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How is your brain’s health?

Nearly 1.7 million people suffer traumatic brain injury (TBI) each year, according to the Centers for Disease Control and Prevention (CDC). Of those, approximately 52,000 people die.

In observance of Brain Injury Awareness Month, the Defense and Veterans Brain Injury Center (DVBIC) at Walter Reed National Military Medical Center (WRNMMC) hosted a Brain Health Seminar on Wednesday, March 28.

“Traumatic brain injury is becoming a common wound of modern warfare. It has been coined the ‘signature wound’ of the War on Terror,” said Talia Thomson of the DVBIC. “Of the military population in 2010, just over 30,000 service members were diagnosed with TBI.”

She defined TBI as “forced trauma (bump, blow or jolt) to the head, either by being shaken or hit which temporarily disrupts the normal function of the brain. The most common cause of a TBI in the military is due to blasts. Other causes of TBI include falls, car accidents and sports.”

During last week’s seminar, speakers from throughout the Walter Reed Bethesda community discussed measures for brain health, including a healthy diet.

Katie Kirkpatrick, a registered dietitian with the Integrated Health Services/General Internal Medicine Department at WRNMMC, said the brain uses a lot of nutrients including vitamins, minerals, proteins, carbohydrates and fats, and about 20 to 30 percent of a person’s calorie intake is used by the brain.

Healthy intakes of folic acid and B vitamins are good for the brain, Kirkpatrick explained. She said B vitamins can lower homocysteine, an amino acid which in elevated levels can increase the risk for dementia, cognitive impairment and brain atrophy. Food sources for folic acid include whole grains, beans, cereals, fruits and vegetables. Good sources for B vitamins include fish, poultry, eggs, dark leafy greens, cereals and beans as well.

The dietitian also encouraged people to eat fruit, vegetables, nuts, herbs and spices, which are good sources of vitamins and antioxidants that help prevent damage to the brain caused by “free radicals” or waste products produced by the body.

Omega-3s, which control clotting and builds cell membranes, are also good for the brain, Kirkpatrick stated. Good sources for Omega-3s include fatty fish such as tuna, salmon, trout and herring, walnuts and flaxseed. She encouraged people not to skip meals; eat every three to four hours; choose balanced meals; limit refined carbohydrates and foods high in sugar; and limit sugar-sweetened beverages, such as sodas, which can be fattening.

Following Kirkpatrick, Dr. Megan Laabs, a neuropsychologist with TBI Service, discussed stress and brain health. She defined stress as “a physiological reaction caused by an awareness of threatening or aversive situations,” and said all stress is not harmful. She used the example of a Bell curve to explain stress levels, where at one end of the spectrum “healthy tension can lead to optimum levels of performance,” but as stress increases, it leads to exhaustion, panic and burnout, eventually causing long-term problems with attention and cognitive function if not properly managed.

Laabs explained some techniques for optimal brain health in handling stress, including exercise such as yoga; diaphragmatic breathing; progressive muscle relaxation; guided imagery; meditation; hobbies; and biofeedback.

Along with being aware of the impact of stress and brain health, sleep is essential for optimal cognitive function, explained Dr. Rachel Colbert, of the Sleep Disorders Center at WRNMMC. She said sleep is also important for restorative reasons, and not all people need eight hours of sleep each night, but everyone should get sufficient amounts of sleep so their judgments and health are not impaired.

Colbert noted things people should avoid that could impact their sleep include: naps, especially those longer than 30 minutes after 3 p.m.; caffeine four to six hours before bedtime; nicotine (especially around bedtime); vigorous exercise within two hours of bedtime; alcohol after dinner; sleeping pills; and evening use of medications with stimulating side effects.

The brain also needs stimulation to remain healthy, and Dr. Mike Pramuka, rehab psychologist in TBI service at WRNMMC, explained how mental exercises can provide this stimulation.

Mental exercise requires effort in order to be beneficial to brain health, Pramuka said. He described examples of mental exercises as learning a new activity; teaching someone else a new activity; making an argument for something you disagree with; making a drawing of your idea instead of talking about it; playing a new game; summarizing the plot of a movie to someone; reading and summarizing what you read to someone; breaking routines; volunteering in a new environment; intentionally getting lost while traveling; using your nondominant hand for some manual tasks; writing in full sentences (especially when texting or e-mailing); and meditating.

“[The mental exercise] needs to be something that’s fun or enjoyable to you, or else you’re going to try it once or twice and give up on it,” Pramuka said. He added that the bottom line is to “perform and engage with other people; do things that are novel and different for you, and build up your working memory.”

“Is there a link between exercise and brain fitness?,” was the question Lt. Col. (Dr.) S. Avery Davis discussed during his presentation. The chief of physical medicine and rehabilitation at WRNMMC said having an “engaging, enriched” environment can help improve cognition. He concluded by stating studies, such as those conducted by researchers at the National Institute on Aging (NIA), University of Illinois and University of Texas Medical Branch, of people 60 and older have shown the ones more active tend to have faster psychomotor speed on reaction time tests compared to sedentary older adults.

In addition, Davis said studies, such as those conducted by researchers at the University of Illinois and Vrije Universiteit in Amsterdam, suggest there’s a positive relation between physical activity and cognitive performance; aerobic fitness has a positive relation to academic achievement; reading comprehension and mathematical calculations/numerical processing are linked to prefrontal cortex and parietal/posterior cingulated cortex, which are stimulated by exercise; and cardiovascular fitness has been linked to the same fronto-parietal network.

Davis said research has also shown that increased aerobic fitness can increase the number of new cells and cell survival formed in the hippocampus, which is crucial for learning and memory.

Although there is room for more research, Davis concluded current studies strongly suggest, “You definitely do get improved cognitive function and performance if you are physically fit.”

For more information about TBI and brain health, call Kate Sullivan of the DVBIC at (301) 295-8531 or Talia Thomson of the DVBIC at (240) 620-8334.