Today we want to discuss a research-based approach to understand the cellular and metabolic aspects of concussion, leading to potential nutritional intervention strategies. It will review current literature to equip clinicians with knowledge of adjuvant nutritional strategies that can aid in optimizing patient recovery after a concussion.
Goals:
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Gain knowledge of concussion causes and common symptoms.
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Understand the standard of care for concussion management.
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Review recent empirical studies on concussion outcomes in animal and human trials.
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Explore potential nutritional supplementation strategies.
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Recognize variations and disparities in nutritional supplement brands.
Overview of Current Landscape
Concussions, traumatic brain injuries, and head trauma continue to be areas of interest and research in fields such as medicine, military, and organized sports. These injuries are associated with various acute and chronic physical, cognitive, and emotional issues. In the United States alone, approximately 700,000 mild head traumas occur annually, resulting in emergency room visits, hospitalizations, and even deaths. It is estimated that one in five children will experience some form of head trauma during their childhood.
Concussions can occur due to direct or indirect hits to the head, face, or neck. They can also result from impacts to other parts of the body, where the force is transmitted to the head. The short-term and long-term effects of concussions have led to extensive research in prevention, intervention, and recovery. Awareness campaigns and programs have been implemented to promote early detection and prevention of concussions, resulting in an increase in reported cases. Organized youth sports have implemented standardized education programs for concussion prevention, detection, and return-to-sport protocols.
Chiropractic care is often sought by individuals who have experienced a concussion, especially if the trauma affected structural alignment. While concussions are functionally rather than structurally based injuries due to their impact on metabolism and neurotransmitters, it is important to acknowledge the structural damage to the brain that occurs during a concussion.
Concussions are typically diagnosed based on symptoms and neurological evaluations, as they may not always be detectable through computed tomography (CT) scans. Rest, avoidance of stimuli, and over-the-counter medications are commonly recommended treatments for concussions. If symptoms persist beyond 7-14 days, further evaluation is usually recommended.
Parents of youth athletes often report ongoing issues even after their child is cleared to return to normal activities and sports. These issues may not manifest as clear concussion symptoms but can still result from the trauma. Children and adolescents may underreport their symptoms due to various reasons, complicating long-term outcomes. Concussion symptoms can vary, including headaches, visual problems, dizziness, sensitivity to light and sound, nausea, emotional changes, cognitive difficulties, sleep disturbances, and more.
Parents and close contacts play a crucial role in detecting changes in a child's personality that may not be evident during medical examinations. Concussions involve complex physiological processes that impact neurological functioning. While 80-90% of athletes are reported to be symptom-free within 7-14 days post-concussion, newer studies suggest that individuals may experience symptoms for up to four weeks after their first concussion. Research has explored factors such as gender, age, ethnicity, genetics, structural integrity, and post-injury inflammatory response as potential contributors to prolonged concussion symptoms.
Concussions can occur in various settings, not just organized sports. Everyday activities like trampolining, outdoor play, snow-sledding, playground activities, and waterparks can also lead to concussions. Rapid response and immediate medical attention are crucial when a concussion is suspected. The acronym RAPID (Remove Immediately, Assess symptoms, Physician evaluation, Implement recommendations, Document progress) can be helpful in managing suspected concussions.
Understanding Concussion at a Cellular Level
Severe concussions can result in torn axonal membranes, leading to brain cell death. This tearing or stretching of axonal membranes releases potassium and glutamate into the extracellular space. Glutamate binds to N-methyl-D-aspartate receptors, opening calcium channels in brain cells and disrupting axonal connections and neurotransmitters. Magnesium levels in the extracellular space decrease simultaneously.
To restore homeostasis, ionic pumps within the brain's cells activate to reverse the calcium imbalance. This process increases glycolysis to meet the increased metabolic demand. However, glycolysis leads to lactic acid accumulation, which hampers mitochondrial function. Inflammatory cytokines are triggered to initiate the repair process after concussion, but chronic inflammation can have detrimental effects on neurological outcomes.
Conventional Medications and Nutritional Supplements: Commonly prescribed medications for post-concussion management include analgesics, NSAIDs, and antiemetics. However, prolonged use of these medications can have adverse effects. Nutritional supplements have been explored as adjuvant therapies for post-concussion recovery. While no single supplement has been proven effective, understanding the metabolic processes involved in concussion supports the potential benefits of nutritional intervention.
Possible Nutritional Interventions
Various nutritional supplement categories have shown promise for concussion recovery. However, it is essential to note that not all categories are suitable for adolescents or children. The following categories have demonstrated potential benefits:
Macro-Nutrients: Increasing protein intake (1-1.5g/kg) after a concussion has shown improved outcomes in severe and mild traumatic brain injury cases. Branched-chain amino acids may also positively impact recovery. PerfectAmino: Increasing protein intake after a concussion, including essential amino acids like those found in PerfectAmino, has shown promising results in improving outcomes for traumatic brain injuries.
Essential Fatty Acids: Docosahexaenoic acid (DHA), an omega-3 fatty acid, has been extensively studied for its potential to counteract glutamate influx and improve outcomes. Supplementation with DHA or omega-3 fatty acids is recommended due to low dietary intake. Dosages should be monitored, especially if individuals are on blood-thinning medication. Omega-3 Health with particularly DHA have been studied extensively for their ability to counteract glutamate influx and improve outcomes. Omega-3 Health by BodyHealth offers a reliable source of essential fatty acids that may aid in neurological recovery.
Antioxidants: Lower serum levels of vitamins A, C, and E have been associated with worse outcomes post-concussion. Riboflavin, resveratrol, curcumin, and other antioxidants have shown potential benefits in adult care for concussion and TBI. Multi Complete: A comprehensive nutritional supplement, by BodyHealth, provides essential macro-nutrients and antioxidants that may support the recovery process and overall well-being post-concussion.
Magnesium: Magnesium supplementation has been effective in managing migraines and headaches associated with concussions. It can reduce muscle tension, spasms, and headaches. Proper dosages and forms of magnesium should be considered, taking into account individual health conditions.
Melatonin: Sleep disturbances are common after concussions and can impact recovery. Melatonin supplementation has shown promise in managing sleep disturbances and alleviating headaches. Appropriate dosages should be recommended based on age and individual response. Sleep: Sleep disturbances are common after concussions and can impact recovery. Melatonin supplementation, such as Sleep by BodyHealth, has shown promise in managing sleep disturbances and alleviating headaches, aiding in the healing process.
Herbal Supplements: Some herbal supplements, such as butterbur and feverfew, have demonstrated positive effects in adult models for managing migraines and headaches. However, these supplements are not recommended for use in adolescents or children without guidance from a primary care provider.
Nutritional Supplement Quality Metrics: When recommending nutritional supplements, it is crucial to consider the quality of the products. Compliance with regulatory measures, such as the Dietary Supplement Health and Education Act (DSHEA) and current good manufacturing practices (cGMP), is essential. However, it is also necessary to research and validate the reputation and quality metrics of supplement companies. Third-party certifying bodies can provide additional assurance of label claims and safety standards. Raw material procurement, testing methods, and FDA citations should be considered when selecting reputable brands.
Alternative Regimens: In addition to medical interventions and nutritional supplementation, alternative regimens such as chiropractic care, acupuncture, guided relaxation techniques, vestibular exercise and therapy, and cognitive behavioral therapy can be helpful in the successful recovery from concussions.
References:
- Bramley, H., Henson, A., Lewis, MM., Kong, L., Stetter, C., Silvis, M. (2017). Sleep disturbance following concussion is a risk factor for prolonged recovery. Clinical Pediatrics (Philadelphia), 56(4): 1280-1285.
- Capó, X., Martorell, M., Sureda, A., Llompart, I., Tur, J., & Pons, A. (2015). Diet supplementation with DHA-enriched food in football players during training season enhances the mitochondrial antioxidant capabilities in blood mononuclear cells. European Journal of Nutrition, 54(1), 35–49.
- Lucke-Wold, B. P., Logsdon, A. F., Nguyen, L., Eltanahay, A., Turner, R. C., Bonasso, P.,... Rosen, C. L. (2018). Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Nutritional Neuroscience, 21(2), 79–91.
- Michigan State University. (n.d.). A Cohort Study Evaluating the Efficacy of PO Magnesium in the Treatment of Acute Traumatic Brain Injury in Adolescents.
- Oliver, J.M., Jones, M.T., Kirk, K.M., Gable, D.A., Repshas, J.T., Johnson, T.A.,... Zetterberg, H. (2016). Effect of docosahexaenoic acid on a biomarker of head trauma in American football. Medicine & Science in Sports & Exercise, 48(6), 974-982.
- Silverman, R. G. (2016). Why Women Are at an Increased Risk of Concussions. Original Internist, 23(1), 11–41.
- von Luckner, A., Riederer, F. Magnesium in migraine prophylaxis-is there an evidence-based rationale? A systematic review. Headache, 58(2), 199-209.
- Womble, M. N., Henley, J. R., Fedor, S. A., & Collins, M. W. (2019). Posttraumatic headache and migraine assessment and management after sport-related concussion. In Neuropsychology of sports-related concussion. (pp. 43–70). Washington, DC: American Psychological Association.