Evaluating and treating traumatic brain injury

There is no cure for traumatic brain injury (TBI), said Michael Lewis, MD, at the 2019 Institute for Functional Medicine Annual International Conference in San Antonio, Texas. But there is a way to effectively evaluate, treat, and manage TBI.

Evaluating and treating TBI should emphasize the importance of diet and exercise, targeted nutritional therapy, and correcting pituitary dysfunction.

Damage continues following the initial injury and can sometimes take years to visibly manifest. Symptoms range from impaired thinking and memory, physical symptoms such as headache, blurry vision, and nausea, emotional and mood such as irritability and sadness, and changes in sleep habits. 

Standard rehabilitation for TBI does address the brain itself, said Lewis. Nothing addresses neuroprotection, neuroinflammation, and neuro-regeneration following concussion or other form of TBI. In fact, the Centers for Disease Control and Prevention simply say to rest, take it slow, and talk to your healthcare provider.

Conventional treatments don’t exist for TBI, so what can we do? Lewis says we must manage neuroinflammation, achieve neuroprotection, and foster neuro-regeneration.

New technologies allow us to test cognition, including assessing vestibular function, EEG-based sideline tests, and eye-tracking diagnostics.

Diet and exercise are also important, and studies have found that participation in physical activity within one week after injury may benefit symptom recovery following acute concussion in children and adolescents. A 2016 consensus statement on concussion in sport says, “the basis for recommending physical and cognitive rest is that rest may ease discomfort during the acute recovery period by mitigating post-concussion symptoms and/or that rest may promote recovery by minimizing brain energy demands following concussion. There is currently insufficient evidence that prescribing complete rest achieves these objectives.”

Other studies say earlier initiation of aerobic exercise is associated with faster full return to sports, school, or work, and each successive day delaying initiation of exercise, individuals had less favorable recovery trajectory. Experts say exercise is medicine for concussion.

Specific nutrition tips can be implemented to treat TBI, Lewis said, including eating small meals every three to four hours; proteins including fish, lean meats, nuts, and eggs; healthy fats and oils including avocados, seeds, and nuts; carbohydrates, including vegetables, fresh fruits, and grains; avoiding simple carbohydrates; eating moderately; and avoiding overeating.  

Research has found that eating neuroprotective diets, like the Mediterranean diet, is linked to lower risk for memory difficulties in older adults, according to a study in the Journal of the American Geriatric Society. Benefits of this dietary approach include better memory, executive function, and visual constructs, Lewis said.

Targeted nutrition therapy is essential, Lewis said. Omega-3 fatty acids are important throughout life and support brain health, development, and function. An ideal omega-3 protocol, Lewis said, uses a concentrated triglyceride omega-3 product. One “dose” equals 3,000 mg of EPA/DHA combined. Start with one dose three times a day for a week (9000 mg), followed by one dose two times a day the next week (6,000 mg), and one dose as an ongoing maintenance dose, and for prevention of head injury.

Cannabinoids are potent antioxidants that protect neurons from glutamate-induced death. Cannabidiol (CBD) is emerging as potential treatment for depression, psychosis, addictive behavior, anxiety, and post-traumatic stress disorder, Lewis said.

Other supplements that work in TBI, though not an all-inclusive list, include creatine, branched-chain amino acids, vitamin D, probiotics, and magnesium, Lewis said.

Lastly, we need to correct pituitary dysfunction. Pituitary remains in place as the brain moves forward then backward. To test function, Lewis recommends testing for direct function, growth hormone, FSH and LH, TSH, ACTH, and function of target organs, IGF-1, testosterone and estrogen, free T4, free and reverse T3, and cortisol. Bioidentical hormone replacement therapy can they be used to correct imbalances, Lewis said.

Other interesting therapies for TBI include:

• Hyperbaric oxygen therapy
• Low energy neurostimulation
• Heart rate variability training
• Vision therapy

Editor’s note: This article is part of Integrative Practitioner’s live coverage of the 2019 Institute for Functional Medicine Annual International Conference. For a full list of coverage, click here.