Brain trauma helped by nutrition

By Dr. Ananya Mandal, MDApr 20 2011

According to a report by the Institute of Medicine, military personnel who suffer traumatic brain injury need to be fed adequately and immediately to reduce the severity of trauma and improve their chance of survival. This finding has implications for people sustaining head injuries in other situations, such as sports and traffic accidents.

According to the new nutritional recommendations food has been found to help traumatic brain injuries among military personal in the field. The report was commissioned by the U.S. Defense Department and released Wednesday. It says in the first 24 hours after head trauma, patients need to receive at least 50% of their typical calorie intake, including a higher-than-normal amount of protein, in order to reduce inflammation and swelling of the brain and provide enough energy to help the brain repair itself. The intensive nutrition regimen should be continued for at least two weeks, the report says.

John Erdman, a nutrition researcher at the University of Illinois at Urbana-Champaign, who headed the panel of independent experts that produced the report said, “The one major [conclusion] is a focus on getting protein and calories in as quickly as possible.”

It is known that traumatic brain injury, or TBI, among U.S. soldiers is a growing problem. The Defense Department says reported cases have tripled to more than 30,000 in the past decade, reflecting injuries from so-called improvised explosive devices, or IEDs, that troops frequently encounter in Afghanistan and Iraq. Apart from the military fields some 52,000 people in the U.S. die each year from TBI, and about 1.5 million patients report to emergency rooms annually with head injuries. As many as 3.8 million people suffer such injuries playing sports each year, says the Brain Trauma Foundation, a research organization. It can range from “mild” concussions, where a confused state or loss of consciousness lasts less than 24 hours, to “severe” episodes, where memory loss lasts more than seven days or even involves piercing of the outer layers of brain tissue.

Bruce Bistrian, a committee member and chief of clinical nutrition at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston added that early feeding was found to mitigate the effects of head injuries and reduce mortality in critically ill people by between 25% and 50%. Even if carried out intravenously, providing necessary nutrition can be challenging in the battlefield or when multiple injuries are involved, because the focus tends to be on stabilizing patients and getting them to safety. “While there's lip service paid [to adequate feeding], they're often not [getting it],” said Dr. Bistrian.

Some experts are also concerned about over-feeding, because the sugar level in the brain needs to stay in a normal range and too many calories can lead to high blood sugar. But low blood sugar is also dangerous and could impede recovery, the committee found. “Coordination among DoD researchers and clinical-care experts could certainly develop clinical research protocols to determine if evidence for benefit can be identified,” said Cynthia Smith, a Defense Department spokeswoman.

Questions remain, however, about how to provide the needed energy and what type of nutrients might be most helpful, said Fernando Gomez-Pinilla, a neurosurgeon at the University of California, Los Angeles an independent observer.