Written by Danae Harding, CNP, NNCP, BScKin, DPSPOR
Mild traumatic brain injury, or concussions, are the most common head injury affecting one percent of the Canadian population annually – this equates to roughly 400,000 cases per year1. Although the majority of cases resolve within 4-weeks, some individuals experience persistent and debilitating symptoms for months and even years. Understanding adequate concussion prevention and treatment strategies is an important health concern, and nutritional intervention plays a large role in recovery.
The brain is a complex organ with high-metabolic needs. For the average adult in a resting state, the brain uses about 20 percent of calories consumed2. In addition to its caloric needs, the brain requires adequate amounts of particular micronutrients for proper functioning. The nutritional needs of the brain post-concussion aim to maximize repair, improve cognitive functioning and reduce inflammation; therefore, it is important to consider food choices and hydration status when recovering from a concussion.
Recommended Macronutrient Breakdown for Post-Concussion Nutrition
The brain requires an uninterrupted energy supply for proper functioning — the primary source of this energy comes from glucose metabolism. Studies have shown that glucose uptake substantially decreases post-concussion due to changes in pathophysiology3. A persistent, inadequate supply of glucose to the brain after traumatic injury can lead to poor outcomes.
Following a ketogenic diet appears to be a promising nutritional therapeutic strategy for promoting recovery post-concussion, although research is still in early stages. The ketogenic diet is a low-carb, high-fat diet that alters the body’s main source of energy from glucose to ketones by inducing fat metabolism. This not only has an energy-stabilizing effect on the brain, but current studies indicate possible neuroprotective effects against damaging free-radicals and other inflammatory markers4,5.
RELATED READING: Concussion Management & Exercises for Recovery
So how do you bring the ketogenic diet to your plate?
When following the ketogenic diet your macronutrient targets are as follows:
- >70% from healthy dietary fats
- <10% from complex carbohydrates
- The remainder from lean proteins.
Although the specific amount of fats and carbohydrates needed to reach a ketogenic state varies between individuals, the majority of people reach ketosis when they consume 20-40 net grams of carbohydrates daily.
Emphasizing the consumption of high-fat foods (fatty fish, olives, avocados, cold-pressed oils, nuts and seeds), non-starchy vegetables (leafy greens and cruciferous vegetables), and low-glycemic index fruits (berries, citrus, melons and stone fruit) can help you achieve these macronutrient recommendations. Simultaneously reducing consumption of simple carbohydrates (white bread, pasta, bagels), highly-processed food items (cereals, pastries, frozen and fast foods) and added sugars (pop, sweets and condiments) with further aid success.
Other tips for following a ketogenic diet include:
- Drink bulletproof coffee in the morning supplemented with MCT oil
- Drizzle all meals with extra-virgin olive oil or MCT oil
- Include “fat bombs” as snacks throughout the day
- Add more avocados into the diet
- Snack on homemade trail mix
- If needed, take “oil shots” to up dietary fat intake to maintain a ketogenic state
To help you bring more dietary fats into your day, I have included a lemon fat bomb recipe below.
Micronutrients to Include, Dietary Sources & Supplementation
Omega-3’s
Omega-3 fatty acids are a polyunsaturated fat that are considered essential in the diet — meaning the body cannot make them, we must get them from food. The nutrition world has long recognized the importance of omega-3 fatty acids and its therapeutic components docosahexaenoic acid (DHA) and eicosapentaenoic acid (EHA); they have been shown to be beneficial for heart, eye, metabolic and mental health, and are essential for brain development and function.
Further, omega-3’s have been proven to have anti-inflammatory effects making it an important micronutrient in concussion recovery. The role of omega-3 in the brain is to improve cognitive functioning, reduce neural swelling, and boost brain-derived neurotrophic factor (BDNF). Including foods rich in omega-3 fatty acids like fatty fish (mackerel, salmon, herring, anchovies) and nuts and seeds (walnuts, flaxseeds, chia seeds), or supplementing with cod liver oil is crucial for concussion recovery. Aim for 2500-3000mg daily for the best effects.
Vitamin B-12 (Cobalamin)
Naturally found in animal products, vitamin B-12 is required for the formation of red blood cells, DNA production and plays a major role in the development and functioning of the brain and cells of the nervous system. Because of this, it is important to include adequate amounts of B-12 to preserve brain and nerve health as well as to promote nerve repair after a traumatic brain injury.
Good food sources of vitamin B12 include organ meats (i.e. liver), clams, grass-fed beef, tuna, trout and salmon. It can also be found in fortified non-dairy products, cereals and nutritional yeast, all of which are good sources for plant-based individuals. Supplementation is an additional option. The adult RDA for vitamin B12 is 2.4 mcg daily.
Antioxidants (Vitamin C & E)
An antioxidant is a substance that helps to protect our cells against damaging free radicals, reducing cell destruction. Following tissue damage from a traumatic brain injury, a biochemical cascade occurs causing an increase in free radical production6. This leads to oxidative stress, an imbalance between the production of free radicals and antioxidant defences.
Increasing antioxidant levels by including foods rich in vitamin C (citrus fruits, kiwis, bell peppers, strawberries, cruciferous vegetables and white potatoes) and vitamin E (wheat germ, sunflower seeds, almonds, peanuts and peanut butter, pumpkin, avocado and fortified food products) can be very useful during periods of concussion recovery and repair.
Magnesium Glycinate
Magnesium is an essential mineral required for over 300 biochemical reactions in the body. Yet magnesium deficiency is one of the most common mineral deficiencies among adults. When it comes to brain health, magnesium is crucial for nerve transmission, neuromuscular conduction, and has a neuro-protective effect against cell death7. Studies have shown that magnesium levels drop immediately after concussion and do not begin to rise for up to 4 days8. As most people are deficient to begin with, this can put individuals with concussion into extreme deficiency.
Increasing the consumption of magnesium-rich foods (leafy greens, dark chocolate, avocados, nuts, legumes and whole grains) or supplementing with magnesium glycinate is beneficial when recovering from TBI due to its many neurological benefits. Research has also shown that supplementing with magnesium can reduce the symptoms experienced9. A 400 mg dose an hour before bed can help to increase serum magnesium levels, in conjunction with increasing magnesium-rich foods.
Zinc
Another essential mineral required for brain health is zinc, which plays a role in memory formation, mood, cognition and focus as well as neuromodulation. It also has powerful antioxidant affects.
Similarly, to magnesium, serum zinc levels in the brain drop immediately following a traumatic brain injury — making zinc an important micronutrient in post-concussion nutrition 1. Increasing zinc consumption either through food or supplementation has shown beneficial effects for mood and cognition in patients with traumatic brain injuries10. Studies have also seen favourable effects on inflammatory markers11.
Further, zinc deficiency plays a role in oxidative stress, meaning deficiency may exasperate oxidative damage associated with concussion. And, as mentioned in the cases of vitamin C and E, this increase in oxidative stress requires a greater supply of antioxidants. As zinc is a powerful antioxidant in itself, increasing consumption of zinc-rich foods (red meat, shellfish, legumes, eggs, whole grains, nuts and seeds) or supplementing with zinc is wise for recovery.
Keto Zesty Lemon Fat Bomb Recipe
Ingredients (makes 16)
- 200g coconut butter
- ¼ cup coconut oil
- 1-2 tbsp organic lemon zest
- 15-20 drops liquid Stevia
- Pinch of pink Himalayan sea salt
Instructions
- Wash and zest the lemons and make sure coconut butter and coconut oil are softened to room temperature.
- Mix all the ingredients in a medium bowl well, making sure the lemon zest and Stevia are distributed evenly.
- Line a mini muffin tin with paper cups and place about 1 tbsp of the mixture into each.
- Place in the fridge for 30-60 minutes to set.
- When done, keep refrigerate for up to 2 weeks. The coconut oil and coconut butter will get soft at room temperature so fridge storage is necessary. For longer storage, freeze for up to 6 months.
Nutritional Breakdown (per 1 bomb)
- Net CHO = 0.8g
- Protein = 0.8g
- Fat = 11.9g
- Calories = 114 kcal
I hope you have found the above information both informative and helpful. The utilization of proper nutrition post-concussion is an important therapeutic consideration for recovery.
Visit Our Concussion Physiotherapists in Langford, Millstream and Sooke
If you’re suffering from a concussion or post-concussion syndrome, Parkway offers concussion physiotherapy services across the South Island.
References
- Langer, L., Levy, C. & Bailey, M. (2020). Increasing incidence of concussion: true epidemic or better recognition? Journal of Head and Trauma Rehabilitation, 35(1), E60-E66.
- Walrand, S., Gaulmin, R., Aubin, R., Spain, V., Coste, A. & Abbot, M. (2021). Nutritional factors in sports-regard concussion. Neurochirurgie, 67(3), pp. 255-258.
- Jalloh, I., Carpenter, K. L. H., Helmy, A., Carpenter, A. T., Mason, D. K. & Hutchinson, P. J. (2014). Glucose metabolism following human traumatic brain injury: methods of assessment and pathophysiological findings. Metabolic Brain Disease, 30, 615- 632.
- Wlodarek, D. (2019). Role of ketogenic diets in neurodegenerative diseases (Alzeimer’s Disease and Parkinson’s Disease). Nutrients, 11(1), 169.
- Gough, S. M., Casellato, A., Ortega, K. J. & Hackam, A. S. (2021). Neuroprotection by the ketogenic diet: evidence and controversies. Frontier in Nutrition, 8
- O’Connell, K. & Littleton-Kearney, M. T. (2013). The role of free radicals in traumatic brain injury. Biological Research for Nursing, 15(3), 253-263.
- Kirkland, A. E., Starla, G. L & Holton, K. F. (2018). The role of magnesium in neurological disorders. Nutrients, 10(6), 730.
- Giza, C. G. & Honda, D. A. (2001). The neurometabolic cascade of concussion. Journal of athletic training. 36(3), 228-235.
- Standiford, L., O’Daniel, M,m Hysell. M. & Trigger, C. (2020). A randomized cohort study of the efficacy of PO magnesium in the treatment of acute concussion in adolescents. American Journal of Emerging Medicine, 44, 419-422.
- Erdman, J., Oria, M. & Pillsbury, L. (2011). Nutrition and traumatic brain injury: Improving acute and subacute health outcomes in military personnel. Institue of Medicine (US) Committee on Nutrition, Trauma and the Brain, National Academia Press, Washington, DC.
- Khazdouz, M., Mazzini, M., Ehsaei, M. M., Ferns, G., Kengne, A. P. & Norouzy A. R. (2018). Impact of zinc supplementation on the clinical outcomes of patients with severe head trauma: a double-blind randomized control trial. Journal of Dietary Supplements, 15(1), 1-10.
