How Food Can Influence Concussion Recovery: Part III

This is PART III of a three part series examining the relationship between food and concussion recovery. In PART I we delved into concussion pathophysiology and we discussed how it relates to cellular metabolism and the diet. In PART II we discussed omega-3 fatty acids, particularly DHA, and how they may support concussion recovery. I also attempted to establish some take home points. I will now provide three examples of daily menus that I would consider meeting the criteria discussed in those take home points. I included a fourth example of a typical day eating a modern western diet just for comparison sake.

This was written in 2016. I will try to update this post if new information comes out since this was written, but please be aware that this a information may become outdated before I am able to do so.

Again…the purposes of my blog posts are to facilitate thought and discussion or perhaps even motivate research to answer the remaining questions on this topic. That is all. If you think that you have a concussion, please go see a concussion specialist.

Keep in mind, these are just examples and they are clearly non-specific in terms of calories. Obviously the appropriate quantities of foods will need to be adjusted for the individual. I based this on what I would consider enough food for myself (a 170lb male) while not training in the weight room due to a concussion with calories ranging roughly between 2200 and 2500. The overall purpose is to give an idea on how the general approach will look. Also remember that a vast majority of concussion symptoms will resolve in 2-3 weeks, so eating this way can be considered temporary (3-8 weeks) when the sole purpose is neurological recovery. Regarding the evidence behind this approach, please see parts 1 and 2 of this series.

To establish the rough macronutrient profile estimates, I used Myfitnesspal.com. Note, that these macronutrient ratios would need further tweaking to get to the therapeutic level of ketones for seizure disorders (Protein + Carb : Fat = 4:1).  Adding Coconut oil, which is 62-70% medium chain triglycerides [1], will likely support modest increases in ketone levels despite having macronutrient ratios closer to 1:1. More research is needed to determine if macronutrient ratios more akin to the full ketogenic diet are needed for therapeutic benefit, however compliance will likely taper down, especially when one is accustomed to eating a diet that is much higher in carbohydrates.

coconut oil chart

Sample Menu Day #1:

Breakfast
-3 scrambled eggs
-3 pieces of bacon
-1 cup of spring mix salad greens
-1 cup of coffee with some creamer/Hot tea (no sugar!)

Lunch
-Large Salad with 1 grilled chicken breast and 1-2 tbsp of olive oil and vinegar dressing
-Unsweetened Ice tea or water with lemon

Dinner
-1 8oz. Salmon Fillet cooked and seasoned as you prefer (consider using one tbsp coconut oil here)
-One white baked potato with butter and preferred seasoning
(removing the potato can decrease your carbs and increase the Fat:carb+protein ratio considerably)
-Asparagus and Broccoli with butter and seasoning
-Unsweetened Ice tea or water with lemon
-One modest serving of fruit (small handful)…preferably berries (blackberries, raspberries, blueberries)
You could add unsweetened full-fat yogurt, heavy cream or coconut milk. You could also add a tbsp of coconut
oil here.

Snack (Can be eaten before and/or after lunch)
-1 serving of macadamia nuts
-1 cheese stick
-Chopped fresh veggies (carrots, celery, bell peppers, broccoli) with salt +/- olive oil based ranch dressing to dip

Macronutrients:
Carbs:  85g
Fat:  176g
Protein: 133g

Sample Menu Day #2:

Breakfast (my favorite on-the-go version)
-3 hardboiled eggs with salt
-Half of an avocado with salt
-1 cup of coffee with some creamer/Hot tea (no sugar!)

Lunch
-Salmon Salad in lettuce wraps
**not a great option for the dairy intolerant folks**
-Unsweetened Ice tea or water with lemon

salmon salad

Dinner
-1 8oz. steak cooked in butter or coconut oil
-One large sweet potato with 1 tbsp of butter or coconut oil
 (removing the potato can decrease your carbs and increase the Fat:carb+protein ratio considerably)
-Brussel Sprouts
-Unsweetened Ice tea or water with lemon
-One modest serving of fruit (small handful)…preferably berries (blackberries, raspberries, blueberries)
You could add unsweetened full-fat yogurt, heavy cream or coconut milk. You could also add a tbsp of coconut
oil here.

Snack
-2 handfuls of cashews
-A few slices of turkey
-Chopped fresh veggies (carrots, celery, bell peppers) with salt +/- olive oil based ranch dressing to dip

Macronutrients:
Carbs:  81g
Fat:  147g
Protein:  112g

Sample Menu Day #3:

Breakfast
-Paleo Egg Muffins (there are 500 million versions of these on the interwebs)
here is one minimalist example…
http://allrecipes.com/recipe/228091/paleo-omelet-muffins/
-1 cup of coffee with some creamer/Hot tea (no sugar!)

Lunch
Cilantro lime sardine salad in avocado
-Unsweetened Ice tea or water with lemon

Dinner

-8oz Grilled Tilapia with butter or coconut oil, lemon, and seasoning
-Plantains sautéed in butter or coconut oil
 (removing the plantains can decrease your carbs and increase the Fat:carb+protein ratio considerably)
-Roasted squash, zucchini, onions with butter or olive oil
-Unsweetened Ice tea or water with lemon

Snack
-Celery dipped in cream cheese
-Several slices of Salami

Macronutrients:
Carbs:  83g
Fat:  123g
Protein: 93g

Example of how NOT to eat when recovering from a concussion…

I tried to go conservative here to demonstrate the differences in macronutrient ratios. At first glance the example below will not seem over the top unhealthy to a lot of people, but the insulin response will be significantly different from the examples above.

Breakfast:
– 1 Wheat Bagel with cream cheese
– 1 8oz glass of orange juice

**The avoidance of fruit for breakfast me come as a surprise to some of you, but I really don’t think that breaking an overnight fast with a food that is primarily carbohydrate is optimal in this setting. Starting the day without boarding the glycemic rollercoaster seems like a good idea in most contexts, but I digress…

Lunch:
-Turkey Sandwich with wheat bread
-Potato chips (2 servings because no one eats just one serving)
-1 apple
-12oz Gatorade

Dinner:
-Spaghetti with sauce and meatballs
-Green beans with butter
-1 piece of garlic bread
-One chocolate chip cookie for desert

Snack:
-One serving of pretzels
-One nature valley granola bar
– +/- you favorite milkshake, um, i mean coffee from Starbucks (Orange Mocha Frappuccino, of course!)

orangemocha

Macronutrients:
Carbs: 335g (add more if you’re partaking in the frappuccino)
Fat: 80g
Protein: 76g

A brief word on supplements:
As a general rule, I tend to prefer whole food sources of desired nutrients. With that being said, I recognize that some people don’t like the taste of fish and/or coconut oil. I am also open to the possibility that supratherapeutic levels of fish oil or MCT oil, via supplementation, may have added benefit for certain people within specific contexts.

For a great in depth discussion comparing eating fish vs. taking fish oil for health, please see this blog post, by Kris Kresser, who has a wonderful blog that is worth checking out. If you can’t tolerate whole fish, then I would consider adding a daily supplement of fish oil or DHA for a few weeks. If you make this choice, it is important to educate yourself, as not all fish oil supplements are created equal! For a fantastic and in depth guide on choosing a quality fish oil supplement, please see this blog post, again by Kris Kresser. It even takes sustainability into account, an increasingly important variable to consider when making food or supplement choices.

A major problem with supplementation, is determining the appropriate dose.  Recommendations in the literature have ranged widely for fish oil [2]. In the two ongoing trials evaluating DHA for concussion recovery, the doses range from 2.2g-3g a day. We will have to await the results of these studies to comment intelligently on dosing, or supplementing in general.

These trials can be viewed here and here.

Coconut oil (which isn’t a whole food to start with) can be easily used to cook with and incorporated into foods. In fact, I use it somewhat regularly at baseline. It  can be further processed to isolate medium chain triglycerides which can also be used as a supplement. The benefit of pure MCT oil is that it is relatively tasteless and can be easily added to food.  If you don’t enjoy the taste of coconut oil, this maybe a viable alternative. Speaking from experience, you have to be very careful about how much you take in the beginning, as it can cause some pretty significant gastrointestinal distress. This can be mitigated through a very slow increase of the dose over several weeks. The doses of MCT oil used in the epilepsy literature range from 2-8 tbsp a day [3-5]. There is not enough literature to make specific dosage recommendations here either, so experimentation is certainly in order.

I would also add that checking ketone levels via a blood ketone meter takes a lot of the guess work out of it allowing you to be much more specific in your macronutrient profiles. I use one while trying to be in ketosis (for general health reasons) here and there. The problem with this, however, is that your average concussion patient will not buy into this, and remember, most get better within 2 weeks, regardless of their diet. For those with protracted recovery or with Post-Concussion Syndrome, however, there maybe greater motivation and a ketone monitor could be considered.

This concludes my three part series on How Food Can Influence Concussion Recovery. I hope that some of you found it informative and/or at the very least thought provoking. It was certainly educational for me to put together! I would love to hear your thoughts and questions. Thanks for taking the time to read.

References:

  1. Fernando, W.M.A.D.B., et al., The role of dietary coconut for the prevention and treatment of Alzheimer’s disease: potential mechanisms of action. British Journal of Nutrition, 2015. 114(01): p. 1-14.
  2. Barrett, E.C., M.I. McBurney, and E.D. Ciappio, ω-3 Fatty Acid Supplementation as a Potential Therapeutic Aid for the Recovery from Mild Traumatic Brain Injury/Concussion. Advances in Nutrition, 2014. 5(3): p. 268-277.
  3. Azzam, R. and N.J. Azar, Marked Seizure Reduction after MCT Supplementation. Case Reports in Neurological Medicine, 2013. 2013: p. 809151.
  4. Courchesne-Loyer, A., et al., Stimulation of mild, sustained ketonemia by medium-chain triacylglycerols in healthy humans: Estimated potential contribution to brain energy metabolism. Nutrition, 2013. 29(4): p. 635-640.
  5. Reger, M.A., et al., Effects of β-hydroxybutyrate on cognition in memory-impaired adults. Neurobiology of Aging. 25(3): p. 311-314.

 

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