Survey suggests performance nutritionists lack concussion recovery knowledge

While some of the surveyed Irish performance dietitians and nutritionists (PDs/PNs) reported recommending nutritional protocols to support brain healing following concussion, this was restricted by the practitioner's knowledge and the limited scientific evidence available.

Participants who did present a practical understanding of concussion recovery mentioned protocols such as carbohydrate reloading, reducing omega-6 intake and acutely supplementing creatine, omega-3 fish oils high in DHA and probiotics, but this knowledge was rarely displayed.

The researchers, from Atlantic Technological University (ATU) in Galway, Ireland, noted that nutrition implementation can be overlooked or implemented with uncertainty, thereby negatively affecting athletes’ recovery following sports-related concussions.

"It is evident that there is a need for research to uncover safe and practical nutritional protocols that they can use to mitigate the effects of SRC and support athletes’ recovery and return to play," the report concluded.

Lead researcher Dr Lisa Ryan, head of the department of sport, exercise and nutrition at ATU and co-founder of the Irish Concussion Research Centre (ICRC), told NutraIngredients that it has always surprised her that the role of nutrition in brain health has not been closely looked at in concussion management and recovery. 

This study represents a stepping stone in the ICRC's efforts to build knowledge in this space.

"We have previously published papers on the role that omega-3 fatty acids may have in brain injury recovery," Dr Ryan said. "We are about to start a research project in collaboration with Sport Ireland investigating omega 3 supplementation with boxers and judo players."

She added that the team has also conducted a "considerable amount of qualitative research" in the area in both male and female rugby players who cite gastrointestinal complaints post concussion that often get overlooked or dismissed by medical teams.

"We hypothesise that the gut-brain [axis] may be of importance in brain injury recovery as gut dysbiosis is a feature post brain injury," she said. "This suggests that there may be a role for targeted probiotics to assist with recovery of concussion symptoms."

Concussion prevalence and nutrition

Sport-related concussions (SRCs), also known as mild Traumatic Brain Injuries (mTBIs), are prevalent​, with up to 3.8 million cases reported in the United States​ annually. 

SRCs are inevitable in contact and collision sports, but due to their subjective and invisible injury presentation, many frequently go undiagnosed or unreported. In sports, sub-concussive impacts and repetitive head injuries (RHIs) are concerns due to their long-term effects on athletes’ health​.

DHA plays a role in brain development, has been shown to be neuroprotective and may aid brain recovery following RHI and concussion​. No specific DHA recommendations exist for high-risk sub-concussive sports athletes. 

In addition, vitamin D is neuroprotective and promotes healing and neural recovery​. Athletes with low vitamin D levels have been found to have reduced neuroprotection, heightened inflammation and compromised and prolonged cognitive recovery​.

Supplementing magnesium​ within 24 hours has also been suggested to replenish depleted brain cellular levels, alleviating symptoms and promoting faster recovery.

Creatine, an essential amino acid, is crucial in energy production, influencing brain and muscle tissue function and performance, and may play a role in brain injury recovery​. However, its effectiveness in addressing concussion-related (RHI or mTBI) issues is uncertain and requires further investigation for preventive and post-SRC protocols.

The survey

In-depth, semi-structured interviews were conducted with seventeen Irish performance dietitians and nutritionists recruited from the Sport and Exercise Nutrition register and other sporting body networks across Ireland. Participants practised or had practised with amateur and/or professional athletes within the last 10 years. 

The interviews revealed that the levels of implementing nutrition practices among Irish PDs and PNs to support recovery following acute SRC diagnosis was highly variable.

Some mentioned exploring, considering and trialling several novel nutrition protocols. Numerous participants mentioned that their athletes had already been prescribed creatine for muscle mass and performance, and some had suggested implementing it acutely in concussion recovery. 

A few participants mentioned increasing healthy omega-3s and reducing omega-6s, and one participant mentioned the use of acute carbohydrate loading. One participant highlighted how fuelling at regular intervals was essential to support brain recovery and recommended that athletes supplement their food with a probiotic to help the gut–brain connection following concussion.

However, the data highlighted several incidences of poor communication where the PDs/PNs were overlooked and, as result, did not know athletes had sustained an impact or SRC. PDs/PNs admitted feeling the need to be present at training and matches to be aware and in the know regarding SRC events. Answers also revealed PDs/PNs seemingly underestimated the significance of their role in acute recovery support.

For example, one participant commented: "I think in that scenario… I would wait to hear from…some other medical professional before doing anything…"

The report noted that awareness of concussion incidence amongst PDs/PNs was likely influenced by a seemingly ‘blasé’ attitude toward the injury, impacting athlete reporting of potential SRCs.

The authors noted as SRCs in collision sports were so frequent and not visible in the way other injuries are, this could lead to poor compliance with recovery support programs.

As stated by one PN, speaking specifically about professional rugby athletes: “They don’t really care… I think it’s cause it’s such a common injury, like while concussion in GAA might be less common. When it’s so common in rugby…concussion is just like another…another injury.”

The report stated: "PDs'/PNs' lack of awareness and nutrition knowledge was a concern as they were not well informed about its role following SRC. As a result, they did not see or consider the benefits of using nutritional support to promote brain tissue healing, which could pose a risk to their athletes.“

Even those participants actively researching nutrition protocols for concussion recovery said they were unsure of protocols due to limited evidence.

"From PD/PN practices, it is evident that there is a need for research to uncover safe and practical nutritional protocols that they can use to mitigate the effects of SRC and support athletes’ recovery and return to play," the report concluded.

Source: Nutrients​
doi: 10.3390/nu16040497​
"Nutritional Considerations of Irish Performance Dietitians and Nutritionists in Concussion Injury Management"
Authors: Emma Finnegan et al.