The human skull is one of nature’s wonders.  Tough, durable, and capable of healing itself, the skull exists to contain and protect the most extraordinary of all things: the human brain.  Injuries to the head, and especially to the brain itself, therefore present serious concerns.  Patients who are recovering from a head injury often need special support.  Their initial injury may only be the beginning of a long, complex journey.  So, as part of Brain Injury Awareness Month, we’d like to help you understand what happens in the brain following a traumatic head injury, and some of the strategies that can boost recovery. 

The Types of Brain Injury 

All injuries to the head and/or brain are potentially serious.  Doctors divide impact-related brain injuries into three basic categories: 

Repetitive Head Injuries (or Repetitive Brain Trauma):  Common in contact sports, these recurring impacts typically do not result in the immediate presentation of symptoms but, over time, could lead to serious conditions like Chronic Traumatic Encephalopathy (CTE).¹  Families of CTE sufferers have reported that their loved ones experienced slowed thinking, mood swings and suicidal thoughts.  Former New England Patriots star Aaron Hernandez, who took his own life while in prison for murder, was later found to be suffering from ‘severe CTE.²'  The raw physics of a given sport is obviously an important factor; research has found that playing ‘tackle’ (i.e., full contact) football results in a hugely increased incidence of repetitive heat injuries compared to ‘flag’ (i.e., non-contact) football.³  An alarming number of former football players are adjudicated to have suffered from CTE, and the rate of neurodegenerative disease among that cohort is elevated by 300-400%.⁴  Boxing and ice hockey are also strongly implicated as sources of repeated head injuries that could lead to CTE.⁵  

Mild Traumatic Brain Injury (TBI):  The most common examples are concussions, also common in contact sports (and which, in the 1920s, gave rise to the expression ‘punch drunk’ to describe the signs of concussion in confused boxers).⁶  However, a mild TBI can also result from a fall, blunt trauma (being struck by an object), a car accident, an assault, and the blast effects from an explosion.⁷  Mild TBIs suffered during a car accident are often of the ‘coup contrecoup’ type (literally ‘strike and counterstrike’).⁸  In these injuries, the initial deceleration (resulting, for example, from a collision between the forehead and the steering wheel) causes an impact of the brain’s frontal region against the skull, and then the equal-and-opposite reaction causes corresponding impact damage to the rear.⁹  While doctors might label such an injury as ‘mild’ because it does not pose an immediate threat to life, these TBIs can have serious long-term effects.  Initial symptoms can include:^{10, 11, 12}  

• Memory problems (including an inability to remember the injury itself) 
• Confusion and disorientation 
• Problems speaking clearly or finding the right words 
• Headaches, dizziness, and blurred vision 
• A ringing in the ears 
• Nausea or vomiting 
• Sleep disruption 
• Emotional changes.  

Moderate and Severe TBI:  These can be caused by a blow to the head or by penetrating injuries such as gunshot wounds.  Vehicle accidents and assaults can also cause these injuries, which tend to be more disabling, to have life-long implications, and to require costly treatment.¹³  Falls which cause a TBI were the leading cause of death among seniors in 2020, a group who are already at risk for dementia which, as we’ll see, is a worrying TBI outcome.¹⁴  Over 54% of all US suicides in 2021 were carried out with a firearm, making this one of the most common forms of severe (and ultimately fatal) TBI.¹⁵ 

The symptoms of moderate and severe TBI are similar to those of mild TBI, but they are more pronounced and longer lasting.  For instance, a moderate TBI results in at least 30 minutes of unconsciousness, while a severe TBI can knock out the patient for over 24 hours.¹⁶ 

Brain Injuries and the Risk of Dementia  

Head injuries and TBIs can result in Post-Concussion Syndrome (PCS) which brings a range of symptoms including poor sleep, pain, mood disorders, reduced motor function, and cognitive impairment.¹⁷  There may be structural changes including a loss of the physical integrity of the brain, as well as damage to specific brain regions responsible for cognition, memory, or motor function.  Disrupted neural circuits communicate less efficiently with other parts of the brain.  Neural tissue often becomes inflamed, leading to cell damage, the loss of neurons, and the formation of tau tangles, abnormal protein collections which are strongly linked to neurodegenerative diseases.^18,19  It is now clear that TBIs can bring about progressive neurodegeneration that can harm brain health for years - or even decades - after an initial injury.²⁰ 

As you read on, our focus will turn to the connection between TBIs and future dementia (and what we can do about it).  Keep in mind, a TBI can be caused by anything that has the force to momentarily but rapidly shift the brain within the skull. ²¹  This includes falls and other accidents, impacts during contact sports, vehicle crashes and – in war zones or the sites of industrial accidents (e.g., the August 2020 ammonium nitrate explosion in Beirut) blast effects.²²    

Dementia and TBI: The Timeline  

The injuries caused by a TBI are discussed medically in two ways.   

1. Primary Injury.  The primary injury is the set of immediate physical or mechanical effects, including fracturing of the skull, tearing of nerve fibers, damage to blood vessels (which can lead to intracranial bleeding), metabolic changes, and brain swelling.²³  The type of damage will depend in part on whether the injury is penetrating (causing an open wound, e.g., the result of a gunshot) or nonpenetrating (e.g., coup-contrecoup, or a fracture which does not leave an open wound).²⁴  These effects can lead to visible symptoms such as a loss of consciousness, confusion, headache, nausea, or blurred vision.²⁵ 

2. Secondary Injury.  Secondary issues include the body’s response, which centers around increased inflammation in the brain (known as neuroinflammation). Other potential issues include:

• Insufficient blood flow to the brain (ischemia) 
• Insufficient oxygen in the brain (hypoxia) 
• Excessive CO2 in the blood (hypercapnia) 
• Low or high blood pressure (hypotension or hypertension) 
• Swelling of the brain (cerebral edema) 
• Increased pressure within the skull, potentially leading to the displacement of brain matter 
• Meningitis, an infection in one of the three meningeal layers that protects the brain 
• Biochemical changes including levels of neurotransmitters and minerals (e.g., sodium and potassium) 
• Epilepsy 

3. Recovery Phase. Once these effects are diagnosed and treatment has begun, the patient enters the Recovery Phase.  During this time, they may continue to experience headaches, dizziness, fatigue, difficulty concentrating, memory problems, and mood swings. 
4. Long-term effects. Then, over the months and years following a TBI, individuals may continue to experience long-term effects, including:

• Chronic neuroinflammation, which plays a major role in neurodegenerative disorders, including Alzheimer’s disease and Parkinson’s disease ^{26, 27, 28}
• Cognitive impairments – difficulties with memory, attention, problem-solving, and language due to disruption within neural networks 
• Physical effects ranging from motor (movement) impairments to chronic pain and headaches 
• The continued formation of tau tangles and the buildup of amyloid-beta, two proteins which are strongly implicated in the onset of Alzheimer’s disease and related dementias  
• Emotional challenges such as mood swings, depression, anxiety, or irritability. 

Taken together, research indicates that individuals who have experienced a moderate to severe TBI have a 200-400% higher risk of developing dementia later in life.²⁹  That’s a worrying statistic, but this isn’t the end of the story.   

Taking Action 

There are now extensive opportunities for rehabilitation following a TBI which extend far beyond the initial assessment by a doctor.  Research has shown that lifestyle and dietary interventions can play a pivotal role in fostering recovery and promoting brain health, particularly:³⁰ 

• Improving Sleep:  Prioritize quality sleep to facilitate post-TBI brain healing and restoration. 
• Regular Exercise:  Incorporate aerobic exercises, strength training, and balance exercises into your routine to support recovery and reduce the risk of secondary complications. 
• Participating in Cognitive Training:  Challenge your cognitive abilities through brain-stimulating activities such as puzzles, memory games, and learning new skills. Cognitive training can help strengthen neural connections and improve cognitive function following a TBI. 
• Eating a Whole Food Diet:  The Western diet (also known as the Standard American Diet) has been found to worsen the impact of TBIs, especially given that it is high in unhealthy fats, refined sugar, and high-fructose corn syrup.^{31, 32, 33}  The best alternative is to embrace a diet rich in whole (i.e., unprocessed, or minimally processed) foods, including fruits, vegetables, lean proteins, and healthy fats – all hallmarks of the Mediterranean and MIND Diets.³⁴  

During recovery from a TBI, adopting a Mediterranean-type diet can be helpful, and it may be beneficial to focus on certain specific nutrients: 

• Magnesium has neuroprotective effects (though it may only be part of the solution and more human studies are needed).^{35, 36}  A deficiency of magnesium in the injured brain is associated with excess glutamate and calcium in the brain (called excitotoxicity), which could significantly contribute to neurodegeneration.³⁷  Other noteworthy minerals sodium and potassium, which could have shortfalls in injured brains.³⁸ 
• Omega-3 Fatty Acids can reduce oxidative stress in an injured brain.^{39, 40}  Two particularly important types of omega-3s are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). 
• B-Vitamins can play an important role in post-TBI recovery.  B3 (Niacin) has been shown to aid movement and memory, B6 (pyridoxine) can reduce the risk of edema, among other benefits, while B9 (folic acid) can strengthen synaptic functions, and B12 (cobalamin) can aid neuronal regeneration and neurological function.^{41, 42, 43, 44}
• Vitamin D can help to address neuroinflammation by reducing the presence of several pro-inflammatory cytokines.⁴⁵
• Vitamin E might reduce edema (brain swelling) and protect cognitive functions, though more human studies are needed for a complete picture of its benefits.^{46, 47}
• Resveratrol, an antioxidant found in grapes and red wine, reduces oxidative stress, and thereby mitigates the cognitive effects of a TBI.⁴⁸ 

A nutrient-rich diet, like the Mediterranean and MIND, offers all of these key nutrients.   

However, if you struggle to consistently follow a good diet, or need a practical way to supplement your nutritional needs, RELEVATE provides many of the nutrients listed above, plus others, for a total of 17 comprehensive brain health nutrients.  This month, we have a special offer including 3 jars of RELEVATE plus the book “The Official MIND Diet: A Scientifically Based Program to Lose Weight and Prevent Alzheimer’s Disease,” which helps to set yourself up on a 6-week MIND diet transformation.  In addition, you’ll receive additional tools, including a 3-month meal and grocery planning pad to help you gain the confidence to make nutritious choices on a daily basis.  Additionally, find a 6-day MIND meal planning inspiration sheet included for your ease in finding new meals or snack ideas.  Plus, you'll get a vibrant MIND diet food groups magnet with weekly servings, keeping your meal planner visible and reminding you of your goals as you embark on your personal MIND diet boot camp!  Learn more and shop by visiting here.   

Acting swiftly after experiencing a TBI can significantly aid in recovery and lower the risk of neurodegenerative conditions.  Stay mindful of your surroundings and decisions to prevent TBIs, and leverage lifestyle and nutrition strategies as powerful tools in your journey toward recovery.  

References

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