Nutrition plays a crucial role in ensuring the best possible outcomes for clients following a brain injury or any type of major trauma. Specialist Nutrition Rehab recently partnered with the charity Headway, to offer a free webinar for clients and their support teams focusing on the top 10 nutritional strategies that can aid recovery after a brain injury. This webinar also addressed strategies that can help deal with the two most common nutrition-related challenges that these clients experience – unwanted weight gain and fatigue.

While many clients spend significant amounts of time and money looking for the “best” food or nutrition supplement to support their recovery, there is no one food or supplement that can accomplish this.  Instead, most clients would get more benefit from investing their time, energy, and money into building healthy habits and a strong nutritional foundation, which can support the rest of their rehabilitation journey. But which habits should they focus on?

Top 10 tips for “eating for recovery”

Case managers can help clients rate their diet!  Give them one point for every “yes” response.

1.  Do they eat at least 5 servings of vegetables and fruit almost EVERY DAY (1 serving = 1 cupped handful of fresh or frozen)?

2.  Do they eat vegetables and fruit from all of the different colour groups over the course of a week (e.g. green, orange/yellow, red, blue/purple and white)?

3.  Do they eat fish twice per week (or take an omega-3 supplement)?

4.  Do they mostly use olive oil or rapeseed oil in cooking?

5.  Do they eat a high-protein food at least twice per day (e.g. meat, chicken, fish, eggs, legumes)?

6.  Do they include legumes, lentils, nuts, or seeds in their diet at least twice per week?

7.  Do they choose mostly whole grains, such as porridge, wholemeal bread, high-fibre cereal, brown rice and whole wheat pasta?

8.  Do they limit foods high in fat and sugar (e.g. biscuits, crisps, chocolate, cakes, pastry)?

9.  Do they drink at least 2 litres of fluid per day (e.g. water, cordial, milk, tea, coffee, pure juice)?

10.  Are they taking a vitamin D supplement?

Scoring:

8-10 points – they are a nutritional superstar!  Keep up the great work.

5-7 points – they are doing some great things and there are a few changes that will improve their health even more!

Under 5 points – don’t worry…there are lots of dietary changes that they can make to help improve their health.

Why is nutrition important after a brain injury?

If your clients imagine that their body is like a house with a renovation team working inside, it makes sense that this renovation team would require plenty of nutritional building blocks to repair the damage caused by a brain injury.  Nutrient building blocks, such as vitamin C, calcium, protein and omega-3 fats for example, come from the foods that your clients are eating.  If your clients are eating lots of vegetables, fruit, oily fish, and high-protein foods for example, they will be giving their renovation team lots of nutrient building blocks with which to repair the damage.  If instead, your clients are mostly eating fast food, takeaway, ready meals, biscuits, chocolate and crisps, then they will not be giving their renovation team everything they needs to repair the damage.  The consequences of not consuming enough nutrient building blocks are, 1) the repairs won’t happen at all, 2) the repairs will take a lot longer than they should or 3) the repairs will happen, but not to a very high standard.

Why do so many people struggle with weight gain after a brain injury?

After any type of major trauma, there is generally huge amounts of inflammation in the body.  This is also a time when people are bedbound (or are certainly much less physically active) and generally not eating very well either.  The combination of these three factors means that most people will lose huge amounts of muscle mass (and weight) very quickly after their trauma.  However, several weeks or months later (after most of the inflammation has reduced), the person’s metabolic rate then becomes very influenced by the amount of muscle mass that remains.  Since the level of muscle mass has now reduced, that means that the person’s metabolic rate is now slower than it was pre-injury and they now require fewer calories in order to maintain their weight.  In many cases after hospital discharge, people can only eat ~50% of the calories that they were eating pre-injury!  This is a huge psychological adjustment for most people and if they are prioritising other areas of their rehab like physio, then they will often revert back to their pre-injury eating habits which can result in weight gain.

The other main challenge for anyone who now mobilises with a wheelchair (or is bedbound due to a pressure sore), is that it becomes difficult for them to even monitor their weight.  Many GP surgeries for example, only have basic stand-on scales which are not suitable.  Without any type of weight monitoring, that means the pounds can creep on slowly over time without anyone noticing (at least until the weight gain becomes quite significant).

For clients who want to purchase their own hoist or wheelchair scales check out, Weight monitoring for wheelchair users, bedbound and bariatric clients.

For more details on the various ways that a brain injury can result in weight gain and obesity, go to our article, Obesity after a traumatic brain injury.

Why is fatigue such a problem after a brain injury?

Physical fatigue and cognitive fatigue are huge problems after a brain injury for a variety of different reasons – poor sleep, sleep apnoea, lack of routine, booming & busting, overstimulation, lack of physical activity and malnutrition or nutrient deficiencies, are just a few examples.  From a nutrition perspective, we must rule out nutrient deficiencies, impaired thyroid function, electrolyte imbalances, dehydration, hormone deficiencies, and high blood glucose levels, as any of these factors can increase fatigue.  The only way to screen for these problems is by completing a comprehensive set of blood tests.

At a minimum, we recommend that the following blood tests be completed:

• Full blood count
• Ureat & electrolytes
• Liver enzymes
• HbA1c
• Vitamin D
• Vitamin B12
• Folate
• Ferritin
• Thyroid function (preferably TSH, T3 and T4)
• Fasting cholesterol
• Testosterone (in men)
• Female hormones (in women, if menstruation has been disrupted)

For more rationale on each of the above, go to our articles on, Fatigue after a brain injury – the 7 blood tests to ask for and Female hormone changes after a brain injury.

If the client’s GP is not willing to complete these blood tests, then we recommend clients get these done privately.  For more information on where to go, check out our previous article, Private blood tests – where and how much?

CLICK HERE to watch the 35 minute video!

TIMESTAMPS:

Nutrition is an important part of recovery after a brain injury. If you have a client who could benefit from working with a dietitian and you would like to make a referral, please get in touch at info@specialistnutritionrehab.co.uk or 0121 384 7087. We’re here to help case management and litigation clients get the expert guidance they need to optimise their recovery.

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