WRNMMC, Bethesda, MD  –   In observance of Brain Injury Awareness Month and National Nutrition Month, both observed during March, the National Intrepid Center of Excellence (NICoE) hosted a virtual program focused on nutrition therapy after brain injury on March 17.
Located at Walter Reed National Military Medical Center (WRNMMC), NICoE is a center of excellence within the Department of Defense because of its diverse capabilities and overarching mission of providing care to service members and families challenged by traumatic brain injury (TBI) and psychological health conditions.
Ruth Clark, a dietitian at NICoE, led the discussion regarding nutrition therapy after brain injury. She explained that following an anti-inflammatory diet and increasing anti-oxidant intake has been shown to help mental and physical health.
A dietitian serving diverse populations for nearly two decades, Clark said some people who suffer a mild brain injury may experience changes to their eating pattern and develop eating disorders. She stated a mild brain injury can cause a person who may have been active before the injury, to develop a sedentary lifestyle and gain weight, or conversely, exhibit a lack of desire to eat.
“I see it on both sides, [and some people] will tell me, ‘I lost my appetite,’ and they’re underweight,’” Clark said.
She said these are some of the reasons it may be necessary to refer someone who suffers a mild brain injury to a registered dietitian as herself.
Clark explained a registered dietitian can formulate individualized meal plans because everyone is different. Also, a registered dietitian is aware of evidenced-based recommendations “because there is so much misinformation out there,” she said.
“Service members are very prone to fad diets for quick results, the consequences of which can compound over time and be dangerous,” Clark added. “Nutrition assessments can uncover unhealthy habits.”
DIETARY CHANGES FOR IMPROVED HEALTH
Dietary changes may help improve mental and physical health, including have an impact on chronic pain, sleep disturbances, depression, anxiety, diabetes and fatigue, Clark said. She added people with poor diets are at increased risk of developing not only chronic disease and physical challenges such as diabetes, pain, heart disease and obesity, but poor nutrition also puts a person at risk for mental health challenges including anxiety, depression and sleep disturbances.
“A main goal of mine when I’m working with individuals who have a history of brain injury is try to get them to move away from the Standard American Diet (SAD),” Clark said. According to the U.S. Department of Agriculture (USDA), the SAD is low in fresh fruits and vegetables, whole grains, lean protein and healthy oils. It’s high in red meat, high-fat dairy products, processed and fast foods, refined carbohydrates, added sugars, salt and calories. “The American food supply is saturated with calorie-dense and nutrient-poor food and beverage choices,” Clark added.
“We focus a lot on inflammation because after brain injury, oxidative stress and inflammation result in the prolonged effects of the brain injury,” she stated. Oxidative stress and inflammation are interactive and play critical roles in ischemia/reperfusion injury in the brain.
THE ANTI-INFLAMMATORY DIET
Recent research published by United States Department of Health and Human Services regarding the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) Diet, an anti-inflammatory diet, shows it may slow cognitive decline with aging, and help prevent Alzheimer’s dementia.
Getting started with an anti-inflammatory diet includes:
• Including fruits and vegetables with every meal
• Decreasing red meat consumption
• Increasing fish intake
• Consuming dairy products to only several times per week
• Increasing intake of whole grains such a quinoa, oatmeal, brown rice
• Eating fresh fruit for dessert and saving ice cream or cookies for special occasions
Foods that should be avoided or reduced include:
• Added sugar: soda, candies, ice cream, table sugar and many other sugars
• Refined grains: white bread, pasta made with refined wheat, etc.
• Trans fats: found in margarine and various processed foods
• Refined oils: soybean oil, cottonseed oil and others
• Processed meat: Processed sausages, hot dogs, etc.
• Ultra processed foods
Nine foods Clark recommends people eat regularly include:
• Leafy-green vegetables
• Vegetables
• Nuts
• Fruits, especially berries
• Olive oil
• Whole grains
• Beans
• Fish

BENEFITS OF ANTIOXIDANTS
Clark explained antioxidants, which include vitamins C, E, and beta carotene, counteract oxidative damage caused by certain foods, and the stress caused by brain injury. She said foods high in antioxidants include:
• Vegetables: artichoke hearts, broccoli, green leafy vegetables, sweet potatoes
• Nuts: walnuts, almonds, flax seeds
• Fruits: berries, tart cherries, grapes
• Whole grains: oatmeal, quinoa
• Dark chocolate
• Tea: green, black, white, oolong
She added that anti-inflammatory spices that are healthier substitutes for salt include paprika, rosemary, ginger, turmeric, sage and cumin.
Clark said a sample menu for an anti-inflammatory diet may be:
• Breakfast: Greek yogurt with berries, walnuts and oats
• Lunch: whole-grain sandwich with rotisserie chicken and vegetable soup
• Dinner: baked chicken or turkey, roasted vegetables and quinoa
Another sample diet may be:
• Breakfast: eggs with a side of fruit
• Lunch: vegetable soup and veggie wrap
• Dinner: broiled salmon served with brown rice and vegetables
She added people should not eat meals within two hours of going to bed, and nighttime snacks should be high protein, low carbohydrate. She also said alcohol and caffeine consumption should be reasonable.
Clark emphasized that hydration is essential, explaining “dehydration can worsen symptoms such as headaches and fatigue.” People should primarily drink water, and decrease their consumption of soda and sugary beverages. “Men should drink at least 13 cups of water per day (104 ounces), and women should drink at least nine cups of water per day (72 ounces).” She recommends people drink at least half of their body weights in ounces of water a day.
SET SMART GOALS
Clark explained that some research shows the more people try to diet the more weight they gain over the long term. “Extremely restrictive diets are very hard to maintain long-term.”
Rather than trying restrictive diets, Clark encourages people to set SMART goals. SMART goals are Specific, Measurable, Attainable, Relevant, and Time-based. Examples of SMART goals she stated were:
• “Starting Monday, I will drink water in place of one of the sodas I drink at work. After a month of sticking to this, I will think about reassessing or adding a new goal.”
• “Starting next week, I will eat one fruit with breakfast every day. I will do this for three weeks. Then I will decide if I want to continue or add another goal at that time.
• “Starting tomorrow I will not eat past 8 p.m. Only water until I wake up the next morning. I will do this for three weeks and see if it makes a difference in my weight or sleep.”
“Nutrition interventions can improve mental and physical health. Working with a dietitian can improve long-term outcomes and success in lifestyle interventions,” Clark concluded.