A bang on the head – nutritional strategies for concussion and head injury in young athletes

Every year, around 700,000 children under the age of 15 attend Accident and Emergency after a head injury, which is a shocking number. While most of them recover quickly, a full recovery is not always straightforward.

Current estimates suggest that up to 30% of children who suffer a sports-related mild traumatic brain injury (mTBIs) go on to develop medium-or long-term symptoms. These include difficulties with concentration and learning, as well as mental health challenges such as low mood and anxiety and even the inability to participate in everyday activities due to poor energy levels.

Whether it is a concussion from rugby, repeated headers in football, or a fall from a bike, a pony or a skiing accident, a blow to the head poses a risk for both short and long-term cognitive problems that can affect both mental acuity and mood.

Understanding why some children bounce back while others struggle is critical. In this blog, I explore what the latest nutrition research reveals, and I discuss practical steps to support healthy brain recovery after a head injury.

Sarah’s story

Writing this blog reminds me of a story of a young girl, whom I will call Sarah. Aged 9, she fell off her pony and hit her head against a stone wall. This head injury triggered a state of chronic fatigue and severe brain fog, which lasted several years. I first met her when she was about 14 years old, and at that time, she spent most of her day in bed and was not at school.

The breakthrough was when we discovered through lab tests that she had severe nutrient deficiencies. And once these were optimised, she was soon out of bed and back riding, and eventually got back to school. The good news is that that is all behind her now, she is in her early twenties, runs her own equine business and is happy and flourishing. But it shows what can happen when an injury gets you into a rut.

Why are knocks to the head so dangerous?

The emerging consensus amongst brain trauma researchers is that knocks to the head result in mild to severe brain injury, and every new hit or fall contributes to brain damage that can potentially result in neurodegeneration like poor memory later in life.  

Brain injuries due to a bash to the head are described as ‘now’ and ‘later’ diseases – those that affect the child immediately and then those that can affect them across their lifetime.

‘Now’ brain injuries: include head injuries that require immediate removal from play, medical examinations, and a considerable amount of recovery before the person can return to play. This is usually due to a concussion.

Some of the symptoms can last from weeks to years, known as post-concussion syndrome, and can include pain, headache, dizziness, difficulty sleeping, feelings of PTSD, such as flashbacks, as well as a foggy brain.

Balance and coordination can be affected in children immediately following even just a few blows to the head. And these head injuries may also lead to cognitive processing issues such as impaired learning, memory issues and mood disorders.

Three or more mild traumatic brain injuries among rugby players have been associated with significant long-term cognitive deficits in memory, processing speed, and attention, as well as heightened impulsivity. Head injuries have also been linked to the onset of depression and low mood.

‘Later’ brain diseases: these include disease-states caused by repeated traumatic brain injuries, and they may also occur due to repetitive minor hits to the head that are not enough to cause a concussion. Later-onset brain diseases are usually associated with cognitive and neurological damage sustained over time rather than a single injury. These may include regularly heading the ball in football, tackling in rugby, being hit by the boom while sailing or being struck in the head in fighting sports like boxing.

Regular sub-concussive brain injuries from impact sports can potentially lead to neurodegenerative disease and linked to a condition called Chronic Traumatic Encephalopathy (CTE), which is a form of early-onset dementia. Progressive brain atrophy, together with other forms of dementia, motor neurone syndrome, Parkinson’s and other conditions, is also linked to regular hits to the head through high-impact sports.

This is partly why researchers have been looking (in addition to safer practices in sport) for other practical ways to prevent any repercussions from head injuries and to help recovery when a child does sustain a nasty bump to the head. Nutrition is one angle that has shown real promise in reducing the impact of head injury. And this is why educating parents and children about the importance of the food they eat and the dietary supplements they take is key to long-term brain health and cognitive function.

Why does nutrition count?

A striking example of why nutrition counts comes from studies of athletes entering the National Football League (NFL) in America, which have found common deficiencies in omega-3 fatty acids, vitamin D and magnesium. Even though they are high-performing athletes, these deficiencies increase the risk of slower recovery from a concussion. It was also noted that shortfalls in these key nutrients may affect brain health and cognition, as well as increase the risk of sports-related injuries.

Which nutrients can help when they have had a blow to the head?

• Protein – consuming enough protein is key as the amino acids (which are the building blocks of protein) help to repair injuries in the body and the brain. Think meat, fish, dairy, eggs, beans and pulses, nuts and seeds. Those people who eat enough protein soon after a mild traumatic brain injury may need a reduced hospital stay and improved recovery outcome.
• Omega-3 fatty acids – as well as ensuring your youngster eats plenty of oily fish, shellfish, walnuts, flax seeds and chia seeds, it is good to supplement with a fish oil or a vegan marine algae supplement. A study on Canadian elite rugby 7s, found that dietary intake of omega-3 fatty acids alone may not be enough to prevent the long-term consequences of concussion and brain injury during sports activities; and that athletes often need to take omega-3 supplements to mitigate neurological risks. Participants in studies receiving the DHA form of omega-3 became symptom-free and able to return to sport faster than those in placebo groups.
• Magnesium – supplementation with magnesium has shown potential benefits in the acute treatment of concussions. Magnesium-rich foods include dark leafy green salad leaves and vegetables, cacao/chocolate, nuts and seeds. Magnesium bisglycinate is one of the most neuroprotective forms of magnesium, and it is readily available as a supplement.
• Vitamin D – every cell in the body has a vitamin D receptor, including our brain cells. Vitamin D comes from sun exposure and eating oily fish such as mackerel and salmon. It has natural anti-inflammatory properties as it is a naturally occurring steroid, so it may play a role in the body’s response to inflammation from a blow to the head. People living in the northern hemisphere need to take a Vitamin D supplement from October to March due to lack of sun during the winter months.
• Choline – foods such as liver, egg yolks, chicken, fish, shiitake mushrooms, peanuts, and milk contain choline, which is a key brain food. One study found that people who experienced the worst post-concussive symptoms had shortfalls in their choline levels. Not enough choline was also associated with more prolonged somatic symptoms such as distressing pain, weakness and shortness of breath.

Other more novel approaches to supporting brain injuries and concussion include:

• N-acetyl cysteine (NAC), a supplement known for its antioxidant properties, has shown promising results in the treatment of concussions, particularly in reducing post-concussive symptoms and supporting traumatic brain injury. The studies suggest that NAC in supplement form can help mitigate oxidative stress and neuroinflammation (the damage from the blow to the head) typically associated with TBI, thereby improving outcomes. Dietary cysteine comes from protein-rich foods, including chicken, turkey, yoghurt, cheese, eggs, beans, sunflower seeds and peanuts.
• Pine needle extract (pinus radiata) contains antioxidants that seem to be very healing on the brain and has a great deal of research on cognitive acuity, focus and processing. It has been the focus of multiple studies, showing promising results for persistent post-concussion symptoms. This comes in a tasty tea or as a supplement.
• Palmitoylethanolamide (PEA) acts on the endocannabinoid system, which regulates many of our most critical bodily functions, including learning and memory, emotional processing, sleep, temperature control, and pain. PEA can help to reduce inflammation and pain, and is neuroprotective to the brain, which may help to prevent future neurological damage. You’ll find dietary PEA naturally in egg yolks, beans, coffee, cocoa/cacao, peanuts and soya beans.

The importance of good sleep hygiene

Enough good-quality sleep is particularly important for a young athlete with any kind of brain injury, and this may be partly due to the action of a hormone called melatonin, which we naturally produce to help us get to sleep each night. Melatonin is both anti-inflammatory and neuroprotective, and it helps us wind down and get to sleep.

Natural ways to create enough melatonin at night are to work on the circadian rhythm (when we wake up and when we go to sleep) by spending time outside at the start of the day and getting some natural light, and then cutting back on screen time in the evening, one to two hours before bedtime.

Food-wise, feed your young athlete plenty of cherries which naturally contain melatonin. The amino acid tryptophan helps to produce serotonin which binds with specific enzymes to produce melatonin. So encourage foods containing tryptophan, such as turkey, chicken, bananas, avocados, cashews, and peanuts. Melatonin is a prescribed medication in the UK but can be bought over the counter in other countries (even if you can get it I advise speaking to your doctor about it).

Round up

Accidents are inevitable when young athletes participate in contact and combat sports, and kids and teens can also easily tumble from their bikes or ponies. We never know when a youngster is going to sustain a head injury, so as a preventative it is essential for young athletes to learn to feed themselves as much of the good stuff as possible. Weaving in more nutritious foods as part of their day-to-day eating habits can equal greater resilience and better potential for recovery.

Even if you are an elite athlete performing at the top of your game through your natural talent, you still need to keep well focused on your nutrition and integrate enough protein, omega-3, magnesium, vitamin D and choline into your diet. And you may want to take professional advice and consider adding a supplement regimen to help soften the blow if you do, unfortunately, experience a head injury.

If you or your child has sustained a significant blow to the head or is involved in a high-level elite sport that has a high risk of head injury, and you want to protect both short and long-term brain health, then get in touch with our NatureDoc clinical team, who can run some laboratory tests to identify and advise on their specific nutrient needs.

Please remember to forward this blog to your children’s sports coaches or local sports clubs and anyone overseeing activities that involve a high risk of head injury. Thanks for spreading the word.

NB. This is an update of a blog originally published 17th March 2024.  

References

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