Omega-3’s and Traumatic Brain Injury Treatment
Want the takeaways of this article? read the TLDR of the research below.
Omega-3s have been used in humans to treat traumatic brain injury. One such study in the American Journal of Emergency Medicine presents a case study about a teenager who suffered a severe TBI in 2010.
Like me, he was diagnosed with a diffuse axonal injury with an initial Glasgow Coma Score of 3, which is the lowest possible score (no response to any stimuli, but still alive).
Thought to be in a permanent vegetative state, he was given a gastric tube (PEG), and a procedure was performed which left him breathing through a tube protruding from his neck (tracheotomy).
Then The Fish Oil Came…
Ten days after the injury, he was given a large dose (15 ml, which is about 13 g) twice a day (30 mL/day) of Nordic Natural UltimateOmega via his PEG (feeding tube).
On the 21st day, he was weaned off of the ventilator, and soon progressed from vegetative state to attending his high school graduation three months later!
What About the Risk of Blood Thinning?
Many Clinicians are afraid to use high-dose omega-3’s because of their blood thinning effects. This paper addresses this concern and shows much evidence to support the use of high-dose fish oils as a treatment for brain injury:
Omega-3 Fatty Acids as a Putative Treatment for Traumatic Brain Injury
Hasadsri, L., Wang, B. H., Lee, J. V., Erdman, J. W., Llano, D. A., Barbey, A. K., . . . Wang, H. (. (2013). Omega-3 Fatty Acids as a Putative Treatment for Traumatic Brain Injury. Journal of Neurotrauma, 30(11), 897-906. doi:10.1089/neu.2012.2672
“…Potential harmful effects of n-3 PUFAs [omega-3s], however, have been described in the literature. Due to the established anti-thrombotic action of these compounds, for instance, they may increase the risk of hemorrhagic stroke, as suggested by a necropsy-based study of four cases in Greenland.138 The authors warn, however, that the power of their analysis is weak given the limited sample size, and that their study may have been subject to inadvertent selection bias.138 In addition, multiple clinical trials have shown that highdose fish oil consumption is safe, even in patients receiving other agents that may increase the risk of bleeding, such as aspirin and warfarin.139–141 The overall clinical data suggests that DHA at doses up to 6 g/day does not have deleterious effects on platelet aggregation or other clotting parameters in normal individuals, and fish oil does not augment aspirin-induced inhibition of blood clotting.137 Platelet function is, on the other hand, inhibited by DHA consumption in type 2 diabetics, but it is suggested that this may actually be of benefit to these individuals, especially when coupled with the other activities of DHA.142 Nevertheless, it may be prudent to discontinue high-dose supplementation in the setting of an acute bleeding illness or in patients at high risk for hemorrhagic stroke or, as is frequently recommended with aspirin, warfarin, and clopidogrel, prior to planned invasive procedures with the highest risk for bleeding complications.143–146″
TLDR: Summary of the above article
In other words, while Omega-3’s have been shown to thin the blood, this was mainly shown by a study which the authors admit is somewhat weak because of a small sample size and selection bias.
Several other studies have shown high-dose fish oil consumption to be safe, even in patients who are receiving other blood thinners like warfarin and aspirin.
And up to 6g/day of DHA does not cause harm on clotting parameters in normal individuals, nor does it change aspirin-induced inhibition of blood clotting.
From the Abstract of this paper: Lien EL. (2009). Toxicology and safety of DHA. Prostaglandins Leukot Essent Fatty Acids 81, 125–132.
“DHA supplementation studies in adults have employed doses ranging from less than 1 to 7.5g/d, and have not resulted in any consistent adverse responses in platelet function, lipid levels, in vivo oxidation parameters, glycemic control, or immune function.”137
Alleviating Blood Thinning Concerns Citations
- 137. Lien EL. (2009). Toxicology and safety of DHA. Prostaglandins Leukot Essent Fatty Acids 81, 125–132.
- 139. Pedersen HS, Mulvad G, Seidelin KN, Malcom GT, and Boudreau DA. (1999). N-3 fatty acids as a risk factor for haemorrhagic stroke. Lancet 353, 812–813.
- 139.Bender NK, Kraynak MA, Chiquette E, Linn WD, Clark GM, and Bussey HI. (1998). Effects of marine fish oils on the anticoagulation status of patients receiving chronic warfarin therapy. J Thromb Thrombolysis 5, 257–261.
- 140. Eritsland J, Arnesen H, Gronseth K, Fjeld NB, and Abdelnoor M. (1996). Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am J Cardiol 77, 31–36.
- 141. Leaf A, Jorgensen MB, Jacobs AK, et al. (1994). Do fish oils prevent restenosis after coronary angioplasty? Circulation 90, 2248–2257.
- 142. Woodman RJ, Mori TA, Burke V, et al. (2003). Effects of purified eicosapentaenoic acid and docosahexaenoic acid on platelet, fibrinolytic and vascular function in hypertensive type 2 diabetic patients. Atherosclerosis 166, 85–93.
- 143. Bays HE. (2007). Safety considerations with omega-3 fatty acid therapy. Am J Cardiol 99, 35C–43C.
- 144. Calo L, Bianconi L, Colivicchi F, et al. (2005). N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: A randomized, controlled trial. J Am Coll Cardiol 45, 1723– 1728.
- 145. Covington MB. (2004). Omega-3 fatty acids. Am Fam Physician 70, 133–140.
- 146. Kris-Etherton PM, Harris WS, and Appel LJ. (2003). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Arterioscler Thromb Vasc Biol 23, e20–30
Omega-3’s and Traumatic Brain Injury Treatment
This article is mainly about how to use liquid omega-3’s as an adjunct therapy to help with brain injury, and other cases of severe brain inflammation. Our article on DHA (docosahexaenoic acid) is more related to normal daily consumption of omega-3’s as a capsule or food.
Moderating inflammation and oxidative stress in the brain after a traumatic brain injury or an ischemic injury like stroke is critical. Omega-3’s are a low-risk therapy that can help thousands of veterans and civilians alike.
When Should I Use Liquid Omega-3’s?
The same way we use N-Acetyl-Cysteine (NAC) in hospitals when we think someone may have overdosed on Tylenol, is the same way we can use fish oil. The reason we use this supplement in a clinical setting is that there is a lot of good research to back it up.
In the same way that we know that NAC cleans out the liver especially if is burdened with drugs like Tylenol, we know that omega-3’s have an anti-inflammatory effect in our body, and they also measurably reduce oxidative stress.
Liquid Omega-3’s helped JJ Virgin’s son recover from a traumatic brain injury. A little oxidative stress in the brain is a good thing, but prolonged oxidative can mean cells in injured areas start to cell death or apoptosis.
CNN Piece About JJ Virgin’s Son:
The List of Benefits Goes On…
After finding very favorable results in a study testing the use of DHA after a severe traumatic brain injury (diffuse axonal injury) in rats (CITE), the West Virginia University School of Medicine conducted a follow-up study to see the effect of DHA supplementation before a brain injury.
The study found that rats who were supplemented with DHA before a brain injury showed less damage done to the brain after, as well as better brain function, as assessed by maze testing.(CITE)
These Are My Two Favorite Fish Oil Products for Therapeutic Use:
Other Products We Like
Feed a Brain Protect and Restore High DHA Omega
Nordic Natural Ultimate Omega
Vital Choice’s High DHA Brain Care
Vital Choice Seafood and Organics
Docosahexaenoic Acid (DHA) for Synaptogenesis
Again, DHA is a kind of Omega-3 fatty acid that is largely found in fatty fish like mackerel, sardines, salmon, and tuna. As shown above, there are studies showing the uses of Omega-3s in the waking of comatose patients.
Because it seems to have an extremely potent effect on neurological recovery and in protecting the brain, not only are sports leagues very interested in Omega- 3s and their effects in preventing and treating brain injury, but scientists in the military are also inspecting this nutrient for brain injury treatment and neuroprotection.
In 2011, an article in Military Medicine, the official journal of The Association of Military Surgeons of the United States (AMUS), wrote that “a comprehensive, coordinated research program to evaluate the multiple uses of n-3 FA [Omega-3 fatty acids] should be a high priority for the Department of Defense.“ (CITE)
Read Our Full Article on DHA to learn about the specific benefits of this precious omega-3.
While in the short-term, it seems like therapeutic (very high) doses of Omega-3s can be beneficial, I do not think that large doses of Omega-3s should be an ongoing practice.
For this reason, in addition to eating plenty of cold water fatty fish, I still supplement my Omega-3s, but I prefer to do so in reasonable amounts (no more than 5g/day). Once you get over a deficiency, you can dial the dosage back a bit.
Read our Full Article on Supplements for Synaptogenesis to learn more about what other supplements feed your brain.
Food First, Supplement Second
I like to supplement with at least 1 – 2.5g/day of Vital Choice’s DHA + Vitamin D3 (1,400mg 2x/day), and often a gram or two of another fish oil supplement.
For a vegetarian source, Nordic Naturals – Algae Omega can be supplemented. Check with your qualified healthcare practitioner for amounts specific to you or your loved one.
Read more about Daily Use of Omega-3’s here.
Gastric Feed Instructions:
Supplementation in conjunction with whole food sources may be beneficial for this nutrient.
When feeding through a gastric tube, in addition to including fatty fish, we can supplement using Nordic Natural UltimateOmega in liquid form.
We can also use a high powered blender like a Blendtec or Vitamix to blend any of the above supplements with the feed.
For vegans and vegetarians we can blend Nordic Naturals – Algae Omega for a good source of EPA and DHA. (left)
Because cod liver oil is rich in many other fat soluble vitamins such as vitamin A, cod liver oil may not be appropriate at therapeutic (very high) doses.
Fat soluble vitamin A is great but at high doses, it can cause hypervitaminosis. As always, work with a qualified practitioner when supplementing, and share this information with your doctor to help us shift this paradigm in medicine.
Read our Ready Made Solutions for Gastric Feeds to learn the details.