Nutrition for Sport Concussion

Sport concussions have been an increasingly important issue over the past decade, especially in youth athlete populations. Despite increased awareness, recognition and treatment pursuits, the role of nutrition is often overlooked as a supportive means for sport concussion recovery. Many treatment protocols include passive and active care modalities, when in reality much of the disruption caused after a concussion can be explained by nutritional deficiencies or issues with energy production in the central nervous system

Although much of the research is still in its infancy, the integration of a safe and low risk nutritional approach may not only be protective, but have the potential to enhance recovery. Outlined below are some key interventions that should be considered in post-sport concussion treatment, as well as tips for possible prevention or earlier recovery from symptoms

Managing Appetite

Sport concussion symptoms such as nausea, headaches and fatigue often contribute to decreased appetite which can limit energy and key nutrient intake to support recovery. It is crucial throughout the recovery process that athletes regularly consume healthy meals and snacks.

If athletes are experiencing low appetite, consider the following:

· Consume small, frequent snacks throughout the day from easily digestible foods including crackers, toast, soups, yogurt, avocado or rice puddings, oatmeal, nut butters, chicken and fish. Small, frequent meals can also help manage nausea because an empty stomach will worsen symptoms.

· Liquid meal replacement options can provide vital nutrients and support daily hydration

o Liquid meal replacement drinks such as Boost, Ensure, Carnation Breakfast, Vega or Rumble Super shake.

o For athletes over the age of 18, a carbohydrate and protein recovery supplement can also be considered, but only after speaking to a qualified sport dietitian or sport medical doctor to discuss options.

Hydration

Headaches are a common symptom of post sport concussion syndrome (Institute of Medicine, 2011), and dehydration can worsen symptoms. A simple pee colour check can be the first step. Urine should be pale yellow in colour – if darker, work on drinking more fluids to rehydrate.

To improve hydration, consider the following:

· Consume hydrating beverages throughout the day including water, dairy or dairy alternatives, smoothies, coconut water, electrolyte beverages including Nunn, meal replacement drinks, 100% fruit juice, and cold or hot soups.

· Drink extra fluid at meals and snacks.

· Choose liquid meal replacement options when appetite is low.

· Avoid alcohol, which can contribute to dehydration.

Important Tip: if the athlete is waking up multiple times throughout the night to use the bathroom, they may need to cut back on fluids, especially before bed. When recovering from a concussion, one of the most crucial aspects is sleep, and any disruption likely contributes to a longer recovery process

Omega 3 Fatty Acids

The most researched nutrient relating sport concussions recovery are omega-3’s which is a type of fat known at polyunsaturated fat. There are three types of omega 3’s, and of these docosahexaenoic acid (DHA) is most abundantly found in the brain. (Arterburn, Hall, & Oken 2006; Scrimgeour & Condlin 2014). DHA has been the focus of much research around sport concussion recovery and studies have shown promise in its role on reducing brain damage and cognitive decline after a concussion injury (Rawson, Miles & Larson-Meyer 2018).

Although there is no current dosing consensus, injured athletes should increase their dietary intake of omega 3 fatty acids, especially DHA. Fish is the richest source of DHA (see Table 1). If considering a supplement, speak to a qualified sport dietitian who can recommend an appropriate and safe option and dose.

Creatine

The brain uses approximately 20% of the body’s total energy (Institute of Medicine, 2011). Concussion causes an energy crisis where the brain’s energy requirement goes into overdrive and looks for alternative energy options to meet demands and support healing (Ainsley Dean, Arikan, Opitz & Sterr, 2017; Giza & Hovda, 2015). This is where creatine can come into play. Creatine is a protein made in the body, but can also come from external sources such as animal proteins or a creatine supplement. After a sport concussion, creatine can cross the blood-brain barrier and provide an energy reserve to the brain, supporting the increased energy requirement to aid recovery (Institute of Medicine, 2011; Petraglia, Winkler & Bailes, 2011; Dolan, Gualano & Rawson, 2018).

Sakellaris et al. (2006 & 2008) examined therapeutic creatine supplementation in children and adolescents with severe concussions. Not only did the treatment group’s length of stay in hospital decrease, they also showed improvements in cognitive function, communication, self-care, and a reduction of headaches, dizziness and fatigue symptoms.

Polyphenols

Polyphenols are a category of plant-based compounds that can have health benefits. Resveratrol is a polyphenol found in foods such as grapes, blueberries and peanuts (HealthLinkBC, 2018), and curcumin is the active ingredient in turmeric spice. Both have shown promising results in reducing inflammation after a sport concussion, along with improving motor performance, visual memory, the brain’s protective membrane and it’s ability to adapt and compensate after injury (Ashbaugh & McGrew, 2015; Zhu., et al 2014; Petraglia, Winkler & Bailes, 2011). Currently, no resveratrol or curcumin supplement doses have been set and so athletes should instead look to add food sources of resveratrol to their diet and consider adding turmeric powder to soups, stews, curries and stir-fries.

Vitamins

Animal and clinical studies have examined the antioxidants Vitamin E and C to help reduce cognitive declines after injury, as both are present in high concentrations in the brain (Petraglia, Winkler & Bailes, 2011). Research findings suggest that a combination of Vitamin E and C results in better improvements in brain functioning, compared to results when given separately (Petraglia, Winkler & Bailes, 2011; Ashbaugh & McGrew, 2016).

What to Limit

Just as there are many nutrition considerations to enhance recovery, there are also those that have been shown to hinder recovery. Alcohol and foods high in saturated fat and refined sugar are important to avoid throughout the recovery process. Especially after a sport concussion, the consumption of alcohol can lead to dehydration, memory concerns, poor concentration and poor judgement. Drinking may also put an athlete at an increased risk of experiencing another concussion while still recovering from the initial injury, prolonging the recovery timeline (Opreanu, Kuhn, & Basson, 2010).

Foods high in saturated fat and refined sugar include deep fried and battered foods, chips, store-bought baked goods, candy, cookies and pop. These types of foods have not only been linked to the brain’s inability to adapt or compensate after injury, but also impair memory and worsen overall injury results (Wu, Molteni, Ying, & Gomez-Pinilla, 2003; Wu, Ying, & Gomez-Pinilla, 2004; Gomez-Pinilla, & Kostenkova, 2008; Wu, Ying, & Gomez-Pinilla, 2014). Injured athletes should limit intake of food high in refined sugars, and plan to choose healthier fats each day including olive oil, avocados, nuts, seeds and fatty fish.

Implementing a Nutritional Approach to Concussion Recovery

With the knowledge of what nutrients may aid in sport concussion recovery, the following steps can help athletes, coaches and other members of the support team apply the above nutrition considerations.

· Seek professional assistance: A qualified sport dietitian can educate athletes, coaches, parents and the medical team on key nutrition principles post injury. This includes education on grocery shopping and meal preparation to assist with sport concussion recovery.

· Track it: Include appetite and hydration monitoring along with other post sport concussion symptom recovery monitoring.

· Plan ahead: When travelling, review hotel and venue menus in advance and consider ways to increase omega-3, polyphenols, and antioxidant rich foods.

· Travel protocols: A qualified sport dietitian can work with the medical team to help develop sport concussion protocols that include nutrition consideration and can be implemented if an injury occurs while a team is travelling.

Key Tips for Athletes:

· Seek support from loved ones to help with grocery shopping and meal prep.

· Stay well hydrated

· Avoid alcohol and limit intake of saturated fats and refined sugars.

· Increase your intake of omega 3 fatty acid rich foods.

· Choose foods rich in resveratrol and add turmeric to your cooking.

· Choose vegetables and fruit high in antioxidants on a daily basis (ex. spinach, broccoli, bell peppers, avocados, strawberries and kiwi fruit).

· If considering a supplement, speak to your sport medicine doctor or a qualified sport dietitian to discuss the need, safety and specific dosing.