As an expert in nutrition and brain health, I get asked routinely if nutrition and nutritional therapy can play a supporting and healing role in traumatic brain injuries (TBIs), including concussions. What we do know is that what we eat and drink directly affects the structure of the brain and structure, of course, influences function and by extension brain repair and maintenance.
The CDC defines TBI as being caused by a bump, blow or jolt to the head or a penetrating brain injury that disrupts the normal function of the brain. A concussion is one type of TBI; the result of some kind of head trauma due to a sport injury, accident, violence/abuse etc.
The effects of a concussion are usually temporary but can include headaches and problems with concentration, memory, balance and coordination.
FACT: Mild TBI or concussions, account for over 75% of TBIs that occur annually in both civilian and military populations
Concussions are usually caused by a blow to the head but violently shaking the head and upper body can also cause concussions. Some concussions cause you to lose consciousness, but most do not. It’s also possible to have a concussion and not even realize it. Concussions are particularly common if you play a contact sport, such as football, and luckily, most people usually fully recover.
What are the physical consequences of a concussion?
In the hours, days and weeks following the initial head trauma, a series of changes develop that progress to swelling and increased inflammation that leads to progressive degeneration within the vulnerable brain regions. Because there are a lot of parallels in the changes seen with normal brain aging and TBI, although much more accelerated in TBI, much of the research and nutritional recommendations are extrapolated from brain aging research. However, a lot of research and TBI specifically has been done with the military and we can draw from that.
Mitochondria are tiny structures within all cells which are responsible for the neuron’s (brain cell) energy production, They bear the brunt of a concussion’s effect and concussion-related mitochondrial damage leads to excessive oxidative damage and increased inflammation. In the years following repeated concussions, the loss of normal brain cell energy production, increased oxidation and long term brain inflammation all contribute to the very symptoms and concerns of TBI such as seizures, sleep disruption, fatigue, depression, anxiety, increased impulsivity & irritability, decreased inhibition and increased cognitive decline. Although no effective treatments are available to alleviate these biochemical events in the brain, there are some promising nuggets where nutrition is concerned; several nutrients can help to reduce the impact of oxidation (think rusting) and inflammation and support energy metabolism in the neurons.
How can nutrition help?
To date, there are very few studies that have purposefully tested the impact of dietary interventions or supplement/enhanced nutrient intake support and their specific role in TBI/concussion management but that doesn’t mean trying to leverage nutrition is a futile effort. We don’t have to wait 15 years for large scale interventional trials to be done; we can start at the next best available evidence and move from there. Not offering patients options is almost unethical; if the intervention is biologically & mechanistically plausible, if we have animal studies with promising results to support it, if the advice is ethical, safe and if the patient has possibly nothing to lose and everything to gain…we should act. (1). While not an exhaustive list, some of the nutrients of interest include:
Zinc: this mineral is involved in over 80 different biochemical reactions in the central nervous system (CNS) including the brain. The body does not store zinc and getting a steady supply everyday is crucial for optimal health but sadly, many don’t get enough of this all-star mineral. One of zinc’s role in the CNS is to reduce damage caused by increased oxidation and inflammation and lower levels of zinc may exacerbate the damage associated from TBI. Zinc also supports brain health via its role in ensuring you have a healthy immune system, optimal brain tissue repair and energy production. Zinc also supports healthy moods via its role in neurotransmitter metabolism.
Food sources: oysters, pumpkin seeds, beef, crab, pork, chicken (dark meat), baked beans
Magnesium: this underappreciated mineral plays an important role in brain functioning as well. In the brain, magnesium helps to prevent over-stimulation of the neurons by blocking glutamate and by regulating the flow of calcium in and around the neurons; in this sense it helps to reduce the impacts of stress and improve moods. Magnesium also relaxes the blood vessels which help to increase cerebral blood flow – the easier blood can flow throughout the brain, the better. TBI causes structural and metabolic changes resulting in lower levels of magnesium in the brain which is associated with increase activity of glutamate and calcium; the uncontrolled activity glutamate and calcium is the predominant contributor to neuronal (brain cell) degeneration and cell death. Studies have suggested that by maintaining magnesium levels post TBI, the brain is more resilient to brain injury.
Food sources: nuts, seeds, spinach, kale and other dark green vegetables, legumes, avocado
Creatine: an amino-like compound that is produced by the body to some degree by the liver, kidney, pancreas and possibly the brain. Creatine is the building block of one of the two main energy molecules phospho-creatine/creatine-phosphate. This energy molecule provides a significant amount of energy to muscles, the digestive tract and the brain. Scans show that creatine levels in the brain drop significantly after TBIs/concussions thereby interfering with one of the brain’s energy source; some human studies have shown benefit from creatine supplementation (the amount of creating in food isn’t high enough to be therapeutic). After supplementation, TBI patients showed improvement in cognition, communication, self-care, personality, and behaviour with significant decreased headaches, dizziness, and fatigue (2, 3).
Food sources: meats (beef, veal, game etc), chicken, turkey, fish
Omega-3 fatty acids: in a word, the darlings of the TBI nutrition world. The long chain omega-3 fats EPA and DHA (not to be confused with the shorter chain omeag-3 fat ALA found in flax, soy, walnuts etc – not the same thing at all), are central when it comes to neuroprotection and reducing the impact of TBI. DHA is the structural omega-3 fat of the neuron – think bricks and mortar – while EPA has a different gig. EPA is best at supporting healthy moods including reducing the risk for, and improving symptoms of, depression and anxiety, two common consequences of TIB and concussions. EPA is also great at reducing inflammation and improving blood flow through the vessels that supply the brain with oxygen and nutrients while shuttling wastes products out.
Food sources: fatty fish such as salmon, trout, sardines, mackerel, herring, omega-3 fortified eggs
Choline: most of choline is used to make an essential building block of cell membranes called phosphatidylcholine. Strong, flexible and adaptive cell membranes are vital for all cells, including brain cells, to work properly and to sustain stresses placed upon them. Sadly, most North Americans get less than 50% of the recommended intake of choline. Less choline makes for unhappy brain cells, not to mention that choline is also needed to make the neurotransmitter acetylcholine which is needed for learning and memory consolidation – have I sold you on choline yet? Research is suggestive of choline’s role in promoting faster recovery from motor deficits (ability to move muscles, coordination etc) in patients with severe TBI. The bulk of the studies though show that choline or it’s metabolic derivatives aren’t the best for injury repair after the fact but rather, choline’s star power seems to be preventative which is which ensuring adequate intakes throughout life is more important; you want to have optimal levels of this nutrient to ensure your cell membranes have what they need to make lots of phosphatidylcholine.
For more, read my post Choline. Always A Bridesmaid, Never A Bride
Food sources: egg yolk, liver, fish/seafood, dark green vegetables, soy (soybeans, tofu, tempeh)
Vitamin D3: the extend of vitamin D’s role in the brain and CNS is not fully understood but we know that the “sunshine vitamin” is very important; the brain has heaps of vitamin D receptors just waiting for vitamin D to attach to them so the vitamin can get to work. Vitamin D tempers the immune system which helps to prevent over-stimulation/activation and it plays a big role in calming inflammation. Unfortunately there is a lack of studies, both animals and humans, to support the use of vitamin D in the treatment of TB but we know Canadians are either deficient or borderline deficient in this nutrient and given it’s role in neurotransmitter function, immune function and anti-inflammatory mechanisms, ensuring your brain is well stocked on this vitamin is just good common sense.
Food sources: milk, fatty fish like sardines, salmon, mackerel, trout, herring, eggs, cod liver oil, liver
Polyphenols: these are a diverse group of naturally occurring compounds widely distributed in many plant foods; basically if the food is a plant, it will have dozens of several hundreds of different types of polyphenols – it’s NOT just about blueberries or green tea. They are potent antioxidants (again, think rust protection) and they beautifully squash inflammation. In a more nuanced manner, they basically get into the brain cell’s hub, the nucleus, and positively influence gene activity (interacting with the brain cells’ DNA). Polyphenols have been shown to play a leading role in influencing brain cell communication; both within cells and between cells; critical steps in controlling neuronal survival. Polyphenols have long been known to protect the brain’s blood vessels and protect against neurodegnerative disease and have long been promoted as being “neuroprotective”.
Food sources: most plant foods such as berries, apples, broccoli, cherries, dark chocolate, green tea, olive or avocado oil, onions
Other emerging and promising nutrients/neutraceuticals of interest
Ongoing research is examining the role of several other nutrients & neutraceuticals; lots more to come, and lots more to consider for anyone who’s experienced a TBI/concussion (4).
- Branched chain amino acids (BCAAs)
- Coenzyme Q10
- Ketogenic diets
- Alpha lipoic acid
- Vitamin E
- Vitamin K2
A nutrition professional with knowledge and expertise in this area can help tailor personalized advice to you, or someone you know, and provide specific recommendations with dosages and nutritional, food-based strategies to set the stage for the best possible repair and healing of the traumatized brain.
Things to consider if you or someone you know might be at risk
Seek medical attention ASAP. The signs and symptoms of a concussion can be subtle and may not show up immediately. Symptoms can last for days, weeks or even longer. Common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia usually involves forgetting the event that caused the concussion.
Signs and symptoms of a concussion may include:
- Headache or a feeling of pressure in the head
- Temporary loss of consciousness
- Confusion or feeling as if in a fog
- Amnesia surrounding the traumatic event
- Dizziness or “seeing stars”
- Ringing in the ears
- Slurred speech
- Delayed response to questions
- Appearing dazed
You may have some symptoms of concussions immediately. Others may be delayed for hours or days after injury, such as:
- Concentration and memory complaints
- Irritability and other personality changes
- Sensitivity to light and noise
- Sleep disturbances
- Psychological adjustment problems and depression
- Disorders of taste and smell
Activities and factors that may increase your risk of a concussion include:
- Falling, especially in young children and older adults
- Participating in a high-risk sport, such as football, hockey, soccer, rugby, boxing or other contact sport
- Participating in high-risk sports without proper safety equipment and supervision
- Being involved in a motor vehicle collision
- Being involved in a pedestrian or bicycle accident
- Being a soldier involved in combat
- Being a victim of physical abuse
- Having had a previous concussion