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

Your Cooking Oil is Harming Your Health and Aging You

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
Bottle of Olive Oil with Wooden Spoon --- Image by © Radius Images/Corbis
Bottle of Olive Oil with Wooden Spoon — Image by © Radius Images/Corbis

If you open a bottle of cooking oil and take months to finish it, heat, light and air start to break down the oil, making it rancid. At best, it smells and tastes different. At worse – potentially toxic compounds are produced in the oil. In this article, I’ll share how to prevent the introduction of bad compounds, how to choose the right product and store it properly and discuss the difference between regular vs. extra virgin olive oil.

Choose the Right Oil for Cooking & Throw Out Your Deep Fat Fryer

For high heat cooking, choose an oil with a high smoke point. When an oil hits it’s smoke point it breaks down and becomes rancid. Rancid oils may smell or taste bad (though sadly some people are accustomed to this taste as “normal”) and may contain toxic compounds, some of which are believe to contribute to cell aging (1, 2, 3). In general, refined oils have a higher smoke point than those that are unrefined. Refer to the usage instructions on the bottle to find out if it be used for high heat cooking.

Use Type of Oil Smoke Point (3) Greater likelihood of Oxidation (> 50 PUFA %) (4) 
Baking
Cooking
Stir Frying
Almond
Avocado
Canola
Grapeseed
Hazelnut
Peanut
Olive
Palm
Pecan
Safflower
Sunflower
High Almond
Grapeseed
Hazelnut
Safflower
Sunflower
Light sautéing
Sauces
Low-heat baking
Coconut
Corn
Hempseed
Macadamia nut, refined
Sesame, refined
Soybean
Walnut – refrigerate after opening
Medium Corn
Flaxseed
Hempseed
Soybean
Walnut
Dressings
Dips
Sauces
*Refrigerate these after opening
Flaxseed
Pumpkin seed
Wheat Germ
Low

In addition to using the right oil for what you are cooking or baking, throw out your deep fat fryer and quit eating fried foods (or at the very least, throw out the oil after each use). Food manufacturers and restaurants re-use oils over and over for frying. After several days they finally throw it out and replace it with fresh oil (5). Each time the oil is used it loses some of its integrity and the smoke point lowers. And though it may take several uses before it becomes rancid (depending on the type used, frying time, heat and other factors), frying decreases the amount of antioxidants in the oil (greater frying time = fewer antioxidants), changes it’s chemical structure and produces trans fatty acids (repeated heating of oil, prolonged heating and heating in an iron container all increase the formation of trans fatty acids) and volatile compounds (such as aldehydes, triacylglycerol oxidation products including alkoxy, epoxy, keto monomeric compounds, and higher molecular weight oxidation products) (6, 7, 8, 9, 10).

Store it Properly

Store your oil in a cool and dry place away from direct sunlight (some oils should be refrigerated – as noted above). When possible, buy oil in dark glass containers. When monounsaturated (MUFA) and polyunsaturated (PUFA) fatty acids in oil react with oxygen they become oxidized and form a variety of chemicals, several of which are toxic (aldehydes, ketones, alkenals). The production of these compounds speeds up when the oil is exposed to heat and light or metals are present. More polyunsaturated fat = greater likelihood of oxidation so check your oil’s PUFA content above and if its high, buy smaller quantities of this oil and smell-check it frequently. If it smells different than when you bought it, toss it in the trash.

What is Extra Virgin Olive Oil vs. Olive Oil?

U.S. Extra Virgin Olive Oil is the oil resulting from the first pressing of olives and is suitable for human consumption without further processing. It has “excellent flavor and odor” (smell).

U.S. Virgin Olive Oil is olive oil obtained by picking and processing olives, or blends of virgin refined olive oil. It has “reasonably good flavor and odor.”

U.S. Olive Oil is a blend of refined and virgin olive oils.

Refined Olive Oil is sold as “Olive oil” or “Pure olive oil” and is the oil obtained from subsequent pressings (after the first pressing) and suitable for human consumption by refining processes which neutralize the acidity or remove particulate. Heating, neutralizing, bleaching and deodorizing may be used (10, 11).

“‘Light olive oil refers only to the flavor and is determined by the amount of extra virgin olive oil added to the refined olive oil.” (12)

Choose an olive oil in a dark glass bottle. California Olive Ranch is a good brand, as are the ones on this list. Or, if you want amazing authentic olive oil from trees that are 2,000 – 3,000 years old, order olive oil from this Masseria in the Puglia region of Italy.

Is Canola Oil Harmful?

If you’ve heard that canola oil is harmful, read this post for a good explanation of oil processing techniques.

There are plenty of oil choices depending on your desire for taste and a temperature you are using.

References
1 J Oleo Sci. 2008;57(3):153-60.
2 Toxicol Mech Methods 2006;16(5):267-74.
3 Deep Fat Frying and Food Safety. USDA.
4 Food Nutr Res. 2011;55:10.5
5 Nahrung 2002;46(6):420-6.
6 Food Chem 2007;104(4):1740–1749.
7 Eur J Lipid Sci Tech 2002;104(12):785–791.
8 J Food Sci Technol 2014;51(6):1076-84.
9 Chem Phys Lipids 2012;165(6):662-81.
10 J Sci Food Agric 2012;92(11):2227-33.
10 Guidance for Industry: A Food Labeling Guide (12. Appendix D: Qualified Health Claims). U.S. Food and Drug Administration.
11 United States Standards for Grades of Olive and Olive-PomaceEffective October 25, 2010. USDA.
12 Grading Manual for Olive and Olive-Pomace. USDA. Effective May 2012.