By Kennedy Springer, MS, RD
Concussions are a hot topic in the sports world, and rightly so. Even with underreporting, it is estimated that 1.6 to 3.8 million sports related concussions occur each year in the United States (Oliver, 2018). Additionally, athletes who have experienced one concussion are at an increased risk for future concussions. As a direct result of increased concussions, athletes are missing crucial training and competition. Following a concussion, athletes are sidelined for an average of twenty-one days and even longer if a previous concussion has occurred (McLeod 2017). This results in major losses to the athlete’s performance and their ability to compete.
Concussions are a type of mild traumatic brain injury in which the brain rapidly moves forward and backwards upon contact, damaging its cells and structures. This results in symptoms such as nausea, sleep disturbances, fatigue, dizziness, headaches, and heightened risk of neurodegenerative conditions (e.g. Alzheimer’s disease, Parkinson’s disease) (Maroon, 2011). The pathophysiology whereby concussion symptoms occur is not fully understood, but proposed mechanisms include mitochondrial dysfunction, production of reactive oxygen species (ROS), and a prolonged inflammatory response (Oliver 2018).
The current recommended management of concussions includes rest from physical and cognitive activities, resolution of symptoms, and progressive return to sport participation (McCrory, 2017). During this time of healing, caloric and protein needs increase; however, due to concussion symptoms the athlete often fails to consume enough food to meet these increased needs. This has led many to question if there is a more proactive approach to treating and preventing concussions. Dietary supplementation has been suggested as an answer. Supplementation has shown promise both before and after concussion, however the findings are speculative because most studies have only been done on animals. So what is known?
Omega-3 Fatty Acids
Omega-3 supplementation has shown potential for concussion treatment and prevention by decreasing inflammation, reducing ROS, and providing the material needed for repairing brain cells (Maroon, 2011). Omega-3 is perhaps the most studied supplement, containing both animal and human studies, but results are varied. Supplementation is safe and tolerated with very few side effects (fish burps, bad breath, nausea, loose stool, heartburn) and may improve concussion outcomes (Lewis, 2016), but a standard protocol for administration has not been established. Current treatment and studies suggest dosing of 2 g/day or 10 mg/kg/day (Trojian, 2017).
N-acetyl cysteine may be beneficial following concussions because it acts as a powerful antioxidant. No research addresses sports related concussions, but in soldiers experiencing a blast injury, administration of N-acetyl cysteine post impact in a 4 gram loading dose followed by 3-4 grams per day for seven days resulted in less symptoms compared to a placebo (Hoffer, 2013). N-acetyl cysteine supplementation has potential, but more research is needed to recommend its use and dosage.
Curcumin, the compound that provides the yellow color in turmeric, has the potential to be neuroprotective both pre- and post-concussion as it inhibits pro-inflammatory responses (Trojian, 2017). Research has only been completed in animal studies and there is currently no recommended dosage for administration.
The mechanisms whereby resveratrol may be beneficial is its ability to reduce inflammation, scavenge free radicals, and increase cerebral blood flow (Trojian, 2017). Findings are limited to animal studies so there is currently not enough research to support supplementation. However, resveratrol is a natural nutrient that can be found in red grapes, blueberries, cranberries, strawberries, pistachios, peanuts, and peanut butter.
Creatine can serve as an energy source to the brain, but creatine levels are reduced following a concussion. Supplementation in the form of creatine monohydrate may be a method used to maintain energy homeostasis and result in decreased production of ROS (Oliver, 2018). Supplementation has shown promise as being protective in animal studies, however human studies are lacking. It is also important to note that while creatine is available for athletes to purchase, there are some regulations. For example, creatine is impermissible for NCAA institutions to provide to student athletes. Additionally, responses to creatine supplementation are individualized and weight gain is a potential side effect, impacting athletes competing in weight class sports.
Most of the current research regarding dietary supplementation and concussions has been done in animals and cannot directly be applied to human athletes. Additionally, results are not conclusive and more research is needed to determine the appropriate supplementation dosages. As stated by the FDA (2019), one can conclude that there is currently no supplement to prevent or treat concussions. What can be done? Begin by ensuring the athlete is meeting their caloric and protein needs. In the acute phase following a concussion, an athlete’s body is in a hypermetabolic state, requiring a 40-100% increase in caloric intake and 1.0-1.5 g/kg of protein (Curtis, 2014). Remember, though, that this may be difficult with appetite changes. At a minimum, aiming for 50% of calorie needs in the first 24 hours is optimal. Once this baseline is established, continue to increase calories daily and encourage a diet of whole food sources of omega-3’s (fish, chia seed, walnuts), curcumin (turmeric), n-acetyl cysteine (meat, legumes, diary), creatine (fish, red meat, poultry), and resveratrol (grapes, blueberries, peanuts). Supplementation is not the quick fix answer for concussions, rather focus on a foundation of appropriate caloric and protein intake.
This article was written by a Collegiate and Professional Sports Dietitian Association Registered Dietitian (RD). To learn more about sports nutrition and CPSDA, go to www.sportsrd.org
Curtis, L., & Epstein, P. (2014). Nutritional treatment for acute and chronic traumatic brain injury patients. Journal of neurosurgical sciences, 58(3), 151–160.
Hoffer, M. E., Balaban, C., Slade, M. D., Tsao, J. W., & Hoffer, B. (2013). Amelioration of acute sequelae of blast induced mild traumatic brain injury by N-acetyl cysteine: a double-blind, placebo controlled study. PloS one, 8(1), e54163. doi.org/10.1371/journal.pone.0054163
Lewis M. D. (2016). Concussions, Traumatic Brain Injury, and the Innovative Use of Omega-3s. Journal of the American College of Nutrition, 35(5), 469–475. doi: 10.1080/07315724.2016.1150796
Maroon, J. C., & Bost, J. (2011). Concussion management at the NFL, college, high school, and youth sports levels. Clinical neurosurgery, 58, 51–56. doi: 10.1227/neu.0b013e3182269efe
McCrory, P., Meeuwisse, W., Dvořák, J., Aubry, M., Bailes, J., Broglio, S., Cantu, R. C., Cassidy, D., Echemendia, R. J., Castellani, R. J., Davis, G. A., Ellenbogen, R., Emery, C., Engebretsen, L., Feddermann-Demont, N., Giza, C. C., Guskiewicz, K. M., Herring, S., Iverson, G. L., Johnston, K. M., Vos, P. E. (2017). Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. British journal of sports medicine, 51(11), 838–847. doi: 10.1136/bjsports-2017-097699
McLeod, T. C., Lewis, J. H., Whelihan, K., & Bacon, C. E. (2017). Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature. Journal of athletic training, 52(3), 262–287. doi: 10.4085/1052-6050-51.6.06
Oliver, J. M., Anzalone, A. J., & Turner, S. M. (2018). Protection Before Impact: the Potential Neuroprotective Role of Nutritional Supplementation in Sports-Related Head Trauma. Sports medicine (Auckland, N.Z.), 4 8(Suppl 1), 39–52. doi: 10.1007/s40279-017-0847-3
Pillsbury, L., Erdman, J., Oria, M., Erdman, J., Oria, M., & Pillsbury, L. (2011). Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. Washington, DC: National Academies Press.
Trojian, T. H., Wang, D. H., & Leddy, J. J. (2017). Nutritional supplements for the treatment and prevention of sports-related concussion-evidence still lacking. Current sports medicine reports, 16(4), 247–255. doi: 10.1249/JSR.0000000000000387
U.S. Food and Drug Administration. (2019). Traumatic Brain Injury: What to Know About Symptoms, Diagnosis, and Treatment. [cited 2020 17 October]. Available from: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378845.htm.