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Brain-Boosting Meal Plans Help Service Members with TBI

Image of During the NICoE intensive outpatient program (IOP), staff nutritionist Ruth Clark teaches hands-on classes in the on-site patient kitchen. (Photo: Tahira Hayes (Ctr), NICoE/WRNMMC, NSA Bethesda). During the NICoE intensive outpatient program (IOP), staff nutritionist Ruth Clark teaches hands-on classes in the on-site patient kitchen. (Photo: Tahira Hayes (Ctr), NICoE/WRNMMC, NSA Bethesda)

Nutrition is one of eight domains of Total Force Fitness. 

Most of us know that changing the way you eat can improve energy, weight, heart health, and other physical issues. But did you know that it can also affect brain health? 

Research has shown that dietary changes may help relieve symptoms that might complicate recovery from a traumatic brain injury (TBI), such as chronic pain, anxiety, depression, and sleep problems. 

The Defense Intrepid Network for TBI and Brain Health (Intrepid Network), a group of 13 TBI clinics that includes two OCONUS sites, treats these symptoms using a comprehensive interdisciplinary model of care. This patient-centric approach includes traditional rehabilitation, neurological, and behavioral health treatments combined with integrative medicine interventions and skills-based training. 

At some Intrepid Network sites, individualized nutrition plans are part of the treatment. The National Intrepid Center of Excellence (NICoE) and the Intrepid Spirit Center (ISC) at Fort Belvoir have registered dietitians on staff who are also military veterans. This common ground makes it easier to build rapport with patients, said Fort Belvoir nutritionist Isa Kujawski, a Navy reservist who spent 10 years on active duty. 

NICoE dietitian Ruth Clark, an Army veteran, describes her approach as “focusing on ways to optimize nutrition in order to maximize healing potential.” During the NICoE intensive outpatient program (IOP), a four-week treatment program for active duty service members diagnosed with mild-to-moderate TBI and associated health conditions, Clark teaches group nutrition classes and sees patients individually to create personalized meal plans. 

Both Clark and Kujawski counsel patients on the benefits of an anti-inflammatory diet, in part because TBI can cause brain inflammation. 

“Inflammation is one of the first things I educate patients on,” said Kujawski. “It’s the body’s defense mechanism but can cause damage over time. That’s why adopting an anti-inflammatory diet is so important, especially for brain health.” Studies suggest that fatty fish, whole grains, legumes, and colorful vegetables and fruits all have anti-inflammatory properties. Processed, package or fried foods should be avoided as they may promote inflammation. 

Many patients come in with what Clark considers overly restrictive diets, limiting both what to eat and how often. She stresses the importance of meal patterns for improved cognition. “Eating more frequently throughout the day gives the brain a steadier source of energy,” she said. 

Military personnel posing in a kitchen Isa Kujawski, nutritionist at Intrepid Spirit Center Fort Belvoir, teaches TBI patients about how diet affects brain health. An anti-inflammatory diet that includes some of the foods pictured can help with common symptoms of TBI, studies suggest (Photo by: Isa Kujawski (Civ), Intrepid Spirit Center, Fort Belvoir).

She also explains how correcting nutritional deficiencies can improve a variety of symptoms, including problems with sleep quality or quantity. 

Sleep is 10 times more effective for overall health than any sexy supplement I can give you, explained Kujawski. 

Her approach is less about being on a diet and more about using food as medicine. The first step: testing micronutrient levels, especially folate and vitamins D, B6, and B12. Most of her patients have a vitamin D deficiency, which can be associated with depression, fatigue, and anxiety. 

Many also have gastrointestinal symptoms when they return from deployment. Causes are varied and hard to pinpoint, but several studies have confirmed a link between TBI recovery and gut health. For Kujawski, this makes sense. “The gut and brain are connected. About 90% of serotonin [a neurotransmitter associated with mood] is made in the gut,” she said. “The state of your brain can affect the state of your digestion.” 

One Fort Belvoir ISC patient found relief by switching from a meat-heavy, high-carb diet to a plant-based one. In an email to Kujawski months after his treatment ended, he wrote: “All of my abdominal inflammation has disappeared … [along with] the massive cramping and abdominal pain I have had for years.” 

Tips for Reducing Inflammation 

  • Use more herbs and spices. Paprika, rosemary, ginger, cloves, and cinnamon are among many that have been shown to reduce inflammation.
  • Increase plant-based proteins. Nuts, beans, and other plant-based proteins are rich in fiber, nutrients, and bioactive compounds that can help reduce chronic inflammation. 
  • Eat the rainbow. Fruits and vegetables of various colors contain different phytonutrients which play varying roles in lowering inflammation. For example, red foods contain lycopene, while green foods contain sulforaphane. 
  • Include more salmon and tuna in your diet. They are good sources of Omega 3, an essential fatty acid that can also be found in whole grains, walnuts, and green leafy vegetables. 
  • Eat dark chocolate that is at least 70% cocoa. Studies show that 1.5 ounces a day decreases inflammation. Dark chocolate contains plant compounds called flavanols, which can lower inflammation by acting as a rich antioxidant while also promoting healthy blood flow.

For more information on the anti-inflammatory diet, see “Eating to Reduce Inflammation,” a resource from the Department of Veterans Affairs.

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