Concussion Recovery – What Was the Condition of the Brain Before the Blow?
- Gary Moller
- 11 minutes ago
- 16 min read
Summary for busy people
Why do some people recover quickly from concussion while others remain unwell for months or even years after what appeared to be a relatively minor blow to the head? Understanding why concussion recovery varies so greatly between people has interested me for much of my working life in sports medicine and rehabilitation. Increasingly, I wonder whether we have concentrated too heavily on the force of the blow and not enough on the biological condition of the brain that received it.
My working hypothesis is that the resilience of the axons and their surrounding myelin, together with mineral balance, nutritional status, essential fatty acids, mitochondrial function and exposure to potentially neurotoxic elements, may influence both susceptibility to concussion and the ability to recover afterwards. These are clinical observations and hypotheses, not settled conclusions. However, there is enough established science surrounding the biology of the nervous system to justify asking these questions and investigating them properly. My starting point remains the same as it has been for years: test, don't guess.
"Perhaps we have concentrated too heavily on the force of the blow and not enough on the biological condition of the brain that received it."
My father's boxing career and a question that stayed with me
My interest in concussion and traumatic brain injury goes back a long way. Some of it comes from my training and work in physical education, sports medicine and rehabilitation, but I suspect the seed was planted much earlier, with my father. Dad served in the Navy and, following his discharge, fought professionally as a boxer for a short time. Curiously, he never talked much about his fights. I often wondered why. Most former sportsmen enjoy telling stories about their exploits when they were young and, if anything, those stories tend to improve as the years roll by. There is that wonderful old saying among ageing sportsmen: "The older I get, the better I was." Dad, however, did not talk about his boxing.
I have sometimes wondered whether boxing itself provides part of the explanation. Boxing is a peculiar sport because, at its most brutal, success may involve striking another person's head hard enough to temporarily disrupt his brain function. There is usually a winner and a loser, and the loser may quite literally have portions of the contest that he cannot remember. I cannot know whether this happened to my father, and I do not want to manufacture a medical history for him after the event. Perhaps he simply did not enjoy talking about boxing. His professional career was thankfully quite short-lived. Nevertheless, I have often wondered whether repeated blows to the head, and perhaps episodes of concussion that were simply accepted as part of boxing in those days, might help explain both the silence and the brevity of his career.
That question stayed with me as I moved into sports medicine and rehabilitation. Why can one person sustain what appears to be a considerable blow to the head and recover remarkably well, while another receives what seems to be relatively minor trauma and remains affected for months or years? The obvious answer is that no two blows are identical, and no two brains are subjected to precisely the same mechanical forces. But I have come to wonder whether there is more to it than that.
"Most former sportsmen find that the older they get, the better they were. Dad, however, did not talk about his boxing."
The glass jaw and the rock jaw
Anyone familiar with boxing knows the expressions. One fighter has a "glass jaw", while another seems to possess a "rock jaw". Two boxers may be the same weight, equally fit, strong and experienced, yet one appears able to absorb blows that would leave the other on the canvas. There are perfectly good biomechanical explanations for some of this. Neck strength matters, as do head movement, fatigue, anticipation, the direction of the blow and, particularly, the rotational acceleration produced within the brain. Previous concussions may matter as well.
But I have long wondered whether there is another part of the story. Could there be something different about the biological integrity of the brain itself? Could a person with structurally robust axons, healthy and resilient myelin and good metabolic reserve have a nervous system better able to tolerate mechanical deformation than somebody whose nervous tissue is already nutritionally or metabolically compromised?
I cannot tell you that this has been proved, because it has not. I regard it as a working hypothesis. However, once we begin examining what axons and myelin are actually made from, how energetically demanding they are to maintain, and what happens to the brain during and after traumatic injury, I think it becomes a question well worth exploring.
"Could the difference between the proverbial glass jaw and rock jaw lie partly in the biological resilience of the brain itself?"
The brain's wiring is living tissue
We commonly describe myelin as insulation around an electrical wire. It is a useful analogy, but it can also be misleading because myelin is anything but inert. Myelin is a specialised, lipid-rich membrane surrounding axons. Within the central nervous system it is produced and maintained by oligodendrocytes. Together, the axon, its internal cytoskeleton, surrounding myelin and supporting cells form a living and metabolically demanding system. This system must be constructed during development, maintained throughout life and repaired where possible following injury.
Research has also uncovered intriguing sex differences in axonal structure and in outcomes following concussion. Experimental studies have reported that female axons can be smaller and contain fewer microtubules, with experimental injury and modelling suggesting greater vulnerability to mechanical disruption under comparable loading conditions. This does not mean that women simply have "weaker brains", nor does it establish a single explanation for the differences sometimes observed between men and women following concussion. Neck strength, hormones, biomechanics and numerous other factors may contribute. Nevertheless, the research tells us that biological differences in the structures being injured deserve consideration.
I originally thought about this mainly in terms of whether one person might have thicker, stronger and more pliable myelin than another. I now think the better concept is the integrity of the entire axon-myelin unit. Myelin thickness may be part of the story, but so may axon diameter, microtubule architecture, membrane integrity, oligodendrocyte health, mitochondrial energy production and the capacity of all these systems to maintain and repair themselves.
And, of course, all of this biological machinery has to be built from something.
"Myelin is not insulation tape. It is living tissue that must be built, maintained, nourished and, following injury, repaired."
Copper and the patterns I keep seeing
This brings me to Hair Tissue Mineral Analysis, or HTMA. Over many years of testing people, I have been struck by how frequently I see patterns that I interpret as being consistent with disturbed copper regulation. My clinical estimate is that such patterns occur in perhaps 80 per cent of the women and girls I test and around 60 per cent of the men and boys. I want to emphasise that these are my clinical observations, not population statistics. The people who come to me for testing are a selected clinical population, and these percentages should not be extrapolated to the population as a whole. Nevertheless, when I see a pattern repeatedly over many years, I pay attention to it.
Copper is an essential trace element involved in nervous-system biology, cellular energy production, antioxidant defence, iron metabolism and neurotransmitter function. But copper does not work in isolation, nor is more necessarily better. Both deficiency and excess can cause problems, and its relationship with zinc, iron and other minerals is important. What matters is not simply how much copper is present, but how effectively it is being regulated, transported and utilised.
This is why, when interpreting HTMA, I do not look at copper as an isolated number. I look at patterns and mineral relationships, then relate these to the person's diet, symptoms, health history, occupation, lifestyle and environmental exposures.
"The chart provides clues. The person provides the context."
Toxic elements add another piece to the puzzle
Something else has caught my attention when testing people suffering persistent post-concussion symptoms, particularly men. I have frequently encountered HTMA findings that prompt questions about possible exposure to potentially neurotoxic elements such as lead, mercury, cadmium and arsenic, and sometimes manganese or aluminium. Quite often, the person's occupational history makes the finding even more interesting.
I have seen this among people who have spent years driving trucks, operating heavy machinery, farming, welding, working around combustion and exhaust fumes, handling treated timber, renovating old buildings or working in environments where dusts, paints, fuels, chemicals and metals may have been part of everyday life. This does not mean that an elevated hair result proves toxic poisoning, nor does it establish that the element caused the person's post-concussion syndrome. Significant findings may require confirmation through appropriate medical, occupational, blood, urine or environmental investigation. Nevertheless, when the HTMA findings and the occupational history point us in the same direction, I think it would be foolish not to investigate further.
There is another reason these toxic elements interest me. They do not necessarily operate independently of nutritional status. Depending upon the particular element, chemical form, dose and duration of exposure, lead, mercury, cadmium and arsenic may interfere with mineral-dependent enzymes and cellular systems, disturb the metabolism or utilisation of essential elements, increase oxidative stress and impair mitochondrial or neurological function. Therefore, it may not simply be a matter of somebody having "too much lead" or "too little zinc". The more interesting problem may be a disturbed biological terrain involving both toxic exposures and impaired regulation of essential nutrients such as copper, zinc, iron, selenium and magnesium.
Now place a concussion on top of that pre-existing terrain. Could somebody enter a traumatic brain injury already carrying a considerable neurological and metabolic burden? Might that help explain why apparently similar injuries can have remarkably different outcomes? Again, I am asking the question rather than claiming to know the answer.
"The concussion may be the event that tips the system over, rather than the beginning of everything that is wrong."
What about fat and cholesterol?
This leads to another subject about which we have received some very confused nutritional messages over the past half-century: fat. Myelin is extraordinarily rich in lipid. Cholesterol, phospholipids and sphingolipids are fundamental components of its structure. Cholesterol is not some foreign substance that unfortunately happens to circulate in our blood. It is an essential biological molecule and is particularly important within the nervous system.
There is an important qualification here. Most of the cholesterol required within the central nervous system is manufactured locally rather than simply being taken from cholesterol circulating in the bloodstream. Brain cells manufacture cholesterol through a biochemical pathway beginning with acetyl-CoA, and cholesterol is subsequently transported and recycled within the brain. So eating an egg does not simply send cholesterol from the yolk directly into your myelin sheath. Biology is much more sophisticated than that.
But neither does this make nutrition irrelevant. The brain cannot manufacture cholesterol out of thin air. Synthesis requires carbon substrates, enzymes, energy and properly functioning cellular metabolism. The manufacture and maintenance of myelin also requires much more than cholesterol alone. Phospholipids, fatty acids, proteins and numerous micronutrients are involved in building and maintaining nervous tissue. This is why I think it is reasonable to ask whether years of poor or restrictive nutrition might affect the resilience and repair capacity of the nervous system, even though we cannot reduce the matter to simply eating more cholesterol.
"The brain cannot manufacture and repair its extraordinarily complex lipid structures out of thin air."
Are some people trying to repair their brains while undernourished?
For decades we were bombarded with messages encouraging us to remove fat from our food. Supermarket shelves filled with products proudly announcing themselves to be "97 per cent fat free" or "99 per cent fat free", as though the removal of natural fat automatically transformed a food into something healthy. I have often wondered about the consequences of this message, particularly for young women.
Over the years I have seen many women eating highly restrictive diets. Some have been extremely low in natural fats. Others have followed vegetarian or vegan diets which, while capable of being nutritionally adequate when carefully constructed, may in practice have been marginal in one or more important nutrients. I am not saying that vegetarianism causes concussion, nor am I saying that eating a low-fat diet causes post-concussion syndrome. Those conclusions would go well beyond the evidence.
What I am asking is whether somebody who has been chronically undernourished, restricting energy and natural fats, or marginal in protein, vitamin B12, iron, zinc, copper, selenium, choline or long-chain omega-3 fatty acids might possess less neurological reserve when an injury occurs. This question becomes particularly relevant when a young woman sustains what appears to have been a relatively modest blow to the head yet remains profoundly affected many months later. Rather than looking only at the accident, I want to know what she was eating before it happened, whether she was consuming enough energy, whether menstruation was normal, whether she was training heavily, whether she ate eggs, seafood or meat, whether there had been previous concussions and whether there were signs of mineral dysregulation.
DHA deserves particular attention in this discussion. Unlike cholesterol, which the brain can manufacture locally, omega-3 fatty acids ultimately depend upon dietary supply. We can convert some plant-derived alpha-linolenic acid into EPA and DHA, but conversion, particularly to DHA, is limited. This is one reason I value oily fish and seafood, or appropriate marine or algae-derived sources of EPA and DHA. It does not mean that DHA prevents concussion or cures post-concussion syndrome. It means that DHA is an important component of normal nervous-system biology and therefore deserves consideration when we are trying to create favourable nutritional conditions for neurological recovery.
"Could some people be asking an injured brain to repair itself while simultaneously depriving it of the raw materials needed for the job?"
Concussion recovery is also a metabolic job
A concussion begins with mechanical energy. The brain moves and deforms within the skull. Axons may be stretched and twisted, cell membranes and ion gradients are disturbed, calcium handling changes and cellular energy requirements increase at precisely the time when normal energy metabolism may be compromised. This is one reason concussion can be deceptive. A scan may reveal little or nothing dramatic while, at the cellular level, the brain may be dealing with a considerable metabolic disturbance.
From that point onwards, recovery becomes an enormous biological undertaking. Cells have to restore their normal ion gradients, mitochondria have to generate energy, membranes must be maintained and repaired, axons and myelin must be supported, neurotransmitter systems have to regain equilibrium, and inflammatory processes must carry out their necessary work without becoming excessive or unnecessarily prolonged. None of this happens for free. It requires energy and raw materials.
This is why I see little sense in asking an injured nervous system to undertake a major rebuilding programme while simultaneously depriving the person of nourishing food. We would not expect an injured athlete to rebuild muscle while chronically starving them of protein and energy. Why should we imagine that the brain, arguably the most metabolically sophisticated organ in the body, can undertake its own repair programme without adequate nutritional support?
"A concussion begins as a mechanical event. From there, recovery becomes a biological and metabolic job."
What I like to see on the table
My preference is for nutrient-dense, minimally processed food. I want sufficient energy and adequate high-quality protein. Depending upon the person's circumstances, that may include eggs, meat, liver and other organ meats in sensible quantities, oily fish, shellfish, full-cream dairy foods and unsweetened yoghurt, together with vegetables, berries, fruit, nuts, seeds and other nutritious plant foods. I am not advocating an extreme high-fat or high-protein diet. I am advocating nourishment.
Eggs are particularly useful because they combine complete protein with natural fats, cholesterol, phospholipids and choline. Seafood can provide DHA and EPA together with minerals such as selenium, zinc, copper, iodine and iron. Meat provides protein, B12, iron and zinc, while plant foods contribute vitamin C, folate, potassium, polyphenols and numerous other compounds. These foods complement one another. The objective is not to identify one miraculous "brain food", but to provide the broad nutritional foundation upon which normal repair processes depend.
This is also why I become concerned when somebody recovering from concussion is simultaneously restricting food because they are unable to exercise and are frightened of gaining weight. That may be precisely the wrong time to impose an energy deficit. Repair costs energy, and the injured brain should not be expected to rebuild itself from nutritional scraps.
"Do not ask an injured brain to rebuild itself from nutritional scraps."
My Super Smoothie as a nutritional foundation
One practical way I try to provide this nutritional foundation is with the FreeRangers Super Smoothie. The current formulation contains whey protein concentrate, hydrolysed collagen, citrulline malate, L-glutamine, New Zealand blackcurrant, creatine monohydrate, glycine, beta-alanine, L-carnitine and taurine. The whey concentrate also contains sunflower lecithin, a source of phospholipids, although the amount present is not separately quantified.
I am particularly interested in the creatine because the brain, like muscle, possesses a creatine-phosphocreatine system that helps buffer cellular energy. Following traumatic brain injury, when energy demand may rise while energy metabolism is disturbed, that becomes biologically interesting. I am not claiming that the creatine in the Super Smoothie treats concussion. Rather, it is one component of a formulation designed to provide useful nutritional substrates within a broader programme of nourishment and recovery.
I prefer to make the Super Smoothie into something resembling a nourishing meal rather than simply mixing the powder with water. Full-cream milk and unsweetened yoghurt provide additional protein, energy and natural dairy fats, while coconut oil can provide another source of energy and fat. I also add one dessert spoon daily of Waihi Bush Organic Omega 3 Super Boost Oil. This provides plant-derived essential fatty acids, but because conversion of plant omega-3 into DHA is limited, I commonly complement it with two capsules daily of Endo-Met EPA-DHA Omega-3 Fish Oil.
I also commonly add one teaspoon daily of Progressive Professional C-Aspa-Scorbate to the smoothie. Vitamin C participates in antioxidant defence and numerous enzyme systems, and the injured brain is dealing with considerable oxidative and metabolic demands. Once again, the distinction is important: I am not presenting vitamin C as a treatment for concussion. I am trying to ensure that the person has good nutritional support while the body's own repair mechanisms do their work.
"I am not looking for a magic concussion supplement. I am trying to provide the recovering brain with the nutritional conditions required for repair."
When additional nutritional support may be appropriate
Inflammation following brain injury is not automatically undesirable. It is part of the body's normal response to injury and participates in clearing damaged tissue and initiating repair. Problems may arise when inflammatory and oxidative processes become excessive or remain active beyond their useful role. Persistent symptoms do not, by themselves, prove that somebody has ongoing neuroinflammation, but it is one of several biological mechanisms that may deserve consideration.
Depending upon the person and the results of assessment and testing, I may therefore consider some additional nutritional support. This might include an extra teaspoon of Sujon New Zealand Blackcurrant Powder in the smoothie. Blackcurrants provide anthocyanins and other polyphenols and offer a useful food-based means of increasing antioxidant intake.
Another optional addition is one 100 mg capsule daily of Progressive Professional CoQ10. Coenzyme Q10 interests me particularly because of its role in mitochondrial energy production as well as antioxidant biology. I may also consider one capsule daily of Progressive Professional Pro-Antho Formula as additional antioxidant support. These are optional additions rather than a standard prescription, and their suitability depends upon the person in front of me.
"Inflammation is part of healing. The problem may be when it becomes excessive or fails to settle when its useful work is done."
Test, don't guess
This is the most important practical message in the article. I do not want somebody reading this, deciding that copper must be their problem and immediately buying copper supplements. Nor do I want somebody assuming that an elevated hair mercury or lead result explains every symptom they have. Minerals interact in complicated ways, and toxic-element findings need context and, where appropriate, confirmation.
One of my starting points is Hair Tissue Mineral Analysis through Precision Health Testing. I am particularly interested in copper, but I never interpret copper in isolation. I look at the mineral relationships and the wider pattern, including zinc, iron, selenium, magnesium and the other essential elements. I am also looking for findings that may justify further investigation of exposure to lead, mercury, cadmium, arsenic, aluminium, manganese and other potentially troublesome elements.
Then I take the history. I want to know what this person eats, whether they have spent years restricting natural fats, and whether they are eating sufficient protein and total energy. I want to know whether they eat eggs and seafood, whether they are vegetarian or vegan and, if so, what that diet actually consists of. I want to know whether they are training heavily while chronically under-eating and what their occupational history looks like. Have they spent 30 years welding, farming, driving trucks, operating heavy machinery or working with treated timber? Have they suffered previous concussions? How well do they sleep? Most importantly, what was their health like before the accident?
The HTMA chart gives me clues, but the person gives me the context. Significant findings may require confirmation with appropriate medical, blood, urine, occupational or environmental investigations. HTMA does not diagnose concussion, heavy-metal poisoning or damaged myelin. It is one investigative tool that can help us decide which questions deserve asking next.
"Test, don't guess. But remember that a laboratory result should begin an investigation, not end one."
Perhaps we have been asking only half the question
When somebody suffers a concussion, naturally we ask about the accident. How hard was the blow? How fast were they travelling? Did they lose consciousness? Was there rotational force? How long were they confused? What did the scan show? These are important questions and should always form part of proper medical assessment.
But after decades of working with injured people, I increasingly wonder whether we have been asking only half the question. The other half is: what was the condition of the brain that received the blow?
Perhaps the boxer with the rock jaw and the boxer with the glass jaw differ partly because the biological structures receiving that mechanical force are not identical. Perhaps the young woman who remains incapacitated following an apparently modest concussion entered that accident with less nutritional and metabolic reserve than anybody realised. Perhaps the tradesman who has spent decades around fumes, metals and industrial contaminants was carrying an additional neurological burden before he ever struck his head. Perhaps mineral dysregulation, inadequate nutrition or poor metabolic health does not cause the concussion at all, but influences the capacity of the nervous system to withstand it and repair itself afterwards.
These remain hypotheses. Some may eventually prove more important than others, and some may have to be discarded or substantially modified as the evidence develops. That does not trouble me. Clinical medicine has always advanced partly through careful observation. We see something repeatedly, ask why it might be happening, examine the physiology, compare our observations with the scientific literature and then test the hypothesis as best we can. Clinical observation should never be dressed up as scientific proof, but neither should it be dismissed merely because research has not yet caught up with the question being asked.
I do not believe we should promise people miraculous concussion cures, and anybody suffering a traumatic brain injury requires appropriate medical assessment and management. But neither should we be satisfied when somebody remains unwell month after month and is simply told to keep waiting. There may be more going on than the original blow. We need to look beyond the accident, look carefully at the person who received it, ask what condition their nervous system was in beforehand and investigate what may now be interfering with recovery.
"Do not look only at the blow. Look at the condition of the brain that received it."
And, wherever possible, test, don't guess.
Medical Disclaimer
This information is provided for educational purposes only and is not intended as personal medical advice, diagnosis or treatment. Concussion and traumatic brain injury can be serious and require appropriate medical assessment. Always consult an appropriately qualified healthcare professional regarding persistent neurological symptoms, suspected toxic exposure, medications, supplements and individual health circumstances.
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