Category: Concussion TBI Therapy Study: DHA and B-Complex

Traumatic Brain Injury: A Brain Food Macronutrient Study (BFNS) of Fish Oil and B- Complex.

Introduction

Traumatic Brain Injury (TBI) is taking a sizable toll on society. Given military, sports and motor vehicle injuries there has been a 4.2 fold case increase since 1998 (Barrett et al., 2014). “TBI is one of the most disabling injuries causing motor and sensory deficits and leading to severe cognitive, emotional, and psychosocial impairment, crippling vital areas of higher functioning.” (Hasadri et al., 2013). Neurodegenerative disease, cognitive deficits, and Parkinson’s Disease affect patients in the long term (Omalu et al., 2006)(Omalu et al., 2010). Currently, there is no cure for TBI.

Utilization of macronutrients to replenish the brain biochemical nutrients upon injury is still in its infancy despite the Institute of Medicine’s TBI Nutrition report of 2011. More recently, the National Institute of Health (NIH) has published details on the efficacy of several brain nutrients including fish oil. They note that a cure must simultaneously attenuate several biochemical factors and “if used appropriately, there may not be a downside to using food agents for therapy.” (Scrimgeor & Condlin, 2014). Nutrition restores vital nutrients, is cost effective, and can possibly restore healthy tissue for the long term.

The brain macronutrient docosahexaenoic acid (DHA) is found in fish oil, free range meat, eggs, milk, and supplements. DHA forms a strong and flexible brain cell membrane given its double bonded structure. Having cell membrane constructed from DHA enables membrane signaling and transmission to function properly. Proper function manifests in accurate cognitive, motor and sensory activities in the brain. B-complex vitamins are the second major brain macronutrient. The B-complex vitamins found in grains, provide energy for mitochondria in the body, cofactors for neurotransmitter production, and substrates for nerve tissue construction.

Concussion patients in the Think Head First LLC, clinic are regularly treated with DHA and B- complex macronutrients in addition to vitamin D, magnesium, and probiotics for concussion. While 26 patients at the clinic completed surveys for this study, only 17 patients were returning patients able to report post concussion (pre-nutrient) symptoms in addition to symptoms one month later (post nutrient). These 17 returning patients are grouped into three groups for analysis purposes. The first group consists of eight returning patients who report ingesting all five nutrients. The second group became our controls. They are five returning patients who ingested no nutrients. One goal of this study was to determine the efficacy of DHA. However, given that these five nutrients are prescribed simultaneously, we evaluate DHA in a third group of patients who at least ingested DHA.

Our data compare the average number of post concussion symptoms per patient (pre-nutrient ingestion) against the average number of symptoms per patient one month later (post nutrient ingestion). A one page questionnaire is utilized asking the patient to check initial post concussion symptoms (pre-nutrient ingestion) from a list of symptoms, list nutrients/drugs taken, then check symptoms from the same list one month later (post nutrient ingestion). We hypothesize that patients who are provided the brain macronutrients of fish oil, specifically docosahexaenoic acid (DHA) and B-complex vitamins, along with the micronutrients of magnesium, vitamin D, and probiotics will have fewer symptoms one month later. We also expect patients who have at least taken DHA will have fewer symptoms one month later.

Methods

Patients

All patients surveyed in this Brain Food Macronutrient Study (BFMS) were concussion patients who randomly visited the Think Head First LLC. outpatient concussion treatment clinic. They were informed of the research study, consented, and asked to complete the questionnaire. Patients completed the post concussive symptoms (pre-nutrient), nutrient/drug, and one month (post nutrient) symptoms sections. New patients only completed the post concussive (pre- nutrient) symptoms section. New patient post concussive (pre-nutrient) data is included in these analyses to identify the frequency of post concussive symptoms in the Results section below.

Supplemental Protocol

The concussion clinic regularly prescribes DHA, B-complex, vitamin D, magnesium and probiotic to their patients for concussion therapy. The brain macronutrient docosahexaenoic acid (DHA) is found in fish oil, free range meat and eggs, milk, and supplements. DHA makes strong and flexible brain cell membrane given its double bonded structure. Having cell membrane constructed from DHA enables membrane signaling and transmission to properly function which manifests in cognitive, motor and sensory activities in the brain. The nutrient dosage prescribed was 390mg DHA and 430mg EPA.

B-complex vitamins are the second brain macronutrient evaluated in this study. B-complex vitamins are found in grains, provide energy for the mitochondria in the body, cofactors for neurotransmitter production and substrates to construct nerve tissue. The B-complex prescribed contained: thiamine (B1) 100mg, riboflavin (B2) 50mg, niacin (B3) 50mg, pantothenic acid (B5) 100mg, pyridoxine (B6) 50mg, biotin (B7) 2mg, folate (B9) 200mcg, and cobalamin (B12) 250mcg.

Vitamin D is responsible for regulating bone health through control of calcium, phosphate and magnesium absorption. It is considered a hormone and actively circulates as calcitriol in the blood. Vitamin D is thought to have immune activity, decrease inflammation and be involved with neuromuscular control. The prescribed dosage was 5,000 IU.

Magnesium (Mg) is important in ATP energy production for the cell and phosphate regulation. Magnesium, potassium, calcium and sodium minerals interrelate. A large percentage of the population is magnesium deficient. The magnesium dosage prescribed was magnesium citrate 50mg, magnesium glycinate 50mg, magnesium maleate 50mg, and malic acid 275mg.

Probiotics aid in intestinal absorption of nutrients. As good bacteria for the intestines, probiotics keep gut tissue healthy and keep bacterial overgrowth under control. The probiotics prescribed are Theradophilus containing 3.0 billion viable microorganisms as Lactobacillus helveticus, Lactobacillus rhamnosus, and Bifidobacterium longum. Two capsules daily.

Results

Baseline post concussion symptoms for all patients

The questionnaires were completed by 26 patients. Patients were either new patients (n=9) completing the questionnaire post concussion (pre-nutrient) at the zero month timeline or returning patients (n=17) completing the questionnaire at the one month timeline (post-nutrient). All patients completed the post concussion (pre-nutrient) symptom section of the survey. In this first section, patients checked all symptoms experienced initially post concussion. There were 29 symptoms listed including: headache, ringing ears, depression, anxiety, eye tracking, unequal pupils, emotional, sad, tired, seizures, nausea, concentration, painful neck, blurred vision, agitated, unusual behavior, irritable, sleeping, slurred speech, double vision, memory, balance, restless, can’t recognize, lost concentration, dizzy, no energy, convulsions, and stutter.

The average number of post concussive (pre-nutrient) symptoms per patient given data from all 26 participants was 11.85. The most frequently experienced symptoms for these participants was 88% headache, 81% eye tracking difficulties, 69% balance, 65% tired and dizzy, 62% painful neck and memory problems, 60% sleeping difficulties, 58% nausea and concentration problems, and 54% anxiety. The remaining symptoms were experienced by less than 50% of the patients.

Findings for Group One – All five prescribed nutrients ingested

Of the returning patients, Group One (n=8) ingested all five prescribed nutrients (DHA, B- complex, vitamin D, Mg, and probiotics) during the one month post concussion. The average number of post concussive (pre-nutrient) symptoms reported in Group One was 18.06. Following ingestion of all five nutrients, the average number of symptoms at one month (post nutrient) reported was 10.75.

One patient experienced 12 concussions and reported 23 post concussion (pre-nutrient) symptoms, ingested the nutrients, then reported 24 symptoms one month later (post nutrient). This patient was atypical in having 12 concussions and in reporting an increase in the number of symptoms, all other patients reported decreases. If this patient is removed from Group One data, the average symptoms post concussion (pre-nutrient) is 17.21 and one month later (post nutrient) is 8.86.

Headache, eye tracking, painful neck, memory, balance and dizziness problems were experienced by 100% of the Group One patients while anxiety was experienced by 94%. Tiredness and sleeping problems were experienced by 88% while nausea and concentration difficulties were experienced by 75%. Group One, after ingesting all five nutrients, experienced the following reduction in symptoms: headache 35%, eye tracking 25%, balance 56%, dizzy 19%, tired 28%, memory 19%, painful neck 44%, sleeping 44%, nausea 33%, concentration 43%, anxiety 28%, depression 33% and emotional 16%.

Findings for Group Two – No prescribed nutrients ingested

Group Two (n=5) of the returning patients ingested no prescribed nutrients in the one month post concussion. Group Two reported a 7.80 average number of post concussive symptoms. One month later, these patients reported an average of 5.40 symptoms.

Initially post concussion, headache was experienced by 100% of these control patients. Eye tracking, nausea, blurred vision, balance, and dizziness were experienced by 60%. One month later, eye tracking, dizziness, concentration and sleeping problems were not reduced. Headache was reduced by 20%, nausea and balance difficulties were reduced by 33%, blurry vision reduced by 67%, and anxiety and tiredness by 50%.

Findings for Group Three – At least DHA ingested

Group Three (n=11) ingested at least the prescribed DHA. The average number of post concussive symptoms in Group Three was 16.55. During the following month, Group Three ingested the DHA. The average number of symptoms one month later (post nutrient) was 10.09.

The one atypical patient who experienced 12 concussions and reported an increase in symptoms after one month is included in the above findings for Group Three. If this patient is removed from Group Three data, the average number of symptoms post concussion (pre- nutrient) is 15.85 and one month later (post nutrient) is 8.05.

Eye tracking difficulties were experienced by 100% of Group Three, while sleeping, headache, tired, memory, painful neck, balance, and dizziness were experienced by 91%. Nausea, concentration problems and anxiety were experienced by 82%. One month later (post nutrient) symptoms were reduced by: headache 25%, eye tracking 20%, balance 70%, dizzy 65%, tired 35%, memory 35%, painful neck 55%, sleeping 51%, nausea 56%, concentration 45%, and anxiety 39%.

Table 1. BFMS – Results: Average Number of Concussion Symptoms Pre/Post Nutrient.

Table 2. BFMS – Results: Group One – All Five Nutrients. Most Prevalent Concussion Symptoms Pre/Post Nutrient.

Table 3. BFMS – Results: Group Two – No Nutrients. Most Prevalent Concussion Symptoms Pre/ Post Nutrient (control).

Table 4. BFMS – Results: Group Three – At least DHA. Most Prevalent Concussion Symptoms Pre-Post Nutrient.

Discussion

Initially, 26 patients completed questionnaires, of these 9 were new patients who had not yet begun nutrients. The data from these 9 patients initial post concussion symptoms was included in the results section above demonstrating that in our surveyed population the concussion patient experiences an average of 11.85 symptoms. Among these symptoms headache and eye tracking difficulties are most predominant.

The 17 returning patients became our main analysis dataset as these patients’ symptoms could be initially evaluated post concussion and one month post concussion. These returning patients were grouped into three groups. Group One (n=8) had ingested all five prescribed nutrients of DHA, B-Complex, Vitamin D, Mg, Probiotic. Group Two (n=5) had not ingested any of the prescribed nutrients. Group Three (n=11) had ingested at least DHA. (Members of Group Three may also be included in Group One.)

The Think Head First, LLC concussion clinic prescribes the five nutrients together (DHA, B- Complex, Vitamin D, Mg, Probiotic), such that our best analysis comes from evaluating the number of post concussion symptoms (pre-nutrient) as compared with symptoms one month later (post nutrient) given ingestion of all five nutrients. These Group One patients demonstrate an average of 18.06 post concussive (pre-nutrient) symptoms, and an average of 10.75 symptoms one month later (post nutrient). Group One patients having ingested all five nutrients show a 40% reduction in the average number of post concussion (pre-nutrient) symptoms as compared with average number of symptoms one month later (post-nutrient). If the one atypical patient (who demonstrates an increase in symptoms) is excluded from the dataset, the average number of post concussion (pre-nutrient) symptoms is slightly reduced to 17.21, however, the average number of symptoms at one month (post nutrient) is 8.86. These results indicate a 49% reduction in post concussion symptoms given the five nutrient ingestion of Group One.

While we would like to have evaluated DHA alone for this study, it is difficult to isolate the effect of DHA since these five nutrients were most frequently taken together. However, Group Three patients at least took DHA. These patients had an average of 16.55 post concussion (pre- nutrient) symptoms and reported an average of 10.09 symptoms one month later (post nutrient). Group Three patients demonstrate a 39% reduction in symptoms. If the one atypical patient is excluded from the dataset, an average of 15.85 post concussion (pre-nutrient) symptoms are reported with a reduction to 8.05 symptoms one month later (post nutrient). These Group Three results show a 49% reduction in symptoms in patients who at least ingested DHA.

Finally, Group Two consists of five control patients took no prescribed nutrients. These patients reported an average of 7.80 post concussion symptoms and an average of 5.40 symptoms one month later. Their average number of concussion symptoms reduced by 31%.

The five nutrient therapy given to Group One reduced concussion symptoms by at least 40% and possibly by 49% excluding the one atypical patient. These results are impressive. Albeit our sample population is small, but the results represent a 9% improvement over the no nutrient controls and an 18% improvement over the no nutrient controls if the one atypical patient is removed from the Group One dataset. Group Three, supplementing at least DHA, reduced concussion symptoms on average by 39% for these 11 patients, and 49% if the atypical patient is removed. Comparing the Group Three at least DHA dataset with the five nutrient dataset from Group One leads us to question whether a majority of the improvement in both groups has come from DHA supplementation. The results from this study demonstrate the efficacy of supplementing the five nutrients dataset as well as supplementing DHA post concussion. A larger more focused study with a more specific dataset, a larger sample size, and more controlled nutrient/drug intake would likely report additional data.

Additionally, we evaluated individual symptoms given the five nutrient and at least DHA therapies. In Group One, the five nutrients reduced the concussion symptoms of balance and dizziness by 56%, painful neck and sleep difficulties by 44%, and concentration problems by 43%. In Group Three, the at least DHA reduced the concussion symptoms of balance anomalies by 70%, dizziness 65%, nausea 56%, painful neck 55%, and sleeping difficulties by 51%.

Given these results in this small data set, the five nutrient therapy of DHA, B-Complex, vitamin D, Mg, and probiotic reduces post concussion symptoms. DHA ingestion reduces concussion symptoms approximately the same amount, however, DHA shows increased efficacy in decreasing dizziness and nausea. Further studies to evaluate these macronutrients would continue to alert health care providers and patients as to the efficacy of utilizing brain macronutrients to heal brain trauma.

References

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 May 14;5(3): 268-77. doi: 10.3945/an.113.005280. Print 2014 May. Review. PMID: 24829473

Hasadri L, Wang BH, Lee JV, Erdman JW, Liano DA, Barbey AK, Wszalek T, Sharrock MF, Wang HJ. Omega-3 fatty acids as a putative treatment for traumatic brain injury. J Neurotrauma. 2013 Jun 1;30(11):897-906.doi:10.1089/neu.2012.2672.Epub 2013 Jun 5.

Omalu BI, DeKosky ST, Hamilton RL, et al. (2006). Chronic traumatic encephalopathy in national football league player: Part II. Neurosurgery 59, 1086-1092: discussion 92-93

Omalu BI, Bailes J, Hammers JL, Fitzsimmons RP (2010). Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: The role of the forensic pathologist. Am J Forensic Med Pathol 31, 130-132

Scrimgeour AG, Condlin ML (2014). Nutritional Treatment for Traumatic Brain Injury. Journal of Neurotrauma 31:989-999. (NIH-R)

We express sincere appreciation to Think Head First, LLC for providing the opportunity to survey concussion patients for this study.  Thank you!!