Concussions and Sports: What You Should Know
(UPDATED DECEMBER 2015)
After working with many clients and receiving numerous questions, I have updated this article to reflect a very specific plan of action for parents and adults to adopt for prevention and repair.
Taking Concussions More Seriously
While at the gym over a year ago, I caught a small part of the World Cup game between Uruguay and England. Within a few minutes, I witnessed Alavaro Pereira take a knee to the face and was knocked out cold. Did they rush him to get medical help and reduce inflammation? No, they let him back in the game. This isn’t a “walk it off” scenario and there’s a lot of hoopla going on right now condemning those in charge for allowing this and other similar examples in sports across the board.
TBI Leading Cause of Death under 45
TBI is the leading cause of death in individuals under the age of 45 years, with an estimated incidence of death reported as 20–30 per 100,000. The majority of TBI cases can be attributed to motor vehicle accidents, motorcycle accidents, bicycle accidents, and pedestrian injuries. It is also a major concern in football, rugby, soccer, lacrosse, baseball and ice hockey – where there have been major increases in concussions.
- According to the CDC, a number of kids coming into the ER with brain injuries went from 153,000 in 2001 to 250,000 in 2009; a 60 percent increase.
- In football and hockey, the number of actual concussions is six or seven times higher than the number diagnosed. Approximately 70 percent of football players and 62 percent of soccer players get at least one concussion per year.
- In a study of Norwegian soccer players, 81 percent had an impairment of attention, concentration, memory, and judgment ranging from mild to severe.
- A new study from the Archives of Pediatrics & Adolescent Medicine found that children who suffer concussions may experience lingering problems with memory and attention, even 12 months after the injury.
- The New York Times reported that 30 percent of concussions are from football in teenagers between 15-19. The NFL has taken steps to reduce the number of head injuries and is raising awareness due multiple football players speaking out.
What are the Repercussions of Getting Concussions?
According to this study, there are multiple mechanisms that lead to secondary damage after a concussion including ischemia, activation of neuronal death cascades, cerebral swelling, and inflammation. Dr. Amen in Making a Good Brain Great explains:
While often there are no immediate symptoms with a concussion and nothing irregular shows up on the CT scan or the MRI, subtle changes occur. Over a period of a few weeks or even months, the individual may become tearful, angry or irritable; have trouble thinking clearly or concentrating; or suffer from headaches, confusion blurred vision memory loss or nausea. There may be personality changes, temper problems, dark thoughts, and difficulty expressing emotions or understanding others.
Despite the technological advances made during the last several decades, there still is no effective neuroprotective therapy currently available for mild let alone severe traumatic brain injuries. The mainstay of treatment for patients with concussions is rest and while the majority of patients have a spontaneous resolution of their symptoms over a short period of time, approximately 10-20% of patients will have persistent symptoms. That percentage is too high for having persistent symptoms.
Another study found that neck strength predicts concussion risk. Biomechanic researchers have suspected that girls have a higher concussion rate than boys in sports like soccer and lacrosse due to differences in neck strength. If your neck is weak, then concussions are more likely because your head will shake more on impact, causing the brain to slam against the skull. Research has backed this claim up and found that for every one pound increase in neck strength, odds of concussion fell by 5 percent. While for some this may not be anything new, but if your neck is lacking in girth, give it more focus.
Exercise Vs. Rest
University of Buffalo researchers published a study in the Clinical Journal of Sports Medicine, that individualized exercise programs just below the onset of symptoms is safe and can relieve nearly all post-concussion symptoms. “The results counter the accepted wisdom that PCS should be treated with rest, reassurance and antidepressants and that physical activity should be avoided.” The athletes who exercised returned to normal within 11 to 36 days, while those who did not exercise required 41 to 112 days of intervention.
Another point I found interesting was “if the patient does not develop symptoms during the exercise test, then the cause of their difficulties is likely to be another source. Most commonly it is neck strain, which tends to cause headaches that mimic a post-concussion headache.”
APOE4 Genotype and Concussions
Increasing evidence has shown that APOE-ε4 genotype is associated with poorer outcomes following a traumatic brain injury, likely due to the reduced ability to repair synapses and protect neurons from injury. TBI’s are associated with increased risk of Alzheimer’s disease. Therefore, the E4 genotype may be useful to know if you are at a higher risk and what you need to do to be pro-active for protection and repair in sports or activities with a higher percentage of head injuries. You can find out your APOE genotype through Nutrition Genome.
Nutrients for Concussions: It’s Time to Move Beyond Ibuprofen
We need to start focusing on what we can do to bolster protection and repair once a concussion has occurred to lower the overall effect. The recommendations of rest and Ibuprofen are not enough; we need to start utilizing nutrients for concussions that have been proven to work in studies. Currently, we can take what we know about inflammation and trauma to the brain and apply it to concussions, and start looking into what supplements can help reduce the damage of concussions. Certain compounds with multiple mechanisms of neuroprotection and anti-inflammatory properties can be applied.
The Best Supplements for Concussion Prevention and Recovery
According to Dr. David A. Honda, the director of the Brain Injury Research Center at UCLA, recovery depends not only on the severity of the blow but also on how many previous concussions a person has suffered. Once a person has suffered a concussion, he or she is as much as four times more likely to sustain a second one.
What are the best supplements for concussions? Inflammation control, blood vessel and tissue repair are in order. Do not wait until you have a concussion to start implementing ways to protect your brain from injury. It is always easier to prevent damage than it is to repair it, and having a nutritional reservoir on hand when it occurs will help first responders of your body to work efficiently.
Remember, these are suggestions based on current research and are in no way intended to take the place of the care from your physician. I recommend taking this article with you to the doctor’s office to assist in a plan.
I played every sport available while growing up, and if my future kids play sports, this is the protocol I will use for protection and will adjust as necessary if a concussion occurs. Remember to choose a good electrolyte drink as well to stay well hydrated.
In terms of the brain, a July publication of The Journal of Neurosurgery, Dr. Julian Bailes and Dr. Barry Sears found that supplementing rats with EPA/DHA fish oil after head injuries reduced the observed issues with a concussion; “Animals receiving the daily fish oil supplement for 30 days post-concussion had a greater than 98 percent reduction in brain damage compared with the animals that did not receive the supplement,” Dr. Sears said. “It is hypothesized that the omega-3 fatty acids in the fish oil reduced the neural inflammation induced by the concussion injury.”
Concussions require tissue repair and anti-inflammatory intervention. “One implication of the study is that concussions, such as those that occur in football, may be best treated with immediate high-dose fish oil supplementation to reduce brain inflammation. The same may hold true of all brain trauma patients,” Sears said.
In fact, Dr. Sears has had success 7 out of 7 times with high dose fish oil and TBI’s. You can read one of the success stories from this CNN article. In this case, a 20-gram dosage was given under a doctor’s care for 48 hours.
How About Fish Oil’s Ability to Provide Preventative Protection Against Concussions?
Other studies have found utilizing rodent models of experimental injury have shown that pre-injury dietary supplementation with fish oil effectively reduces post-traumatic elevations in protein oxidation resulting in stabilization of multiple molecular mediators of learning, memory, cellular energy homeostasis and mitochondrial calcium homeostasis as well as improving cognitive performance.
The benefits of pre-traumatic DHA supplementation have not only been independently confirmed, but DHA supplementation has been shown to significantly reduce the number of swollen, disconnected and injured axons when administered following traumatic brain injury. Of note, DHA has provided neuroprotection in experimental models of both focal and diffuse traumatic brain injury.
Studies show that brain magnesium levels fall 50% for 5 days after injury to the CNS. Low magnesium levels facilitate secondary injury processes including inflammation, excitotoxicity, mitochondrial dysfunction, energy failure, edema formation, free radical production, and apoptosis, among others. When magnesium levels are significantly decreased after trauma, the cells are less capable of providing sufficient energy for repair and restoration; events that may result in cell death.
Post-traumatic administration of magnesium to restore normal magnesium homeostasis reduces neuronal cell death and increases the likelihood of recovery. Studies of both animal and human brain trauma victims suggest higher magnesium levels are associated with better recovery. The majority of people are magnesium deficient to begin with.
Amount: 6-8mg per kilogram of body weight (weight divided by 2.2 to get your weight in kilograms, then multiply this number by 6-8)
3. C-Salts Buffered Vitamin C (best high potency L-ascorbate for low and high doses or sensitive stomachs)
The brain consumes a disproportionate amount of the body’s oxygen as it derives its energy almost exclusively from oxidative metabolism. Current studies suggest that oxidative stress lasts at least 24 hours after a traumatic brain injury and that antioxidant reserves like vitamin C are severely compromised, however vitamin E received a zero net loss in rats. Vitamin C has a short half-life, and the supply is needed to be continually refilled, especially during injury and illness. Flavonoids also play an important role in controlling the inflammatory process.
Amount: 500mg-3000mg depending on age and weight in two doses daily, and may require hourly dosing (100mg-1000mg) after injury.
TBI patients have increased urinary zinc losses and acutely reduced serum zinc levels. Human clinical data suggest that supplemental zinc can be used during recovery to improve cognitive and behavioral deficits associated with brain injury. Additionally, pre-clinical models suggest that zinc may increase resilience to traumatic brain injury, making it potentially useful in populations at risk for injury. It would appear that this is especially true for injuries to the temporal lobe.
Melatonin is released by the pineal gland when it gets dark, inducing sleep. Researchers have paying more attention to its role in concussion recovery that looks very promising for chronic headaches and poor sleep patterns.
Protecting the mitochondria in brain cells is a major focus for brain injuries. Melatonin is a powerful antioxidant that concentrated in the mitochondria of the cell – especially brain mitochondria – making it neuroprotective. Melatonin has been evaluated to be effective in TBI where it improves mood and behavior, decreases brain edema, decreases intercranial pressure and significantly increased superoxide dismutase and glutathione peroxidase (both reduce inflammation).
Acetylcholine is the neurotransmitter of the vagus nerve, which enervates numerous organs. The vagus nerve also is connected to the brain stem, as seen here. Acetylcholine requires adequate choline to function correctly. Choline is connected to lower anxiety levels, plays an important role in cell membrane health, and improving memory.
A study using a rat model found that dietary choline supplementation resulted in a modest degree of improvement in spatial memory as assessed in the Morris water maze test. In addition, choline treatment resulted in significant cortical tissue sparing, reduced brain inflammation, and normalized some TBI-induced deficits in nAChR expression. If an injury has occurred to the temporal lobe and memory is affected, it would stand to reason that choline supplementation should be used.
Studies have found that Branch Chain Amino Acids (BCAA’s) have increased recovery after traumatic brain injuries. One study found significant reductions were seen in the concentration of branched chain amino acids (BCAAs) after a TBI. Dietary consumption of BCAAs restored hippocampal BCAA concentrations to normal, reversed injury-induced shifts in net synaptic efficacy, and led to a reinstatement of cognitive performance after concussive brain injury. All brain-injured mice that consumed BCAAs demonstrated cognitive improvement with a simultaneous restoration in net synaptic efficacy.
Promix is a grass-fed whey concentrate for 5 lbs. and 76 servings at $79.99. That is $1.05 per serving. Compare that to other grass-fed whey protein powders that are 1-2 lbs. and may cost twice that much per serving. See a full analysis of whey protein powders here.
Amount: 1 serving in the morning and post-workout
Animal TBI models have demonstrated that nicotinaminde (B3 niacin) yielded beneficial effects including reduced cortical damage, inflammation, and behavioral disruption in animals receiving infusions. It would stand to reason that B12, folate, B2 (riboflavin) and B6 would also be crucial, since they are all involved in neurotransmitter synthesis in the brain and controlling inflammation from preventing elevated homocysteine and high nitric oxide levels.
Amount: 1 serving daily
Vitamin D supplementation and the prevention of vitamin D deficiency may serve valuable roles in the treatment of TBI. Vitamin D deficiency may increase inflammatory damage and behavioral impairment following experimental injury. Maintain your vitamin D levels between 40ng/ml and 50ng/ml with blood tests every six months. If you are very low in vitamin D, you will need to supplement with higher amounts of Vitamin D to boost levels.
Other Supplements of Interest with Concussion Recovery
Lion’s Mane is a mushroom that caught my attention while reading research showing that the hot water extract stimulates the Nerve Growth Factor (part of a family of similar proteins that serve to promote the health and normal function of the brain and nervous system) and accelerates the growth of the myelin sheath. After a concussion, significant damage is done to the myelin sheath of the nerve leading to the brain cell. Regenerating the myeline sheath is a crucial step towards recovery and preventing damage.
One study found that neuronal excitability from glutamic acid (glutamate levels are elevated after an injury) appears to be attenuated in the presence of Lion’s Mane. There are also fatty acids in Lion’s Mane that are believed to be responsible for enhancing cognitive function. More research is needed for Lion’s Mane which appears to have amazing potential.
Amount: 2000mg-3000mg in two doses. You want a hot water and alcohol extract of lion’s mane.
Curcumin and Resveratrol: Preclinical studies have suggested that pre-traumatic and post-traumatic curcumin (from the spice turmeric) supplementation may bolster the brain’s resilience to injury and serve as a valuable therapeutic option. These studies demonstrated that both pre- and post-traumatic curcumin administration resulted in a significant reduction of neuroinflammation. Resveratrol has been demonstrated to effectively cross the blood-brain barrier, increase cerebral blood flow, reduce inflammation and improve outcomes in animal models following multiple acute neurological traumas. Resveratrol treatment in immature rodents reduced post-traumatic neuronal loss and improved behavioral measures of locomotion, anxiety, and novel object recognition memory.
Amount: Check with doctor
Green Tea Extract: Green Tea contains a flavanoid called EGCG, the amino acid theanine and methylxanthine. All have been found in vitro and in vivo to have neuroprotective effects including protection from excitotoxic injury and inhibiting inflammation. This product also contains phosphatidylcholine.
Amount: Check with doctor
If you are a doctor or know of a doctor doing work like the Amen Clinics specializing in concussions/TBI’s, please leave a comment so that we can create a global directory where people can be under the best care.
Practitioners affiliated with Nutrition Genome: Orange County, CA and Louisville, Colorado
Amen Clinics: Orange County, San Francisco, Washington D.C., Washington State, Atlanta, New York