Feed your head
Jul 21, 2016
Can nutrition influence concussion recovery in athletes?
A concussion is defined as a traumatic brain injury causing the brain to function abnormally as a result of a violent blow to the head or neck. Of the 30,000 concussions that occur annually in Canada among 12- to 19-year-olds, 60 percent are related to sports activity, according to Statistics Canada, however, it’s estimated that the number of concussions is actually many times more than reported. Although the majority of athletes who experience a concussion are likely to recover, many may experience chronic cognitive and neurobehavioural difficulties related to recurrent injury.
To date, there are no universally accepted and defined nutrition guidelines recommended for individuals with such traumatic brain injury. However, in recent years, research has begun to examine how nutrition interventions can potentially improve cognitive and neuromuscular function in athletes. Much of the focus has been on antioxidants and anti-inflammatory agents such as omega-3 fatty acids, vitamins, phytochemicals and polyphenols, creatine, and zinc.
Omega-3 fatty acids are essential polyunsaturated fats that serve many functions, including restoring cell energy, reducing oxidative stress and inflammation, and repairing cellular damage. It’s estimated that up to 80 percent of North Americans are deficient in omega-3 fatty acids.
They are most commonly found in fatty fish, krill, and algal oil. There are three types of omega-3 fats: alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA). DHA is the predominant polyunsaturated fatty acid in the central nervous system and has been shown to be neuroprotective in nondeficient animal models. Dietary supplementation with omega-3 fatty acids has been demonstrated to improve cognitive function after traumatic brain injuries. More specifically, DHA consumption has been shown to improve performance on visual perception, learning, and memory tasks in patients with cognitive decline.
Recommendations: Most clinical studies of DHA have used doses of two to six grams a day. The best way to get enough DHA is to eat at least two servings of 75 grams (2.5 ounces) of fish a week. Choose fatty fish more often, such as salmon, mackerel, sardines, herring, arctic char, anchovies, and trout.
Creatine is a naturally-occurring compound found in fish and meat, and is also produced by the liver, kidneys, and pancreas. Once converted to phosphocreatine, it is stored in the muscles and used for energy. It is being explored as a neuroprotective supplement for traumatic brain injuries and has been found to buffer and regulate cellular energy, and therefore has been associated with improved symptoms in neurological disorders caused by an inadequate neural energy supply. Research suggests that creatine supplementation prior to a concussion may provide the most protective benefit from impaired protein synthesis and nerve damage due to oxidative stress. Increasing dietary creatine can provide a reserve in the brain for when an energy crisis occurs, as in the case of the secondary injury resulting from a concussion. With this backup, the level of impaired brain functions such as verbal memory, reaction time, processing speed, and tasks requiring complex attention and understanding, may be reduced.
Recommendations: Although there are currently no recommendations for specific supplementation of creatine, athletes may receive additional neuroprotective benefits from their regular supplemental use of creatine.
Oxidative stress occurs after a concussion as a byproduct of the disruption in energy balance, consequently damaging cellular structures. Because antioxidants may reduce the amount of cellular destruction in the brain, their role in concussion treatment has been mounting. Vitamins C, D, and E, as well as phytochemicals and polyphenols such as curcumin (found in turmeric) and resveratrol (found in red wine and nuts), have been examined for their antioxidant and anti-inflammatory properties. Cellular damage as a result of disrupted calcium balance has also warranted isolated examination of vitamin D for its role in maintaining normal cellular calcium metabolism, but further research is needed.
Research indicates that a combination of a variety of vitamins (through food and/or supplementation) rather than taking any one isolated vitamin shows more positive results in the prevention of brain injury.
Recommendations: Consume a diet rich in antioxidant- and anti-inflammatory-containing foods, including a variety of fruits and vegetables, nuts and seeds, fatty fish, and other foods containing omega-3 fatty acids. Vitamin D can be found naturally in some foods including egg yolks, fish, and liver, but more predominantly in fortified dairy products and cereals. It can also be obtained from sun exposure, however, this amount is often not enough to meet the daily recommended intake of 600-800 IU/day. Therefore, it’s recommended that adults take >800-1000 IU/ day from food and dietary supplements to meet their requirements. A combination of foods high in antioxidants and those containing anti-inflammatory properties may enhance their neuroprotective properties rather than any one source alone. In some cases, antioxidant supplementation may be useful to improve cognitive functioning post concussion.
Other nutrients that have been studied for the potential treatment of traumatic brain injuries include zinc, for its role in normal brain development, and glutamine, for its potential role in delaying muscular atrophy. Although neither appears to be directly linked to concussion treatment, identifying and addressing athlete deficiencies of these two nutrients can help prevent further oxidative damage, promote neurological recovery, and retain an optimal level of amino acids to protect against the loss of lean mass that can hinder recovery. There appears to be no further benefit to super-supplementing an athlete’s diet with either micronutrient beyond their usual maximum daily intake levels.
The Bottom Line
There is evidence suggesting nutrition interventions supporting brain injury-associated neuro-inflammation, including foods and dietary supplements which provide neuroprotective benefits, may be beneficial in treating traumatic brain injury inflammation. However, further study is needed to determine the effects of multiple nutrition interventions in conjunction with overall dietary intake on athletes with concussion. Although at this time we cannot definitively recommend specific amounts of nutrients for the treatment of traumatic brain injury, we have sufficient evidence to suggest that the aforementioned nutrients consumed daily as part of a healthy balanced diet are the best defence against the subsequent long term neurological effects from a concussion.
Originally published in Coaches plan by the Coaching Association of Canada on coach.ca and written by Angela C. Dufour, MEd., RD, CSSD, IOC Dip Sports Nutr, CFE, ISAK 2, Erin Selig, (Dietetic Intern) and Amanda Grant, RD (candidate). (Original post available here).
Angela Dufour owns and operates Nutrition in Action, a private counseling and nutrition services practice for athletes, coaches, and the general public in Bedford, Nova Scotia, and also works with the Canadian Sport Centre Atlantic. She is the author of PowerFuel Food: Planning Meals for Maximum Performance (Glen Margaret Publishing, 2013).
Coaches plan is an online magazine for Canada’s coaches published three times a year by the Coaching Association of Canada. To read more Coaches plan articles, please visit coach.ca.