Important news for traumatic brain injury treatment.
Actress Natasha Richardson died from complications from bleeding in the brain after sustaining a traumatic brain injury (TBI) in a tragic skiing accident in 2009.
The Centers for Disease Control and Prevention defines a TBI as an injury caused by “a bump, blow or jolt to the head, or a penetrating head injury that disrupts the normal function of the brain.” The severity can range from mild, where the person suffers a brief change in mental status or consciousness, to severe, where there is an extended period of unconsciousness or amnesia following the trauma.
Most of the civilian TBIs that happen each year are concussions, which fall in the mild category, due to falls, motor vehicle accidents, and collisions with a moving or stationary object (e.g., sports injuries). Among civilians in the U.S. each year, it is estimated that 1.7 million people sustain a TBI, a contributing factor for nearly one-third of all injury-related deaths.
For military personnel, the majority of TBIs occur from blast injuries. TBI is a significant cause of mortality and morbidity among soldiers in conflicts in Iraq and Afghanistan. There has never been a single successful pharmaceutical treatment for TBI, yet there is evidence that nutrition can affect brain function in both healthy and injured people.
A surprising new recommendation from military-funded research urgently states that those who suffer a severe traumatic brain injury (TBI) should receive adequate calories and protein within the first 24 hours post-trauma, and for the first two weeks of treatment.
Dr. John W. Erdman, Professor Emeritus of Nutrition and Food Science, University of Illinois says, “Before now, existing guidelines about how soon to feed or not feed were all over the map. Until this study, there has been nothing that has pulled together all of the evidence-based data focused on TBI.” Erdman is Chair of the research committee commissioned by the Department of Defense to conduct a comprehensive review about the role of nutrition in TBI treatment over the last decade.
Surprisingly, research showed a significantly more positive outcome following feeding of calories and protein within the first 24 hours of a severe TBI, as brain inflammation was greatly reduced compared to other protocols. Early nutrition should be provided intravenously or via nasal tube for patients who are severely injured and unable to feed themselves. The recommended level of nutrition is calories, in the form of glucose, representing more than 50% of the patient’s total energy expenditure, together with 1 – 1.5 g of protein per kilogram of body weight. This feeding should be continued for two weeks, as inflammation usually peaks within that time frame.
Erdman says, “The brain uses glucose essentially for 100% of its fuel, unlike other organs in the body which use fat and other nutrients. Glucose has to be maintained, but the data has shown us that protein is also really important for rapid recovery and reduction of inflammation.”
The study will now continue to evaluate other specific nutrients showing positive potential: choline, creatine, n-3 fatty acids, and zinc. Investigations about the benefits of vitamin D, antioxidants, resveratrol, curcurmin and ketogenic diets will also be investigated, but not with the same urgency.
Military researchers and sports organizations are sharing findings, particularly about better treatment for concussion. Every case is different, but there are parallels between the damage that occurs from repetitive blast injuries on the battlefield and repetitive hits to the head sustained by some contact sports players. Experts hope that this new recommendation and ongoing research will lead to better outcomes for anyone who suffers a TBI.
CONNECT THE DOTS
Visit the CDC site for more information about Traumatic Brain Injury and the leading causes. To read the full report “Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel”, visit the Institute of Medicine of the National Academies.