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Fish oil and football: an unlikely pair

Head trauma from football, and its delayed (and catastrophic) health effects, are a major issue in sports today. What if something as simple as fish oil supplementation could help with this

Study under review: Effect of Docosahexaenoic Acid on a Biomarker of Head Trauma in American Football

Introduction

Professional American football players are exposed to repeated head trauma, which has been linked[1] with symptoms of progressive brain injuries. Concussion, or mild traumatic brain injury (mTBI), occurs when contact and acceleration forces propagate through the brain. During impact, these forces are transferred to the brain and vascular tissues, causing micro-scale deformations.

Traumatic brain injury is classified as mild if the individual experiences loss of consciousness and/or disorientation for less than 30 minutes. Although it is called ‘mild’, symptoms can be traumatic and include behavioural and emotional disturbances evident post-concussion. More recently, the public has been made aware that repeated mTBI is also a risk factor for a variety of dementia-related neurological dysfunctions, most notably chronic traumatic encephalopathy[2] (CTE). CTE is a progressive neurodegenerative disease that affects people who have received repeated blows to the head, with some of its signs and symptoms shown in Figure 1. There have been a number of high-profile cases involving famous contact sport athletes as well as reports of military veterans[3] succumbing to the devastating effects of CTE.

Figure 1: Signs and symptoms of chronic traumatic encephalopathy (CTE)

Currently, there are a number of clinical studies[4] analyzing potential biomarkers of mTBI injury, as well as developing bioassays to detect these. The most promising biomarker[5] of head trauma is the presence of neurofilament light protein (NfL) in blood serum and cerebrospinal fluid (CSF). Neurofilaments are a structural element of long myelinated neurons that are damaged and hypothetically released into the CSF and blood during trauma such as mTBI. The CSF is the fluid found in the brain and spinal cord and, among many other functions, acts as a protective buffer against impact. Elevation of NfL concentrations in CSF has been shown in boxers[6] who have sustained repeated concussive head impacts during professional fights. There is even a correlation between the number of blows a boxer receives in a single match and the concentration of NfL detected.

To sample the NfL protein in CSF requires an invasive procedure known as a lumbar puncture. This method involves the insertion of a needle into the spinal canal and is therefore a complicated and delicate procedure to perform. On the other hand, a blood serum test is a much simpler method with fewer possible complications. Recently, researchers recorded elevated serum NfL levels in collegiate American football players[7] over the course of a season, which suggests that blood tests may be a valid but less invasive procedure than lumbar punctures for detecting head trauma.

In sports like American football, the prevention of head injuries is obviously highly desirable. Yet independent medical and scientific experts have questioned[8] the usefulness of today’s head-protection equipment. They have reported abject deficiencies in their ability to significantly reduce the incidence—or even the severity—of concussions received by players during gridiron game time.

In the absence of appropriate protective equipment, there is increasing interest in the use of nutritional supplements to protect athletes from concussion-induced brain damage. Omega-3 fatty acids, such as docosahexaenoic (DHA) or eicosapentaenoic acid (EPA), have received considerable attention recently for their supposed neuroprotective[9] properties. It is believed that omega-3 fatty acids are a precursor to compounds that are involved in anti-inflammatory and cytoprotective signaling. In favor of this theory are a number of animal studies[10] that have shown prior administration of supplemental omega-3 fatty acids—at relevant human dosages—attenuates brain damage caused by head trauma. It has been hypothesized that these supplements mitigate brain damage and the subsequent neurological symptoms.

DHA and EPA are the long chain polyunsaturated fatty acids 22:6 n-3 LCPUFA and 20:5 n-3 LCPUFA, respectively. See the sidebar of “Something Fishy” in NERD 9.2 to review how LCPUFAs are named. Omega-3 fatty acids are important for many reasons, including the health of cells in the central nervous system. Polyunsaturated fatty acids play a critical role in making cell membranes more fluid as well as giving rise to many different biologically active metabolites that influence health and disease.

A recently published study analyzed the effect of differing doses of supplemental DHA on serum NfL[11] in American high school football players. Oliver and colleagues hypothesized that over the course of one season, supplemental DHA would reduce brain damage in those football players who would naturally be subjected to repeated head impacts.

Since the early 20th century, science has shown that repetitive concussion can cause a progressive neurological dysfunction. This dysfunction has more recently been classified as CTE and due to its prevalence in athletes from contact sports, highlights the clear environmental etiology behind CTE neuropathology. To minimise the risk of developing CTE, scientists are studying various nutritional supplements that may impart neuroprotective properties.

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