Have you or someone you know experienced a traumatic brain injury (TBI)? TBI is not a trivial occurrence and poses a significant public health concern around the globe. The Centers for Disease Control and Prevention estimates that each year a TBI is sustained by 1.5 million Americans and that 5.3 million people are living with a permanent TBI-related disability.
Navigating life after TBI can be challenging. The effects of brain injury can be long-lasting and lead to enduring changes in the lives of the person affected and the people who love them. Moreover, for many, it can be challenging to find effective treatment. As the medical community seeks innovative solutions, scientists continue exploring nutrients’ potential role in TBI prevention and recovery.
Omega-3 fatty acids have long been celebrated for their various health benefits, but can they play a role in TBI? While traditional medical treatments are crucial for TBI recovery, incorporating nutrition strategies may offer a complementary approach to healing and recuperation. This article will investigate the recent evidence to better understand the role of omega-3s in TBI treatment and care.
What is a TBI?
A TBI is a brain injury that results from a bump, blow, or jolt to the head or a penetrating head injury that disrupts normal brain functioning. TBIs can be broadly classified as penetrating and non-penetrating TBIs.
A penetrating TBI happens when an object pierces the brain tissue, such as when a piece of shrapnel hits someone. A non-penetrating TBI occurs when an external force is strong enough to move the brain within the skull, such as in a car crash. The cause of the TBI can dictate the short and long-term effects on the brain.
There are many different types of TBI, such as:
- Diffuse axonal injury (DAI): Refers to the widespread damage of the brain’s white matter and commonly occurs after car accidents, falls, or sports injuries.
- Concussion: A mild TBI that is often caused by a hit to the head or rapid movement of the brain within the skull.
- Hematomas: Refers to bleeding in and around the brain caused by a burst blood vessel.
- Contusions: Bruising or swelling of the brain after a very small blood vessel bleeds into the brain, commonly occurring when the head abruptly decelerates.
- Skull fractures: Breaks in the skull bones can lead to blunt force trauma of the brain tissue.
- Chronic traumatic encephalopathy (CTE): A progressive neurological disorder that may be caused by repeated TBIs over time.
- Post-traumatic dementia (PTD): PTD may arise after a single, severe TBI and shares some features with CTE.
Despite unique and individual differences in injury and symptomology, there are some commonalities across all types of TBI. Generally, pathological commonalities include excitotoxicity, ionic disturbance, decreased cerebral blood flow, edema, oxidative stress, inflammation, and damage or death to brain cells. These injuries can occur at the time of impact and can continue for months or years after the initial injury. For these reasons, TBI can be a very complex disease and is often challenging to treat.
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Traditional Approaches for TBI Prevention & Treatment?Â
Several factors, such as the type, severity, and location of the injury, will influence TBI treatment strategies. While concussions can be classified as mild, moderate, and severe, mild TBIs are the most common form and typically include recreational- and sports-related concussions.
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Over the years, progress has been made in the in-hospital treatment of more severe TBIs, however, treatment options for mild TBIs are less clear. Mild TBI treatment (mTBI) often includes rest and management of symptoms with over-the-counter pain relievers. Prevention of future concussions is also critical, so even after symptoms go away, it’s recommended to return to daily activities gradually. Moreover, dietary and supplementation protocols have been investigated to find additional neuroprotective strategies to help mitigate damage and advance recovery after TBI.
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Scientific Associations between Omega-3s and TBI Recovery
Omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are crucial for brain health but for different reasons. DHA accumulates in the brain and neural tissue’s cellular membranes, improving function and neural protection. EPA is more involved with vascular function, facilitating healthy blood flow and improving oxygen and nutrient delivery. Moreover, the metabolites of DHA and EPA provide additional benefits, acting as potent anti-inflammatory agents and regulating the inflammatory response. For these reasons, they have been explored as possible interventions for preventing and treating TBIs.
While human research on nutrition approaches to TBI care is limited, it is growing. A 2022 systematic review examined the evidence on nutritional interventions prescribed to people within 14 days of mild TBI and measured recovery outcomes. Eleven studies conducted across several countries were included in the review, and various nutrition interventions were assessed. Three of these studies investigated the effects of DHA and EPA on mTBI recovery when provided within 120 hours of injury. All three trials demonstrated that omega-3 fats facilitated symptom resolution and highlighted the potential for DHA and EPA to be used post-TBI to enhance recovery.
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Similarly, a 2023 systematic review aimed to consolidate the research explaining dietary interventions in humans with chronic symptoms (greater than 1 month) after an mTBI. The review identified nine studies with reported chronic symptoms that included cognitive difficulties, functional disabilities, mood disorders, and sleep disturbances. Of these studies, only two were identified as having investigated omega-3 supplements.
While the participants reported several improvements in symptoms, the studies included additional treatments, such as “brain coaches” or additional multivitamins, making it hard to determine whether these improvements were attributable to the omega-3s or the other interventions. After the review, the author’s main finding was that more high-quality studies are needed to advance the understanding of nutrition interventions in TBI care.
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New Review Outlines Nutrition Strategies to Mitigate TBI
Since there is limited research exploring nutrition approaches directly to TBI prevention and recovery, a group of scientists wrote a recent review (2024) that synthesized the current literature on the neuroprotective effects of supplements in the context of TBI and potential downstream symptoms. The reviewers emphasized human research and, where human studies were not available, discussed animal models and the mechanisms uncovered that could be studied in the future. The authors aimed to identify the nutrition interventions with low risk but a potential benefit to support those who have had or are at high risk for a TBI.
Among the supplements investigated, five studies using DHA and EPA were included. Based on the literature reviewed, the authors noted that the potential mechanisms of action by which DHA and EPA may benefit brain health include decreased neuroinflammation, attenuation of neurofilament-light levels (a biomarker of neuroaxonal injury), preservation of brain volume, improved cerebrovascular responsiveness and cognitive function; and reduced risk of Alzheimer’s Disease.
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The review concluded that a carefully designed omega-3 supplement protocol may benefit those with or at high risk of TBI since the Standard American Diet tends to be low in EPA and DHA. The authors further recommended regular consumption of 2-4 grams of EPA + DHA daily (ideally 2g from DHA) as a general guideline for those at high risk of head traumas.
This recommendation serves as both a preventative measure and as part of a treatment plan after a TBI occurs. This amount is generally recognized as safe and effective. Yet, the best way to determine omega-3 needs is first establishing omega-3 status. By measuring current Omega-3 Index levels, one can identify the precise dose necessary to meet individual needs.
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Summary
TBIs represent a significant public health concern, challenging to diagnose and treat. Yet, diet appears to be a modifiable risk factor contributing to brain health, and evidence supports the use of specific dietary approaches to mitigate the damage inflicted by TBIs. Certain nutrients, such as omega-3 fats, specifically DHA and EPA, may play a role in preventing and treating damage from a TBI.
The current evidence indicates that 2-4 grams per day of DHA + EPA could be a safe and effective dose to support those at risk of TBI. However, assessing current Omega-3 Index levels could also provide a more precise strategy to ensure optimal levels of omega-3 fats are bioavailable. While more research is still needed, particularly human research regarding mild TBIs and gender differences between TBI care and recovery, omega-3 fats are likely a low-risk approach for optimizing brain health and neural protection.
