feed the brain - brain injury association of massachusetts conference/annual... · –...

Feed the Brain:Nutrition and its Role in

Brain Injury Recovery

Demsina Babazadeh, MPH, RD, LDNClinical Registered Dietitian

Traumatic Brain Injuries and Stroke RehabilitationSpaulding Rehabilitation Hospital-Boston

Clinical Registered DietitianBrigham and Women’s Hospital

dbabazadeh@partners.org

March 29, 2018

Disclosure Statement

• Employee of Spaulding Rehabilitation Hospital and Brigham and Women’s Hospital

• No competing financial interest

Learning Objectives• Nutrition Basics

– Nutrients in food– Why are they important?

• Post Brain Injury– The change in demand for these nutrients

• Supplements– What is the evidence?

We’ve all got only 1 brain, need to keep it functioning optimally!

Nutritional Basics

http://excellentquotations.com/quote-by-id?qid=61094

What is in your food? Minerals

Vitamins

Protein +

Fat

Carbohydrates+

Fiber

Energy-yielding nutrients

CARBOHYDRATEPROTEIN

FAT

https://www.smartmeetings.com/meeting-planning/99039/serve-brain-food-next-event

Carbohydrates • Breaks down into glucose for energy

– Provides 45-65% of daily energy for the body– Average ~ 200 gram/day

• Complex vs. Simple • Under strict regulation

– If fed, excess is stored– When starving, body goes into ketosis

Ketosis• Ketones= by-product of fat

metabolism– Body’s glucose stores are completely

depleted– Minimum of 120 gm Carbohydrates

to prevent

• “Carb flu”

https://keto-recipes.com/keto-faq/what-are-macro-nutrients-and-why-are-they-important/

https://www.dreamstime.com/stock-illustration-keto-food-pyramid-nutrition-infographics-diagram-ketogenic-diet-image55874898

• Literally translates to the word “primary”• Nitrogen

– Toxic substance in the body– Excreted in urine

• Almost the ”universal” nutrient

• But NO storage in the body

Protein

So excess protein intake, nitrogen will be excreted in urine i.e., won’t be used and can’t be stored!

Nutrition Basics for Better Health and Performance. Elizabeth A. Applegate. Edition, 3, revised. Publisher, Kendall Hunt Publishing Company, 2017. ISBN, 152492368

Fats• Huge energy powerhouse

– Breakdown to 9 kcal/gram– Most Americans consume 1/3 of their calories from fat

o 270,000 calories per year 6,000 teaspoons of fat

• Vital fats have important roles in our body

https://www.dietdoctor.com/academy-of-nutrition-and-dietetics-stop-worrying-about-saturated-fat

What happens following a TBI andinsult has been done to the brain?

https://www.institute.org/health-care/services/diabetes-care/healthyplates/

Nutrients 2.0

CARBOHYDRATEPROTEIN

FATVITAMINSMINERALS

https://www.nchpad.org/1098/5547/Back~To~School~With~TEAM~AWESOMEhttps://joantwarren.com/2017/06/

Brain Demand• Carbohydrates are the main source of fuel preferred

by the Brain!– 25% of RMR/EER go straight to brain– 5.6 milligram glucose per 100 gram human brain tissue per minute

• Neurons have the highest energy demand, requiring continuous stream of glucose to excite

http://ib.bioninja.com.au/standard-level/topic-6-human-physiology/65-neurons-and-synapses/neurons.html

Carbohydrates 2.0• Need to help repair neuron firing • Grains and complex carbohydrates are preferred

– B-vitamins– Blood sugar balance

oFiber contentoHigh blood sugar mortality

https://www.livestrong.com/article/299539-how-many-calories-are-in-one-baked-sweet-potato/https://foodtolive.com/shop/organic-green-lentils/ https://repkefitness.com/blog/millersvillepersonaltrainer-carbs-blog/

Carbohydrates 2.0

Check the label:If the item has more SUGAR

than protein or fiber,there are better options to

choose from!

http://ogahealth.com/brain-idea-clipart/thinking-brain-idea-clipart-brain-clipart-free-download-best-rhclipartmagcom-idea-storm-pencil-and-in-color-rhmozirucom-idea-brain-idea-clipart-clipart-jpg/

Complex vs. Simple CarbohydratesAvoid

• Sweets• Refined Flour

(“white”/bleached flour”– This includes “Gluten Free”

• Sugar sweetened beverages

• Honey

Choose• Whole grains

(wheat/multigrain)• Beans and legumes• Sweet potatoes • Bright colored fruits• Green leafy vegetables

– Yes, vegetables have carbohydrates in them!

Fats 2.0 • Trans Fats• Saturated Fats• Monounsaturated Fats• Polyunsaturated Fats

– Omega-6 (AA)– Omega-3 (EPA, DHA,

ALA)

https://www.livestrong.com/article/86264-natural-fat-foods/http://ohthatstasty.com/friday-funnies/friday-funny-the-good-kind-of-fat/

Which Fats to chooseAvoid

• Trans fats• Cooking with Saturated

fats• Excessive Saturated fat

from animal products (dairy products are okay)

• Excess Omega-6 oils• Coconut oil/Palm oil

Choose• Omega-3s

– Fatty fish– Flax seed/oils– Grass fed/Free-range

meats and eggs• Monounsaturated fats

– Avocados– Olive oil– Nuts

• Building blocks– GABA– Dopamine– Serotonin

• Mood stabilizers via hormones• Impact cognition and memory• Balance blood sugars

Protein 2.0

https://www.drivelinebaseball.com/2017/12/3-protein-requirements-athletes/https://www.jackedfactory.com/best-protein-powder-women/Nutrition Basics for Better Health and Performance. Elizabeth A. Applegate. Edition, 3, revised. Publisher, Kendall Hunt Publishing Company, 2017. ISBN, 152492368

Hasadsri L, Wang BH, Lee JV, et al. Omega-3 fatty acids as a putative treatment for traumatic brain injury. J Neurotrauma 2013;30(11):897–906.

Secondary Cascades after TBI

• Fatty acids– Omega 6 pro-inflammatory– Omega 3 anti-inflammatory

o ALA leafy green vegetables, nuts, flax seed

o EPA & DHA oily fish (18.7% in Salmon, 32.9% in tuna)

• Brain composition is altered by dietary intake

U.S. FDA has ruled that intakes up to3.0 gm/day are recognized as safe

.. But you may need more!

The “Western diet” is thought to have 12-20 times more Omega-6 compared to Omega-3

Omega-3

Nutrition Basics for Better Health and Performance. Elizabeth A. Applegate. Edition, 3, revised. Publisher, Kendall Hunt Publishing Company, 2017. ISBN, 152492368http://www.nutritionforest.com/omega-3-fish-oil.html

• Studies have suggested early initiation of Omega-3’s after injury can be beneficial for recovery

Omega-3

• Increased bleeding risk– Anticoagulants (Warfarin/Coumadin, Heparin/Lovenox)– Only for supplement users

• PCBs– “PCBs are probable human carcinogens and can also cause

non-cancer health effects, such as reduced ability to fight infections, low birth weights, and learning problems.”– EPA

– Treated to remove contaminants– Choose one with total PCBs are less than 5 ppb

Omega-3

Vitamin D• Huge regulator• Anti-inflammatory• Low-levels (<30) linked to poorer mood & cognitive

decline

Curcumin– “Turmeric”

https://www.bodybuilding.com/content/your-expert-guide-to-turmeric.htmlhttp://www.naturemade.com/herbs/turmeric-curcuminhttps://vs-corp.com/longvida/https://www.modernhoney.com/golden-milk-recipe-and-natural-stress-relief-remedies/

Hasadsri L, Wang BH, Lee JV, et al. Omega-3 fatty acids as a putative treatment for traumatic brain injury. J Neurotrauma 2013;30(11):897–906.

• Inhibits glutamate• Increase cerebral blood flow• Anti-depressant effects

Magnesium

http://yourbeauty411.com/sources-of-magnesium/

Hasadsri L, Wang BH, Lee JV, et al. Omega-3 fatty acids as a putative treatment for traumatic brain injury. J Neurotrauma 2013;30(11):897–906.

Vitamins—B-Complex• The term “complex” is misleading, vitamins do not

work together– Complex means that all the B-vitamins are in 1 pill– How many B-vitamins are there?

• Water-soluble

• Energy releasing

B1- ThiamineB2- RiboflavinB3- NiacinB5- Pantothenic acidB6- PyridoxineB7- BiotinB9- Folic acidB12- Cyanocobalamin

8!!

https://economictimes.indiatimes.com/magazines/panache/have-you-been-using-vitamin-b-for-a-while-it-may-up-lung-cancer-risk/articleshow/60189767.cms

Vitamin E• Fat-soluble• One of the largest Antioxidants

– Protects cell membranes

• 5-7 year storage time

Institute of Medicine (US) Committee on Nutrition T, Erdman J, Oria M, Pillsbury L. Antioxidants [Internet]. National Academies Press (US); 2011 [cited 2018 Mar 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209332/https://alwayshealthyliving.com/benefits-of-vitamin-e-oil-for-skin/

“Okay, I’m ready to go to the grocery store and buy ALL these supplements!”

Regulation and Safety• The laws governing supplements are different

than those governing food

“Product intended to supplement the diet that contains at least one of the following: vitamin, mineral, herb, or other botanical, amino acid, metabolite, concentrate, extract or dietary substance.” (DSHEA, 1994)

NOT checked for:• Quality• Quantity of active ingredient• Interaction with your other

medications• Complications risk in

surgery• Unsafe side effects

US Food and Drug Administration. (1994). Dietary Supplement Health and Education Act of 1994 Public Law 103-417103rd Congress. Retrieved January, 21, 2002.https://thrivous.com/products/clarity-daily-nootropic

Is there a diet that will give me all of these things?

https://gymflow100.com/the-zone-diet/https://www.amazon.com/Paleo-Solution-Original-Human-Diet/dp/0982565844https://www.amazon.com/Complete-Anti-Inflammatory-Diet-Beginners-No-Stress/dp/1623159040https://www.amazon.com/MIND-Diet-Scientific-Enhancing-Alzheimers/dp/1612436072https://draxe.com/mediterranean-diet/https://www.amazon.com/Diet-MIND-Science-Alzheimers-Cognitive/dp/0316441155

Mediterranean Diet

Fruits Non-starchy

vegetables Whole grains Beans Potatoes Nuts Olive Oil Fish

https://www.lifehack.org/articles/lifestyle/5-secrets-getting-the-most-from-your-vitamins-and-supplements.htmlhttps://www.rd.com/health/wellness/mediterranean-diet-infographic/

Conclusion• All nutrients in our food play a role– don’t skip any of

them• Supplements may be required if diet is inadequate

– Make sure to check for quality! – Sometimes quality = $$

• Consumption of a balanced diet is key!• Great potential for future directions, we all eat– why

not treat our body with FOOD

https://easyhealthoptions.com/eat-foods-help-prevent-alzheimers/

Questions

Or contact me at:dbabazadeh@partners.org