Concussions, Traumatic Brain Injury Recovery: New Hope from Nutritional Supplements

When two of my close friends, both accomplished doctors, suffered severe concussions last year (in separate accidents!), the impact of traumatic brain injury (TBI) became painfully real to me. One friend, an anesthesiologist, had to take a six-month leave from her career. Witnessing their struggles made me wonder, Why don't we know more about how to heal from concussions?

Understanding the TBI Epidemic

Traumatic brain injuries (TBIs) have become a silent public health crisis, affecting lives in unexpected ways. In the United States, TBI-related emergency room visits increased by 53% between 2006 and 2014, representing millions of altered lives [1].

These injuries range widely in severity and impact. Some patients, like my friend, suffer from mood changes, memory difficulties, and inability to do tasks like read or watch TV. Others suffer from devastating emotional effects like depression or uncontrollable anger [2].

From mild concussions to severe trauma, TBIs can have long-lasting cognitive, emotional, and physical effects that take months or even years to resolve [3].

Promising Supplements for TBI Recovery

A comprehensive review recently published in the journal Nutrients has shed light on several supplements that show promise in aiding TBI recovery [4]:

Omega-3 Fatty Acids (DHA and EPA): Found primarily in fish oil, these nutrients may help reduce inflammation and neural damage while supporting the brain's energy supply post-injury [5].

Creatine Monohydrate: This compound, often associated with athletic performance, could aid cognitive function and address the energy crisis that occurs in brain cells following a TBI [6].

Branched-Chain Amino Acids (BCAAs): These essential amino acids might help restore brain network excitability and balance neurotransmitter release, potentially improving cognitive function after injury [7].

Magnesium: Involved in numerous brain processes, magnesium may help modulate excitotoxicity, a damaging process that occurs following brain injury [8].

Choline: As a precursor to the neurotransmitter acetylcholine, choline supplementation might help preserve the integrity of the blood-brain barrier and reduce brain swelling [9].

Blueberry Anthocyanins: These powerful antioxidants found in blueberries show promise in protecting against oxidative stress and supporting cognitive function [10].

Beyond Supplements: A Holistic Approach

While supplements offer potential benefits, the review emphasizes that they're just one piece of the puzzle. A holistic approach to TBI recovery should also include:

1. Blood glucose management
2. Proper thermoregulation
3. Sleep optimization
4. Caffeine moderation

These factors play crucial roles in creating an optimal environment for brain healing and recovery [11]. It is important to consult a concussion or TBI specialist when constructing a recovery program.

The "Left of Bang" Strategy

One intriguing concept highlighted in the article is the "left of bang" approach. This strategy focuses on nutritional optimization before an injury occurs, potentially preparing the brain to better withstand and recover from trauma. It involves addressing nutrient deficiencies and considering overall metabolic health as a preventative measure [4].

I myself have a balanced approach toward prevention based on evidence like this. For my patients whom I have determined such measures are appropriate, I often recommend magnesium, creatine monohydrate, and Omega-3 supplements. The others mentioned (BCAAs, choline, and blueberry anthocyanins) are easy enough to get sufficient levels from a balanced and nutritious diet containing healthy sources of meat, eggs, and (of course) blueberries.

The Critical Role of Concussion Specialist Guided Rehabilitation

While nutritional interventions show promise, it's crucial to emphasize the irreplaceable role of professional medical guidance in TBI recovery. Concussion specialists bring a wealth of expertise and tailored approaches that are essential for optimal healing [12].

Every brain injury is unique, and so should be its treatment. Concussion specialists conduct comprehensive evaluations to understand the specific nature and extent of the injury. This may include cognitive testing, balance assessments, and visual examinations. Based on these results, they develop personalized rehabilitation plans that address each patient's individual needs and symptoms [13].

Multi-disciplinary Approach

Effective TBI rehabilitation often requires a team of specialists. A concussion expert can coordinate care between neurologists, physical therapists, occupational therapists, speech therapists, and mental health professionals. This multi-disciplinary approach ensures all aspects of recovery - physical, cognitive, and emotional - are addressed [14].

Recovery from TBI is rarely linear. Concussion specialists play a crucial role in monitoring progress, identifying setbacks, and adjusting treatment plans accordingly. They can recognize subtle signs of improvement or regression that might be missed by non-specialists [15].

Safe Return-to-Activity Guidance

‍One of the most challenging aspects of TBI recovery is determining when it's safe to return to normal activities, work, or sports. Concussion specialists use evidence-based protocols to guide this process, helping prevent premature return that could risk re-injury or prolonged symptoms [16].

Working with concussion specialists can bring structure to the recovery process and hope when progress seems slow. They know exactly when to push and when to advise rest, tailoring every step of the rehabilitation to your needs.

Conclusion and Future Outlook

While this research offers hope, it's important to note that TBI recovery remains complex and individualized. These findings aren't a cure-all but rather potential tools in a broader treatment arsenal.

For those dealing with TBI or at high risk, it's crucial to work closely with healthcare professionals. They can help develop a comprehensive recovery plan that might include some of these nutritional strategies alongside active recovery programs.

As research in this field continues to evolve, we may see more targeted and effective approaches to TBI recovery in the future. For now, this growing body of evidence suggests that nutrition could play a more significant role in brain health and recovery than previously thought [17].

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References

1. Peterson, Alexis B. et al. (2019). Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths, United States, 2014.
2. Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. Psychiatric Clinics, 37(1), 1-11.
3. Corrigan, J. D., & Hammond, F. M. (2013). Traumatic brain injury as a chronic health condition. Archives of physical medicine and rehabilitation, 94(6), 1199-1201.
4. Conti, F., et al. (2024). Mitigating Traumatic Brain Injury: A Narrative Review of Supplementation and Dietary Protocols. Nutrients, 16(15), 2430.
5. Bailes, J. E., & Mills, J. D. (2010). Docosahexaenoic acid reduces traumatic axonal injury in a rodent head injury model. Journal of neurotrauma, 27(9), 1617-1624.
6. Sakellaris G, Kotsiou M, Tamiolaki M, Kalostos G, Tsapaki E, Spanaki M, Spilioti M, Charissis G, Evangeliou A. Prevention of complications related to traumatic brain injury in children and adolescents with creatine administration: an open label randomized pilot study. Journal of Trauma. 2006 Aug;61(2):322-9.
7. Cole, J. T., et al. (2010). Dietary branched chain amino acids ameliorate injury-induced cognitive impairment. Proceedings of the National Academy of Sciences, 107(1), 366-371.
8. Vink, R., et al. (2003). Magnesium attenuates persistent functional deficits following diffuse traumatic brain injury in rats. Neuroscience letters, 336(1), 41-44.
9. Reno, E. (2013). Effect of Citicoline on Functional and Cognitive Status among Patients with Traumatic Brain Injury. Journal of Emergency Medicine, 44(3), 732.
10. Krikorian, R., et al. (2010). Blueberry supplementation improves memory in older adults. Journal of agricultural and food chemistry, 58(7), 3996-4000.
11. Lucke-Wold, B. P., et al. (2018). Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Nutritional neuroscience, 21(2), 79-91.
12. Marshall, S., et al. (2015). Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain injury, 29(6), 688-700.
13. Collins, M. W., et al. (2016). Statements of agreement from the targeted evaluation and active management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15-16, 2015. Neurosurgery, 79(6), 912-929.
14. Keyser-Marcus, L. A., et al. (2002). Acute predictors of return to employment after traumatic brain injury: a longitudinal follow-up. Archives of physical medicine and rehabilitation, 83(5), 635-641.
15. McCrory, P., et al. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British journal of sports medicine, 51(11), 838-847.
16. Giza, C. C., et al. (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports. Neurology, 80(24), 2250–2257.
17. Gomez-Pinilla, F. (2008). Brain foods: the effects of nutrients on brain function. Nature Reviews Neuroscience, 9(7), 568-578.

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Until next time - Cheers to your health!

Hillary Lin, MD