Feeding the Brain: Nutrition for Patients With Traumatic Brain Injury

AUTHOR:
Anne Danahy, MS, RDN

More than 1.7 million people in the United States sustain a brain injury each year. These injuries are a major cause of death and disability in people younger than 45. Approximately 5.3 million Americans are living with disability from a traumatic brain injury (TBI),¹ which often results in cognitive, behavioral, and physical deficits. In some cases, symptoms and long-term complications of a TBI may be improved with nutrition interventions.

What Is a TBI?

A TBI is a sudden trauma to the brain. It is often caused when the head violently hits an object, such as in a motor vehicle accident, sports, or a combat injury.² TBIs can range from very mild to severe, depending on the extent of the force or injury. A concussion is the on the mildest end of the TBI spectrum. Brain injury due to sports contact has received considerable attention lately because of the risk of repeated injury. Mild, repetitive TBI has been associated with neurodegenerative diseases.³

Potential Complications

Persons who sustain even a mild TBI are at risk for short-term and longer-term adverse neurological and cognitive symptoms. They include dizziness, confusion, impaired concentration, headaches, impaired sense of taste or smell, fatigue, difficulty sleeping, lower impulse control, and mood changes.^1-3 Physical complications of TBI may include loss of balance, gait unsteadiness, impaired coordination, blurred vision, and nausea.³

Anxiety and depressive disorders are very common among persons who have sustained a TBI, with as many as 70% of patients experiencing anxiety and up to 50% experiencing depression.⁴ Anxiety and depression can have an impact on eating patterns and food choices, leading to weight gain and obesity. In addition, symptoms of depression can be intensified with a poor diet.

Weight management is also a concern in patients with TBI. Those who are hospitalized after a severe TBI often lose weight. One study found an average loss of 11 kg among patients in the intensive care unit, even though they received enteral nutrition.⁵ In this study, which followed the cases of 107 patients, 60% of patients were discharged from the hospital at a higher weight than when they were admitted. Those with a lower body mass index prior to their injury were at greatest risk for excessive weight gain.⁵ The researchers determined that eating disorders are common after a TBI, largely due to hyperphagia (excessive hunger or food intake) and the presence of dysexecutive syndrome (loss of brain function that impairs judgment, planning, and insight).

Nutrition Implications of TBI

After a brain injury, metabolic changes affect recovery, including inflammation, changes in energy metabolism, gastrointestinal tract function, and insulin resistance.

Researchers have examined the potential effects of nutrition intervention as part of complementary therapy in acute TBI treatment, and in minimizing the longer-term complications. Some of their findings include the following:

• Patients treated with enteral nutrition within 48 hours after injury have better survival rates.³ Enteral nutrition supplemented with glutamine has been shown to reduce length of hospital stay, reduce loss of muscle tissue, and decrease infection rate.¹
• Vitamins D and E, niacin, zinc, and magnesium have neuroprotective benefits, and supplementing with these vitamins and minerals has been shown to improve recovery, especially in patients who are deficient.^1,3,6
• Supplementing with ω-3 fatty acids can reduce inflammation and oxidative stress, promote brain-cell survival, and help the brain recover from injury.^5,6 Animal studies suggest that supplementing with ω-3s before and after a brain injury improves functional outcomes, including memory, spatial learning ability, and cognitive function.⁷
• Animal studies confirm that a high-fat diet and obesity can exacerbate the effects of a TBI in terms of brain insulin-resistance, which contributes to increased neuroinflammation.⁸
• Those living with a TBI for longer are at greater risk of obesity, and they are more likely to have hypertension, diabetes, heart failure, or poor health. Nutrition recommendations for those with a TBI should consider the challenges of the patient’s injury, especially any physical limitations in activity, or cognitive or behavioral issues that affect eating habits.⁹
   

The Bottom Line

Researchers agree that much remains to learn about the impact of nutrition and specific nutrients on TBI recovery. It is known, however, that malnutrition or undernutrition can impair recovery after a brain injury and increase the risk of complications such as depression, obesity, and weight-related diseases.

When working with persons with a history of TBI, RDs should consider the long-term risk of neurodegenerative disease and assess for any effects of the injury that may have nutrition implications. These might include anxiety, depression, sleeping problems, loss of taste or smell, or hyperphagia. An energy-balanced, anti-inflammatory diet with adequate sources of ω-3 fats, and a vitamin D supplement as appropriate, is especially important for these patients.

Contributed by Anne Danahy, MS, RDN

References:

1. Scrimgeour AG, Condlin ML. Nutritional treatment for traumatic brain injury. J Neurotrauma. 2014;31(11):989-999.
2. Traumatic brain injury information page. National Institutes of Health, National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Traumatic-Brain-Injury-Information-Page Updated June 18, 2018. Accessed December 18, 2018.
3. Lucke-Wold BP, Logsdon AF, Nguyen L, et al. Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Nutr Neurosci. 2018;21(2):79-91.
4. Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: a systematic review. J Neurotrauma. 2016;33(22):1969-1994.
5. Crenn P, Hamchaoui S, Bourget-Massari A, Hanachi M, Melchior J-C, Azouvi P. Changes in weight after traumatic brain injury in adult patients: a longitudinal study. Clin Nutr. 2014;33(2):348-353.
6. Vonder Haar C, Peterson TC, Martens KM, Hoane MR. Vitamins and nutrients as primary treatments in experimental brain injury: clinical implications for nutraceutical therapies. Brain Res. 2016;1640(pt A):114-129.
7. Barrett EC, McBurney MI, Ciappio ED. ω-3 fatty acid supplementation as a potential therapeutic aid for the recovery from mild traumatic brain injury/concussion. Adv Nutr. 2014;5(3):268-277.
8. Karelina K, Sarac B, Freeman LM, Gaier KR, Weil ZM. Traumatic brain injury and obesity induce persistent central insulin resistance. Eur J Neurosci. 2016;43(8):1034-1043.
9. Dreer LE, Ketchum JM, Novack TA, et al. Obesity and overweight problems among individuals 1 to 25 years following acute rehabilitation for traumatic brain injury: a NIDILRR traumatic brain injury model systems study. J Head Trauma Rehabil. 2018;33(4):246-256.