Mild traumatic brain injury (mTBI) is responsible for up to 90% of all traumatic brain injuries (TBI) globally. However, this figure is likely to be underestimated because many mTBIs go undiagnosed or unreported. Recovery from a concussion can be a challenging journey, marked by a need for patience, rest, and understanding of the various factors that contribute to healing. Nutrition is one aspect of healing that is often underestimated and overlooked. Following mTBI, patient needs are unique, and this review presents the potential for certain nutritional therapies to support the brain in recovery, specifically omega-3 fatty acids.
This article aims to provide a structured overview of how an anti-inflammatory diet can aid in concussion recovery, incorporating findings from research and practical advice.
Understanding Mild Traumatic Brain Injury (mTBI)
Mild TBI is identified by an impact, directly or indirectly to the head from an external physical force, with a Glasgow Coma Scale (GCS) score between 13 and 15. Incidence of mTBI can occur following a wide range of events, from a motor vehicle accident, a fall, assault, a military blast, as well as collisions in sport, or children playing. These cognitive, sensory, behavioral, emotional, and physical disturbances following mTBI affect functioning of the brain and may lead to long-term impairments if not treated and managed correctly. It may take time for injury symptoms to manifest, and severity will vary. Nevertheless, most individuals should recover within 1-3 months.
The Neurometabolic Cascade and Energy Crisis
In response to mTBI, a cascade of secondary neurometabolic events occur which can create functional disturbances, imbalances between cellular ions (Na+, K+ and Ca2+), an overproduction of free radicals, and result in an “energy crisis”. During the “energy crisis,” metabolic homeostasis, energy metabolism, and blood flow processes are disrupted. This energy supply and demand mismatch results in hypermetabolic events such as hyperglycemia, protein catabolism, and as a consequence, result in a hypometabolic cellular states. The intracellular flux of ions (Ca2+) contributes to mitochondrial dysfunction, oxidative stress, neuroinflammation, cellular damage and in some cases death.
During the secondary phase of injury, free radical production, oxidation, and inflammation accelerate aiming to protect the brain, restore functioning and undo intracellular damage. As a result, these changes increase the brain's need for anti-inflammatory and antioxidant nutrients. However, oxidation can become damaging and deplete cellular antioxidant levels if prolonged; promoting further metabolic disruption and neuroinflammation, which is associated with the worsening of symptoms, their duration, and the risk of developing persistent post-concussion syndrome (PCS). Inflammatory responses will be initiated to provide neuroprotection but, if prolonged, will hinder brain recovery and result in PCS.
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Therefore, if not correctly managed these originally positive mechanisms (free radical production and inflammation) could create an environment for a secondary impact to occur, poor recovery, tissue damage and subsequent cell death - a concern for cases that go undiagnosed.
Recovery and the Role of Nutrition
Following mTBI the majority of patients will recover. Recovery is defined clinically through the resolution of symptoms (via SCAT5 and symptom severity scores), illustrating cognitive and physical functioning, which will permit them to begin returning to normal daily activities, such as school, work, and sport. However, this does not account for neurobiological recovery. Individual symptoms are thought to resolve within 10-14 days, however research has found that less than half of patients do so with a majority recovering from day 28 to 33 post mTBI.
Present mTBI recovery protocol advice for patients is to follow a period of cognitive and physical rest for 24-48 hours (h), to improve symptoms and reduce metabolic brain demands. Following this initial rest, patients are encouraged to gradually resume normal daily cognitive and physical activities (including screen time) at a pace that does not worsen or generate new symptoms. At this moment, mTBI treatments and therapy recommendations are limited.
A significant body of scientific knowledge is published on the role of nutritional strategies in optimizing brain development and supporting repair and function throughout life. In addition, a patient's initial nutritional intake and diet quality will influence the availability of energy and nutrients to mediate metabolic alterations and provide support to the brain post-injury; highlighting the role nutritional protocols play in supporting acute repair and recovery (<14 days approx.), and potentially prevent the prolonging and worsening of outcomes post mTBI. However, research is limited on what nutritional support(s) is safe and effective for humans to implement post mTBI. Instead, research using nutrient and non-nutrient therapies for acute mTBI recovery has been carried out in preclinical studies and animal-based trials using enhanced feeding or supplement protocols.
The Anti-Inflammatory Diet: A Cornerstone of Concussion Recovery
There is a direct connection between inflammation and nutrition that can influence concussion recovery. Inflammation is a natural response to injury; however, chronic inflammation can hinder the healing process and further exacerbate symptoms. What you eat affects your health, whether you’ve sustained a traumatic brain injury or are in perfect health. But nutrition is especially important after a brain injury. Diet can be the difference between your brain getting “just enough to squeak by” vs. being well-supported. Healthy eating won’t make post-concussion syndrome go away, but it can significantly improve recovery outcomes.
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Here’s the good news: You don’t have to completely revamp your eating habits overnight. Even small improvements can have an outsized impact on your brain health and concussion recovery!
Key Components of an Anti-Inflammatory Diet
During concussion recovery, your brain requires specific nutrients to repair and regenerate damaged cells, reduce inflammation, and optimize cognitive function.
Omega-3 Fatty Acids: These healthy fats, commonly found in fatty fish like salmon, walnuts, flaxseeds, and chia seeds, are known to support brain health. Omega-3 fatty acids have anti-inflammatory properties and are crucial for maintaining the structural integrity of brain cells. Docosahexaenoic acid (DHA) is an omega-3 fatty acid known for its role in developing and maintaining healthy brain cells. It may have anti-inflammatory properties, which is important because many concussion patients experience increased inflammation both in their brain and throughout their bodies.
- A study by Miller et al. found that 2,000 mg of a DHA supplement twice daily for 12 weeks is a feasible and safe early treatment method following SRC in pediatrics. DHA shows that it may allow for faster symptom resolution, and sooner RTP.
Antioxidants: Food rich in antioxidants, such as berries, dark leafy greens, and colorful fruits and vegetables, can help protect your brain from oxidative stress. Antioxidants fight inflammation, reign in free radicals, and help your body retain and use key vitamins. Spices and fresh herbs, fruit, and vegetables are good sources of antioxidants, vitamins, and minerals. Turmeric is particularly effective; try putting it on your eggs, in sauteed zucchini, or mixed into homemade mac ‘n’ cheese.
Vitamins and Minerals: B vitamins (especially B6, B9, and B12), vitamin D, and magnesium are essential for brain function and repair. Leafy greens, lean meats, nuts, and fortified dairy products are excellent sources of these nutrients. You can have your doctor test your blood for vitamin levels. If any are low, you will likely need supplements to correct the problem. While most people can get sufficient vitamin C from their diets, vitamin D deficiency is common.
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Protein: Consuming an adequate amount of protein is essential for repairing damaged tissues, including those in the brain. Sources of protein like local or grass-fed beef, lamb, poultry, fish, eggs and beans provide amino acids necessary for the healing process. Most Americans eat too little protein. For example, if you tend to eat chicken all the time, mix in some fish, eggs, and nuts. If you’re vegan, take extra care to get enough protein from legumes and nuts. If you’re not used to eating beans, give your stomach a few days to get used to them.
Water: Out of all the advice we share in this post, drinking enough water is the #1 most important recommendation. The human brain is 73% water. Water helps you digest and absorb other nutrients, helps you feel focused and alert, and assists in cell growth, among many other things. Drinking enough water can also protect against some metabolism issues and chronic diseases. The easiest way to ensure you drink enough water is to bring water with you, wherever you go.
Foods to Embrace
- Fatty Fish: Salmon, mackerel, and sardines are excellent sources of omega-3 fatty acids.
- Berries: Blueberries, strawberries, and raspberries are packed with antioxidants.
- Leafy Greens: Spinach, kale, and collard greens provide essential vitamins and minerals.
- Nuts and Seeds: Walnuts, flaxseeds, and chia seeds offer omega-3s and other nutrients.
- Lean Proteins: Poultry, fish, beans, and lentils support tissue repair.
- Colorful Fruits and Vegetables: A variety of colors ensures a wide range of antioxidants.
Foods to Limit or Avoid
- Caffeine and Alcohol: To learn how caffeine and alcohol interact with your brain, read our post about caffeine, alcohol, and post-concussion syndrome.
- Processed Sugar: You don’t have to completely eliminate processed sugar from your diet, but gradually reducing it will help your recovery. The type of sugar you consume will impact brain performance.
- Artificial Sweeteners: Do your best to cut out artificial sweeteners entirely. Substances like aspartame and saccharin trick your brain into thinking you’ve consumed calories when you haven’t. This sort of trickery is not good for people with a brain injury.
- Fad Diets: Be wary of any fad diets. From juice cleanses to the cabbage soup diet, there are many trends that won’t give your brain everything it needs. You shouldn’t have to choose between your weight and brain health. A diet rich in healthy sources of protein and fat, plus plenty of fruits and vegetables, can help you maintain a healthy physique while caring for your brain.
Practical Tips for Implementing Dietary Changes
- Start Small: Don’t try to overhaul your entire diet at once. Begin by adding one or two servings of omega-3-rich foods per week or swapping sugary snacks for fruits.
- Plan Your Meals: Planning helps you make healthier choices and ensures you have the necessary ingredients on hand.
- Read Labels: Be mindful of added sugars, unhealthy fats, and artificial ingredients in packaged foods.
- Stay Hydrated: Drink plenty of water throughout the day to support brain function and nutrient absorption.
- Emphasize moderation and variety: Don’t worry about ruthlessly eliminating all sugar from your diet. For example, if you were eating two candy bars a day, try cutting back to one, and then to one every other day, and so on. Try to work different sources of good nutrients into your meal plan every week.
- Give any dietary change time: If you feel weird on Day 1, don’t take that to mean the change isn’t for you.
The Importance of Hydration
Out of all the advice in this post, drinking enough water is the #1 most important recommendation. The human brain is 73% water. Water helps you digest and absorb other nutrients, helps you feel focused and alert, and assists in cell growth, among many other things. Drinking enough water can also protect against some metabolism issues and chronic diseases.
Here’s how to calculate how much water you need: Divide your weight in pounds by two. That’s approximately how many ounces of water you need to drink each day. For example, let’s say you weigh 150 lbs.
Patients with pre-existing health conditions should consult their medical provider regarding how much water they should be drinking.
The easiest way to ensure you drink enough water is to bring water with you, wherever you go.
Additional Habits and Behaviors
Changing the foods you eat is just one part of the picture. Other habits and behaviors impact how well your body is able to absorb and use those nutrients.
- Exercise regularly: This will improve your metabolism (making it easier for your body to get the nutrients it needs from each meal), encourages healthy blood flow to the brain, and can help alleviate some of your symptoms. Some people struggle with increased symptoms during or after exercise.
- Eat smaller meals more frequently: Each large meal pulls blood to your stomach for digestion, then floods your system with nutrients. Your brain may suffer from those large swings in nutrient availability. If your autonomic nervous system is dysregulated, it might also benefit from smaller, more frequent meals.
- Pack healthy snacks: To keep your brain well supplied throughout the day, pack healthy snacks wherever you go.
Scientific Evidence and Studies
Several studies support the role of specific nutrients in concussion recovery. For instance, research has highlighted the benefits of omega-3 fatty acids in reducing inflammation and supporting brain cell structure.
- Miller et al. found that symptom resolution was four days earlier for the DHA group (16.1 days) compared to the placebo group (20.9 days), although the p-value was 0.082. ImPACT neurocognitive test scores normalized earlier for the DHA group at 12.2 days compared to 16.8 days for the placebo group (p = 0.382). RTS initiation time was sooner for DHA at 14.0 (9-39) days versus placebo at 19.5 (8-66) days. Clearance to begin RTP was earlier for DHA at 21.4 days compared to placebo at 23.4 days (p = 0.115). The rate of follow-up and completion was poor in the DHA group (50%, n = 10).
- Standiford et al. reported that PCSS from 0 to 48 h for the magnesium group improved significantly (p = 0.016), compared to the placebo group (p = 0.08). The magnesium group PCSS had significantly decreased at 48 h.
- Abdullah et al. found that calorie and protein intakes were below estimated REQ amounts. Calorie and protein intakes, increases were linked with the TBI type, severity (92% mTBI) and DD.
- Bica et al. found no evidence that a 2,200mg omega-3 fish oil supplement dose for 30 days reduced RTP time following acute SRC (p = 0.397).
- Bisri et al. reported that MMSE scores improved greatly for HSL treatment.
- Chen et al. found that domains of long-term memory (p = 0.0256) at week 4, and drawing at week 4 (p = 0.0066), and 12 (p = 0.0472) improved for the cerebrolysin group.
- Falk et al. observed a high rate (92.8%) of symptom resolution with a high dose of omega-3 (DHA and EPA) for 12 weeks post-TBI.
Addressing Common Concerns and Misconceptions
- Myth: Diet alone can cure a concussion.
- Fact: While nutrition plays a crucial role, it is just one component of a comprehensive recovery plan that may include rest, physical therapy, and cognitive rehabilitation.
- Myth: All fats are bad for concussion recovery.
- Fact: Healthy fats, particularly omega-3 fatty acids, are essential for brain health and reducing inflammation.
- Myth: Supplements are always necessary.
- Fact: A well-balanced diet can provide many of the nutrients needed for recovery. However, supplements may be beneficial in certain cases, especially if deficiencies are present.
The Role of Healthcare Professionals
It is essential to consult with healthcare professionals, including doctors, nutritionists, and dietitians, to develop a personalized nutrition plan tailored to your specific needs and recovery goals. A healthcare provider can assess your nutritional status, identify any deficiencies, and recommend appropriate dietary changes and supplements.
The Importance of Early Intervention
Following diagnosis of concussion/mTBI during the acute phase (<14 day window), either nutrition/nutritional intervention are prescribed. For this review the acute phase of injury will be defined as minutes after the event up to and including 7 days post event. Measured concussion/mTBI recovery <14 days for adults and <28 days for children post injury onset.
Treatment for PCS
Treatment for post-concussion syndrome at CognitiveFX is intense! You’ll engage in difficult physical and cognitive exercise. Treatment pushes your brain to respond better and faster, forging healthier connections between your neurons and the blood vessels that supply them with fuel. This process (neuroplasticity) demands a lot from your brain, which means your brain will demand a lot of nutrients in response.
While home-cooked meals are always best, many patients don’t have the endurance to cook for themselves after a long day of treatment. Many of our patients travel to our clinic from all over the world; if that’s you, you might not have use of a kitchen during your stay. Alternatively, you can order lunch from Kneaders or Aubergine & Company through Cognitive FX (gluten-free options available).
tags: #anti-inflammatory #diet #concussion #recovery