The 5, 7, 2, 4, 100, 200 solution
After any injury, your body goes into a hypermetabolic state (hyper is the Greek word for "over"), meaning that it suddenly requires more calories than normal to provide the energy and material to rebuild damaged tissues. True, an injured brain won't be producing new cells, but this 2 percent of your weight that consumes 20 percent of your calorie intake will need extra energy to establish the new connections that can enable you to function.In fact, feeding patients with brain injuries is so important that neurologists at Presbyterian Hospital/Weill Cornell Medical Center in New York have actually put some hard numbers to it: 5, 7, 2, 4, 100, 200.
Translation: Patients with brain injury who are not fed either intravenously or through a tube into the stomach within 5 days after the injury occurs are 2 times more likely to die than are patients who get fed. Patients not fed within 7 days are 4 times more likely to die. And the best menu provides 100 percent of the normal recommended daily calories for that particular patient; up to 200 percent is even better.
"There is no miracle drug for patients with severe traumatic brain injury," says Roger Härtl, director of neurotrauma at the Brain and Spine Center of Weill Cornell Medical College. "But we have been able to reduce the mortality and improve outcome in these patients dramatically over the past 15 years by maintaining their blood pressure and supplying the brain early on with oxygen and nutrients. We now start feeding patients with severe brain injuries very aggressively from the moment they first hit the intensive care unit, and early nutrition is now recognized as one of the most important factors improving outcome in these patients."
So important, in fact, that the regimen has now been incorporated in the international Guidelines for Management of Severe Traumatic Brain injury.
Protein possibilities
Leucine, isoleucine, and valine are amino acids, the building blocks of protein. Because these three particular amino acids share a distinct chemical structure — a long central chain with smaller side chains branching off — they're called branched chain amino acids (BCAA, for short).The body uses BCAA to build neurotransmitters, the naturally occurring chemicals that enable cells to exchange messages: Think! Move! Feel! Unfortunately, an injury to the brain that damages the hippocampus, a part of the brain that helps direct memory and cognition, may reduce brain levels of leucine, isoleucine, and valine.
As long ago as 1983, studies suggested that intravenous doses of BCAA would benefit patients with liver disease by forcing additional amino acids into their brain. Some sports nutritionists think that BCAA supplements can improve muscle performance.
Neuroscientist Akiva Cohen and his team at The Children's Hospital of Philadelphia see a more direct application. When they added BCAA to the drinking water of brain-injured mice, Cohen's team observed improvements in both mouse memory and cognition.If future studies with human beings demonstrate the same effect, patients with traumatic brain injuries might be able to avoid the feeding tubes and intravenous needles to improve their thinking and remembering simply by sipping a glass of branched-chain-amino-acid-enriched (building blocks of protein) water.
A follow-up study in 2013 showed that the amino acids also improve "wakefulness" — the ability to stay awake and alert — after traumatic brain injury (TBI), thus enhancing recovery.
The (eventual) official word
Because military personnel, especially those in combat zones, face a distinct risk of TBI, in 2009, the Department of Defense (DoD) asked the Institute of Medicine (IOM) to convene an expert committee to review the potential role of nutrition in the treatment of and resilience against TBI.The IOM is the division of the National Academy of Sciences that sets and publishes the RDAs, RDIs, and other nutritional recommendations. To meet the DoD request, IOM set up a Consensus Study on Nutrition, Trauma, and the Brain to determine "the potential role for nutrition in providing resilience (i.e., protecting), mitigating or treating of primary (i.e., within minutes of insult), secondary (i.e., within 24 hours of insult), and long-term (i.e., more than 24 hours after insult) associated effects of neurotrauma, with a focus on traumatic brain injury."
Two years later, in 2011, IOM issued a first report from the study. The primary message, an echo of Dr. Härtl's: All military personnel suffering from traumatic brain injury should get adequate protein and calories as soon as possible to reduce inflammation and improve their recovery and eventual outcome. This advice, they noted, also applied for non-military people, such as athletes, who were at risk of concussion and other brain injuries.