Q) My daughter suffered a concussion some time ago and is really taking a long time to recover. Is there any kind of role that her dietary choices may play in her return to health?
A) Post-concussion syndrome is a condition that has received ample attention over the last decade as we have finally begun to recognize the devastating effects that having “your bell wrung” can actually have on our health. Unfortunately, despite all the research being poured into it, this disorder remains one without many concrete strategies that sufferers can engage in to hasten their recovery. However there does appear to be some relatively low risk strategies that can be tried that do have some scientific evidence supporting their potential to be useful.
One of these is to change your diet to a ketogenic one. There are a number of ketogenic diets (KD) out there, but at their essence, they are diets that attempt to mimic the body’s state during fasting without impairing its ability for growth. They do so by limiting the amount of carbohydrates and proteins consumed, thereby forcing the body to become incredibly efficient at breaking down the fat consumed in our diet or from the various stores found within our body in an attempt to meet its energy needs. As glucose levels within the body decline, fat-derived ketone bodies transition into our body’s primary source of energy, a metabolic state known as ketosis.
The classic KD is a very low carb, moderate protein and high fat diet that derives 70-90% of its calories from fat, 8-15% from protein and only 2-5% from carbohydrates. There are a number of variations of this diet such as a high protein version whereby the ratio is around 60% fat, 35% protein and 5% carbs, a medium-chain triglyceride diet, a modified Atkins diet and a low-glycemic-index treatment among others. These offer practitioners a chance to find an option that is more palatable to them by allowing them to select meals that have a little less fat in them or more protein or adding more vegetable derived calories (although from non-starchy vegetables).
The standard and the high protein ketogenic diets are the ones that have been most extensively studied for their health benefits and risks. There are risks involved if these types of diets are not properly formulated including nutrient deficiencies, gout, hypovolemia, hypokalemia (a deficiency of potassium which can cause our heart to beat out of rhythm among other symptoms) and kidney stones. Thus, it is essential to consult with a dietician or do some extensive research into them before diving into it.
The diets are defined by a lengthy list of foods that should be limited or avoided including:
· Grains and products made from them (rice, quinoa, pasta, cereal, wheat, oats..)
· Legumes and beans
· Sugar
· Alcohol
· Low-fat dairy products
· Starchy vegetables and tubers (potatoes, yams, peas, corn..)
· High-carb fruits (oranges, apples, bananas…)
· Refined fats and oils (vegetable oil…)
These types of diets, despite the lengthy list of restrictions, can be among the easiest to follow given that they do not usually come with calorie restrictions so you’re not in a constant state of starvation and many of the allowed options (virtually all meats, eggs, cheeses, fish, olive and coconut oils, salad greens, kale, green beans, broccoli…) allow for some very satisfying meals.
The choice in fats appears to be important as well. While foods rich in saturated fats (like red meat, whole milk and butter) are allowed, it is best to attain the vast majority of your fat content from unsaturated sources. Examples are those found in olive oil, avocados, fish, nuts and seeds such as those advocated in Mediterranean type diets. These seem to lead to better health outcomes, particularly when it comes to cardiovascular type diseases.
These types of diets have been used for years with positive outcomes in patients with drug-resistant epilepsy and there are a number of concurrent studies being conducted on what benefits, if any, they might confer upon other neurologic disorders such as Alzheimer’s and Parkinson’s and post-concussion syndrome.
Previous research has shown the diet may induce an anti-inflammatory effect, improve the brain’s tolerance to temporary decreases in oxygen supply and possibly provide some degree of neuro-protection so the fact that they might benefit damaged brains does not seem to be a large reach. Initial studies, as per usual scientific protocols, have been conducted on mice so one should not extrapolate the results to humans without some degree of hesitation. They are, however, very promising nonetheless.
Researchers found that the mice that had suffered a traumatic brain injury (TBI) and were fed a KD type diet (in this case 90.5% fat, 9.2% protein and 0.3% carbs) showed improvements in their visual and spatial memory as well as reduction in the damage caused to their neurons and glial cells by the injury. The results are such that the same researchers are now planning a clinical study in human patients with TBI with the help of registered dieticians.
Let’s hope that the results are as encouraging as the mice models were as people who are losing months to years of their prime to these types of injuries could certainly use a little good news and a treatment plan that involves more than simply waiting for an indefinite amount of time to pass before they can resume their lives.
Next week, COVID news permitting, we’ll talk about some of the other possible medical conditions these diets may benefit. For more information about this or any other health related issues, please contact your pharmacist.
