Brain Injuries in the Military: The Role of Nutrition, Sex Differences, and Preventative Care in TBI Recovery

Traumatic brain injuries (TBIs) are a critical concern in the military. Whether from blast exposure, falls, or combat-related incidents, TBIs can have long-lasting effects on cognitive, physical, and emotional well-being. According to the Defense and Veterans Brain Injury Center (DVBIC), between 2000 and 2019, nearly 414,000 U.S. service members, and more than 185,000 Veterans seeking health care from Veterans Affairs had been diagnosed with at least one TBI. A majority of those TBIs were classified as mild, but a brain injury is a brain injury, and the symptoms and co-morbidities associated with TBIs constitute a significant cause of disability outside of the military (U.S. Department of Veterans Affairs, n.d.).

The term “mild” is often misleading, as these injuries can lead to a range of symptoms, including headaches, memory problems, fatigue, and cognitive dysfunction. Many military personnel experience these symptoms for months or even years after the initial trauma, particularly when TBIs are compounded by conditions such as post-traumatic stress disorder (PTSD). While conventional treatments focus on addressing the immediate aftermath of injury, more attention is being given to the roles of nutrition, sex differences, and preventative care in optimizing recovery and long-term outcomes.

Traumatic Brain Injuries in the Military: A Silent Epidemic

The sheer number of military personnel affected by TBIs is staggering, but the challenges don’t end with the injury itself. TBIs can lead to secondary injuries, which include biochemical and molecular changes that exacerbate the initial trauma. These secondary injuries can impair cognitive function, create chronic health conditions, and dramatically impact quality of life. The burden of brain injuries often continues long after a soldier returns home, making it essential to explore new strategies for long-term recovery.

The Role of Nutrition in Brain Health

The brain is one of the most energy-demanding organs in the body, consuming around 20% of our daily caloric intake. When the brain is injured, these energy demands increase, and ensuring adequate nutrition becomes a key factor in recovery. Research shows that early nutritional intervention can significantly reduce mortality and improve outcomes in TBI patients. Unfortunately, nutritional support is often overlooked in the acute treatment phase, and many patients struggle to meet their energy and protein needs during recovery.

In a study of Malaysian TBI patients, researchers found that the majority were not consuming enough calories or protein, which severely impacted their recovery outcomes​ (Abdullah et al., 2020). While the focus is often on the initial trauma, the brain’s ability to repair itself in the weeks and months following the injury is crucial. Ensuring proper nutrition—especially protein and healthy fats—can make a significant difference in this process.

Key Nutrients for TBI Recovery

Certain nutrients have been shown to help the brain heal more effectively after trauma. These include:

• Omega-3 Fatty Acids: These essential fats are critical for brain function and have been shown to reduce inflammation and improve cognitive function in TBI patients. Omega-3s help to repair damaged brain cells and support the brain’s neuroplasticity—its ability to reorganize and form new neural connections (Noguchi et al., 2017). Some researchers have even argued that it’s unethical not to provide omega-3 supplementation to soldiers, given the evidence supporting its benefits. Studies suggest that omega-3 supplementation may help to prevent cognitive decline and improve overall brain function in individuals with a history of TBI. While more research is needed, omega-3s represent a promising avenue for both the treatment and prevention of brain injuries in military personnel (Coulter, 2014).

• Protein: Protein is essential for the growth and repair of tissues, including those in the brain. TBI patients often have higher protein needs due to the body’s increased metabolic rate following injury. Studies suggest that 1.5 g/kg/day of protein may be required to meet the needs of TBI patients ​(Erdman, 2011).
• Curcumin: This anti-inflammatory compound found in turmeric has gained attention for its potential role in reducing brain inflammation following injury. Animal studies suggest that curcumin may help to improve cognitive function and reduce the risk of secondary brain injuries​(Sun et al., 2020; Wu et al., 2014).
• Glutamine: Glutamine is an amino acid that plays a vital role in gut health, which can be compromised in patients with TBI. Gut health and brain health are closely linked through the gut-brain axis, and glutamine may help to maintain gut integrity, reduce inflammation, and promote overall recovery ​(Pathare et al., 2020).

These nutrients represent just a few of the many dietary factors that can influence brain recovery after a TBI. However, ensuring that military personnel are receiving adequate nutrition is often easier said than done. For many soldiers, access to high-quality food is limited, and the rigors of military life make it challenging to prioritize nutrition.

Gut-Brain Axis: An Overlooked Piece of TBI Recovery

The gut-brain axis—the two-way communication between the gut and the central nervous system—plays a critical role in maintaining overall health, particularly after a brain injury. Traumatic brain injuries can lead to gut dysbiosis, a disruption in the gut microbiome that can worsen inflammation and hinder the body’s ability to recover. This relationship works both ways: a compromised gut can negatively impact brain health, and a brain injury can worsen gut function.

Studies have shown that gut health interventions, including the use of probiotics like Lactobacillus acidophilus and supplements such as glutamine, can help support the gut-brain axis and improve recovery outcomes for TBI patients​ (Pathare et al., 2020).

Sex Differences in TBI: A Critical Consideration

The military workforce is predominantly male, but sex differences in TBI presentation and recovery are crucial for understanding how to tailor care to the individual. Men and women experience TBIs differently, both in terms of symptoms and recovery outcomes.

Research has shown that women may experience more severe symptoms following a TBI, particularly when it comes to cognitive and emotional effects. Women are also more likely to develop post-concussion syndrome (PCS), a condition characterized by prolonged headaches, dizziness, and memory problems. These differences may be partly due to hormonal fluctuations, particularly levels of estrogen and progesterone, which are known to influence brain function and recovery ​ (Ma et al., 2019).

Hormonal Influence on TBI Recovery

The hormonal changes women experience throughout their lives—from menstruation to pregnancy to menopause—can impact how they respond to brain injuries. Estrogen is thought to have a protective effect on the brain, reducing inflammation and supporting neurogenesis (the growth of new brain cells). However, when estrogen levels drop—such as during the luteal phase of the menstrual cycle or after menopause—women may be more susceptible to brain injury and its effects​(Johnson_Sobel_DEI).

Interestingly, research is beginning to explore the potential use of progesterone therapy for TBI patients, particularly women. Some studies suggest that progesterone may help to reduce inflammation and support brain repair, offering a new avenue for treatment. More research is needed, as these early studies were completed on rats, but these early findings suggest that hormonal treatments could one day play a role in improving TBI outcomes for women ​(Ma et al., 2019).

Differences in Symptom Reporting

Men and women also differ in how they report symptoms following a TBI. Women are more likely to report cognitive and emotional symptoms, such as memory problems, anxiety, and depression, while men may focus more on physical symptoms like headaches and dizziness. This discrepancy in symptom reporting can lead to underdiagnosis or mismanagement of TBIs in both genders, as clinicians may overlook or downplay certain symptoms based on a patient’s sex.

Understanding these differences is critical for providing comprehensive care to military personnel with TBIs. By recognizing that women and men may experience and recover from brain injuries differently, clinicians can tailor their treatments to address the specific needs of each patient.

Long-Term Effects of TBI: What the Data Shows

TBIs don’t just affect cognition—they have long-lasting effects on both physical and mental health. Studies show that individuals with a history of TBI are more likely to develop mental health disorders, including depression, anxiety, and PTSD. The risk of suicide is also significantly higher in individuals with a history of brain injuries, particularly among military personnel ​(Miller et al., 2021).

Research on long-term TBI outcomes in U.S. military personnel shows that both men and women with a history of TBI, before the age of 40, experience a marked decline in their ability to perform daily tasks, such as bathing, dressing, and feeding themselves. The data shows that women have a 44% increased risk of functional decline, while men have a 58% increased risk​ (Tabio et al., 2021). These findings highlight the critical importance of early intervention and comprehensive care to prevent further deterioration of health and function.

Preventative Care, Early Intervention, & The Importance of Comprehensive Care

Given the significant long-term effects of TBIs, preventative care is essential for military personnel. Early intervention—particularly in the form of nutritional support, lifestyle changes, and medical care—can go a long way in preventing the long-term complications associated with TBIs.

Military personnel face unique challenges when it comes to brain injuries. Addressing these challenges requires a comprehensive approach that includes nutrition, preventative care, and a deep understanding of sex differences in injury presentation and recovery. By focusing on these areas, we can help improve recovery outcomes and provide long-term support.

*This is a synopsis of a paper co-authored with Dr. Deb Sobel.

References

1. Abdullah, M. I., Ahmad, A., Syed Saadun Tarek Wafa, S. W. W., Abdul Latif, A. Z., Mohd Yusoff, N. A., Jasmiad, M. K., Udin, N., & Abdul Karim, K. (2020). Determination of calorie and protein intake among acute and sub-acute traumatic brain injury patients. Chinese Journal of Traumatology, 23(5), 290–294. https://doi-org.uws.idm.oclc.org/10.1016/j.cjtee.2020.04.004
2. Coulter, I. D. (2014). The response of an expert panel to Nutritional armor for the warfighter: can omega-3 fatty acids enhance stress resilience, wellness, and military performance? Military Medicine, 192–198.  https://uws.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=109683190&site=ehost-live
3. Erdman, J. (2011). Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. National Academies Press. 6, Energy and Protein Needs During Early Feeding Following Traumatic Brain Injury. https://www-ncbi-nlm-nih-gov.uws.idm.oclc.org/books/NBK209308/
4. Ma, C., Wu, X., Shen, X., Yang, Y., Chen, Z., Sun, X., & Wang, Z. (2019). Sex differences in traumatic brain injury: a multi-dimensional exploration in genes, hormones, cells, individuals, and society. Chinese Neurosurgical Journal, 5(1). https://doi-org.uws.idm.oclc.org/10.1186/s41016-019-0173-8
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6. Pathare, N., Sushilkumar, S., Haley, L., Jain, S., & Osier, N. (2020). The impact of traumatic brain injury on microbiome composition: A Systematic Review. Biological Research for Nursing, 22(4), 495–505.  https://uws.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=146204763&site=eds-live&scope=site
7. Rai, V. R. H., Phang, L. F., Sia, S. F., Amir, A., Veerakumaran, J. S., Kassim, M. K. A., Othman, R., Tah, P. C., Loh, P. S., Jailani, M. I. O., & Ong, G. (2017). Effects of immunonutrition on biomarkers in traumatic brain injury patients in Malaysia: a prospective randomized controlled trial. BMC Anesthesiology, 17(1), 81. https://uws.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=28619005&site=ehost-live
8. Sun, G., Miao, Z., Ye, Y., Zhao, P., Fan, L., Bao, Z., Tu, Y., Li, C., Chao, H., Xu, X., & Ji, J. (2020). Curcumin alleviates neuroinflammation, enhances hippocampal neurogenesis, and improves spatial memory after traumatic brain injury. Brain Research Bulletin, 162, 84–93. Retrieved from: https://uws.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S0361923020305037&site=eds-live&scope=site
9. Tabio, L., Walker, R. L., Crane, P. K., Gibbons, L. E., Kumar, R. G., Power, M. C., Kelley, A. S., Larson, E. B., & Dams-O’Connor, K. (2021). Association of Lifetime TBI and Military Employment with Late Life ADL Functioning: A Population-Based Prospective Cohort Study. Archives of Physical Medicine and Rehabilitation. Retrieved from: https://uws.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=34283993&site=ehost-live
10. U.S. Department of Veteran Affairs (n.d.). Traumatic brain injury (TBI). Retrieved from: https://www.research.va.gov/topics/tbi.cfm
11. Wu, A., Ying, Z., & Gomez-Pinilla, F. (2014). dietary strategy to repair plasma membrane after brain trauma: implications for plasticity and cognition. Neurorehabilitation & Neural Repair, 28(1), 75-84.  https://journals.sagepub.com/doi/10.1177/1545968313498650?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&

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