More than two million Americans suffer from traumatic brain injury (TBI). An injury to the brain can trigger a number of secondary effects including inflammation, hypoxic/ischemic injury, excitotoxicity, and oxidative stress. These effects lead to cognitive and behavioral changes.

Neuropsychiatric symptoms might not appear immediately following a TBI, but they are very common and can lead to long-term problems that are hard to treat.

Traumatic Brain Injury

Nutraceuticals

One of the treatment options for TBI is the class of therapeutic nutritional substances known as nutraceuticals. Originally, they were defined as “any substance that is a food or part of a food and provides medical or health benefits, including the prevention and treatment of disease.” The term now includes dietary supplements, such as vitamins, minerals, amino acids, herbals, and food products that provide health benefits. The FDA does not regulate nutraceuticals, so their bioavailability and metabolism can vary.

This makes their use doubly difficult to administer safely. Hundreds of thousands of people die each year from improper medical care. Nevertheless, a few nutraceuticals have been shown to have some positive effect on TBI while being relatively safe.

Nutraceuticals for TBI

Zinc

Zinc is essential for CNS function and TBI patients are at risk for zinc deficiency. A randomized, prospective, double-blinded controlled trial demonstrated that 12 mg of zinc for 15 days in 68 TBI patients resulted in improved visceral protein levels, lower mortality, and more favorable neurologic recovery.

Vitamins C and E 

Oxidative damage is thought to play an important role in secondary injury in TBI. Vitamin E administration in one randomized clinical trial of 100 patients with severe head injury resulted in fewer deaths and better outcomes. Vitamin C was associated with stabilized or reduced edema on CT scans.

Vitamin D

Vitamin D can help reduce inflammation, oxidative stress, and cell death in TBI. It may have a synergistic effect when used with progesterone. A randomized clinical trial of 60 TBI patients found that 60% of those receiving progesterone plus vitamin D had Glasgow Outcome Scale scores of 4 (good recovery) or 5 (moderate disability) as opposed to only 45% receiving progesterone alone or 25% who got only placebo.

Magnesium

Magnesium is one of the most widely used nutraceuticals because it is essential for CNS functioning. After a TBI, magnesium deficiency can result in increased oxidative stress and cell death and has been associated with greater neurologic impairment. Although animal studies have shown some evidence of the neuroprotective effects of magnesium, human trials have been mixed. This may be due in part to the difficulty in rapidly replacing total body stores of magnesium.

N-acetylcysteine

N-acetylcysteine – or NAC – is an effective free radical scavenger and improves microcirculatory blood flow in the brain and tissue oxygenation. A randomized, double-blind, placebo-controlled study in 81 patients with TBI of oral NAC found NAC had a significant effect. Oral NAC supplementation led to improved neuropsychological test results, reduction in TBI symptoms, and complete symptom resolution by day 7 of treatment compared with placebo.