Proper and adequate nutrition is essential for the gymnast who has suffered a concussion. Because of these “invisible injuries”, nutrition is often overlooked and this will only delay the healing time. Plus it can lead to further issues with the gymnast’s nutrition and health.
What are Concussions?
A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.
Early concussion treatment is crucial for a faster and more successful recovery.
How Often do Gymnasts get Concussions?
In one study of 437 college gymnasts, 42% reported seeking treatment for a concussion. Obviously, this is a select group of high level gymnasts doing more advanced skills and more likely to experience a concussion compared to the average recreational gymnast. Regardless, these are not stats to ignore. Gymnasts are at risk for head injuries.
Nutrition Issues Post-Concussion
It’s not uncommon for individuals suffering from a concussion to experience temporary changes in appetite. They may experience dizziness, nausea, or poor appetite which can make it difficult to meet nutrition needs.
In addition, research shows there is an increased rate of anxiety and disordered eating in gymnasts who have experienced a concussion. I’d argue this is similar for other injuries due to the nature of the sport and fear of weight gain, body change, etc.
Many gymnasts over-restrict their nutrition when injured or have to take time off gym. What worsens the return-to-play timeline is the fact that most gymnasts are already underfueling (low energy availability or RED-S), which could certainly have contributed to the injury in the first place.
One study found that 32% of gymnasts who had a concussion (42% of the 437) sought treatment for mental health issues (anxiety) and 34% sought support for an eating disorder sometime after the concussion.
Nutrition for Concussion Recovery
Concussions are often thought of as “invisible injuries”. Sometimes recovery can be slower and certainly not as external as healing a broken bone.
The brain uses about 20% of your daily calorie needs and relies predominately upon carbohydrate. The equivalent to 8 slices bread a day or about 130g carbohydrate.
Many gymnast, parents, and medical providers will reach for supplements and other strategies during times of injury, but the most important priority is adequate nutrition.
For a gymnast, special attention needs to be paid to adequate fueling. RED-S, relative energy deficiency in sport, is a huge threat to a gymnast’s career and longevity in the sport. This is one of the most important aspects of fueling the gymnast that everything else hinges upon in terms of performance and recovery.
The good news is that adequate fueling is the treatment for RED-S. Read more here.
Stabilize blood glucose
There are some acute changes to brain glucose metabolism during the early phase of a concussion, so it’s a good idea to make sure meals and snacks are balanced. Pairing fat, protein, and or fiber with carbohydrate is a way to slow down the rise in glucose and allow for a more steady release of energy. Concussion recovery will benefit from this approach to nutrition.
The brain is made of 60% fat, which is also the building block of many hormones and insulates nerves. Fat should be included at all meals and most snacks. There is not evidence to go over-board with fat (i.e. adding it to coffee, excessive amounts in smoothie, “fat bombs”, etc).
If you “google” concussion nutrition, you’re likely going to stumble across articles on the ketogenic diet. This diet was developed for children suffering from intractable epilepsy; meaning their seizures do not respond to medication (and often multiple medications).
As a pediatric dietitian formerly trained in the classical ketogenic diet, this is not something I would do for a gymnast trying to recover from a concussion. True ketogenic diets are very strict, mostly fat, not palatable, and have significant side effects that have to be managed.
Supplements for Concussions
The FDA released multiple warning letters to manufacturers who claim that their dietary supplement prevents, lessens the severity of, or hastens recovery from a concussion. Most of the ingredients included in these supplements include antioxidants (vitamin C and E), Vitamin D, Curcumin, Creatine, Omega 3 fatty acids, and other ingredients like melatonin and resveratrol that have been mostly studied in animal models (mice, rats, etc).
As always, supplements should be seen as “advanced nutrition strategies”. Gymnasts need to have the “big rocks” of nutrition in place before adding a bunch of supplements that are likely to be minimally effective without adequate and proper nutrition. This is taking a “food first” approach while also strategically using the science.
But, when suffering from an injury and trying to do everything possible to speed up the comeback process, it makes sense to see if there are any proven supplements that can help.
Vitamin C and E
It’s common to find sports supplements with high doses of vitamins C and E advertised as “antioxidant” support to reduce oxidative stress. Excessive antioxidant supplementation can actual be counterproductive for repair and recovery.
In adolescents, doses of vitamin E higher than 800 mg per day have shown to cause hemorrhage. This is one reason why just blindly supplementing with high doses of antioxidants can be counter-productive (and dangerous) for an athlete.
Supplementing with lower doses of vitamin C (<500 mg per day) are unlikely to causes issues, but doses higher than 2000 mg per day are shown to cause nausea, kidney stones, diarrhea, and gastritis.
Vitamin D and Iron
I’ve written Vitamin D and Iron extensively as they are essential for athletes, especially high level gymnasts. I recommended gymnasts have these checked at least once a year and supplemented if needed since they have such a huge impact on energy, recovery, etc.
Vitamin D plays an important role in lowering brain inflammation. However, studies tend to show that it’s more important to supplement when levels of vitamin D are low versus just globally supplementing an individual regardless of their levels. For athletes, we like vitamin D to be between 40-50 ng/mL for optimal health and performance.
Omega 3 Fatty Acids and Concussions
Omega 3 fatty acids (specifically eicosapentanoic acid and docosahexaenoic acid, EPA and DHA) are known to be effective in blunting delayed onset muscle soreness, about 48 hours after the exercise. These are something that I will often recommend to gymnasts.
For concussions, research has shown that supplementation with omega 3s before sustaining a concussion can protect against reduced plasticity of neurons and impaired learning by normalizing levels of proteins associated with neuronal circuit function, cognitive processing, synaptic facilitation, neuronal excitability, and locomotor control.
DHA plays the major role in decreasing brain inflammation, and it must be supplemented as it is not made in the body.
Magnesium, Riboflavin, and Concussions
Magnesium is an essential mineral in the body that is involved in hundreds of chemical reactions in the body. Magnesium helps w/ blood glucose regulation, lowers lactate production during exercise, helps with Vitamin D absorption in those with deficiency, and is often low in conditions like type 2 diabetes, metabolism syndrome, etc. Magnesium is also supplemented at times in individuals experiencing migraines.
Riboflavin also plays an important role in oxidative metabolism. Studies have shown a synergy between both riboflavin and magnesium for reducing headaches, which is a common post-concussion symptom.
Curcumin and Concussions
Curcumin or curcuminoids is the active anti-inflammatory compound found in turmeric. Turmeric is often way over-marketed as an “anti-inflammatory” ingredient or supplement.
Importantly, curcumin, like many other polyphenols, has poor bioavailability that can be improved with piperine co-ingestion or a lipid preparation (fat). Piperine is the major component of black and long peppers. It has been shown to inhibit enzymatic conjugation of curcumin, allowing greater levels of unconjugated curcumin to be absorbed into blood (Shoba et al. 1998) and increase curcumin tissue retention time. Lipid formulations like BCM-5 and Meriva dosed at 200-500 mg twice a day are used.
To date, there have not been any studies conducted looking at the use of curcumin post-concussion in humans. Therefore, any possible benefit is just an extrapolation from the current research regarding inflammation. Curcumin is currently being studied to evaluate its efficacy in preventing neurodegenerative diseases, especially in combination with vitamin D.
Creatine and Concussions
Creatine monohydrate is well known for its improvements in exercise power, aerobic and anerobic performance, body composition (increases in lean mass), and strength. There are other forms of creatine available, but there are not studies supporting the use of other formulations over creatine monohydrate.
Some studies support that creatine can also help reduce muscle damage or enhance recovery following intense exercise, including lowering inflammatory markers. Studies show mixed results, but it may be beneficial.
As for concussions, it’s known that creatine levels in the brain decrease post-concussion. Creatine is involved in energy production in the brain.
One study in children with mild to severe TBI used creatine supplementation for 3-6 months resulted in fewer children with severe disability or impairment and more with complete recovery. These same results were not seen in adults.
There are some specific nutrition strategies that can be used post-concussion for a gymnast. As always, it’s always recommended that high level gymnasts work with a sports dietitian to optimize nutrition in terms of prevention and improving longevity in the sport. This can be very proactive in terms of preventing injury and speeding up return to play in the case of an injury. In terms of concussions, there are many aspects of the gymnast’s nutrition that should be addressed to help with optimal healing. If you have any additional questions feel free to contact me.
Does your gymnast need help with nutrition?
1. Check out our 1:1 coaching program for competitive gymnasts (upper level compulsory through optional/elite gymnasts). This comprehensive nutrition program teaches competitive gymnasts and parents how to fuel for optimal performance and longevity in sport. We have are in-network with most major insurances and coverage for the program tends to be great for most families. Click here to learn more.
2. If you are a gymnast parent who wants to learn how to help your gymnast with nutrition, hop on the waitlist for our online nutrition program for parents, The Balanced Gymnast Method™ Course. You’ll get step-by-step instruction on how to fuel your gymnast (and so much more—like how to know if they’re growing well, deal with picky eating, navigate sugar, etc).
3. If you’re a coach or gym owner (or part of a Booster Club), our Signature Nutrition Team Talk Series is the perfect way to level up your gymnasts’ performance and recovery this season (and help their parents). There is not a more cost-effective way to help your gymnasts and parents with nutrition.