The landscape of brain health is rapidly evolving, particularly when it comes to prevention and recovery from concussions and TBI. Brain health is complicated, especially when dealing with chronic symptoms following a TBI. A one-size-fits-all approach isn’t going to work. Therapies targeting the inflammasome is essential to maintain or regain brain health after injury. While targeted rehabilitation remains the mainstay of concussion care, a return to the basics, providing a neuro-permissive environment offers hope for those suffering a decrement in brain health. Omega long-chain polyunsaturated fatty acids (LCPUFA) are essential components of membrane phospholipids and also precursors to a number of bioactive lipid mediators. Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are essential for optimal brain development and function. Dietary enrichment with DHA and other long-chain n-3 PUFA, such as eicosapentaenoic acid (EPA), has shown beneficial effects on learning and memory, neuroinflammatory processes, and synaptic plasticity and neurogenesis. Additionally, ARA, DHA, and EPA also are precursors to endocannabinoids. The endocannabinoid system comprises cannabinoid receptors, their endogenous ligands, the endocannabinoids, and their biosynthetic and degradation enzymes. Anandamide (AEA) and 2-arachidonoylglycerol (2-AG) are the most widely studied endocannabinoids and are both derived from phospholipid-bound ARA. The endocannabinoid system also has well-established roles in neuroinflammation, synaptic plasticity and neurogenesis, suggesting an overlap in their neuroprotective effects. There exists a complex interplay between omega-3s and omega-6s and the endocannabinoid system. DHA and EPA supplementation reduces AEA and 2-AG levels, with reciprocal increases in levels of the analogous endocannabinoid-like DHA and EPA-derived molecules, docosahexaenoyl ethanolamide (DHEA) and eicosapentaenoyl ethanolamide (EPEA) in particular. Addressing chronic TBI symptoms requires a holistic approach that the author will discuss, covering the importance of early return to exercise, good nutritional habits, targeted nutritional supplement therapy to improve inflammatory status, and objective evaluation of pituitary dysfunction and appropriate hormone replacement when indicated.

Learning Objectives:

1. Review the role of targeted nutritional supplementation before and following a concussion
2. Summarize the interaction between essential fatty acids and the endocannabinoid system and how it affects brain health
3. Discuss why a holistic approach to brain health and brain injury is important to achieve success with patients