Omega-3 fatty acids and their neuro-protective abilities following brain injury

The slippery truth about oil: can omega-3 fatty acids really help recovery after traumatic brain injury (TBI)?

We need omega-3 polyunsaturated fatty acids for a wide variety of physiological functions linked to the brain's development, functioning, and ageing.

Indeed, omega-3 deficiencies may increase the risks of developing psychiatric disorders such as depression, dementia and autism. [1]

Increasingly, however, research has been around omega-3 fatty acids (O3FAs) for their neuro-protective abilities in the wake of brain injury.

We’ve filtered out some of the more mega omega-3 findings since brain injury researchers first started assessing the benefits over 20 years ago.

   Omega-3 fatty acids are safe, affordable, and readily available worldwide to potentially reduce the burden of traumatic brain injury. [2]    

Unlike most other types of fatty acids needed to stay healthy, our body can’t make any or enough of the main omega-3s needed for brain health, including:

-         ALA (alpha linolenic acid).

-         EPA (eicosapentaenoic acid).

-         DHA (docosahexaenoic acid).

To counter the deficit, we need to eat foods rich in O3FAs - vegetable oils, nuts and seed for ALA and oily fish and other seafood for EPA and DHA – or consider dietary supplements; there are now multiple supplements available to suit all diets including algae oil as a vegan option.

But growing research suggests we should also be turning to O3FAs as part of treatment and neurorehabilitation plans post-TBI.

Preliminary findings of a US study released only last month suggest that high doses of O3FA supplements after TBI in rats can prevent neuroinflammation [3].

And research published in July last year by a Chinese university team showed O3FAs could protect against blood-brain barrier disruption caused by TBI in mice [4].

They also discovered that the O3FA-rich fish oil used in the trial helped lessen neurological impairment and clear the glymphatic pathway - a waste clearance system in the brain, as yet only partly understood by scientists [5].

   Due to the global burden and human suffering of TBI, and in lieu of no demonstrated effective pharmacological treatment, the use of O3FA presents an attractive option.[6]   

In May last year, in the Journal of Neurosurgery, leading US medics set out a case for a large multicentre trial of the impact of O3FAs on TBI recovery after positive outcomes were observed in a study of nine patients [6].

The patients, aged between 19 and 59, had sustained severe TBIs due to blunt head trauma and, as such, were categorised as <8 on the Glasgow Coma Scale (GCS). 

On or soon after, they were admitted to the hospital. In addition to standard treatment, they were given high-dose supplements of purified omega-3 oil with a 2:1 ratio of EPA and DHA in a mixture of micronutrients known to enhance the effects of O3FAs.

All of the patients’ GCS scores improved over the course of the study.

And when compared to relevant historical data on TBI outcomes, the authors concluded O3FAs ‘provided benefits to the neurological outcomes of severe TBI and a significant return of function.’

Scroll back to 2018 and, again in China, medical researchers discovered that O3FAs could protect neurons against TBI-induced destruction (neuronal apoptosis) [7].

A year earlier, a team comprised of both US and Chinese researchers had used spatial cognitive deficits, brain tissue loss and brain repair processes as markers by which they would test the impact of O3FA supplements post TBI in mice [8].

Their results indicated that ‘repetitive and prolonged [O3FA] treatments after TBI are capable of enhancing brain remodelling and could be developed as a potential therapy to treat TBI victims in the clinic.’ 

In 2014, a mini-review of the beneficial effects of omega-3 fatty acids in experimental TBI models between 2004 and 2012 concluded:

• O3FA intake could lessen secondary TBI effects.
• O3FA supplements should be a therapeutic option for TBI survivors [9].

And in the same year, a review of the role of O3FAs in traumatic neurological injury by experts at London’s Centre for Neuroscience and Trauma highlighted the following:

• O3FAs as a potential treatment for TBI.
• O3FA intake after or before injury improves outcomes.
• Understanding the role of O3FAs in neuroplasticity is critical [10].

It’s 2011 and, in another US trial, concentrated fish oil rich in EPA and DHA was reported as having ‘significantly reduced’ axonal damage after head injury in rats [11]. 

The effect was observed after just 30 days of O3FA dietary supplementation.

   Well tolerated and easy to administer, nutritional interventions using omega-3 fatty acids present a unique advantage and opportunity.’[12]   

Finally, in a wide-ranging 2013 review of the physiological functions of O3FAs in the central nervous system [12], US researchers describe their ‘uniquely protective role’ against the degenerative effects of TBI.

And they conclude that O3FAs can: 

• Reduce inflammation.
• Restore cellular energetics.
• Attenuate apoptosis.
• Repair cell damage.

Related articles 

Nutrition and rehabilitation - It is already widely accepted that our mood, behaviour and brain function are all influenced by our diet. But for brain injury survivors, scientists are now discovering diet can make a big difference to rehabilitation outcomes.

Nutrition after brain injury - A lived experience

Further talking heads articles

To celebrate brain awareness week we’ve selected 12 of the many events being promoted in the UK by the British Neuroscience Association (BNA) that highlight some of the astounding work being done to help us better understand the human brain.

Lose yourself in the music that has uplifted brain injury survivors and their families – 26 sounds (and a singing bowl!) to fine-tune neurorehabilitation.6 sounds (and a singing bowl!) to fine-tune neurorehabilitation.

Crafts to support neurological occupational therapy and brain-injury rehabilitation

200 Home activities for brain injury survivors and their families

Over 30 online communities to help keep spirits high among brain injury survivors and their families during the covid19 lockdown

Twenty apps to boost brain injury rehabilitation

Waltz with us on world stroke day

How to enjoy a daily dose of exercise despite brain injury

References

[1] K. Lange, “Omega-3 fatty acids and mental health,” Global Health Journal, March 2020.

[2] J. Mills et al, “Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model,” Journal of Neurosurgery, January 2011.

[3] E. K. Black et al, “The effect of dietary supplementation with high- or low-dose omega-3 fatty acid on inflammatory pathology after traumatic brain injury in rats,” Translational Neuroscience, February 2021.

[4] E. Zhang et al, “Omega-3 Polyunsaturated Fatty Acids Alleviate Traumatic Brain Injury by Regulating the Glymphatic Pathway in Mice,” Frontiers in Neurology, July 2020.

[5] H. Benveniste et al, “The Glymphatic System and Waste Clearance with Brain Aging: A Review,” International Journal of Experimental, Clinical, Behavioral and Technological Gerontology, March 2019.

[6] J. E. Bailes et al, “Omega-3 fatty acid supplementation in severe brain trauma: case for a large multicenter trial,” Journal of Neurosurgery, May 2020.

[7] X Chen et al, “Omega-3 polyunsaturated fatty acid attenuates traumatic brain injury-induced neuronal apoptosis by inducing autophagy through the upregulation of SIRT1-mediated deacetylation of Beclin-1,” Journal of Neuroinflammation, November 2018.

[8] H. Pu et al, “Repetitive and Prolonged Omega-3 Fatty Acid Treatment after Traumatic Brain Injury Enhances Long-Term Tissue Restoration and Cognitive Recovery,” Cell Transplantation, April 2017.

[9] P. R. Kumar et al, “Omega-3 Fatty Acids Could Alleviate the Risks of Traumatic Brain Injury – A Mini Review,” Journal of Traditional and Complementary Medicine, April 2014.

[10] A. T. Michael-Titus et al, “Omega-3 fatty acids and traumatic neurological injury: from neuroprotection to neuroplasticity?” Trends in Neurosciences, January 2014.

[11] J. D. Mills et al, “Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model,” Journal of Neurosurgery, January 2011.

[12] L. Hasadsri et al, “Omega-3 Fatty Acids as a Putative Treatment for Traumatic Brain Injury,” Journal of Neurotrauma, January 2013.