This holiday season, actor Will Smith will star in a true-life big screen drama tackling the issue of concussion and traumatic brain injury (TBI) in American football players. With new evidence coming to light about the serious negative impact that head injuries can have on athletes long-term, emerging research indicates omega-3 fatty acids may play a role in protecting the brain from serious damage.
 
The feature film Concussion follows the work of neuropathologist Bennet Omalu, MD, MBA, MPH, CPE, DABP-AP, CP, FP, NP, co-founding member of the Brain Injury Research Institute, and his discovery that repeated head injuries experienced by American football players—now referred to as chronic traumatic encephalopathy (CTE)—were linked to significant cognitive failure. Symptoms of CTE include depression, impaired judgment and cognitive ability, violent and suicidal tendencies, and even symptoms similar to Alzheimer’s disease.
 
The discovery was made when he conducted the autopsy of beloved National Football League (NFL) hero Mike Webster, who died unexpectedly in 2002 after years of mental health struggles, including drug abuse, depression and severe cognitive decline. While initially Mr. Webster’s death was reported as a heart attack, Dr. Omalu’s assessment left him questioning how Mr. Webster’s failing brain health had contributed to his dramatic downfall.
 
Continued post-mortem research by Dr. Omalu led to the discovery of abnormal accumulations of tau proteins in Mr. Webster’s otherwise healthy looking brain, leading to a condition different from Alzheimer’s, but with similarly devastating effects.
 
These findings were published in 2005 in the peer-reviewed medical journal Neurosurgery. Despite support from numerous scientists backing his hypothesis and diagnosis of CTE, the NFL unanimously panned Dr. Omalu’s findings, accusing him of fraud, and asking him to retract his report.
 
Dr. Bailes & the Omega-3 Link
To address the controversy surrounding CTE and football brain injuries, the NFL hosted the first league-wide Concussion Summit in 2007 along with researchers and scientists. According to Dr. Omalu, Dr. Julian Bailes, also a co-founding member of the Brain Injury Research Institute and professor and chairman of the Department of Neurosurgery, West Virginia University School of Medicine, reached out to him to present data on his behalf.
 
Dr. Bailes (played by actor Alec Baldwin in the film) had been conducting research on the impact of traumatic brain injuries in football players, contributing to a published study in Neurosurgery in 2005 concluding that dementia-like symptoms in football players could be related to repetitive cerebral concussions.
 
Dr. Bailes continued his own research on traumatic brain injury (TBI), and in his quest has become a strong proponent of omega-3 docosahexaenoic acid (DHA) in preventing concussions and TBI. 
 
In 2011 a study conducted by Dr. Bailes, published in Neurosurgery, examined DHA supplementation in adult male rats prior to TBI, and found that it reduced injury response, measured by axonal injury counts, markers for cellular injury and apoptosis, and memory assessment. In his conclusion, Dr. Bailes called for further research to see how this information could be applied to protecting the mind prophylactically from brain injury.
 
In an interview featured on brainline.org, Dr. Bailes outlined the importance of DHA during these times of crisis. “There’s a couple of things that can protect the brain,” said Dr. Bailes. “One is omega-3 fatty acids, particularly, DHA (docosahexaenoic acid), which is the major structural fat of the brain.” He suggested that with brain injuries such as concussion or MTBI [mild traumatic brain injury] preventive DHA before an accident occurs is essential. “If you don’t have this dietary supplement in your system, the body really doesn’t have a chance to repair. It even appears in some of our published work, at least laboratory work, that DHA is preventative against concussion.”
 
Dr. Lewis & Military Minds
Dr. Bailes’ research also led to collaborations with Michael Lewis, MD, MPH, MBA, FACPM, FACN, president and founder of the Brain Health Education and Research Institute.
 
A retired colonel with the U.S. Army Medical Corps, Dr. Lewis, along with Dr. Bailes, published “Neuroprotection for the Warrior: Dietary Supplementation With Omega-3 Fatty Acids,” (Military Medicine, 2011), which explored how omega-3 supplementation prior to brain injury could benefit athletes and military personal alike.
 
According to the report, both athletic and military nutrition traditionally focused on energy and hydration. However, this method was failing soldiers, as the greatest medical obstacles facing them were cognitive issues such as post-traumatic stress disorder, suicide, and the long-term effects of TBI. The report urged a more “holistic approach” toward nourishing the mind and body of soldiers with supplementation of omega-3 fatty acids “to increase the resilience of the brain to withstand kinetic and psychological insult.”
 
The need for TBI support continues to grow. Since 2000 there have been 333,169 TBI diagnoses among U.S. military members, according to the Defense and Veterans Brain Injury Center.
 
Dr. Lewis continues to explore omega-3 supplementation in brain injury patients, and has established protocols for treating it preventively and during crisis. In discussing his research, Dr. Lewis noted, “My [omega-3 supplementation] protocols have been picked up by most university athletic programs, and they are now using omega-3s for their athletes before and after concussions. Through my non-profit I hear from people all over the world telling me how omega-3s have helped their loved ones who had been in a coma, or are dealing with the after effects of a concussion.” He added that many athletic trainers, even on the professional level, have also begun supplementing players with omega-3s using his protocol, or an adjusted version of it, in an attempt to decrease the amount of brain injury among team members.
 
He said the military has continued to explore research on omega-3s for suicide prevention through the National Institutes of Health (NIH), but have yet to roll out a comprehensive omega-3 supplementation program among military personnel.
 
When it comes to head injuries and concussion, Dr. Lewis believes there is much more that could be done to protect the brain prophylactically. “If you go to CDC.gov/concussion and look at what’s the standard of care for concussion, essentially what the CDC tells us is rest; don’t have any kind of cognitive or physical stress; talk to your healthcare provider—basically treat the symptoms.”
 
To Dr. Lewis, this is not an acceptable response. “The idea the brain needs time and will heal itself, that’s well and good, but what happens when it doesn’t? While that might be great for 60, 70 or 80% of people, what about the ones that don’t get better or continue to struggle with the symptoms? We continue to treat the symptoms with more and more pharmaceuticals, and that’s not good either.” With a different medication prescribed to treat each individual symptom, Dr. Lewis said often those struggling with the aftermath of head injury can end up on numerous medications, leading to further complications, side effects or even addiction.
 
“I believe there is more that can be done to help people with head injuries,” he continued. “I’ve chosen to focus on what is the brain made of in the first place, and omega-3s are an incredibly important part of that.”
 
He explained that in Western society the amount of omega-3s relative to the amount of omega-6s in the body has become increasingly deficient. One approach in addressing this is drastically reduce the amount of omega-6s in the diet, but this could take a year or two to change, and the food supply in America would make it extremely difficult. “I chose to work on the other side of the equation,” said Dr. Lewis, “looking at how can we increase the omega-3s, and how to do it really quickly. And when you do it that way you actually do treat the symptoms, while changing the brain. It’s actually that simple. You are what you eat.”
 
Dr. Lewis is optimistic that the film Concussion will continue to spread the word about this promising area of research to a more mainstream audience. “There’s definitely a buzz around the film now, but once it hits theaters I think it’s going to help increase awareness. Obviously in the last five or so years there’s been a lot of increased awareness—I think initially because of the military—and now a lot of it is about the NFL. So I think the movie is going to add to that. There’s always people who are going to take it to the extreme and say we should ban football, but the problem isn’t just football—pretty much all sports have an inherent risk, whether it’s soccer, rugby, hockey or basketball. Hopefully it will continue to move the science forward in how we can decrease this risk.”