The number one question that I get asked when I tell people what I do is, “What does nutrition have to do with brain injuries?”  

That is usually followed closely by the question, “do people with a brain injury need a special diet?”

Based on current evidence, almost everyone in the population should be striving for an anti-inflammatory, Mediterranean-style diet containing lots of vegetables, fruit, whole grains, olive oil, fish and foods which promote a diverse gut microbiome (1,2,3).  This includes people with brain injuries.  So while people with a brain injury don’t need a special diet per se, eating a nutritious, anti-inflammatory, Mediterranean-style diet after a catastrophic injury is more important than at any other time.  Unfortunately, most clients are not eating anything remotely close to this. 

Instead, for the reasons outlined below, vulnerable clients tend to consume a high proportion of fast food, take aways, ready meals, biscuits, chocolate, crisps, and energy drinks.  These foods are known to increase inflammation, increase weight, cause insulin resistance and even increase certain types of pain (not to mention increase the risk of cardiovascular disease down the road) (4, 5, 6).  I find that these clients also end up being prescribed multiple laxatives because their gut isn’t functioning properly due to a lack of fibre.

Why are some clients not making nutritious food choices?

Once they are discharged from hospital back into the community, less nutritious food choices in this population often relate to: lack of nutrition knowledge, difficulty with planning meals/food shopping/preparing meals, support workers with limited nutrition knowledge and cooking abilities, capacity issues, fatigue and feeling overwhelmed.  

Regardless of the reason however, the bodies and brains of these vulnerable clients (who have been through phenomenal trauma), are often not being given enough of the most basic nutrients in order to be able to heal.  When clients are first referred to me, most are deficient in at least one nutrient (usually more).  So it is always a delicate balance between ensuring they are well-nourished enough to get the most out of their therapy and rehabilitation and being realistic and practical with what they can implement and manage.  I know many people are hoping that certain supplements will offer some type of miracle for brain injury recovery, but in the absence of a nourishing diet (which is one of the foundations to recovery), the impact of any one supplement is going to be minimal. 

Managing other medical conditions (in addition to the brain injury)

Issues around a poor diet are then compounded when you have clients who have other medical conditions which need to be managed in addition to their brain injury.  The top 4 conditions I’ve encountered include:

• Diabetes and pre-diabetes
• Gut-related problems – diarrhoea, constipation, irritable bowel syndrome, reflux
• Dysphagia (swallowing problems)
• Over/under weight

It’s not uncommon for clients to have three or more conditions which all need to be managed simultaneously – perhaps brain injury + dysphagia + diabetes for example.  Sadly, many clients find that either no one has offered to refer them to a dietitian or they don’t meet the referral criteria for the community dietetic service provision within their local NHS Trust. 

Here’s when you should consider referring to a dietitian (NHS or private):

1. If there has been a 10% unexplained weight LOSS in the last 3-6 months.
2. If there has been a 10% unexplained weight GAIN in the last 3-6 months.
3. If the client has a diagnosed medical condition such as diabetes or pre-diabetes.
4. If the client has dysphagia and the family or support workers are struggling to offer them a nutritious and varied diet.
5. If the client has unresolved constipation, diarrhoea, abdominal pain or bloating.
6. If the client is suffering with severe fatigue.
7. If the client has a Grade 3 or 4 pressure sore.
8. If the client has taste or smell loss.

For more information on exactly how a dietitian can help in the above situations, click HERE.  If you are not sure if your client would benefit from seeing a dietitian, please get in touch for a free, no-obligation discussion of your client’s needs and how a dietitian can help. For more information, contact Sheri Taylor, Specialist Rehab Dietitian at info@specialistnutritionrehab.co.uk or 0121 384 7087.