Nutrition For A Traumatic Brain Injury: A Functional Medicine Approach
A Traumatic Brain Injury (TBI) could happen to anyone, old and young, and when it does, there isn’t a cure or magic bullet for recovery. The brain is complicated and Dr. Michael D. Lewis, an expert on nutritional interventions for brain health, has created a functional medicine approach to care for TBI’s! (1) He believes standard rehabilitation procedures drop the ball and aren’t effectively healing the brain post-injury.
Dr. Lewis points out one huge concern following a brain injury is treatment plans do not address the BRAIN itself! There aren’t protocols and recommendations for neuro-protection, neuro-inflammation, and neuro-regeneration following a concussion or any other type of brain injury. It raises some questions – how do we manage inflammation in the brain? It’s not the same as the inflammation throughout the body and it’s a lot tougher to deal with. How do we achieve neuro-protection? How do we keep good brain cells alive and functioning well? Can we foster neuro-regeneration?
Visualize Muhammed Ali whom was punched in the head a countless number of times as a young man, and then fast forward to how he was the last couple decades of his life as he suffered with Parkinson’s Disease. What was going on within the brain in between those years from boxer to retiree? How did punches to the head eventually lead to Ali passing away? How can we interrupt that process? Those are some of the unknown’s medical professionals are still trying to figure out about TBI.
A Traumatic Brain Injury Is A Primary Injury
When you have a traumatic brain injury (TBI), you have a primary injury, which creates mechanical energy. The mechanical energy is the energy or force being passed to or through the brain during an injury, and can result from many different things: a slip on the ice and hit your head, colliding with someone on the sports field, a car accident, getting hit by a roadside bomb in Iraq and so much more.
When the mechanical energy races through the brain, your body sets off a serious of biochemical cascades – all which cause inflammation. A traumatic brain injury is an injury, and how does the body respond to injuries? Inflammation! And it happens within seconds, minutes, hours, weeks, years, and even decades, as we see with Muhammed Ali. One often misunderstood thing is you don’t have to be knocked unconscious to have a TBI.
Myths About Concussions and Other Traumatic Brain Injuries
Here are ten misperceptions and old wives tales to dispel about concussions.
Myth: You have to lose consciousness to have a concussion.
That is False. Whiplash can cause a concussion.
Myth: You have to go to sleep after you sustain a concussion.
That is False. Light movement actually speeds up the healing time.
Myth: Male athletes are more likely than females to get concussions.
That is False. Females have higher rates and tend to be worse and have worse outcomes.
Myth: There is no harm in finishing the game after hitting your head.
That is False. Get out of harm’s way. When in doubt, sit them out. No game is worth exacerbating an injury.
Myth: I don’t need to see a doctor if the only thing he or she will tell me is to get some rest.
That is False. Please have your body and brain checked for other possible injuries.
Myth: You must be hit in the head to have a concussion.
That is False. Even an intense roller coaster ride has been known to cause a TBI.
Myth: Once your headache is gone, it’s okay to return to play.
That is False.
Myth: All medical professionals are trained to manage concussions.
That is False. Even some of the most expert neurologists around the country don’t know a lot about TBI. Not all professionals understand TBI or what to do to treat one.
Myth: A CT scan or MRI can’t help with concussion diagnosis and treatment – unless there’s a brain bleed, you won’t see anything related to a concussion.
Myth: Athletes should stop participating in sports after sustaining three concussions.
That is False. There’s some science behind stopping after three concussions because the risks start to go up – but there’s no hard and fast rule. It’s individual. Concussions are like snowflakes – everyone is different. Some people should stop after one, and according to Dr. Lewis, some people have dozens and seem to be relatively OK.
Myth: An injury must be visible to have a concussion.
That is False. For example, concussions among military personnel are very common. Imagine the energy going through a human body and the brain when a soldier is involved in a blast big enough to destroy a huge military vehicle and the paved road it’s driving along – Injury doesn’t have to be visible.
Causes of Traumatic Brain Injury
- Sports concussions
- IED blast exposure
- Car accident
- Other blunt trauma
- Anoxia: lack of oxygen to the brain, such as a near drowning, heart attack, stroke
- Chemotherapy (a chemical attack of the brain)
- Chronic Stress (a form of a chemical attack on the brain)
Symptoms Following a Traumatic Brain Injury
The symptoms following a TBI can be grouped into four categories: Thinking/Remembering, Physical, Emotional/Mood, Sleep
- Difficulty thinking clearly
- Feeling slowed down
- Difficulty concentrating
- Difficulty remembering new information
- Fuzzy or blurry vision
- Nausea or vomiting (early on)
- Sensitivity to noise or light
- Balance problems
- Feeling tired, having no energy
- More emotional
- Nervousness or anxiety
- Sleeping more than usual
- Sleeping less than usual
- Trouble falling asleep
Standard Rehabilitation Following a Traumatic Brain Injury "Drops the Ball"
When a head injury occurs, you’re told to remove the person from the situation immediately. This recommendation remains true but the recommendation for complete physical and cognitive rest until the person is asymptomatic, and prescribing medications for symptoms are not ideal recommendations. New research is telling us this is the wrong thing to do.
Physical Activity to Promote Recovery Following a Traumatic Brain Injury
Physical activity within the first week of injury helps symptom recovery. In fact, for every day delaying initiation of exercise, individuals have less favorable recovery trajectory. (2) This is complicated. Why does exercise help the brain?
At the 5th International Conference on Concussion in Sport, held in Berlin, October 2016, medical professionals came to a consensus there isn’t any evidence that rest post-injury is good: There is currently insufficient evidence that prescribing complete rest achieves desirable objectives. After a brief period of rest during the acute phase (24–48 hours) after injury, patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds (i.e., activity level should not bring on or worsen their symptoms). (3)
According to research, earlier initiation of aerobic exercise following an acute sports concussion was associated with faster full return to sport and school or work. In this study, if participants delayed exercise for just 3 days, 46% had difficulty returning to school/work and if exercise was delayed for 7 days, 83% of the participants had difficulty returning to school/work. (4) Those are astonishing statistics and provides greater insight into the benefits and safety of aerobic exercise within the first week of the injury.
In another study with 103 adolescents ages 13 to 18, those who participated in in aerobic exercise, versus stretching, following a sports-related concussion recovered faster. Researchers concluded exercise is more effective than stretching after a sports-related concussion to help with speed of recover. (5)
Basic Nutrition Following a Traumatic Brain Injury
A Mediterranean Diet is associated with better cognitive function, and is the only diet backed by research for brain health. There aren’t any studies looking at a diet for concussions, so extrapolating the research leads us to the Mediterranean diet for brain health. (6)
- Eat small meals every three to four hours
- Proteins: include fish, lean meats, nuts, and eggs
- Healthy fats & oils: include avocados, seeds, and nuts
- Carbohydrates: focus on vegetables, fresh fruit, and high-fiber grains
- Avoid sugar and processed carbohydrates because they are inflammatory
- Eat moderately – do not overeat
- Weight gain is common following brain injury
Omega-3 Fatty Acids Following a Traumatic Brain Injury
When the omega-3 fat, DHA, is available to the brain after an injury, versus not having it, recovery is better. Think of this analogy: if you have a brick wall and it gets damaged, wouldn’t you use bricks to repair that wall? Yes! The same for the brain. It takes omega-3’s to create a brain, so why wouldn’t you use them to repair the brain? Think of it as adding “bricks” to help prevent TBI and/or repair the brain when injury does occur.
The body needs inflammation as a response to injury, but we must be able to resolve the inflammation. This happens by ensuring your body’s levels of omega-3 fats, DHA and EPA, are high enough. A diet too high in omega-6 fats causes inflammation and is also prothrombotic, causing blood to clot undesirably. Unfortunately, the standard American diet is too high in these fats, which primarily come from soybean oil and other vegetable oils (corn, safflower, sunflower, canola).
Reducing omega-6 fats and saturating the body with omega-3 fats will foster the crucial balance of omega-3’s to omega-6’s, and this is ideally done daily, but definitely immediately following a brain injury.
There are many other reasons to use omega-3 fats for the brain.
- Omega-3 fatty acids are a broad, holistic approach that can impact neuro-protection, neuro-inflammation, and neuro-regeneration.
- Saturating the brain of TBI patients with omega-3 fatty acids can help, and is safe and well-tolerated, even for prolonged periods.
- Omega-3s are used by thousands of people around the world.
- Omega-3s are currently in use by dozens of university athletic programs as a result of research about brain injury and omega-3s.
What Does it Take to Achieve a Healthy Level of Omega-3 Fats?
Supplementing with 3 grams of EPA and DHA per day (the amount the FDA generally recognizes as safe) will drive the body’s % of omega-6’s down to desirable levels or better.
There’s a cool website called essential fatty acid education (efaeducation.nih.gov), which will estimate your omega-3 levels. This allows you to know whether your omega-3’s and omega-6’s are balanced.
The Omega-3 Protocol Following a Traumatic Brain Injury
Following a concussion or any type of brain injury, it’s important to immediately saturate your body with omega-3s (7). Here’s how:
Note: one “dose” equals 3000 mg of EPA/DHA combined. This amount is for post-TBI and as a maintenance dose. This level increases the brain’s resilience to withstand an injury if it does happen. It’s about neuroprotection.
- One dose three times a day for a week (9000 mg) after a brain injury (breakfast-lunch-dinner).
- One dose two times a day the next week (6000 mg) after a brain injury (breakfast-dinner).
- One dose daily as an ongoing maintenance dose.
My personal favorite liquid fish oil is Nordic Naturals Omega-3, 16oz. lemon flavor.
One Tablespoon will provide 2235mg EPA, 1500mg DHA, and 945mg other omega-3s. If you would rather use soft gels, a great choice for this situation is Nordic Naturals ProOmega 2000
. Two softgels will provide 1125mg EPA, 875mg DHA + 150mg other omega-3s. Taking four to six soft gels per day gets you the amount of omega-3's you want after a brain injury.
Nutrition Supplements For a Traumatic Brain Injury
#1: Fish oil!
#2: CBD oil. Read more about using CBD oil for Traumatic Brain Injury.
#3: Other, and this is by no means a complete list!!!
- Creatine, CoQ10, PQQ – mitochondrial function
- B-vitamins – neuroprotective
- Protein/BCAA’s – supports BDNF
- Vitamin D – neuroprotective
- Probiotics – gut-brain connection
- Magnesium – support neurotransmitters, sleep
- N-Acetyl-Cysteine – supports glutathione production, which is the body's master antioxidant
- Phosphatidylserine/Phosphatidylcholine – neurotransmitter support
- Mushrooms (maitake, shiitake) – cognitive support
- Sulforaphane – NRF2/glutathione support
- What is sulforaphane? It comes from cauliflower, Brussel sprouts, kale, kohlrabi, cabbage, and broccoli sprouts; however, it doesn’t get created within the food until you’ve chewed it. The amount of sulforaphane in broccoli sprouts decreases with age, so mature broccoli is low in sulforaphane. Sulforaphane reduces oxidative stress on cells, supports phase 2 liver detoxification, and promotes glutathione production.
Correcting Pituitary Dysfunction After a Traumatic Brain Injury
The pituitary gland is connected to and sits at the base of the brain. It’s so important that it’s encased in bone, but when we get our heads rocked, it’s vulnerable. Even though it’s protected from direct force/contact, as the brain moves forward then backwards during trauma, that connection between the pituitary and brain can be compromised and pulled on.
This is a concern because the pituitary gland regulates hormones like growth hormone, FSH and LH, TSH, ACTH. Following a TBI, all these hormones can all be measured in the blood to ensure levels weren’t affected by the brain injury.
This cutting-edge information about traumatic brain injury is so important to pass along. Correcting pituitary dysfunction, following exercise and diet recommendations, and implementing Dr. Lewis’s omega-3 protocol will change people’s lives when it comes to recovering from a TBI.
Kelly Harrington, MS, RDN
Registered Dietitian Nutritionist for Healthy Goods
1. Lewis, Michael D. Evaluating Traumatic Brain Injury. The Institute for Functional Medicine. AIC 2019 May.
2. Leddy JJ et al. Exercise is Medicine for Concussion. Curr Sports Med Rep. 2018 Aug; 17(8):262-270.
3. McCrory P et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. BJSM. Apr. 26, 2017.
4. Lawrence DW et al. Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. Apr. 18, 2018.
5. Leddy JJ et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion. A Randomized Clinical Trial. JAMA Pediatr. 2019;173(4):319-325.
6. Brainline: All about brain injury and PTSD. Feed your body, feed your brain: nutritional tips to speed recovery.
7. Brain Health Education and Research Institute. Omega-3 Protocol for Brain Injury.