Thursday, October 4, 2012

Omega-3s and Traumatic Brain Injury

This past weekend, I went to Hershey Park and spent the entire day going on roller coasters, or, as they were called by the medical advisory signs posted throughout the park, Aggressive Thrill Rides. Over the course of the day, I was tossed, shaken, rattled, and accelerated within an inch of my life, confirming my suspicion that I’m not a huge fan of roller coasters. By the end of they day, I felt pretty sick and had a headache.

While it wasn’t exactly like having a concussion, I spent a lot of the next day wondering whether modern roller coasters are designed to prevent brain injuries in the same way they’re now designed to prevent whiplash injuries. I don’t have any clear answers, but allow me to explain my concerns. As most of us know, whiplash injuries happen due to rapid deceleration, frequently because of some kind of impact, which causes the head to move rapidly forward and then backward. Fortunately, roller coasters decelerate a bit more gradually, so that whiplash injuries don’t happen. Additionally, the simple use of headrests means that whiplash injuries are less common.

However, the brain is also injured by rapid deceleration. Of course, many brain injuries happen because the head itself comes into collision with a solid object, such as a windshield, the ground, a tree limb, etc. but many other injuries happen because of the motion of the brain inside the bony skull. This type of brain injury happens when, for example, a car stops suddenly – the skeletal body stops quickly, but the brain, resting in a liquid environment inside the skull, doesn’t stop at the same time as the skeleton. Instead, the brain keeps moving forward after the skull has stopped moving, and collides with the skull. This is referred to as a coup injury. What happens next is that the brain ‘bounces’ off of the interior surface of the skull, and then hits the opposite side of the skull. This second impact is called a contrecoup injury. In both cases, the brain is bruised where it came into contact with the skull. So, as you can imagine, with all of this rapid deceleration and changing of direction on the roller coasters, at speeds in excess of 50-70 mph, I was concerned about how my poor old brain was doing.

One of the most concerning things about brain injury is that there are no established therapies for recovery after an injury, be they from car accidents, collisions on the football field, or IEDs in Afghanistan. To be sure, a lot can be done to medically manage acute trauma, and there are physical and occupational therapy treatments to help patients recover function, but there is little that can be done to help conserve or repair brain tissue. If you break a leg really badly, you treat the acute injury, you put a cast on it, and then you go to physical therapy to regain function – when it comes to the brain, there is no cast to use, so this crucial repair phase is lost.

However, there may be some hope for preserving brain tissue when it comes to traumatic brain injury. A number of interesting animal studies have suggested that the omega-3 fatty acid DHA, which comes from fish oil, reduces inflammation in the brain following brain injury (1, 2, 3), and at least one of them also indicates that DHA also helps preserve brain function. In addition, there is a published case study in the American Journal of Emergency Medicine of a case in which a teenager was able to progress from an injury-induced vegetative state to near-normal functioning after use of extremely high doses of DHA and EPA. This is all extremely exciting information, and prompted two authors to suggest in the journal Military Medicine that the Department ofDefense seriously investigate the prevention and treatment of traumatic braininjury using omega-3 fatty acids. This isn’t quite time to start jumping up and down giving one another high fives, but, should human trials pan out, this could be a great treatment for a very serious problem.

So what does all of this mean to a consumer? First of all, do what you can to prevent injuries in the first place. This means wearing proper protective equipment when playing contact sports like football and hockey, wearing a seatbelt when driving or riding in a car, and, possibly, limiting your use of roller coasters. An ounce or prevention is worth a pound of cure, and when the cure is experimental, that ounce is worth much more than a pound of it. Second, this is yet another reason to take fish oil for preventive health. While the effects of omega-3 fats as treatment for brain injuries are questionable, these studies have demonstrated that fish oil seems to exert a protective effect when taken in advance, and hopefully you’re already taking fish oil for cardiovascular health.

Before I sign off for the day, here are a few notes about omega-3s, separate from their use in brain or heart health. The first is that quality does matter when it comes to fish oil, and it’s worth investing in ‘the good stuff’. While mercury, dioxins and other contaminants are of some concern with fish oil (and high quality oils will have removed these substances), the greater concern is freshness – fish oil spoils easily in processing, and taking spoiled fish oil is as good as not taking any. You may pay less in buying a low price fish oil, but if the fish oil has spoiled, you’re losing money.

Secondly, it’s now becoming clearer that relatively high doses of fish oil are necessary to achieve true benefit both in the cardiovascular and neurological realms, so consume your fish oil or cod liver oil with some liberty. A number of companies are now selling concentrated EPA/DHA products that allow you to get relatively high doses of these active compounds without taking massive amounts of capsules.

Finally, we are now, at long last, seeing the emergence of vegetarian EPA/DHA formulas. Previously, these were completely nonexistent, and vegetarian consumers were left with the choice of either taking non-vegetarian fish oil, or taking flax oil, whose benefits on cardiovascular health were largely hypothetical. Now, finally, we are seeing oils containing EPA and DHA that are derived from algae. These oils offer patients the ability to gain important nutrients, while maintaining their dietary preferences.