Every year in the US, roughly 3.5 million traumatic brain injuries (TBIs) occur, resulting in greater than 300,000 hospitalizations and 52,000 deaths annually. Unfortunately, TBIs are a major cause of disability and death, with more severe TBIs having worse outcomes.
Omega-3 fatty acids are an important contributor to brain structure and function. Additionally, anecdotal case reports support the idea that omega-3 fatty acids may actually provide a neuroprotective effect when in comes to major brain injuries. This article will explore the mechanisms by which omega-3s may help and the current evidence supporting the use of omega-3s in TBIs.
What are omega-3 fatty acids?
To understand omega-3 fatty acids, we first must break down the different types of fats. There are two major types of fatty acids: unsaturated fat (“good fat”) and saturated fat (“bad fat”). Unsaturated fats can be further broken down into two types: monounsaturated and polyunsaturated fats.
Omega-3 fatty acids are a type of polyunsaturated fat that are implicated in several biological processes. They help to maintain the structure of our cell membranes while also supporting our endocrine and cardiovascular systems. Recent research also suggests that omega-3 fatty acids may also be protective when it comes to TBIs.
What are TBIs?
TBIs can occur due to a penetrative head injury or a blow, jolt, or bump to the head. Such an injury can adversely affect the brain’s normal functioning, potentially leading to disability or death. TBIs most often occur from motor vehicle accidents, falls, contact sports, or violence.
TBIs are categorized as either mild, moderate, or severe, with “mild TBIs” usually being considered concussions. When it comes to TBIs, we know them to happen in two separate stages:
- Primary injury. This refers to the injury that happens immediately upon the traumatic event, where the damage occurs instantly.
- Secondary injury. This phase refers to the ongoing damage that ensues in the brain after the initial insults in the days and weeks that follow. During this time, there is progressive cell death and worsening brain damage outside of what has already occurred with the primary injury. It can involve damage to nerve fibers, brain swelling, inflammation, reduced blood flow, and changes to brain cells.
How do we treat TBIs?
Because primary injury is oftentimes unavoidable, the secondary injury phase may be a potential target for therapeutic treatments of TBIs. In doing so, we may prevent or minimize the brain damage, thus improving long-term outcomes. Traditional approaches utilize pharmaceuticals that are meant to disrupt one enzymatic process. However, TBIs are very complex, requiring a more holistic and broad approach. One such possibility involves treatment with omega-3 fatty acids.
What is the role of omega-3 fatty acids in the brain?
Recall that omega-3 fatty acids are essential to maintaining the structure and function of cell membranes. This certainly holds true when it comes to the cell membranes of the neurons in our brains. Our dietary intake of omega-3 fatty acids thus directly impacts the function of our brain.
How might omega-3 fatty acids affect TBIs?
Knowing the importance of omega-3 fatty acids in brain function, the question arises: can omega-3 fatty acids improve TBI outcomes? The answer is potentially yes, particularly these two types of omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Both EPA and DHA:
- Have neuroregenerative properties
- May mitigate some of the underlying mechanisms contributing to secondary injury in a TBI
- May be used prophylactically to minimize TBI risk
- Improve outcomes in TBI animal models
Human data
There are a few case reports evaluating the effects of omega-3 fatty acids in treating TBI. Let’s review the findings:
- A trapped miner suffering from neurologic dysfunction and coma was treated with oxygen therapy, resuscitation, dialysis, and 21.2 g daily of omega-3 fatty acids. The patient demonstrated neurological recovery and was discharged home from rehab 2 months later.
- A teenager suffering from a severe TBI received 20 g of omega-3 fatty acids daily. The patient was weaned off the ventilator, transported to rehab, and discharged home four months post-injury.
- An 8-year-old girl suffered anoxic brain injury and was comatose after a near drowning accident. She was given a high dose of fish oil 82 days later and was then discharged home one month later.
Keep in mind that these situations only provide anecdotal evidence, and no well-controlled clinical studies have evaluated the effect of omega-3s in TBI.
How should we use omega-3s in TBI?
One of the cases above utilized 6,756 mg DHA, 9,756 mg EPA, and 19,212 mg total of omega-3 fatty acids. When it comes to mild TBIs and concussions, the Brain Health Education and Research Institute recommends concentrated fish oil containing around 3,000 mg of omega-3 fatty acids three times daily for at least one week. Afterwards, the dose can be decreased down to twice and then once daily.
Are there any risks of omega-3 fatty acids?
Omega-3 fatty acids are antithrombotic agents; thus, they may cause excessive bleeding or potential hemorrhagic stroke. However, several clinical trials have demonstrated that high-dose fish oil is safe, even when used concomitantly with blood thinners.
Conclusion
In summary, omega-3 fatty acids are essential to maintaining the structure and function of the brain. As a result, high doses of fish oil may also provide neuroprotective effects in the TBI setting with little risk of side effects.
References
- Omega-3 fatty acids & the important role they play. Cleveland Clinic. Accessed May 29, 2024. https://my.clevelandclinic.org/health/articles/17290-omega-3-fatty-acids
- Lewis MD. Concussions, traumatic brain injury, and the innovative use of omega-3s. Journal of the American College of Nutrition. 2016;35(5):469-475. doi:10.1080/07315724.2016.1150796
Written by Dr. Brandon Welch
Dr. Brandon Welch, PharmD., MS (c), CSNC is nationally recognized human performance specialist and wellness clinician. Brandon went to the University of South Florida, where he completed his doctorate of pharmacy degree and his bachelor’s degree in bio-medical sciences with a concentration in biochemistry. He later decided to expand on his education and went back to school to obtain his master’s degree (in progress) at the University of Florida in Physiology and Kinesiology with a concentration in human performance. He is a certified sports nutritionist and weight-management consultant. For years, he has been teaching athletes effective and practical ways to improve their health in order to optimize human performance. He has worked with elite athletes ranging from “weekend warriors” to professional athletes in the NHL and NFL. He has also done extensive work in consulting retired athletes and the professional league coaching staff on metabolic health for peak performance.