Concussion symptoms? What if diet is not enough?
Concussion Recovery: Your diet is impeccable. Now what?
No matter who you are, after a concussion you want to get back to your life. Whether that’s your sport, work, or just hanging with friends and family.
It’s been shown that, without treatment, around 40% of individuals who sustain a concussion will go on to experience post-concussion syndrome. Some of these symptoms can last for years…
The foundations of concussion treatment.
Nutrition. Movement. Mindset. (Sound familiar? Hint: Check out the site homepage.)
In concussion, the highest-yield interventions you can do to recover include managing what you put into your body (nutrition) and specific exercise (movement) strategies.
Last week, I posted a brief overview of the evidence-based nutritional strategies that can be used to speed your concussion recovery.
But, what if…
You’re eating “perfectly” (whatever that means) and you’re still dealing with post-concussion symptoms?
Or you’re an athlete with an acute concussion and can’t afford more time away from the team than your typical healthy concussion recovery time (around 4 weeks).
Well, this week we’re going to talk about just that - how to leverage nutritional supplements to speed and optimize your recovery.
Understand the beast to beat the beast.
As more and more research comes out, our understanding of concussions is growing and so is our ability to naturally treat a concussion.
Currently, we understand that several big things are happening…
Whether you were eating great and “nutrient-dense and replete,” or you were eating poorly and “nutrient deficient and deplete...” Concussion doesn’t care. You still need to:
Restore normal energy levels in the brain.
Repair any stretched and jostled nerve cells.
Regulate systemic and brain inflammation levels.
Restoring normal energy levels
Remember, following a concussion…
Brain energy levels take a dive in the first 3-5 days
Brain energy levels take 21-30 days to return to normal (*in the research)
Your experience of symptoms is likely caused by energy deficits in particular brain areas.
The goal with supplementation for this aspect of concussion is helping to provide the brain with “easy energy.” This, alone, can help alleviate some of the symptoms of your concussion and allow you to approach your rehab with more success.
While there are several supplements we can consider for supporting energy levels in concussion, I am only going to mention one here. This nutrient is heavily researched in the sport and exercise world, it’s safe and inexpensive, and likely has notable benefits in concussion treatment and prevention. It’s creatine.
Creatine
Creatine is a molecule that is used for “quick energy” in your muscles and the brain.
Following mTBI, creatine levels in the brain decrease.
Creatine supplementation has shown promise in decreasing symptoms and speeding recovery in TBI patients.
We’re waiting on future research to determine appropriate dosing in traumatic brain injury, however, we currently understand this to be a safe supplement when dosed at around 5g per day.
Some people discuss a loading dose of 20g for one week, then dropping to 5g per day. Depending on the duration of use, this is likely optional.
Repairing any stretched and jostled nerve cells
Remember, following a concussion…
Nerve cells (neurons) “shear and stretch” with the impact of concussion.
This stretching causes a release of chemicals that causes an inflammatory response.
This leads to functional cell damage and “cell waste” build up.
There are about five nutrients that come to mind with evidence in helping individuals recover from concussion by working on the structural aspect (“nerve cells”) of recovery.
The supplement I am going to mention here is relatively common, has received mixed mainstream press in heart health, and grosses a lot of people out in the liquid form… We’re talking fish oil (EPA/DHA).
Omega-3 Fatty Acids (EPA/DHA):
Omega-3 Fatty Acids are polyunsaturated fats that play a critical role in all cell membranes, including neurons. As an overgeneralization:
EPA → Anti-inflammatory
DHA → Structural support
In addition to the basic notes above, EPA/DHA have also been shown to reduce excitotoxicity, protect mitochondria, protect brain metabolism, and protect neuroplasticity in animal studies of concussion.
As with creatine, there is growing evidence that fish oil may confer protective (pre-concussion) benefits as well as treatment (post-concussion) benefits at around 3g per day of combined EPA/DHA.
Vegans folks, you can get your omega-3s from alpha-linolenic acid (ALA). Just know that you are going to have to take mega doses to reach the doses recommended for EPA/DHA from fish oil. Humans only convert about 10-20% of ingested ALA into EPA/DHA.
Regulate systemic and brain inflammation levels.
Remember, following a concussion…
There is a neurometabolic cascade that leads to neuroinflammation.
Neuroinflammation likely leads to gut inflammation.
This gut-brain inflammation creates a loop of systemic inflammation.
Regulating inflammation and quenching free radicals with antioxidant nutrients is what most people think of when they think of natural supplements.
Everyone and their mom’s dog is trying to sell some sort of “antioxidant” product.
With that said, there are around ten nutrients that actually cut the mustard with modulating inflammation specific to concussion. (Who first said “cut the mustard? Why was mustard so hard to cut? White people are weird.)
Now, of the ten nutrients that come to mind, there is one in particular that serves multiple purposes and is a powerful enough antioxidant that it is used in the emergency rescue of Acetaminophen (Tylenol) toxicity.
N-Acetyl Cysteine (NAC).
N-Acetyl Cysteine (NAC) is a precursor molecule to our body’s main antioxidant, Glutathione.
Studied in soldiers who took NAC (compared to placebo) had 86% resolution of TBI symptoms (compared to 42% of the placebo group).
Fun Fact: NAC is what makes the OTC drug Mucinex work at breaking up your mucus.
In the concussion realm, we typically dose NAC at around 500mg once or twice per day.
Bringing it together.
Concussion/mTBI is a complicated condition that takes a multi-modal approach to treat successfully. To date, we do not have a single successful drug for traumatic brain injury. Thus, a natural and integrative approach is your best option if you want therapy beyond “rest and wait” or “take this pill to cover up X symptom.”
If you or a loved one is dealing with concussion symptoms, your first step should be diet and getting in to be evaluated by a concussion-literate doctor. Your concussion doctor should understand that concussion encompasses physical, cognitive, and mental/emotional symptoms - each requiring a unique approach. Your treatment should include a balance of metabolic and physical approaches to recovery.
The metabolic approach to concussion is built on the foundation of your “concussion recovery diet,” and then augmented by a couple of specific (not handfuls of generic) supplements targeting the metabolic processes of concussion unique to your case and presentation.
It is the need for specificity that I did not list out all of the supplements that I may use for concussion patients. You are a snowflake, your brain is a snowflake, and so is your concussion. Your recovery cannot be cookie-cutter.
This metabolic approach creates a healthy chemical environment that provides your cells with the fuel and supportive nutrients that they need to properly support your exercise, visual/vestibular, and physical rehab during your recovery.
Dr. Mark Heisig is a licensed naturopathic doctor with continuing mTBI education from The American Academy of Neurology (AAN), Complete Concussion. Management (CCMI) and The Carrick Institute. His office is located in Scottsdale, AZ.