Embed Size (px)
Citation preview
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
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/
