Tackling Concussions Head-On: How Nutrition Can Improve Outcomes

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football

I sat on the floor hunched over and crying. My elbows were raised – close to my eyes as my arms hugged my head, hands clenched at the base of my neck. My brain felt like a percussion instrument shaking inside my skull. As the pounding grew more intense the pain became unbearable. I had a concussion, my second in two years, which earned me a night in the ER.

Concussions are common in sports and recreation. Though considered a mild type of traumatic brain injury because they are usually not life-threatening, all concussions should be taken seriously. A single blow to the head can result in short-term loss of brain functioning or long-term changes in thinking, language, emotions and sensations including taste, touch and smell (1). Repeated concussions can be very dangerous and may lead to permanent changes in brain functioning or in extreme cases, death (2). Though widely recognized in football players, concussions happen in all sports – even in everyday activities – and they are occurring at younger ages. Athletes who have had one concussion have a greater risk (2 – 5.8 times higher) of experiencing another concussion (3). Multiple blows to the head could lead to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease associated with poor memory, changes in personality, behavior, speech and gait (4). Posthumous examination of some former NFL players in addition to a few college football players who committed suicide revealed CTE. In March 2016, the NFL acknowledged the link between traumatic brain injury and CTE. The movie ‘Concussion,’ set for release in late December, 2015 highlights concussions in former NFL players though the league has gone to great lengths to make today’s game safer.

Decreasing the Damaging Effects from Concussions

Anyone who experiences a blow to their head or body (a forceful blow to the body can cause the brain to shake inside the skull) should be immediately examined by a physician with experience in the evaluation and management of concussions. Though the person may say they feel fine and can continue with regular activities, symptoms of concussion do not always appear immediately and may instead be delayed for several hours. Continuing to play or perform mental tasks like studying can increase severity or symptoms and cause complications including the possibility of developing permanent brain damage.

Symptoms of Concussion may include:

  • Confusion
  • Headache
  • Vision changes
  • Memory loss
  • Difficulty with coordination, clumsiness or stumbling
  • Dizziness
  • Irritability
  • Personality changes
  • Slurred speech
  • Delayed response to questions
  • Nausea or vomiting
  • Sensitivity to light and noise
  • Problems sleeping
  • Seizures
  • Loss of consciousness

In addition to the symptoms that occur soon after a concussion, some people experience Post-Concussion Syndrome (PCS) days or weeks later. PCS can cause many of the same symptoms experienced after a concussion as well as trouble concentrating, apathy, depression and anxiety. Symptoms may last a few weeks. If you suspect PCS, have the patient evaluated by a psychiatrist (5).

Nutrition Management

In addition to rest, following a graduated return-to-play and school protocol, and other steps you should take to treat concussions, emerging research suggests nutrition may play an important role. Certain nutrients seem to help reduce some of the damaging effects from concussions:

Protein: 1 – 1.5 grams of protein per kg body weight per day is recommended along with sufficient calories to reduce the inflammatory response (6).

EPA and DHA Omega-3 Fatty Acids: EPA and DHA, omega-3 fatty acids found in fish and algae, increase fluidity of cell membranes, reduce inflammation and enhance cerebral blood flow (which is reduced for up to a month or longer in athletes that recover slowly) (7). Cell membranes are like gateways allowing substances to enter cells or blocking their entry. When cell membranes are more fluid (and therefore less rigid), they perform better, opening the gate for nutrients to come in. DHA, in particular, makes up 97% of the omega-3 fatty acids in the brain and is essential for normal brain functioning (8). Several animal studies show EPA and DHA supplementation before or after a traumatic brain injury helps limit structural damage and decline in brain functioning (9, 10, 11, 12, 13, 14, 15).

There is no clear consensus regarding optimal intake of EPA and DHA prior to or after a concussion. Given that many Americans do not eat enough fish and an estimated 75% of American diets are too low in EPA and DHA, it makes sense to start by meeting the general guidelines for recommended intake of EPA and DHA by:

  • Consuming fatty fish varieties that contain high levels of omega-3s, including salmon, tuna, mackerel and herring at least twice per week;
  • Take an omega-3 supplement providing EPA+DHA daily (be sure to look for high-quality fish oil, algal oil or krill oil supplements in your local grocery or health store);
  • Eat and drink DHA omega-3-fortified foods and beverages, including milk, 100% juice, and yogurt.

Research has yet to identify exactly how much EPA + DHA may be helpful after a concussion. However, according to the Food & Drug Administration (FDA), doses of EPA + DHA up to 3 grams per day are considered safe.

Zinc is necessary for optimal brain functioning while a deficiency of this mineral may compound oxidative damage from concussions. Though zinc supplementation may be an effective treatment modality, additional research needs to determine if zinc supplementation is safe after concussions. The Upper Limit for zinc is 40 mg per day.

Animal and human studies suggest creatine helps prevent secondary brain injury after traumatic brain injury. However, animal studies show long-term creatine intake may decrease its beneficial effects on the brain after injury. Future research needs to better elucidate the relationship between creatine pre-TBI and creatine post-TBI and outcomes.

Other potential approaches to addressing concussions through nutrition include ketogenic diets which are very high-fat, minimal-carbohydrate diets that are effectively used to decrease both the incidence and severity of seizures in children with epilepsy. Ketogenic diets provide an alternate energy source for brain functioning – ketones derived from the breakdown of fat. This may be important since available glucose, the primary energy source for brain functioning, may be decreased after a concussion.

Current research supports the integration of a dietitian into the team of health professionals treating concussions. Though nutrition interventions are considered preliminary at this time, consideration should be given to nutrition strategies that may reduce long-term effects while causing no further harm.

Disclosure: I am a GOED/Omega-3 Science Advisory Council Member supporting the research behind omega-3 EPA and DHA for a healthy brain, heart and eyes.

References

1 What are the Potential Effects of TBI? Injury Prevention & Control: Traumatic Brain Injury. CDC. http://www.cdc.gov/TraumaticBrainInjury/outcomes.html

Concussion (Traumatic Brain Injury). Pubmed Health.

3  Harmon KG, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26. http://www.amssm.org/Content/pdf%20files/2012_ConcussionPositionStmt.pdf

4  McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte T, Gavett BE, Budson AE, Santini VE, Lee H, Kubilus CA, Stern RA. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropathol Exp Neurol 2009; 68(7): 709–735.

Post-Concussion Syndrome. PubMed Health 

6 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. The National Academies Press. 2011. http://www.nap.edu/catalog/13121/nutrition-and-traumatic-brain-injury-improving-acute-and-subacute-health

7  Meier TB, Bellgowan PS, Singh R, Kuplicki R, Polanski DW, Mayer AR. Recovery of cerebral blood flow following sports-related concussion. JAMA Neurol 2015;72(5):530-8.

8 Salem N Jr, Litman B, Kim HY, Gawrisch K. Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids 2001; 36(9):945-59.

9 Mills JD, Hadley K, Bailes J. Dietary supplementation with the omega-3 fatty acid docosahexaenoic acid in traumatic brain injury? Neurosurgery 2011;68:474–81

10 Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acid supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma 2007;24:1587–95

11 Wu A, Ying Z, Gomez-Pinilla F. Dietary omega-3 fatty acids normalize BDNF levels, reduce oxidative damage, and counteract learning disability after traumatic brain injury in rats. J Neurotrauma 2004;21:1457–67

12 Wang T, Van K, Gavitt B, Grayson J, Lu T, Lyeth B, Pichakron K. Effect of fish oil supplementation in a rat model of multiple mild traumatic brain injuries. Restor Neurol Neurosci 2013;31:647–59

13 Mills JD, Bailes J, Sedney C, Hutchins H, Sears B. Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model. J Neurosurg 2011;114:77–84

14 Wu A, Ying Z, Gomez-Pinilla F. The salutary effects of DHA dietary supplementation on cognition, neuroplasticity, and membrane homeostasis after brain trauma. J Neurotrauma 2011;28:2113–22

15  Wu A, Ying Z, Gomez-Pinilla F. Exercise facilitates the action of dietary DHA on functional recovery after brain trauma. Neuroscience 2013;248:655–63

Drink Up (Alcohol) and Shortcut Muscle Growth and Recovery

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Alcohol

After making the game winning catch, a leaping single-handed snatch with just a few seconds left on the clock, its time to celebrate and drinks are on the house. And, you deserve a few beers or a little CÎROC® right?

Before you reach for that second (or third) drink, read this: drinking alcohol can interfere with muscle growth and delay recovery from training. In a recent study, men completed a leg workout followed by cycling at a moderate pace for 30 minutes and a set of 10 intervals (the study design was developed to mimic playing a team sport). Immediately and 4 hours post exercise they consumed whey protein, whey + alcohol or whey + carbohydrate. Alcohol plus whey protein reduced rates of muscle protein synthesis (muscle protein synthesis correlates with muscle growth over time) by an astounding 24% compared to drinking the whey protein without any alcohol. When alcohol was consumed without protein (as is often the case when athletes go out and party after a game), there was a 37% reduction in muscle protein synthesis. This study shows that alcohol interferes with muscle repair and recovery.

Here’s a breakdown of what alcohol can do to your performance and recovery:

  1. Alcohol interferes with the muscle growth and repair.
  2. Drinking alcohol can affect the way an athlete eats after a workout or game. Think about it – how often do you make healthy food choices after you’ve had a few drinks? “I’ll have another Long Island Iced Tea alongside the chicken and steamed vegetables platter with a side of mashed sweet potatoes.” Yeah right.
  3. Alcohol decreases blood testosterone levels in men in a dose dependent manner. The more you drink the more your testosterone decreases.
  4. Alcohol makes you dehydrated. That pounding headache you woke up with the last time you drank too much? Part of that is the result of dehydration.
  5. Alcohol impairs memory, focus, reaction time, accuracy and fine motor skills.Drinking alcohol before a competition or game may decrease your focus, coordination, and reaction time, all of which are crucial for good performance. This loss in focus can also increase your risk for injury. Drinking alcohol after a training session or game can also impair memory, which can affect the way that you remember training strategies or game plans.

Overall, drinking alcohol before or after exercise is not a good idea. The American College of Sports Medicine recommends that athletes avoid alcohol 48 hours before a game or performance. Additionally, they recommend drinking plenty of water and eating well after a game. And though it’s tempting to go out and party to celebrate, think before you drink and drink responsibly.

References:

Bianco A, Thomas E, Pomara F, Tabacchi G, Karsten B, Paoli A, Palma A. Alcohol consumption and hormonal alterations related to muscle hypertrophy: a review. Nutrition & Metabolism 2014;11(1):26.

Parr EB, Camera DM, Areta JL, Burke LM, Phillips SM, Hawley JA, Coffey VG. Alcohol ingestion impairs maximal post-exercise rates of myofibrillar protein synthesis following a single bout of concurrent training. PloS one 2014;9(2):e88384.

Kozir LP. ACSM current comment: Alcohol and athletic performance. American College of Sports Medicine. Internet: http://www.acsm.org/docs/current-comments/alcoholandathleticperformance.pdf?sfvrsn=5 (accessed 13 November 2014).

Back to School Begins with Breakfast

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When it comes to learning, breakfast may be just as important as taking notes in class and completing assigned homework. A good diet actually changes the brain by creating more brain cells, strengthening communication between cells, and improving blood flow which leads to more glucose and oxygen delivery to the brain. What does this mean for students? A growing body of research shows kids who eat breakfast have:

  • more energy
  • better memory
  • improved problem-solving skills
  • improved mathematics skills
  • better scores on standardized tests

Yet statistics show up to 40% of kids and teens skip this meal. How can you serve a nutritious meal in a hurry? Check out my tips from today’s segment on Channel 8’s Let’s Talk Live

Fighting Food Cravings

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It’s 4:30 pm and you’re staring at the computer but can’t seem to read the words on the screen. Instead you are completely immersed in the thought of a light and fluffy cupcake topped ever so gracefully with swirls of sweet light yellow buttercream icing. The plan of action is simple and swift: as soon as 5pm strikes you’ll dash out of the office to the corner bakeshop before they run out of these freshly baked delights. If food cravings make you feel like a hostage to your obsession with a specific food or flavor, you may be wondering what causes them and how you can overcome them.

Just last week dietitian Leah Holcombe and I were talking about food cravings and we both came up with a number of reasons why people get them and how you can overcome them, based on our combined experience. From our perspective, you may be craving a certain food because:

  • You simply haven’t eaten enough calories. Before you cave, sit down and eat a meal or mini-meal, wait and see if you still want to dive into that gallon of ice cream with a ladle. As Leah said – when you are full on healthy items it is hard to overeat.
  • You skipped a meal. Meal skipping is a surefire ticket to overeating and making bad food choices. If you are hungry, your brain is running low on glucose, the first thing you’ll want is sugar or a calorie-dense food (fat). Perfect solution: that cupcake.
  • You crave comfort. One lady I counseled years ago ate extremely large amounts of shelled, roasted peanuts (and she was very specific, they had to be shelled, salted and roasted). Turns out her father brought these home for the family on occasion when she was a kid. She and her siblings dove in with delight. So, it wasn’t necessarily the peanuts she was craving but the fond memory from childhood that she wanted to relive as an adult.
  • Habit. Sometimes we simply eat out of habit. Maybe you are used to ordering fries alongside your hamburger or getting a large sweet tea every time you visit a restaurant. If you eat out of habit you need a reason and willpower to break that habit. But, it can be done.

Well, it turns out that food cravings activate a reward center in our brain according to this article published in the Wall Street Journal. And, interestingly enough, studies show that food cravings involve social, emotional and psychological factors. For more on what the research says, click here for the full article.