Do a quick Google search on concussion recovery tips, and you’ll find loads of (often conflicting) information on rehabilitation exercises, timelines for returning to work or school, and ways to train your brain back to full function. However, there’s much less discussion about how everyday factors like diet, hydration, and meal timing can support your brain’s recovery.
In this blog, we’ll explore how these often-overlooked aspects of your daily routine can help optimize your concussion recovery and get you back to feeling like yourself.
The mechanism of concussion injuries has been covered extensively in our blog series, but it’s worth reiterating here to help explain why we recommend these lifestyle interventions.
A concussion occurs when an impact to the head or body is strong enough to transfer force to the brain, causing a shearing effect that damages neurons. This happens because different brain structures (like gray and white matter) move at different speeds due to their varying densities.
This shearing sets off a cascade of neurochemical and metabolic events, including excitotoxicity, mitochondrial dysfunction, oxidative stress, and neuroinflammation, all of which impair normal brain function.
Holistic recovery aims to address not just the physical symptoms of a concussion but also to create an optimal environment for the brain to heal on a cellular level through diet and nutrition.
The gut-brain axis is a complex, two-way communication pathway between the brain and the digestive system. This connection between your intestines and brain communicates through nerves (i.e., CNX; Vagus nerve), peptides, hormones, immune cells, and other small molecules (short-chain fatty acids).
Sundman, M. H., Chen, N. K., Subbian, V., & Chou, Y. H. (2017). The bidirectional gut-brain-microbiota axis as a potential nexus between traumatic brain injury, inflammation, and disease. Brain, behavior, and immunity, 66, 31-44.
Because of this two-way communication network, disruptions in the function of brain cells can be further compromised by dysfunctions in the digestive system. Therefore, when we have sustained a brain injury, we want to make sure that not only are our diet and lifestyle behaviors giving our brain the building blocks that it needs for recovery, but we also aren’t adding to the level of dysfunction that our brain has to deal with by having our digestive system as an additional source of inflammation.
Inflammation is one of the most misunderstood processes in the human body, and there is a lot of confusion on the internet about whether it is good or bad.
The truth is – it depends.
Inflammation is your healing response. Every time there is an injury, the process of inflammation brings in the cells that are going to repair that damage. Therefore, we need inflammation to heal from injuries. No inflammation, no healing. So, in that regard, it is a vital thing.
The problem with inflammation is when we get too much, or it lasts too long.
The “correct” inflammatory response is high enough to heal the injury but not so high that it becomes problematic elsewhere. Furthermore, once the healing has finished, the inflammation must return to pre-injury levels.
Therefore, in concussion recovery, we are looking to “optimize” the inflammatory process in our brains to help it heal without having higher levels of inflammation than is needed or having it last longer than the healing process dictates.
We previously discussed the importance of the gut-brain axis and how dysfunction in one system can exacerbate symptoms in the other. While this connection can contribute to problems for some individuals, it also presents an opportunity: optimizing your diet can support brain healing after a concussion.
If we can optimize our diet after a concussion, we can ensure that the brain gets all the vitamins and nutrients it needs to heal. We can ensure that our gut is not an additional source of inflammation that may be exacerbating our concussion symptoms.
To reduce inflammation through our diet there are a few different diets that have been shown to benefit neurologic conditions:
There is no “concussion diet” per se. Still, each of the above diet plans has the same general principles of reducing processed foods and refined sugars, eating nutrient-dense whole foods, and erring on the side of fewer calories rather than more.
If we’re playing the logical reasoning game, we’d recognize that the opposite of “reduced processed foods, sugars, and calories” is eating a Western Diet.
This means we should likely avoid the stereotypical “Western Diet” high in processed foods and refined sugars, low in whole foods, low in nutrient-dense foods, and very carbohydrate-heavy. The typical Western Diet has been proposed to aggravate the neuronal inflammation present after injury through molecular cross-talk between neurons and digestive systems.
Let’s take a closer look at some recommended diets for concussion recovery.
The Mediterranean diet is a diet that is primarily based on eating whole foods, with an emphasis on a large variety of fruits and vegetables, limiting red meat, and getting healthy fats from sources such as salmon and olive oil. This diet is rich in vitamins, minerals, and antioxidants and limits inflammation by cutting out processed foods and refined sugars. The only change that we make from the Mediterranean diet for our concussion patients is cutting out the moderate amount of wine intake because of its negative impact on concussion healing and symptom burden. For more information see our blog: Post-concussion recovery: The critical risks of alcohol consumption.
Here is a sample meal following the Mediterranean diet:
The Paleo and Ketogenic diets are similar diets based on eating whole foods and significantly reducing carbohydrate intake from all sources.
Ketogenic diets specifically reduce carbohydrates to the point where your body goes into a state of ketosis, generating fuel through the development of ketones rather than through breaking down carbohydrates into glucose.
Paleo-based diets play on the idea of only eating whole foods available to early humans. Therefore, they cut out all dairy, grains, legumes, processed foods, and refined sugars.
Both diets have been shown to reduce overall inflammatory load and improve blood sugar regulation in other neurological conditions.
Here is a sample meal on the paleo diet:
Time-restricted feeding (TRF) is the technically correct term for what many folks call “Intermittent fasting.” This is not so much a diet but more a method of timing your meals and can be done with any other diet you choose to enjoy.
The basis of TRF is that your day is split into “feeding” and “non-feeding” windows, where you are only allowed to consume calories in your “feeding” window so that your body does not have to process food all day. Get it? You put time restrictions on your feeding (“TRF”).
There are various approaches to TRF, but two standard options are the 14-hour and 16-hour fasting splits.
Limiting feeding windows helps your body take a break from constant digestion and focus on important repair work. During fasting periods, your body can produce more energy, clear out damaged cells, and improve brain function by strengthening connections between existing brain cells. Time-restricted feeding also helps balance your blood sugar, reduce inflammation, and make you more resilient to stress—all of which are especially helpful for healing and feeling your best after a concussion.
Please consult your doctor before starting TRF (or Intermittent Fasting; IF), as there are certain people and medical conditions where intermittent fasting is not recommended.
Calorie restriction is an emerging dietary option for concussion recovery, but we still don’t have a lot of data on its use in humans.
Mouse models have shown reducing the number of calories eaten in a day can improve concussion symptoms compared to a regular diet. Furthermore, eating a high-fat diet leads to worse outcomes than a standard diet (Mychasiuk et al., 2015). In addition, intermittent fasting (utilizing fasting every other day) also showed increased healing effects similar to those seen in calorie restriction in mouse models of concussion.
Mechanisms that lead to improved recovery with calorie restriction include reductions in inflammation, oxidative stress, improved neuron function, improved cellular repair, increased cardiovascular function, and reductions in LDL cholesterol (bad cholesterol).
When translating these results into humans, we want to make clear that calorie restriction does not mean not eating. It is recommended that you restrict calories by 15-30% from pre-injury levels and only for a short period.
It’s also important to note, and a callback to the introduction, that moving away from a Standard American/Western Diet will inherently reduce calories by consuming more whole foods and nutrient-dense (e.g., whole grains, fruits, veggies) rather than calorie-dense foods (e.g., ultra-processed foods, fried foods, etc.).
Of note, prolonged or extreme calorie restriction can reduce cognitive function and increase cognitive symptoms (O’Leary, 2024). Therefore, if you are going to try restricting calories for a prolonged period as a method of concussion recovery, you should do it under the supervision of a trained medical professional.
Hydration is an essential part of concussion recovery because it can ensure that your brain has the proper environment for healing and that you are not accidentally increasing your symptom burden from being dehydrated.
The brain is over 80% water; thus, changes in your brain’s water content can profoundly affect its ability to function. Research has shown that as little as 2% of body mass dehydration can lead to a 2% reduction in body mass and significant impairments in attention, executive function, and motor coordination (WhittBrodt, 2018). Furthermore, dehydration can lead to overlapping symptoms of concussion, such as headache, dizziness, trouble concentrating, fatigue, and exercise intolerance.
Therefore, it is recommended that you consume at least 2-3L of fluids per day, with most of those fluids being water. You should avoid fluids high in sugars, such as juices and soft drinks, and be mindful of your timing of fluids high in caffeine, such as coffee or green tea. Herbal tea, sugar-free carbonated water, and decaf coffee are all great ways to get additional fluids if you need to supplement your water intake. Electrolytes can be helpful in some people, but they are optional and should not be the primary source of fluids. They should be used as a supplement for those who are excessively sweating, with POTS, etc.
When consuming your fluids, you should aim for small amounts of consistent daily intake, as your body can only absorb 800-1000mL of water per hour at the maximum.
One of the troubles with diet optimization after a concussion is that everyone’s digestive system is unique and will have its own food sensitivities. One of the suggestions we give patients with a high level of neuroinflammation driven by gut dysfunction is to remove some of the most common foods known to cause sensitivity. Some of these are going to be triggers for some people and not others, but after a concussion, it is not a bad idea to stay on the safe side and remove them all for the first two weeks after sustaining an mTBI. They include:
If you think that you are going to struggle to remove all those common food sensitivities from your diet, your healthcare practitioner can help to guide you through a progressive elimination, re-introduction diet to find which of those foods specifically may or may not be contributing to gut inflammation, but if you can – just remove them all.
In conclusion, there are a lot of different dietary interventions that you can implement to optimize your recovery from a brain injury. The most important takeaways when it comes to diets for concussion recovery are reduction of high processed sugars and carbohydrates (no Western Diet), increase in intake of nutrient-dense foods (omega-3s, antioxidants, etc.), ensure proper hydration, reduce overall caloric intake, and avoid common food sensitivities. Not all these interventions will work for all people in all circumstances, so it is best to work with a trained healthcare professional to help you optimize your diet for your body and your recovery journey.
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