Clinical Nutrition for Concussion Healing

A concussion is a traumatic brain injury.  It is a contact injury resulting from the brain forcefully banging up against the inside of the skull, whether due to an outside blow to the head or from excessive speed rattling the brain into the skull without a force (like in whiplash).   The brain is very sensitive.  This is a physical, chemical, and neurological insult.  Physical trauma to the tissues causing inflammation (altered chemistry) and altered neurological function (including sympathetic overdrive, which in turn causes more inflammation).

Concussions can occur at any age.  For both adults and children, our awareness, assessment, and diagnosis have improved dramatically over the past decade.  Our treatment protocols are improving too, but at a slower rate due to the difficulty of creating a consensus for such a complex neurological sequela.

This is coming along!  We have better, unified recommendations for return-to-play and return-to-learn/work.  Practitioners are developing better treatments for neurological rehab. (If you want to learn more in this area, read our Pediatric Concussion Update blog.) We have a lot of great minds exploring the issue and coming up with solutions. One very important area of recovery is inflammatory control.

Inflammatory control does not mean taking anti-inflammatories.  (Not that they are bad or never indicated, that is just not the type of mediation we are going for right now.)  When our body, especially our brain, is under a high oxidative load (meaning inflamed), we go into survival mode. Our nervous system function is altered, which is where most of the symptoms of concussions come from.  Inflammation is not evil, but it is only meant to be part of an acute healing response.  When it goes too far or for too long, problems arise.

This is where clinical nutrition comes in to play for concussion rehab. When you can lower the inflammatory load and support brain healing, you are on your way to recovery. This will also boost your response to all of the other important therapies guiding you along your journey to getting your life back.

Enough said.  Let’s get to work!

Start with Food

With both acute concussions and chronic post-concussive syndromes, you are very, very likely going to need to support your chemistry with supplements.  That being said, no fancy nutraceutical is going to override a crappy diet.  You need to eat to heal.

The Anti-Inflammatory Diet

There is not really one “the” anti-inflammatory diet; there are many variations depending on practitioners’ specific recommendations. (I like Dr Weil’s Anti-Inflammatory pyramid if you want a little more guidance.)  The general principles of an anti-inflammatory diet are:

Avoid High Inflammation Foods

·       Sugar ·       Wheat ·       Dairy ·       Artificial Sweeteners & Additives ·       Any foods that you are personally reactive to!

Encourage Anti-Inflammatory Foods

Healthy Fats o   Fish, coconut, olive oil, avocado, nuts and seeds Routine clean protein o   Especially in the morning and after activity o   Choose seafood, grass-fed meats, and vegetarian sources Lots of nutrient-dense foods (likes vegetables, fruit, & eggs) Focus on a whole-food (real-food) plant-based diet Stay alkaline (which basically means eat a lot of green foods and healthy fats). Spices & herbs like turmeric, cumin, cinnamon, cayenne, and ginger.

Managing blood sugar is important for concussion rehab and goes in part with mediating inflammation.  Unfortunately, part of being stuck in “go-mode” means that your physiology is sending you messages requesting readily available energy sources (like starchy foods, sugar, and caffeine).  Be aware if you have noticed a change or increase in cravings.  Emphasizing more protein and fat in your diet help with this and reduce cravings and crashes.  Don’t let yourself get to the hangry stage. It’s not a good place for decision making.

If this feels like a lot, take one step at a time. You are going to do more good doing a little than doing nothing.  Make a plan. Give yourself a timeline to implement Start by adding the good if removing the “bad” feels oppressive. Start somewhere!

Boost Your Body

Part of the altered neurological function in concussions syndromes is over-activation of the sympathetic nervous system (survival mode). This creates a dysfunction in the neuro-enteric-axis (brain-gut connection) mediated by the vagus nerve. Within 6 hours following a traumatic brain injury, there is an increase in intestinal permeability and marked changes in intestinal histology and microbiota. What this means for you practically is that your body is not digesting, absorbing, and metabolising nutrients the way it should.  You can see how this spiralling cascade of sympathetic imbalances starts to build on itself. Survival mode, higher inflammation, poor digestion and nutrient absorption, and on top of it all, your head hurts.  This is why I use high-quality nutritional supplements to boost my patients and help them turn the tides for a positive wave of compounding benefits.

Omega-3 Essential Fatty Acids

Omega-3 EFAs are possibly the most important and well-researched supplement for inflammatory modulation. If you have pain or any inflammatory condition, you need this. Your brain is also the fattest organ in your body and needs a lot of support! I’d suggest mixing dietary and supplemental forms of omega-3 fatty acids. Fish is by far your best food source.  You want to make sure whatever supplement you choose is high in EPA (which support inflammatory and hormonal balance) and DHA (which is a building block for the nervous system).  You get what you pay for in terms of quality and purity, so please do not choose the cheapest fish oil on the shelf.

I usually recommend 2-4 grams a day for most people. (1-2 grams for kids, depending on age.)  I like Super EFA Liquid from Genestra because you can get a full dose in 1 tsp instead of popping multiple pills each day, which can get fatiguing.

Anti-Oxidants

Oxidative Load is what fancy chemists call inflammation. Anti-oxidants reduce oxidation (think rusting) by donating an electron to neutralize free-radicals.  Sounds heroic, eh? Anti-oxidants are a very important part of your body’s regulation of inflammation and reduction of damage to tissues.  There are many different categories of anti-oxidants and each has a slightly different function or area of focus.  The vitamins A (β-carotene), C, and E and the minerals Zinc and Selenium are particularly potent.  ALA (alpha-lipoic acid) is another very important anti-oxidant, especially for the brain and in regards to glucose metabolism.

Fortunately, there are a plethora of products out there contain many of these nutrients in one convenient supplement.  I really like UltraInflamX Plus 360 from Metagenics. It is a medical food support that houses several powerful anti-oxidants and inflammatory modulators.  It does not contain ALA, so that is one you may want to add on top.

Probiotics

As I mentioned above, a concussive insult to the brain also results in an insult to the gut and digestive function.  Probiotics play a supportive role in the digestive process and intestinal permeability. We want to reinforce the body’s GI protective layer of microbiota while it is vulnerable.  Overgrowth of the “wrong” bacteria will also create byproducts (like LPS) that will increase the inflammatory load.

My probiotic recommendations are very specific depending on the patient. It is not “one-size-fits-all” and eating yoghurt is not enough. If you are looking for a good place to start, Ther-Biotic Complete from Klair Labs is a very good product.

All the Other Nutrients

I could probably go on and on explaining why each known nutrient is important for concussion rehab and brain healing. Unfortunately, it becomes very impractical to supplement with every known nutrient.  I high-quality multivitamin/mineral can help fill in some of the gaps in your diet.  (In my non-pregnant adults, I usually recommend Mitocore from OrthoMolecular Products or PhytoMulti (with or without Iron) from Metagenics.) Here are some other key nutrient players to be aware of:

• B vitamins, including choline – Support nerve function, neurotransmitter balance, and energy production. Please choose MVM and supplements with methylated B12 and folate (unless you have specifically done the screening and know that you are a good methylator).
• Magnesium – Is important for a few hundred enzymes and works as a muscle and nervous system relaxant. Can also support better sleep and is used in headache treatments.
• Zinc – Is also important as a cofactor for a few hundred enzymes in the body. Zinc is supportive of your Central Nervous System. It also supports the immune system and antimicrobial function.
• Vitamin D – This prohormone has a slew of functions in the body, from immune function to mood support.  The vast majority of us up North “over the wall” are deficient, even in the summer.  Vitamin D is neuroprotective and is an upstream regulator for the genetic expression of the enzyme necessary to build melatonin, which is critical for good sleep.

Sleep Support

Sleep disruption is very commonly a symptom of a concussion.  Your brain and your body need sleep to heal. It is only during deep sleep that your cerebrospinal fluid is able to wash through all the crooks and crannies of your brain to clean out the waste.  If you are not sleeping well, you will not heal quickly.  Establish good sleep habits, including creating a cave (dark, cool, quiet) and following a bedtime routine.  No screens for at least an hour before bed.  I would also recommend the last snack you eat before bed include protein.

Supplemental sleep support may include:

• Melatonin – Helps you fall asleep.
• 5-HTP – Helps you stay asleep
• Herbal medicine for stress response. If your cortisol curve is off (which can be determined by a 4-point salivary cortisol test), your stress hormones (including epinephrine/adrenaline) may be spiking at the wrong time. Imbalances in your HPA Axis will worsen your concussion symptoms and slow your progress.

I know you are an intelligent being but I still feel the need for a disclaimer.

This is not a comprehensive list.  Sometimes concussion support includes mitochondrial resuscitation, neurotransmitter support, and other fancy compounds like proline-rich polypeptide complexes.  This is meant to be an overview of the items that would be the most comprehensive and benefit the most people. By no means does nutritional advice from a blog EVER replace one-on-one, catered health care.  If you are suffering from an acute concussion or (especially) chronic post-concussive syndrome, I STRONGLY recommend that you seek advanced clinical nutrition support from a naturopath, nutritionist, doctor, or dietitian who is familiar with brain injuries or neurological conditions.

Select References

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3. Lewis MD, Bailes J. Neuroprotection for the Warrior: Dietary Supplementation with Omega-3 Fatty Acids. Military Medicine 2011; 176(10): 1120–1127.
4. Packer L, Witt EH, Tritschler HJ. alpha-lipoic acid as a biological antioxidant. Free Radic Biol Med. 1995; 19(2):227-50.
5. Rocamonde B et al. Neuroprotection of lipoic acid treatment promotes angiogenesis and reduces the glial scar formation after brain injury. Neuroscience 2012; 224: 102-15.
6. Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acids supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma. 2007;24(10):1587-95.