Traumatic brain injury (TBI) is a significant health concern, affecting millions worldwide each year. According to the Centers for Disease Control and Prevention, approximately 1.5 million Americans sustain some form of TBI annually. The consequences of TBI can range from mild, temporary symptoms to severe, long-term disabilities. While medical interventions play a vital role in the initial management of TBI, emerging research highlights the importance of nutrition in supporting the brain's healing process. This article explores how a well-planned diet can be a powerful tool in the recovery journey after a head injury.
The Connection Between Nutrition and Brain Recovery
Following a TBI, the brain undergoes a complex healing process. Supplying the brain with essential nutrients through diet is crucial for recovery. Deficiencies in certain nutrients can disrupt brain functioning, impacting a patient's ability to think clearly. A healthy diet is essential for recovery after a brain injury. The brain requires a significant amount of energy to function, and a TBI can disrupt its normal metabolic processes.
In the first few days after a TBI, ensuring adequate caloric intake can help boost the brain’s healing process, making nutrition an important consideration for improving TBI care. Researchers will present their work this week at the American Physiology Summit, the flagship annual meeting of the American Physiological Society (APS), in Long Beach, California.
Understanding the Nutritional Needs After TBI
After a brain injury, eating enough calories is vital to help our brains function well. Hypermetabolism and increased catabolism after TBI lead to hyperglycemia, protein wasting, and increased energy demand, which may be as high as 200% of the usual energy requirement.
The secondary response to trauma increases the secretion of catecholamines, which antagonize insulin, and inflammatory mediators. Hormonal changes after TBI can lead to hypermetabolism by increasing the secretion of corticosteroids, counterregulatory hormones, and cytokines. In the acute phase of TBI, energy requirements increase to 100%-200% of baseline-predicted resting energy expenditure (REE), which may persist for several weeks to several months, depending on the severity of the neurotrauma and level of recovery. In the acute phase of TBI, factors including the patient’s body temperature, use of sedatives, mechanical ventilation, and the severity of brain injury modify the REE, making it very challenging to predict an individual’s nutritional requirements; this difficulty may lead to inadequate nutrition.
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For TBI patients, undernutrition is associated with an increased mortality rate, more infectious complications, and worse neurologic outcomes. Therefore, timely and effective nutritional therapy is particularly crucial in the management of TBI to improve patients’ prognoses.
Key Dietary Components for Brain Healing
Protein: The Building Block for Recovery
Protein is the building block for recovery, and the protein needs of people recovering from traumatic brain injuries are elevated.
Healthy Fats and Omega-3 Fatty Acids: Fueling Brain Function
Healthy fats are essential, as a portion of many brain cells are covered in a fat layer called myelin. This helps information travel between brain cells quickly and thus is essential for processing information efficiently. Incorporating healthy fats and omega-3 fatty acids found in fatty fish (think salmon, tuna, sardines, mackerel, and herring, among others), nuts, and seeds is a great way to support your brain health as you recover. The omega-3s that we get from fatty fish are great for the brain. Omega-3 fatty acids are beneficial and necessary for every person. Substances in foods high in omega-3 help alleviate the condition and accelerate brain recovery after a concussion.
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Whole Grains: Sustained Energy for the Brain
Reach for whole grains instead of refined grains. The fiber in whole grain products is digested slowly, helping your energy remain stable throughout the day.
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Fruits and Vegetables: Antioxidant Powerhouses
Adding antioxidant-rich fruits such as blueberries to a nutritional diet also can help improve cognitive functions. Berries are high in antioxidants, which protect the brain from damage and reduce inflammation. Some berries improve cognitive functions, improve thought processes and positively affect memory.
Dark, leafy greens such as kale and spinach are excellent foods for survivors of brain injuries. Kale in particular contains a high level of B-vitamins. B-vitamins improve communication between brain cells and boost neuronal repair after TBI.
Hydration: Essential for Brain Function
Drinking eight glasses of water daily is a great way to help prevent fatigue and other symptoms.
Practical Dietary Strategies for TBI Recovery
Embrace the Mediterranean Diet
According to Gavi, one of the more popular diets linked to promoting brain health after a TBI is the Mediterranean diet. “I work a lot of my TBI patients towards a Mediterranean dietary pattern,” Gavi said. The Mediterranean diet can vary, but in general it consists of high portions of fruits, vegetables, grains, legumes, nuts, fish and olive oil. A Mediterranean diet emphasizes whole grains, fish, olive oil, and fresh fruits and vegetables and promotes overall health and weight management, crucial aspects of TBI recovery.
Time Management for Meals
As far as managing the eating schedule, it’s important to make sure that the patients are not skipping meals or snacks. They should be eating every four to five hours,” Gavi said. Again, setting an alarm can help keep meals consistent for steady energy throughout the day. If you’re away from home, bring snacks to take with you to boost your energy between meals!
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Smart Shopping Habits
Being in a busy store with lots of choices can quickly become overwhelming and fatiguing, making it tempting to make poor food decisions. It may be helpful to shop at a time when you have the most energy or the store is less crowded. Stick to a list of needed items and start shopping from the perimeter of the store - where the healthiest foods are - and work your way in if needed. Read labels to check for salt and added sugar. Stock up on frozen fruits and veggies for your freezer. They’re just as nutritious as fresh produce if you select ones without sauces or gravies that add excess fat and salt.
Addressing Eating Challenges
It’s not unusual for someone with a traumatic brain injury to forget to eat or feel too fatigued to cook or eat. Taste changes may even make you disinterested in food.
Foods to Embrace and Foods to Limit
Power Foods for Brain Recovery
- Fatty Fish: High in omega-3 fatty acids, essential for brain cell repair and neuroplasticity.
- Berries: Rich in antioxidants, protecting the brain from damage and reducing inflammation.
- Leafy Greens: Excellent source of B-vitamins, improving communication between brain cells.
- Nuts and Seeds: Provide omega-3 fatty acids and essential minerals.
- Dark Chocolate: High in magnesium and antioxidants, supporting brain health (choose varieties with at least 70% cocoa and consume in moderation).
- Eggs: A good source of choline, which is vital for concussion patients due to its high choline content. Choline is a nutrient that affects mood and memory.
Foods to Limit or Avoid
- Sugary Drinks: Steer clear of sugary drinks, as they can lead to weight gain and energy crashes, which can be especially problematic for those experiencing fatigue.
- Processed Foods: For example, if all you’re eating is highly processed foods, then that could have a negative impact on brain function over time,” she said.
- High-Salt Foods: Opting for low-salt food choices can help you maintain healthy blood pressure. Salt is known to raise blood pressure and increase the risk of stroke.
- Foods High in Saturated Fat and Processed Sugar: In general, it is important to avoid foods containing saturated fat and processed sugar.
Addressing Specific Nutritional Challenges in TBI Patients
Hypermetabolism and Energy Expenditure
In the acute phase of TBI, energy requirements increase to 100%-200% of baseline-predicted resting energy expenditure (REE), which may persist for several weeks to several months, depending on the severity of the neurotrauma and level of recovery. The American Society for Parenteral and Enteral Nutrition-Society of Critical Care Medicine (ASPEN-SCCM) and many clinicians recommend that indirect calorimetry is the current “gold standard” to measure energy requirements in patients with TBI whenever possible (quality of evidence: very low [ASPEN-SCCM]) [8,17]. The ASPEN-SCCM guideline suggests that if indirect calorimetry is not available, a published predictive equation or a basic weight-based equation (25-30 kcal/kg/d) be applied to determine energy requirements in critically ill patients (quality of evidence: expert consensus) [17].
Delayed Gastric Emptying and Enteral Nutrition Intolerance
Gastroparesis, or delayed gastric emptying, is one of the major factors that cause feeding intolerance, which is exhibited in 45%-50% of TBI patients. There are several strategies to improve feeding tolerance in patients with TBI. First, the American Dietetic Association recommends positioning patients in a 45° head-of-bed elevation position to prevent aspiration pneumonia (grade II) and to minimize gastroesophageal or laryngopharyngeal reflux of gastric contents (grade I). Second, concentrated enteral formulas (≥ 1.5 kcal/mL) may reduce the risk of reflux or intolerance while meeting caloric requirements in less volume [20]. Thirdly, for EN, a continuous infusion is preferred rather than administration as a bolus.
Timing and Route of Nutritional Support
According to meta-analyses of previous RCTs comparing early (within 24-48 hours) versus delayed EN, patients who received early EN showed lower mortality, reduced infection rates, and shorter hospital stays. Both the ASPEN-SCCM and ESPEN guidelines recommend initiating early EN (within 24-48 hours) instead of delaying EN (quality of evidence: very low [ASPEN-SCCM]; grade of recommendation: B - strong consensus [ESPEN]). Early EN therapy is more beneficial, especially in high-risk patients.
The Gut-Brain Connection
“We’re learning so much more about the gut-brain interactions and the role the microbiome has on brain health,” she said. Gavi said much of the research behind fermented foods shows how proper gut health can support brain health. Some of the fermented foods she recommends include sauerkraut, pickles, yogurt and kefir (drinkable yogurt).
Beyond Diet: Complementary Strategies for Recovery
Besides the fact that you should make your diet balanced in restoring the brain after a concussion, rest, quality sleep, and lack of stress will help you. Also, follow the instructions given by your doctor.
The Road to Recovery: A Holistic Approach
The journey to recovery after a traumatic brain injury is fueled by more than just determination; it runs on nutritious foods to help your brain and body heal. A healthy diet promotes recovery for our patients. Nutrition is an important part of concussion recovery. The effects of brain injury can make shopping for and cooking food difficult, especially if memory or planning skills are affected. When cooking, make extra portions and freeze them in sealed containers. Check the label. Clearer labelling has made it easier for consumers to know what’s in their food. Remember, a healthy diet is just one way to stay healthy.
The Importance of Professional Guidance
What makes a ‘good diet’ varies from person to person and depends on a number of factors such as your level of physical activity, your general health and how your brain injury affects you. Consult with your healthcare provider for personalized recommendations before starting any nutrition routine. Working with a dietician can help TBI survivors determine which dietary choices are best for them.