Nutrition A Paradigm Shift In The Treatment Of TBI and Strokes

Recently the Department of Defense together with the Institute of Medicine published ‘Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011)’ 

In the report, there were a number of nutrients found to be effective.  While there are a number of them found naturally through food sources including polyphenols which are rich in botanicals including Turmeric, Amalaki, Haritaki, Gymnema, Green Tea, Guggul, Cocoa, Cinnamon, and Cayenne Pepper, the Essential Fatty Acids (EFAs) including the Omega 3s EPA and DHA found in fish, fish oil and algae, and the essential amimo acids including Alanine, Arginine, Aspartic Acid, Cystin, Glutamic Acid, Glycine, Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Proline, Serine, Thereonine, Trytophan, Tyrosine, Valine found rich in whey isolate protein (if using a whey isolate that is 100 percent casein free it can be used by one following a GFCF diet)

“The branched-chain amino acids (BCAAs) (leucine, isoleucine, and valine) are nutritionally essential in that they cannot be synthesized endogenously by humans and must be supplied by the diet.  They differ from other essential amino acids in that the liver lacks the enzymes necessary for their catabolism.  If the results in mice can be reproduced in people, patients with traumatic brain injuries could receive the BCAAs in a drink.”~ Akiva S. Cohen, Ph.D., a neuroscientist at The Children’s Hospital of Philadelphia

There is a wealth of research linking nutrition to cognition.  Part of this may be due to the microbiome and research has found that food can change gut bacteria as quickly as a day.

The following are clips pulled from the report ‘Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011)

• Summary Full report to read online 
• Chapter on essential amino acids 
• Chapter on polyphenols
• Chapter on Omega 3s 

Branched –Chain Amino Acids and the Brain

In the brain, BCAAs have two important influences on the production of neurotransmitters.  As nitrogen donors, they contribute to the synthesis of excitatory glutamate and inhibitory gamma-aminobutyric acid (GABA) (Yudkoff et al,, 2005).  They also compete for transport across the blood-brain barrier (BBB) with tryptophan (the precursor to serotonin), as well as tyrosine and phenylalanine (precursors for catecholamines) (Fernstrom, 2005).  Ingestion of BCAAs, therefore, causes rapid elevation of the plasma concentrations and increases uptake of BCAAs to the brain, but diminishes tryptophan, tyrosine, and phenylalanine uptake.  The decrease in these aromatic amino acids directly affects the synthesis and release of serotonin and catecholamines.  The reader is referred to Fernstrom (2005) for a review of the biochemistry of BCAA transportation to the brain.  Oral BCAAs have been examined as a treatment for neurological diseases such as mania, motor malfunction, lateral sclerosis, and spinocerebral degeneration.

A list of human studies (years 1990 and beyond) evaluating the effectiveness of BCAAs in providing resilience or treating TBI or related diseases or conditions (i.e, subarachnoid hemorrhage, intracranial aneurysm, stroke, anoxic or hypoxic ischemia, epilepsy) in the acute phase is presented in Table 9-1; this also includes supporting evidence from animal models of TBI.

Clips from Table 8-1 Relevant Data Identified for BCAA

Aquilani 2008 TBI Randomized placebo-controlled trial Post injury supplementation of BCAAs

Disability Rating Scores DRS) improved significantly for treated patients while the score in the placebo recipients remained virtually unchanged.  68% of treated patients achieved DRS scores that allowed them to exit the vegetative or minimally conscious state.  From day 15 to discharge from rehabilitation center, further significant brain function improvement was detected in patients in treatment group; no improvement was detected in placebo.

Evangeliou 209 Refractory epilepsy Ketogenic diet, supplemented by powdered mixture of BCAA

Adding BCAA to ketogenic diet resulted in a 100% seizure reduction in 3 patients who had experienced seizure reduction on ketogenic diet alone.  Four patients who already had 50% reduction on ketogenic diet alone achieved an additional 20-30% reduction.    One patient who had 20% reduction on ketogenic diet alone, achieved 50% reduction after adding BCAA.

Cole 2010 TBI, lateral fluid percussion Postinjury, consumption of BCAAs

After being treated with BCAA for 7 days, in vitro analysis showed that hippocampal slices from injured mice incubated with BCAA fully restored  synaptic function

Clips from Summary

TBI has been associated with neurological disorders, neurodegenerative disorders (e.g., Alzheimer’s disease, Parkinson’s disease, and chronic traumatic encephalopathy), neuroendocrine disorders, psychiatric and psychological diseases, nonneurological disorders, and musculoskeletal dysfunction.  Managing this multifaceted disease is a challenge.  Given TBI’s complex pathobiology and acute, subacute, and long-term effects both the timing and duration of administration of any potential interventions are important to consider.  Nutrition has emerged as a possible approach for the prevention of or therapy for injuries to the brain, including neurodegenerative disorders and ischemia.  DoD requested that the Institute of Medicine (IOM) convene and ad hoc committee to review the existing evidence for the potential role of nutrition in providing resilience or treating the acute and subacute effects of neurotrauma, with a focus on TBI.

In spring of 2010, the IOM appointed a committee of 11 experts with extensive knowledge in the areas of neurology; nutritional sciences, clinical nutrition, and dietetics; physiology; physical medicine and rehabilitation; psychiatry and behavioral science; biochemical and molecular neuroscience; epidemiology/methodology; and the pathobiology of TBI.  Two public workshops featuring presentations by civilian and military subject matter experts in TBI provided important information for the committee.

Clip from Conclusions and Recommendations

This report emphasizes the importance of nutrition not only to augment overall defensive mechanisms against the effects of TBI but also as postinjury treatment to lessen the acute and subacute effects of TBI.  The committee found that the majority of clinical guidelines for TBI do not specifically address optimal nutritional support for TBI.

About Omega 3s if purchasing fish oils from Amazon

Warning from Nordic Naturals

The professional line of Nordic Naturals is the preferred line by most.  You can only purchase the professional line at an authorized distributor online such as http://www.speech411.com or https://getiqed.com/collections/nordic-naturals-professional or from a healthcare professional. Very few online sites are authorized to sell the professional line even though you can find it all over, for example on Amazon.  There has been a rise in fraudulent sellers including on Amazon.  Don’t purchase the professional line of Nordic Naturals at Amazon as nobody selling there is authorized to sell there.  The issue with that isn’t just buying a product that wasn’t authorized to be sold on a particular website.  Amazon has a problem with fraudulent sellers mainly from China (see some of the references below) and this problem is not just limited to fish oils, and it’s not just limited to Amazon.   Nordic Naturals has hired a company to help them as they purchased some of the bottles or NN ProEFA 369 sold on Amazon and some were packed with cotton. They do not pack their fish oils with cotton which means you do not know what is in those capsules, or where they were packed.  As you can see from the links below at times the product’s exact description and sometimes reviews all look legitimate.  When a product is counterfeit however and there are side effects or injuries,  the customer and the actual manufacturer are the ones that suffer. Example of how this is not just a fish oil issue

LISA GENG