What supplements may improve brain function after an injury?

Doctor's Answers (1)

Dr Ng Beng Yeong

"Psychiatrist with over 20 years of experience"

Many animal studies show that supplements have the potential for improving the effects of a brain injury but none have been shown to be of consistent benefit in human studies. Instead of focusing solely on supplements, it is important to talk about diet as well as most of our nutritional needs can be best obtained from food. May I suggest the following:

1.     Increase dietary omega 3 DHA in diet and supplements.

2.     Avoid sugar, alcohol, caffeine, stimulants, saturated/trans fats, highly salted foods

3.     Include many fresh, whole, organic fruits, vegetables and spices (especially curcumin) in the diet.

4.     One can supplement with antioxidants and phytochemicals

5.     It is important to correct any underlying nutrient deficiency

6.     Bear in mind that eating healthy foods is the most important.

7.     If sleep disruption, use melatonin or sleep formula.

8.     If there are headaches or pains when chewing food, one can consider puree or smoothie.

Sleep‐wake disturbances are prevalent in persons with traumatic brain injuries (TBI). It has been estimated that 40‐70%  have sleep-wake problems for years after TBI. This can worsen their related neurobehavioral impairments, which include: agitation, depression, anxiety, slowed processing speed, attention, memory and decision making. One possible treatment is to take time‐released 2‐5 mg melatonin caps 2 hours before bed nightly for 4 weeks. Positive outcomes of improved sleep quality, improved vitality and mental health, decreased anxiety & fatigue, have been reported. This treatment is generally considered safe.

Following TBI, one of the initial changes involves a dysfunction of the mitochondria inside the neurons of the brain.  Mitochondrial are responsible for energy production and are critical to the survival of neurons. The injury to the mitochondria leads to a condition called oxidative stress where individual atoms of oxygen that we inhale become very toxic to the brain. Next, the oxidative stress induces brain inflammation which leads to an assortment of degenerative diseases, The goals of nutritional intervention include the following: 1. Reduce brain inflammation; 2. Reduce oxidative stress; 3. Support brain neuronal repair; 4. Reduce glutamate excitotoxicity.

I will often recommend people supplement their diet with some Omega-3 or fish oil. Flaxseed oil is recommended to people who are vegetarians. Docosahexaenoic acid, or DHA, is a type of omega-3 fatty acid. Accumulating evidence suggests that DHA may act as a promising recovery aid, or possibly as a prophylactic nutritional measure, for persons with mild TBI.  It is also possible to obtain DHA via a diet containing fatty fish, flaxseeds, canola oil, soybeans, pumpkin seeds, tofu and walnuts.

Development of antioxidant strategies is of primary interest in ongoing efforts to optimize brain injury treatment. The overall trend of using antioxidant therapies to improve the clinical outcomes of TBI was positive. Both pharmaceutical and nutraceutical anti‐oxidants are being used and developed for TBI.

Supplements usage

The antioxidants found in vitamins C, E, and beta carotene help counteract free radicals (unstable molecules that damage the brain cells) and reduce inflammation in the brain. Curcumin, the bioactive component of the spice herb turmeric (Curcuma longa), has a long history of medicinal use due to its antioxidant and anti-inflammatory properties. There is some evidence of improved motor & learning performance, blood–brain barrier integrity, cognition & reduced cerebral edema in brain injured animals.

A major limitation to the therapeutic potential of curcumin is the poor solubility, low absorption from the gut, rapid metabolism, and rapid systemic elimination. Nevertheless, improved bioavailability is possible and a number of unique formulations have already earned the distinction of being generally recognized as safe from the US Food and Drug Administration. Another nutrient, creatine,  could improve cognition & behaviour, maintain mitochondrial function & improve cerebral vascular function, which is common during the initial, acute phase of TBI

Supplementation with Vitamins B3 (found in chicken and tuna), D (most dairy products, fatty fish such as salmon, tuna, and mackerel) & E (nuts and seeds, spinach, sweet potatoes) improved cognitive function following repetitive concussive brain injury. 

The anti-oxidant N-acetylcysteine is another important consideration. There have been human trials done after an injury during active military duty. Positive effects include decreased brain inflammation and oxidative stress markers, increased brain glutathione and reduced glutamate neurotoxicity. There is reduced brain oedema and cell death. N-acetylcysteine supports neuron regeneration and there is a substantial improvement of cognition and psychomotor performance. So far no safety concerns have been noted. It can cause nausea.

Zinc also has antioxidant effects. It reduces inflammation. Serum levels of zinc have been shown to decrease after mild TBI. Zinc supplementation after mild TBI may have potential benefits of reduced oxidative stress and inflammation, and decreased depression, anxiety and neuropsychiatric symptoms. More is not necessarily better as zinc can cause nausea at high doses.

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