Diet and nutrition after brain injury

Thank you so much. We have a limited amount of time together, and I have tried to keep the talk to around 30 minutes, so I am going to do my best to give you as much value as I can based on the experience I have working with people with brain injuries, which I have been doing exclusively for about eight years.

There are three things I want you to get out of the talk today: first, what you should be eating for a healthy brain and to recover from a brain injury; second, how to manage body weight, as many clients struggle with increasing weight after their brain injury; and third, how to reduce fatigue, which is one of the number one symptoms many clients experience.

I like to start with why nutrition is important after a brain injury or any major trauma. I find that even many health professionals have not made the connection between diet and recovery. I use an analogy of a house: imagine your body is a house, and inside is a 24-hour live-in renovation team. Any time there is damage, your team is there repairing it. The quality of their work is dependent on the building materials you provide. Are you giving them high-quality materials, or are you just giving them duct tape and cardboard? For someone with a brain injury, your body has been through a hurricane. If you are eating a nutritious diet—lots of protein, omega-3 fats, vegetables, and fruit—you are giving your team the supplies to repair the damage. If you rely on processed foods, you are not giving them the blocks they need, and repairs may take longer or not happen at all.

We are going to start with a little quiz to gauge your current nutrition. This is for general brain health, not just for brain injury recovery. For each question, give yourself one point if the answer is yes:

Do you eat at least five servings of vegetables and fruit almost every day? One serving is roughly the amount you can hold in one cupped hand.

Do you eat vegetables and fruit of all different colors throughout the week? There are five groups: red, orange/yellow, green, white, and blue/purple.

Do you eat fish twice per week, or if you are vegetarian, are you taking an omega-3 supplement?

Do you use mostly olive oil or rapeseed oil for cooking?

Do you eat a high-protein food at least twice per day?

Do you include legumes, lentils, or nuts at least twice a week?

Do you choose mostly whole grains?

Do you limit foods high in fat and sugar?

Do you drink at least two liters of fluid per day?

Are you taking a vitamin D supplement?

If you scored 8 to 10, you are a nutritional superstar. If you scored 5 to 7, you are doing great, but there is room for fine-tuning. If you scored less than 5, there are many opportunities to improve your recovery through diet.

Step number one is to get blood tests done, as there is a high probability of nutrient deficiencies after trauma. You should ask your GP to check your full blood count, urea and electrolytes, liver enzymes, and HbA1c. More specifically, I recommend checking vitamin D, vitamin B12, and folate, especially if you are on anti-seizure medication. Also, check ferritin, thyroid function, fasting cholesterol, and, in men, testosterone levels.

Step number two is to monitor your weight. Many people gain weight because their metabolism slows down due to a loss of muscle mass in the hospital. You need a way to track your weight consistently, such as investing in wheelchair or hoist scales. If you notice a steady upward trend, you need to address it. You will likely need to eat fewer calories than you did pre-injury to maintain your weight.

Step three is to eat more vegetables and fruit, focusing on a rainbow of colors. Half of your plate should be vegetables or fruit at lunch and dinner. Step four is to eat more omega-3s and healthy fats, such as oily fish or plant-based oils. Be careful with high-calorie healthy fats like nuts and avocado.

Step five is to get enough protein. A portion is the size of a deck of cards. Aim for at least two portions per day to help with brain and tissue recovery. Step six is to choose high-fiber, whole-grain versions of carbohydrates, like oats or brown rice, and consider chia or flax seeds to aid digestion.

Step seven is to drink at least two liters of fluid per day. Step eight is to limit high-fat and high-sugar foods, as they lack the necessary nutrients and provide excess calories. Step nine is to take a vitamin D supplement as recommended by your pharmacist or doctor.

Finally, step ten is physical activity, especially resistance training to rebuild muscle, and step eleven is getting enough quality sleep. To manage fatigue, combine blood test corrections, healthy nutrition, hydration, and a structured routine.

You have to nourish to flourish. Think about one change you can make this week. If you need a dietitian, ask your GP for an NHS referral or find a private practitioner through the British Dietetic Association website.