The role of nutrition in mild traumatic brain injury rehabilitation for service members and veterans

Issue title: Why Military Neurorehabilitation Research is Relevant to Everyone

Guest editors: David X. Cifu and Sidney R. Hinds

Article type: Review Article

Authors: Monti, Katrina^{a; b; c; *} | Conkright, MAJ William^{c; d} | Eagle, Shawn R.^e | Lawrence, David W.^{f; g} | Dretsch, LTC Michael^h

Affiliations: [a] Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA | [b] CICONIX LLC, Annapolis, MD, USA | [c] Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA | [d] Army – Baylor Graduate Program in Nutrition, Joint Base San Antonio, San Antonio, TX, USA | [e] Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA | [f] Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada | [g] Faculty of Medicine, University of Toronto, Toronto, ON, Canada | [h] Walter Reed Army Institute of Research-West, Joint Base Lewis-McChord, Tacoma, WA, USA

Correspondence: [*] Address for correspondence: Katrina Monti, E-mail: katrina.s.monti.ctr@health.mil.

Abstract: BACKGROUND:Veterans Affairs and the Department of Defense (DOD) acknowledge that nutrition may be a modifier of mild traumatic brain injury (TBI) sequelae. Military clinicians are considering nutritional supplements and dietary interventions when managing patients with mild TBI. Therefore, clinicians should be familiar with the current evidence for nutritional interventions in mild TBI and special considerations related to the military lifestyle. OBJECTIVE:This narrative review aims to summarize the existing evidence surrounding the role of special diets and select nutrients in mild TBI outcomes, gut microbiota changes, and special considerations for Service members and Veterans recovering from mild TBI. METHODS:We conducted a literature review in PubMed and Google Scholar limited to nutritional interventions and nine topics with primary focus on mild TBI, although we included some articles related to moderate-to-severe TBI where relevant: 1) ketogenic diet, 2) Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, 3) omega-3 fatty acids, 4) creatine, 5) vitamin D, 6) weight management, 7) gut microbiota, 8) caffeine, and 9) alcohol. We summarized key findings and safety factors where appropriate for each intervention. We also identified nutritional supplement safety and operational rations considerations and areas in need of further research. RESULTS:Preclinical studies and early human trials suggest that the specific nutrients and diets discussed in the current article may offer neuroprotection or benefit during mild TBI rehabilitation. Omega-3 fatty acids, creatine, and vitamin D are generally safe when taken within recommended guidelines. CONCLUSION:More evidence is needed to support nutritional recommendations for enhancing neuroprotection and mitigating mild TBI symptoms in humans. The DOD’s Warfighter Nutrition Guide recommends a whole food diet rich in antioxidants, phytonutrients, omega-3 fatty acids, micronutrients, probiotics, and fiber to optimize long-term health and performance.

Keywords: Traumatic brain injury, concussion, nutrition, diet, rehabilitation, gut microbiome, military

DOI: 10.3233/NRE-230241

Journal: NeuroRehabilitation, vol. 55, no. 3, pp. 281-294, 2024