.org. All of the information about our runs and fundraising initiative can be found on our instagram/website, in addition to education around how to live a brain healthy lifestyle. We meet every Sunday at 9:00 AM at 1830 Bloor Street West for our run through High Park. There are three levels to the run so we cater to all levels of fitness. It’s all one continuous run, but we break it down into beginner, intermediate and advanced levels.

UK: I think beginner is my level right now. I know everyone says this but my cardio is so bad currently. I blame COVID as most soccer leagues got shut down this past summer.

MG: I don’t know. I think you can do more than that. So, the beginner level is the first 2-3Km of the run intermixed with exercises. If you want to continue on for the intermediate level, it’s for a total of 5-6Km with plyometrics. And, if you’re feeling brave and want to challenge yourself to the advanced level, it’s for a total of 10-13Km.

UK: Cool. What does a typical day for Matt Galati look like? What time do you get up?  What is your morning routine like? Do you read? Do you write? When is your first meal? When do you workout? How many hours of sleep do you get?

MG: It depends on the day, but every day I wake up and I purposely set my clinic office hours a little bit later to ensure that I can exercise. I try to do aerobic exercise in the morning before work to make sure that my brain is primed for the day. Then I go to work and usually have meetings in the afternoon. I have to admit, by the time I finish answering all my emails and stuff, it’s a little late. I don’t get to bed until like 12-1 o’clock, which is not good. I do not endorse that. It’s not one of our pillars at Brain Changes hahaha. In fact, it is the opposite. Good sleep hygiene is actually super important. And I admit that sleep is the one pillar I am not great at. But, it’s important because sleep is so important for memory, cognitive functioning, immune function and gut health.

UK: I agree. Sleep is extremely important. In fact, it is the chief reason I completely stopped doing nursing night shifts about three years ago. I try to guard my sleep schedule very carefully. It’s funny we talk about sleep because just last week, I bought a device called oura ring which monitors your heart rate, body temperature and how well you sleep during night time. It is pretty cool, a tiny ring in your finger.

MG: Cool. I will look into it.

UK: Do you fast?

MG: I do. I do intermittent fasting. I intermittently fast for around 18 hours at a time. I love it. I don’t fast every day, but there are a number of days during the week that I do fast and I feel great.

UK: So, it’s water only fast, no food or drinks?

MG: Correct.

UK: I want to lose 10lbs. I am sure there are many others who want to lose weight and you know, be in decent shape, nothing crazy. Do you think nutrition, what you eat plays a bigger role or exercise plays a bigger role if someone wants to lose weight?

MG: I think the two in combination are always the best. You have to eat a high fat, low carb diet. A lot of people are scared of fats but you need to eat healthy fats. It’s actually very good for you because fats are what comprise your body and brain cells. Carbs are immediate building blocks so if you are overeating, your body uses what it needs for immediate energy and stores the rest leading to weight gain and insulin resistance. Carbs in excess are also unhealthy because they lead to the creation of end-products which clog the arteries in your body/brain. So, if you are eating a diet high in healthy fats and low in carbs, that’s good for weight loss and brain health.

A healthy diet in conjunction with exercise is even better. Specifically, HITT training is the best type of exercise to lose weight. Basically HIIT is short bursts of very intense exercise, which gets the heart rate up really high, alternating with periods of less intense exercise like walking. The body has been shown to continue to burn calories during those periods where you are not exercising vigorously, so it’s the most efficient way to lose weight.

UK: I always say HITT training is somewhat similar to when you do sprints during a soccer game and then you are back to walking or jogging again. You sprint again and rest again.

MG: Exactly. And, you only need like 10 minutes a day. I don’t think you need to lose 10lbs by the way.

UK: I completely disagree with your last statement. The story is I haven’t posted on my social media for a very long time so I need to post a new picture. But, I need to lose 10lbs first so I look good. But, yeah I rarely post on Facebook and Instagram. A nurse once told me, “Urgen, you are extremely mysterious and handsome.” I tend to agree with both.

MG: Hahaha. You need to start coming out for some Brain Gains on Sundays.

UK: I will. What is the most important book that you have ever read?

MG: The most important book that I ever read was my bible while I was recovering. It’s a book called SPARK : The Revolutionary New Science of Exercise and the Brain written by a man called John J Ratey who is an MD. It’s all about the effects of aerobic exercise on the brain and cognition. So, that’s where I really learned about neuroplasticity and the ability of the brain to change/create brain cells through physical exercise. This book is really what inspired my rehabilitation regimen at home and helped me recover.

UK: What would someone who doesn’t like you say about you?

MG: Oh wow.

UK: Can I guess?

MG: Sure.

UK: Matt can only do 10 pull ups. He is soft.

(I am soft too since I can’t even do 10 pull ups. Here is video proof of me not being able to do 10 pull ups).

MG: Hahaha maybe. Yeah, maybe that’s what they say but I don’t know. It is a good question. But I think that in any walk of life, anytime you are trying to do something for the betterment of society or try to elicit change, you are always going to have people that are supporters and there’s always going to be haters. You just have to push past the haters and you have to know on the inside why you are doing what you are doing and that you’re doing right by yourself and anyone else you are trying to help. You have to feed off of your supporters and ignore the haters.

UK: Well said. It is impossible to make everyone happy. This past year or so, I have been practising saying no to a lot of things and as predicted, some of my friends and co-workers were not happy with me. But, I think saying no is a skill worth learning. I say no a lot these days.

MG: Well, I mean, if you want to spread yourself thin throughout this life and you want to just coast, sure you can scratch everybody’s back. You can be everybody’s friend but any time you want to make a difference, you want to make a change, you are already a polarizing character because you have drawn a line in the sand and choose a side. At that point, people usually choose to be either in your camp or on the other side of the line.

UK: One thousand percent. We are both huge soccer fans. Talk to me more about your soccer journey, which team do you support and your favourite soccer player.

MG: Okay. I will admit that in terms of watching soccer, I don’t watch soccer as much as I used to but it is still my favorite sport to play. I played throughout my entire childhood and I built myself up to a high level. I played up to OYSL provincial soccer here in Canada. I was actually scouted at the age of 14 to play for a Canadian recruit team across seas against semi-professional teams in England like Rushden & Diamonds F.C and Gillingam F.C. Yeah, so that was like the highest level of soccer at which I played. And at one point I did want to make it big in soccer, I was highly considering it.

Maybe it was not a realistic goal for a small kid from Canada trying to make it big in international soccer, but it was a dream. Unfortunately, in Canada we are only able to play outdoor soccer a few months of the year versus athletes in Europe that play all year around. And, even if you are great here, there’s always somebody there that’s just as good, taller and they are able to practice way more. It didn’t work out this time around, but maybe in the next life I’ll come back as a child prodigy from Brazil and become the next Ronaldinho hahah.

UK: Hahaha. Oh man, Ronaldinho was so good when he was playing for Barcelona. Who is your favourite soccer player?

MG: My favourite soccer player growing up was always Gattuso.

UK: Also, quickly Lakers or Miami Heat tonight? Game 4 of NBA Finals.

MG: I am going to say Miami because I want them to win tonight. I want to see Jimmy “buckets” have a great game and light a fire under Lebron’s ass.

UK: I am rooting for Miami too and not sure if you watched game 3 but Jimmy Butler had a triple-double.

MG: Yeah, I watched it. He was great.

UK: What comes to your mind when you hear the word bitcoin?

MG: Volatile.

UK: Sure. How do you define success?

MG: To me success is doing something that gives you internal gratification and means something to you. It doesn’t matter if it’s gratifying to anybody else as long as it makes you happy. If it makes you happy, then it brings purpose to your life and there is no better success than that.

UK: Before I wrap this up, I got one more question, what is the best and worst thing about working with nurses?

MG: I can’t think of any bad thing.

UK: You are starting to get a little nervous there.

MG: Hahaha. Realistically, I have a lot of respect for nurses because I remember when I was a patient at Toronto rehab, I rarely ever saw the doctor and it was always the nurses that were caring for me. So, I have a very skewed view and I am more on team nurse than team doctor.

UK: Got it. Lastly, what’s next for the Brain Changes Initiative? Where do you see the Brain Changes Initiative in the next 4-5 years?

MG: I see Brain Changes as the Heart and Stroke Foundation of a brain injury. I think we have a bright future because we are really trying to change the treatment of and stigma behind brain injury. We have already started providing awareness/education, and carrying out our groundbreaking research for brian injury rehabilitation. These initiatives will only snowball and as I mentioned before we are going to be the one-stop-shop for Traumatic Brain Injury recovery through our patient navigation pathway and resource bank. I just think that the possibilities are endless because traumatic brain injury is such an untapped and ignored field of medicine. And there’s so much to do with it.

TBI survivors aside, we will continue to build a community of Brain Ambassadors/Brain Changers who are open to learning about/living a brain healthy lifestyle.

UK: That’s all I got for you man. Look, I admire what you are doing today especially after everything you have been through. Hearing stories like yours motivates me to do more with my life and I am sure many others as well so thank you. And, that was super fun.

UK: Where should I send everyone? Where can people find you on the internet and find out more about the Brain Changes Initiative?

MG: Yeah visit our Instagram @brainchanges. 

UK: IG page is on fire.

MG: Yeah, IG page is on fire for sure. We have got some cool posts and we got some fire stories. Our website is brianchages.org. You could also find some more ancillary information on the Toronto Rehab Foundation website and on their Instagram page. We have a strong association with them because that’s where our research is being done.

And, we are looking forward to seeing anybody who wants to come out for some Sunday Brain Gains. We encourage anyone who wants to get involved with our community in any way; whether you want to join our board, volunteer or even if you want to become a Brand Ambassador and share your story, we are open to anybody who wants to get involved.

UK: Awesome, man. Thank you so much for your time this morning. We have to do this again in the future.

MG: Absolutely.

This interview has been edited and condensed. Thanks to Matthew Galati for his contributions, all errors are mine.