Tackling Concussions Head-On: How Nutrition Can Improve Outcomes

Tweet about this on TwitterPin on PinterestShare on LinkedInShare on Google+Share on FacebookBuffer this pageDigg thisEmail this to someoneFlattr the authorShare on StumbleUponShare on Reddit


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

Are Your Muscles Sore and Joints Hurting? Here’s What You Should be Eating

Tweet about this on TwitterPin on PinterestShare on LinkedInShare on Google+Share on FacebookBuffer this pageDigg thisEmail this to someoneFlattr the authorShare on StumbleUponShare on Reddit

When I first started cross country in high school I would go to sleep in a homemade pajama of Ben Gay slathered all over my sore legs. And then each morning at 5 am my sister would have to pry me out of bed for our newspaper route. As I threw one sore leg after the other off the bed I absolutely dreaded the thought of running, a necessary task since she made me go to the houses with the dogs that chased us and the sketchy places by the woods (I’m the youngest). If you too have tried Ben Gay, massage, ice packs or any other modality for trying to decrease muscle soreness and keep your joints moving, it’s time to fight exercise-induced inflammation through your diet.

Here’s what I’ll cover in this post (and as shared on Talk of Alabama this morning – see their website for more information):

  • The top two foods you need to decrease muscle soreness
  • Foods that keep your joints healthy

Talk of Alabama

Decreasing Muscle Soreness

When it comes to exercise, some inflammation is good and actually essential for muscle growth and repair. But, excess inflammation can lead to muscle cell damage and that feeling like you couldn’t possibly get off the couch for days. So, I recommend athletes include tart cherry juice into their regular nutrition regimen as a preventative measure. Research shows **tart cherry juice can help decrease exercise-induced muscle soreness and inflammation. Try it in a shake or check out my gelatin chews below.

Research from the University of Georgia found 2 grams of ginger, either fresh ginger or in spice form (they tested McCormick ginger), helps reduce muscle pain when consumed daily for 11 days prior to exercise testing. I have a few recipes below you might want to try. Also, check out Reed’s Ginger Brew (it is like ginger ale but made from real ginger with 17 grams per bottle!).

Keeping Your Joints Moving

Fatty fish including salmon, mackerel, herring, anchovies etc. contain long chain omega-3 fatty acids that have modest anti-inflammatory effects and have been shown to decrease cartilage breakdown (cartilage is like a sponge that cushions your joints so they can easily glide on top of one another) and inflammation in cell culture studies. In addition, research studies show these fatty acids can improve several symptoms associated with *rheumatoid arthritis and possibly even decrease the need for anti-inflammatory drugs. *Always talk to your physician if you have a disease such as rheumatoid arthritis.

Plus, there are two types of plant-based foods you should focus on. Foods rich in vitamin C including citrus, bell peppers, broccoli, strawberries, cauliflower, pineapple, kiwi. Vitamin C is necessary for repairing and maintaining cartilage and higher intakes are associated with less severe cartilage breakdown. In addition to vitamin C, yellow and orange fruits and vegetables contain an antioxidant that may improve bone formation and decrease bone breakdown. And finally, ginger is also effective for reducing joint pain though you have to consume it regularly over several weeks (500 mg ginger extract was used). 

Cherry Ginger Smoothie

Ingredients
8 oz. vanilla soymilk
1 scoop unflavored or vanilla whey protein (if using unflavored you may need to add a sweetener)
½ cup frozen tart cherries
2 tsp. (or more if desired) fresh cut ginger
Ice as desired

Directions
Add vanilla soymilk to blender followed by the rest of the ingredients in order. Blend until smooth.

Honey Ginger Salmon

Ingredients
4 salmon fillets (4-6 oz. each)
2 tsp. finely grated fresh ginger or 1 tsp. ginger spice
3 Tbsp. honey
2 tsp. olive oil
¼ cup soy sauce

Directions
Mix all ingredients except salmon in a bowl. Place marinade and salmon in large resealable plastic bag so that marinade coats salmon fillets. Refrigerate for 30 minutes or longer. Remove salmon fillets and grill 6 to 8 minutes per side or bake at 350°F for 15-20 minutes.

Fig Cherry Ginger Chews

Ingredients
13 dried figs
1/2 cup dried tart cherries
3 tsp finely grated fresh ginger

Directions:
Place all ingredients in a food processor and mix throughly. Take small portions out and make small balls. If you want them even sweeter, roll finished balls in cane sugar or powdered coconut sugar.

Tart Cherry Gelatin

Ingredients
2 packets gelatin mix
2 cups tart cherry juice
3 tsp fresh ginger

Directions
Boil 1.5 cups tart cherry juice. While juice is boiling place remaining 1/2 tart cherry juice in a bowl and mix in gelatin packets. Let sit for at least one minute. When juice is finished boiling mix it into juice & gelatin mixture until throughly blended. Add 3 tsp. fresh grated ginger and 1 – 2 Tbsp. sugar if desired. Place mixture in an 8×8 pan and refrigerate for at least one hour. Remove from refrigerator and enjoy!

** TV segment, but not post, sponsored by the Cherry Marketing Institute