Concussions are a fairly common injury in the world of sports medicine. As hard as it might be to admit it, the CDC reported 1.7 million concussions within the U.S. population last year. Furthermore, this type of mild traumatic brain injury (mTBI) is not exclusively seen in sports medicine. All the population can be exposed to this, and 90% of concussion patients have a resolution of symptoms after four weeks. Nevertheless, the remaining debilitating post-concussion symptoms can lead to neurodegenerative consequences later in life. Nowadays, integrating an anti-inflammatory nutritional approach after a concussion is integral to preventing post-concussion syndrome (PCS).

Post-concussion considerations:

• A patient with PCS can develop increased intestinal permeability within 4 hours after the injury. Indeed, this is due to the connection between the brain and the enteric nervous system.
• Dehydrated patients are more likely to suffer from post-concussion complications.
• In addition to intestinal permeability, patients with PCS are more likely to develop small intestine bacterial overgrowth, known as SIBO.
• A concussion is rapidly followed by brain hypometabolism, and studies have shown that a moderate caloric reduction may improve cognitive impairment.

Brain hypometabolism:

Indeed, the brain is a highly metabolic organ that requires an elevated and uninterrupted energy supply, usually glucose. After a concussion injury, the brain can be susceptible to diminished glucose uptake resulting in a bioenergetic deficit. Recently, research has shown that a ketogenic diet has potential therapeutic applications to reverse the energetic deficit.

In this one-arm study, post-concussion patients taking a very high fat-ketogenic diet reported improved visual memory and decreased concussion-related symptoms. 

The researchers noted that a ketogenic diet could promote multiple benefits to PCS patients. 

Ketone Diet Benefits:

• Ketone body metabolism produces lower amounts of reactive oxygen species (ROS).
• A high-fat ketogenic diet upregulates mitochondrial antioxidant systems that scavenge ROS.
• This dietary approach increases the activity of the Nrf2 anti-inflammatory pathway.
• Overall improvement of neurotransmitter levels.

Supplements and Herbs vs. Concussion:

The recovery of an injury is affected by the patient’s nutritional status. Indeed, there are specific nutrients in the particular case of a concussion:

• Boswellia: The use of this herbal component has proven to enhance the cognitive outcome in patients with diagnosed diffuse axonal injury (DAI). In a double-blind, randomized study, 38 patients with DAI experienced an increased cognitive function when Boswellia was applied to their treatment. 

• N-Acetyl Cysteine: Treatments with NAC after ischemic injuries is associated with brain cell damage prevention and lower death. In addition, NAC stimulates and promotes glutathione peroxidase activity. Furthermore, this effect is linked with NAC’s potent ROS scavenging function.
• Fish oil: The application of omega-3 fatty acids is linked to the conservation of the brain’s protection mechanisms and maintenance of the integrity of brain cells.
• Vitamin D: vitamin D increases resilience to TBI due to its role during the conversion of tryptophan to serotonin. Furthermore, the genetic impact of vitamin D modulates serotonin levels, which controls mood, decision-making, and social behavior.
• Curcumin: Curcumin is a potent anti-inflammatory agent linked to reversing behavioral deficits in locomotion and memory. In addition, curcumin acts as an antioxidant reducing oxidative stress and thus improving synaptic simplicity and cognition. 

The overall objective of using herbs and supplements to improve TBI and concussion secondary effects is to increase the body’s resilience. In addition, the recovery process will always be joined by a depletion of the vitamins and antioxidants pool, making us susceptible to other conditions. It is vital to support our patients with antioxidants, anti-inflammatory compounds, and enough vitamins to accelerate this curing process. – Ana Paola Rodríguez Arciniega, MS

Bibliography:

Ellis, E F et al. “Restoration of cerebrovascular responsiveness to hyperventilation by the oxygen radical scavenger n-acetylcysteine following experimental traumatic brain injury.” Journal of neurosurgery vol. 75,5 (1991): 774-9. doi:10.3171/jns.1991.75.5.0774

Moein, Payam et al. “The effect of Boswellia Serrata on neurorecovery following diffuse axonal injury.” Brain injury vol. 27,12 (2013): 1454-60. doi:10.3109/02699052.2013.825009