According to the Centers for Disease Control and Prevention, an estimated 1.5 million Americans sustain some type of traumatic brain injury (TBI) annually. Almost a quarter-million people who experience a TBI are hospitalized and roughly 50,000 people die due to these injuries.
For those who survive a TBI event, full recovery can sometimes be challenging. A nutritionally dense diet, however, may be key to achieving that goal.
Natalie Gavi, MS, RD, a neurology dietitian with the UCLA Steve Tisch BrainSPORT Program, says there is quite a bit of ongoing research linking nutrition to recovery from moderate to severe TBI cases. She also noted there is more evidence around nutrition with moderate/severe TBI than with mild TBI (mTBI).
“There is still so much we’re learning, but right now we’re using nutrition as a way to support symptom management or manage side effects of mTBI, like headaches or concussions,” said Gavi. “We don’t have as solid of an understanding of the role nutrition has in healing mTBI, therefore a lot of the interventions are focused on symptom management.”
TBIs can range from more mild incidents that cause the head and brain to jolt forward or backward quickly, damaging or creating chemical changes to the brain, to higher-impact events that directly affect the brain and its function. Mild TBIs generally are not associated with periods of unconsciousness, but more severe injuries almost always are.
Mediterranean diet and brain health
According to Gavi, one of the more popular diets linked to promoting brain health after a TBI is the Mediterranean diet. Its brain benefits have been supported by research.
“I work a lot of my TBI patients towards a Mediterranean dietary pattern,” Gavi said. “As far as the evidence and the research shows, that style of eating has shown to be the most beneficial in terms of promoting brain health.”
The Mediterranean diet can vary, but in general it consists of high portions of fruits, vegetables, grains, legumes, nuts, fish and olive oil. Many people who eat according to this diet usually consume meat and dairy products in moderation.
Fish and omega-3 fatty acids have proven to be imperative for brain health, Gavi explained. However, consuming the proper source of omega-3s is just as important. Omega-3s are nutrients that come from food or supplements. They are responsible for keeping the heart, the immune system, and other organs functioning at a high level.
“There are different types of omega-3s,” Gavi said. “The omega-3s found in plant-based foods are not the same as the omega-3s that are necessary to support brain health. The omega-3s that we get from fatty fish are great for the brain. The brain is made up of fat and the fat is necessary for the electrical signals to fire and process at the correct speed.”
Gavi recommends fatty fish for that reason, but understands that not everyone can eat seafood. In that case, she recommends eating what the fish eat – microalgae – as a vitamin supplement to get the brain-specific omega-3s.
Fruits and berries associated with brain function
Adding antioxidant-rich fruits such as blueberries to a nutritional diet also can help improve cognitive functions. Pomegranates, for instance, have been linked to prevention of neuronal damage from free radicals in middle-age and older adults, leading to improved memory.
“When it comes to nutrition for brain health, I am a strong proponent of looking at varieties,” Gavi said. “Pomegranates are great, so if people enjoy them then they should absolutely incorporate them into their diet.”
Gavi said it is important to get multiple sources of antioxidants. The colors in each fruit and vegetable represent different antioxidants and polyphenols, which all play different roles in the body.
“The blue from the blueberries is going to provide a different benefit than the red in pomegranates, cherries and strawberries,” said Gavi. “However, with each patient the diet is going to be very individualized.”
Gavi explained not all people recovering from a TBI will like or be receptive to the same foods, so dietary plans will look different for each person.
Here are five foods she recommends for improving brain power:
- Berries: The flavonoids inside of blackberries, blueberries, raspberries and cherries are linked to improved memory.
- Green vegetables: Super greens such as spinach, kale, broccoli and collards are high in vitamin K and have been proven to slow cognitive decline.
- Fatty fish: The high level of omega-3 fatty acids in fish such as salmon, herring, mackerel, sardines, halibut, trout and tuna assist with the elimination of beta-amyloid (a protein that produces clumps most commonly in the brains of patients with Alzheimer’s disease).
- Walnuts: Protein and healthy fats in walnuts help improve memory and focus.
- Coffee/tea: Some studies have shown that coffee and tea drinkers who consume higher levels of caffeine perform better on tasks that require mental focus.
Are any foods bad for the brain?
Gavi said she is careful not to villainize food, but instead takes an “all food fits” approach.
“For example, if all you’re eating is highly processed foods, then that could have a negative impact on brain function over time,” she said. “On the flip side, if you’re following a Mediterranean dietary pattern and you have an occasional burger or pizza, it’s not going to hurt you.”
However, some studies advise people recovering from TBI to avoid the following foods, as excessive consumption can negatively affect the brain over time:
- Alcohol
- Soda/sugary drinks
- Fried foods
- Cakes/doughnuts
- Red meat
- Butter and cheese
The brain-gut health connection
Understanding the brain-gut interaction is key when it pertains to brain function and nutrition, Gavi stated.
“We’re learning so much more about the gut-brain interactions and the role the microbiome has on brain health,” she said. “What I like to do is find out what types of fermented foods my patients actually enjoy and find ways to incorporate that into their diet so we are promoting diversity in the gut microbiota as much as possible.”
Gavi said much of the research behind fermented foods shows how proper gut health can support brain health. Some of the fermented foods she recommends include sauerkraut, pickles, yogurt and kefir (drinkable yogurt). She also recommended adding certain prebiotic foods to the diet such as onions, banana and whole grains.
Managing dietary patterns
Helping people recovering from a TBI migrate to a healthier diet is just part of the work. Some TBI injuries can affect appetite, Gavi said, as the brain may not properly communicate with the gut, making it difficult for an individual to realize they need nourishment.
In addition, if someone who has suffered a TBI is experiencing depression or anxiety due to the injury, this may alter their desire to eat altogether.
“As far as managing the eating schedule, it’s important to make sure that the patients are not skipping meals or snacks. They should be eating every four to five hours,” Gavi said. “A lot of mTBI patients, especially athletes who are removed from their sport, sometimes go from eating on a schedule to not eating as much or not eating at all. Their eating schedule is thrown off, so I help them get back to recognizing their cues on when it’s time to eat.”
Gavi said finding the right dietary fit for patients requires trial and error, but research continues on how to better support people recovering from a TBI.
“We don’t have a lot of research that shows how diet can impact the brain right after an injury, but it is something we are learning more about,” Gavi said.
To learn more about traumatic brain injuries, visit the UCLA Steve Tisch BrainSPORT Program.
