Nutrition

Following a concussion it’s important to consider food choices and whether foods are inflammatory or anti-inflammatory. For example, sugar, red meat, and many processed and refined foods are fairly inflammatory while high water vegetables (greens, etc.), chicken and fish, and healthy fats like coconut oil work well to reduce inflammation.

Hydration is an important piece of managing concussion symptoms - be sure to drink plenty of water. Many in our community always carry a large water bottle with them.  

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Author Rebecca Denniss is a doctoral researcher in the UK, under the supervision of Dr. Lynne Barker, Dr. Catherine Day, and Dr. Paul Richardson. She is investigating the potential for micronutrients to improve cognition following traumatic brain injury. Read the blog post about her research.


What kind of foods do you need to eat to maximize the opportunity for the brain to repair?

  • Meat, fish, and eggs are good sources of most of the B vitamins, vitamin D, iron, zinc, and selenium. In terms of red meat, it is good for micronutrients but should be eaten in moderation with greater amounts of protein from white meat/fish.

  • Vegetarians and vegans: You can get similar micronutrients from the legume family (beans, lentils, etc) and grains. The only problem with this form of diet is getting enough B12. In Japan and Scandinavia the regular consumption of certain varieties of seaweed results in enough B12, or you can add nutritional yeast to dishes.

  • Oily fish (salmon, mackerel, trout, herring, light tuna, sardines) are excellent sources of omega-3.

    • Fish canned in brine is better than canned in oil as the omega-3 leeches out into the oil somewhat.

    • Wild fish is a better source of omega-3 than farmed fish.

    • For vegetarians and vegans, taking refined algae oil is a great alternative, as the fish eat the algae and that’s where they get their omega-3s from.

  • Avoid oils high in omega-6, for example, sunflower, corn, cottonseed and soybean oils, and instead pick fats relatively low in omega-6 like butter, lard, coconut oil, palm, and olive oils.

  • Vegetables, particularly the green and leafy ones, are great for many of the vitamins and minerals (including calcium), and sea vegetables (nori and certain other seaweed) are an excellent source of B12 for vegetarians and vegans.

  • Fruit and vegetables also provide excellent levels of vitamin C and nuts and seeds are good for B6, vitamin E, selenium, magnesium, zinc, and omega-3.

  • A useful short article regarding which foods are unusually high in a given nutrient is Best Foods for Every Vitamin and Mineral.


The Importance of nutritional choices following a concussion

Research is pointing to the importance of nutritional choices following a concussion, including specific ‘macronutrients’ (fats, proteins, carbohydrates) and ‘micronutrients’ (vitamins and minerals). Macronutrients provide energy in the form of calories and are the building blocks for tissues, such as omega-3 fatty acids, which are important in recovery from a concussion. Micronutrients are required components of cellular mechanisms, with 19 micronutrients (both vitamins and minerals) considered ‘essential’ as they cannot be manufactured within the body.

The initial injury in a concussion results in a number of damaging processes within the brain (see ‘Background’ section below for details). Pathways carrying nerve impulses between brain cells are insulated with a substance called myelin; both the pathways and the insulation can be damaged in a concussion. The cells necessary for myelin production and repair require biotin (B7), cobalamin (B12), vitamin A, vitamin K, iodine, iron, and omega-3 polyunsaturated fatty acids to function properly.

Problems in cellular functioning as a result of concussion result in over-production of reactive molecules and free radicals, which may lead to metabolic stress and neuroinflammation. To counteract these processes the body needs a good supply of antioxidants. Most people are familiar with vitamins C and E as antioxidants (Sorice, Guerriero, Capone, Colonna, Castello, & Costantini, 2014). However, research has shown that riboflavin (B2), niacin (B3), folic acid (B9), vitamin K, and magnesium also function either as anti-oxidants or directly reduce cellular stress.

When considering neuroinflammatory processes, vitamin D, B6, zinc, selenium, and omega-3 polyunsaturated fatty acids seem to balance the brain’s inflammatory response.

Omega-3, in particular, is essential in this regard as EPA and DHA (omega-3 fatty acids from fish or algae oil) are precursors to molecules called protectins and resolvins that help resolve inflammatory processes.

The difference between omega-3 and omega-6:

The modern westernized diet is rich in omega-6 ever since the process to refine vegetable and grain oils was discovered. This has caused an imbalance in the intake of omega-3 and omega-6. Omega-6 oils are not by their nature necessarily bad for you; however, research has shown that they are pro-inflammatory in nature, compared to the anti-inflammatory nature of omega-3. It is therefore important to actively eat omega-3 following a concussion to achieve a balance in your omega-3/omega-6 intake.

Energy production (which occurs within the mitochondria, the cell’s batteries) is essential to all on-going cellular functions as nothing can occur in the absence of energy. Most of the B vitamins along with iron, magnesium, and omega-3 are required for efficient mitochondrial function and cellular energy production.

Following a concussion, some micronutrients can become depleted including vitamins C, D, E, magnesium, zinc. The macronutrient omega-3 can also be depleted. These need to be replaced for the body to be able to respond to the injury adequately and to encourage repair processes.

Research in rats and mice has shown that good levels of micronutrients and omega-3 polyunsaturated fatty acids prior to sustaining a head injury result in a better outcome. There is currently a lack of human research in chronic traumatic brain injuries, and there is presently no advice on nutrition for individuals with traumatic brain injury (TBI).

This lack of nutrition advice following a concussion is particularly concerning as research has shown that following a traumatic brain injury individuals with cognitive problems may make poorer food choices, and as a result can have an insufficient dietary intake of essential vitamins and minerals.

Excellent resources for the effect of micronutrients on the body

Handbook of Vitamins, Zempleni, J., Suttie, J. W., Gregory III, J. F., & Stover, P. J., CRC Press, 2013.

Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. Editors: John Erdman, Maria Oria, and Laura Pillsbury.


Background: What happens to the brain after a concussion

The initial impact (either direct or indirect) of a concussion mild traumatic brain injury (mTBI) results in non-uniform distribution of contusions (bruises), lacerations (cuts), and axonal injury. This injury then leads to a biochemical, metabolic cascade within the cells of the brain. This secondary cascade includes many different processes, the extent to which they occur affecting the severity of cognitive problems experienced post-injury.

Edema:
Excess fluid can be either be within the cell or in the fluid surrounding the cells. Excess fluid within the cell (cytotoxic edema) results in a breakdown in cellular energy production and cell death. Excess fluid accumulation in the spaces around brain cells (vasogenic edema) results in raised intracranial pressure which can be life-threatening if severe. These processes don’t occur in isolation; they are interrelated.

Excitotoxicity:
Excess release of excitatory neurotransmitters from cells which causes cell damage and cell death.

Cellular energy production:
Through several factors including poor blood supply to the region of damage, cytotoxic edema and excess cellular calcium results in problems with cellular energy production, mainly affecting the mitochondria, which are the battery packs of the cell.

Axonal degeneration:
Apart from the most severe traumatic brain injuries, axons (the communication pathways of the neuron) remain intact but damaged. These axons can either repair over time or can degenerate and disconnect. Diffuse axonal injury, affecting communications within the brain, more commonly occurs with mTBI.

Neuroinflammation:
After a brain injury, inflammatory processes within the brain recruit reparative mechanisms to the part of the brain that was damaged. When these reparative mechanisms become protracted following TBI, they aggravate the initial injury, worsening cognitive problems.