Mitigating Traumatic Brain Injury: A Narrative Review of Supplementation and Dietary Protocols

Abstract

Traumatic brain injuries (TBIs) constitute a significant public health issue and a major source of disability and death in the United States and worldwide. TBIs are strongly associated with high morbidity and mortality rates, resulting in a host of negative health outcomes and long-term complications and placing a heavy financial burden on healthcare systems. One promising avenue for the prevention and treatment of brain injuries is the design of TBI-specific supplementation and dietary protocols centred around nutraceuticals and biochemical compounds whose mechanisms of action have been shown to interfere with, and potentially alleviate, some of the neurophysiological processes triggered by TBI. For example, evidence suggests that creatine monohydrate and omega-3 fatty acids (DHA and EPA) help decrease inflammation, reduce neural damage and maintain adequate energy supply to the brain following injury. Similarly, melatonin supplementation may improve some of the sleep disturbances often experienced post-TBI. The scope of this narrative review is to summarise the available literature on the neuroprotective effects of selected nutrients in the context of TBI-related outcomes and provide an evidence-based overview of supplementation and dietary protocols that may be considered in individuals affected by-or at high risk for-concussion and more severe head traumas. Prophylactic and/or therapeutic compounds under investigation include creatine monohydrate, omega-3 fatty acids, BCAAs, riboflavin, choline, magnesium, berry anthocyanins, Boswellia serrata, enzogenol, N-Acetylcysteine and melatonin. Results from this analysis are also placed in the context of assessing and addressing important health-related and physiological parameters in the peri-impact period such as premorbid nutrient and metabolic health status, blood glucose regulation and thermoregulation following injury, caffeine consumption and sleep behaviours. As clinical evidence in this research field is rapidly emerging, a comprehensive approach including appropriate nutritional interventions has the potential to mitigate some of the physical, neurological, and emotional damage inflicted by TBIs, promote timely and effective recovery, and inform policymakers in the development of prevention strategies.

Keywords: nutraceuticals; post-concussion syndrome; supplements; traumatic brain injury.

Figure 1

Proposed approach to assessment and intervention in those at high risk of TBI. (1) A full health assessment to screen for and address nutritional and metabolic health markers that may be associated with worse outcomes after TBI. (2) Consider a “left of bang” nutritional approach focused on compounds available in the diet that may mitigate the effects of impact or whose levels or requirements are potentially modified by the accumulation of multiple smaller impacts over time (e.g., creatine, choline, omega-3s). (3) Immediately post-impact, a focus on physiological parameters and sleep is likely to assist in recovery. Additionally, (4) and (5) show supplementation with higher doses of diet-derived compounds may be considered, in addition to other supplements with symptom-specific benefits such as melatonin. Figure made with Biorender.