Traumatic brain injuries (TBI), also known as concussions, are impacts to the head that interrupt the normal function of the brain. Concussion is the most common but least serious type of brain injury. It is estimated that one in every 2,000 people will experience an episode of concussion requiring hospital treatment each year. However, the actual figure could be much higher, as many people do not seek treatment for concussion. Researchers from the World Health Organization estimated that the true number of people affected by concussion each year could be as high as one in 165.
In New Zealand we are a sporting lot and having an understanding of how to assess a concussion can mean the difference for the person who has been injured. See this pdf for Concussion assessment on the side line.
Team-mates, coaches and parents: Your responsibility
You MUST do your best to ensure that the player is removed from play in a safe manner, if you observe them displaying any of the visible clues or signs or symptoms of a suspected concussion.
You MUST NOT allow a player to play sport until they have completed the graduated return to play (GRTP) protocol if they are displaying signs or symptoms of a suspected concussion sustained while playing your (injury) sport or another sport.
You MUST ensure that the player is in the care of a responsible adult and inform them of the player’s suspected concussion.
Players: Your responsibility
If you have symptoms of a suspected concussion you must STOP playing and INFORM medical and/or coaching staff immediately.
Be honest with yourself and those looking after you.
If you have symptoms of a suspected concussion sustained while playing your (injury) sport or any another sport, you MUST NOT play sport until you have completed the graduated return to play (GRTP) protocol.
According to the World Health Organization, the leading cause of TBI include:
Falling, (off a wall, out of a window, jockeys off horses, off playground equipment)
Car accidents (RTA’s with whiplash cause diffuse axonal shearing)
Playing contact sports Rugby, Football, Ice Hockey, Boxing, MMA (getting your “bell rung”)
Running into objects (like a pole, wall, or getting into a car or climbing up
Physical assault or attack
Most cases of concussion occur in children and teenagers aged five to 14, with the two most common causes being sporting and cycling accidents. Falls and motor vehicle accidents are a more common cause of concussion in older adults. People who regularly play competitive team sports such as football and rugby have a higher risk of concussion. Men are less likely to report a concussion and thus are more likely to suffer long-term effects. Culturally, concussions have been treated as somewhat casual—they are often referred to as “just a bump on the head,” or “part of the game”. However, a concussion or TBI is far from trivial.
How TBI affects patients
Most people with concussion do not require any treatment as they normally get better by themselves. However, they will require a period of careful monitoring, ranging from several days to several weeks, depending on the severity of the concussion.
Unfortunately a small percentage of people do not recover in the time frames, and their symptoms persist.
Symptoms and effects of concussions can affect physical coordination, cognitive function, memory, and even emotional state. Those with concussions often describe a period in which their personality was altered, or where they were “just not feeling” themselves anymore. This results from the brain seeking to return to normal function. Concussions symptoms include:
Headache or Head Pressure
Dizziness or Disorientation
Changes in balance
Changes in your ability to think
The most serious cases of TBI involve secondary brain injury while an individual is recovering from a concussion. This is called “Second Impact Syndrome”. The key to recovering from TBI is early diagnosis and immediate treatment. Many patients brush off the effects of concussion without realizing that effective treatment and rehabilitation is available.
Concussion: First Aid
The brain is the most nutrient-dependent, energy-dependent and stress-vulnerable organ in the body. When it’s damaged by a concussion, providing it immediately with the right nutrients to maintain energy levels and reduce stress is crucial for speedy recovery without lingering symptoms.
The standard medical advice for treating the acute phase of a concussion is rest, with a gradual return to normal activity. For optimal recovery, however, treatment of a concussion should also include nutrition and supplements designed to increase the production of brain-derived neurotrophic factor (BDNF). When the brain is injured, it responds by releasing a lot of natural chemicals to repair the injured neurons. In particular, it releases BDNF, which helps neurons grow, restores communication among them and reduces the risk of neurodegeneration. Often called the brain’s Miracle-Gro, high levels of BDNF are crucial for good recovery from a concussion.
Numerous studies have shown that the best way to raise BDNF levels is with intense exercise. For the first few days after a concussion, however, even mild exercise often isn’t a good idea. At that point, the patient often feels dizzy and nauseous and has severe headaches. Rest and very mild exercise—no more than 10 minutes of walking—are usually all the patient can manage. But the first few days after the injury are also when BDNF is needed the most for healing. Immediate nutritional steps to support BDNF production can be extremely valuable for speeding recovery.
Nutrition to Support BDNF
After a head injury, the body needs extra protein right away for healing and rebuilding damaged tissues. Starting within a day of the injury, I recommend consuming extra protein each day at the rate of about a gram per kilogram of body weight. High-protein foods such as steak and eggs are good choices, but the nausea that often goes along with a concussion may make that option very unattractive. Therefore, I recommend a daily shake made with whey protein or pea and rice protein with added branched chain amino acids, combined with 10 grams of the supplement creatine monohydrate. Creatine is crucial for energy production within the cells. It helps give the brain an intense and immediate hit of energy, which it needs to help the cells start to heal.
Taking vitamin D supplements helps raise BDNF production. We know that serum levels of BDNF tend to rise in the spring and summer and drop in the fall and winter, probably because of reduced exposure to sunlight. Taking vitamin D supplements is a good surrogate for the effects of sunlight on BDNF production. Vitamin D is neuroprotective in other ways as well. I recommend a daily dose of 5,000 IU.
The omega-3 fatty acids EPA and DHA are very helpful for reducing inflammation from a concussion. The DHA in fish oil helps build strong, flexible cell membranes in neurons. The EPA suppresses the production of prostaglandins and other inflammatory chemicals. DHA has also been shown to increase BDNF levels in people with traumatic brain injuries. During the first few weeks of the concussion recovery period, I suggest supplements of a high-quality fish oil up to 4,000 mg daily. After that, continue with 2,000 to 4,000 mg a day for 3 months.
Studies have recently shown that administering glutathione after a concussion reduces brain tissue damage by an average of 70 percent. In a clinical setting, glutathione can be given intravenously. Oral supplements of glutathione are destroyed by stomach acid, however. For home treatment, the best approach is to nutritionally support the body’s natural pathway for producing glutathione by providing plenty of the building blocks: vitamin C, selenium, niacinamide (vitamin B3), N-acetyl-L-cysteine (750 to 1,000 mg) and broccoli extract.
Magnesium is one the best nutrients for speeding recovery from concussion and preventing delayed brain injury and post-concussion syndrome. It reduces inflammation and raises glutathione in cells. We know from studies that after a concussion the levels of magnesium in the brain drop by 50 percent and stay at that low level for 5 days before slowly returning to preconcussion levels. Because magnesium is crucial for repairing and regrowing neurons, low levels in the brain will slow recovery; raising the level can help shorten recovery time. To raise magnesium levels, I recommend daily supplements containing up to 600 mg of magnesium.
Just as magnesium levels in the brain drop sharply after a concussion, so do zinc levels. Supplemental zinc during the recovery period can help improve cognition and mood. To raise zinc levels, I recommend daily supplements containing 40 mg of zinc.
Curcumin (the active ingredient in the spice turmeric) is an extremely valuable supplement for treating concussion. After a traumatic brain injury, curcumin supplements can help reduce cognitive impairment, help stabilize energy use in the brain and reduce membrane damage in the neurons. In animal studies and in human trials, the supplement raises BDNF production. This supplement is so helpful due to its multiple anti-inflammatory mechanisms for a damaged brain that I recommend it to all my concussion patients.
Taking the right nutritional supplements as soon as concussion is diagnosed can play an important role in healing the damage quickly and completely. The supplements are particularly valuable for helping to avoid post-concussion syndrome and preventing future injury. The tree of health can only bloom if the roots—the brain—and the branches and leaves—the body—are nourished together.
So to summarise:
Eat protein, low-no carbs or sugar
Vit D3 5000IU’s/day
EFA’s (Omega 3) high DHA (greater DHA then EPA ratio) 4000mg/day
Support Glutathione production with vitamin C, selenium, niacinamide (vitamin B3), N-acetyl-L-cysteine (750 to 1,000 mg) and broccoli extract.
Curcumin + Bozwiella (increase to bowel tolerance levels)
Remember: no Alcohol, Sugar, Carbs, TV, Computers, iPads, rest and sleep as much as you can for the first 72 hours.
Most concussions resolve in 2 weeks.
If you still have symptoms after 6 weeks then you need to book into see Dr Stefan Billing for a post concussion syndrome assessment.