Nutritional Therapies for Traumatic Brain Injury

You have just experienced a traumatic injury to your head; a series of changes are about to occur in your brain that will have short and long term negative consequences. You just joined the ranks of 1.7 million other people living in the U.S. who experience a traumatic brain injury (TBI) every year. TBI is an alteration of brain function caused by external forces leading to loss of consciousness, temporary memory loss and alterations in mental state at the time of the injury.

A study by the Mayo Clinic found that one-third of patients’ brains showing pathology and evidence of chronic degenerative diseases had participated in contact sports. The popular press has carried numerous stories about retired players of the National Football League who have a threefold increase in their risk of developing depression as well as a variety of worsening cognitive impairments. Indeed, all athletes, especially young adults, exposed to repetitive concussions are at increased risk of developing cognitive deficits.

In the hours, days and weeks following initial accident a series of secondary biochemical changes develop that lead to a progressive degeneration within vulnerable brain regions. Many of these changes are also commonly seen associated with advanced normal aging and are thus rather well studied. One of the initial changes involves a dysfunction of the mitochondria inside of the neurons of the brain. Mitochondrial are responsible for energy production and are critical to the survival of neurons, which use a lot of energy. The injury to the mitochondria leads to a condition called oxidative stress where individual atoms of oxygen that we inhale become very toxic to the brain. Next, the oxidative stress induces brain inflammation which leads to an assortment of degenerative diseases, particularly during the years following the TBI event. These three critical events following the TBI, i.e. loss of normal energy production, oxidative stress and long term brain inflammation, underlies the development of seizures, sleep disruption, fatigue, depression, impulsivity, irritability and cognitive decline. Although no effective treatments are available to alleviate these biochemical events in the brain, research has advanced sufficiently to understand how specific chemicals in the diet can target the negative effects of oxidative stress and inflammation.

A series of recent studies (Nutritional Neuroscience 2018, 21:79), conducted primarily using animal models, have discovered that adding certain vitamins and minerals to the diet might alleviate some of the long term consequences of TBI. I would never recommend taking mega-doses of any supplement, thus I have listed the dietary sources of these nutrients. It is always most effective, and considerably cheaper, to obtain nutrients via their natural sources. Supplementation with Vitamins B3 (found in white meat from turkey, chicken and tuna), D (most dairy products, fatty fish such as salmon, tuna, and mackerel) & E (nuts and seeds, spinach, sweet potatoes) improved cognitive function following repetitive concussive brain injury.

Magnesium and zinc are both depleted following TBI. Zinc supplementation for four weeks reduced inflammation and neuronal cell death and decreased the symptoms of depression and anxiety in rats following TBI. Both zing and magnesium can be obtained by eating nuts, seeds, tofu, wheat germ and chocolate. The omega-3 fatty acids DHA and α-linolenic acid were also shown to be neuroprotective in animal studies whether taken prior to, or after, the injury. Thus, people who participate in contact sports might want to add these fats to their regular diet. However, don’t waste your money on α-linolenic acid or DHA supplements; adequate amounts are easily obtained via a diet containing fatty fish, flaxseeds, canola oil, soybeans, pumpkin seeds, tofu and walnuts.

Sulforaphane was shown to improve blood–brain barrier integrity, reduce cerebral edema and improve cognition in a rodent model of TBI. Sulforaphane can be obtained via a diet containing brussels sprouts, broccoli, cabbage, cauliflower, kale, broccoli sprouts, turnips and radish. Finally, enzogenol improved cognition when administered to TBI patients in a randomized, controlled study. Enzogenol is a water extract of the bark from Pinus radiate that contains high levels of proanthocyanidins. Once again, do not waste your money, proanthocyanidins are easily obtained by consuming grapes (seeds and skins), apples, unsweetened baking chocolate, red wines, blueberries, cranberries, bilberries, black currants, hazelnuts, pecans and pistachios.

Interventional studies with natural anti-oxidants and anti-inflammatories via the diet are becoming attractive options for patients with TBI. Unfortunately, very few clinical trials to treat this neurological condition have been performed. Finally, because I have written so often about this topic in other blogs, I must also recommend a daily puff of marijuana which will reduce the consequences of oxidative stress and brain inflammation following TBI.

^{© Gary L. Wenk, Ph.D. is the author of The Brain: What Everyone Needs to Know (2017) and Your Brain on Food, 2nd Edition, 2015 (Oxford University Press).}