The driving rain and violent gusts of wind are brutal. The crowd is freezing cold, but they don’t care. Their favorite football team is on the pitch.
Suddenly, a player increases the tempo, sinking all his strength into the opponent. Cries are heard in the stands.
The player jumps, shakes the blow, ready for the next game. But he suffered a sub-concussion – a critical component of chronic traumatic encephalopathy (CTE), a traumatic brain injury that often goes unnoticed during play.
The impacts to the head he sustained cause subclinical brain damage. Experts call this type of impact an under-concussion, a traumatic brain injury that does not have the signs and symptoms of a concussion. Under concussions often go unnoticed during play, but have been shown to play a critical role in the risk of developing CTE.
This disturbing scenario frequently occurs on soccer fields, basketball courts, and other sporting venues. The Centers for Disease Control and Prevention estimates that between 1.6 million and 3.8 million sports and recreation-related concussions occur each year in the United States. Although the prevalence of sub-concussion injuries is not well quantified due to the nature of the injury, the frequency is likely exponentially higher.
To remedy this, researchers at Virginia Tech in the College of Agriculture and Life Sciences are studying how docosahexaenoic acid (DHA), a type of omega-3 fatty acid generally inadequate in the diets of college athletes, helps protect the brain from trauma in a proof-of-concept study.
“It would be such an important discovery if a nutrition or dietary supplement intervention could make a difference in athletes’ risk of brain injury,” said Michelle Rockwell ’97, ’99 and ’19, adjunct faculty member at the Department of Human Nutrition, Food and Exercise and the principal investigator of the research project.
Research funding was originally awarded to Texas Christian University, but the Virginia Tech College of Agriculture and Life Sciences received the last two years of the three-year, $ 1.13 million DSM Nutritional grant. Products and will combine the results of the two sites.
The research team selected football because of the repetitive impacts to the head, which exceed 500 per college season and 5,000 during an NFL career. In the end, they chose linemen as the study group. The research was conducted from June to December 2020, covering the soccer summer camp and the entire soccer season.
“This is the first time that a randomized, controlled trial of DHA supplements with in-depth measures of head impact and brain damage has been conducted in soccer players,” said Rockwell, also a research assistant. principal within the Carilion Clinic Department of Family and Community Medicine and an assistant professor with the Virginia Tech Carilion School of Medicine. “DHA has been shown to be effective in reducing traumatic brain injury in mice, but we don’t watch the mice play on Sunday afternoons.”
The ultimate goal of the research is to identify dietary or supplement strategies that athletes or teams could implement to protect the brains of their athletes as one of the many measures put in place to protect their health.
Research in mind
Picking up on research where TCU researchers left off in 2020, researchers at Virginia Tech studied the Hokie football offense and linemen for an entire season. About half of the linemen received daily DHA supplementation and the remaining participants received a matched placebo, with the research being conducted in a double-blind scenario.
The dose of DHA, commonly found in foods such as oily fish and other seafood, given to athletes daily was in the range of two grams – a large amount but understandable given that average body weight of the participants was over 250 pounds.
Before the players entered the field, functional magnetic resonance images were taken in Stephen LaConte’s lab, associate professor at the Fralin Biomedical Research Institute at the VTC, to assess both structure and function of the brain in collaboration with collaborators from Harvard University and the University of Munich. These analyzes were repeated midway through the season and again after the football season. Ben Corl, associate professor at Department of Dairy Sciences was also a collaborator. Corl’s lab worked with researchers to analyze fatty acids in the blood.
Slipping on built-in GPS trackers into their helmets, players analyzed a plethora of motions, including gravitational impact forces, peak force, and rotational forces. Each of these impacts could contribute to micro-damage to the brain. Biomarkers in the bloodstream have been shown to reflect these brain damage in previous studies. Researchers measured the following biomarkers in this study: neurofilament lumen (Nf-L), total tau protein, glial fibrillar acidic protein (GFAP), and carboxyl-terminal ubiquitin hydrolase L1 (UCH-L1). A series of neurocognitive tests were also administered to assess functional changes associated with season and supplements.
From the master’s committee to research
To help keep the data collection team small during the COVID-19 pandemic, only a handful of students assisted with research, providing support to the core research team, monitoring supplement compliance, treating samples, administering tests and managing data. In total, three graduate students and five undergraduates were involved in the project in 2020 and seven students are involved in the data analysis phase of the project.
Peter Ritz ’19, from Plano, Texas, is one such student. He first met Rockwell as a graduate sports dietetic assistant at Virginia Tech in 2017 and worked full time overseeing nutrition programs for the soccer, women’s lacrosse and tennis teams while completing his master’s degree in applied nutrition and physical activity through Online Masters Program in Agricultural and Life Sciences at the College of Agricultural and Life Sciences. Ritz was the first to graduate from the Concentration in Applied Nutrition and Physical Activity.
The relationship began when Ritz asked if Rockwell would serve as an advisor to the masters committee due to his background in sports nutrition.
“I was interested in omega-3 fats, like fish oil, because I had read research linking them to brain health and was surprised that the NCAA supplement rules were ‘era did not allow schools to provide them to athletes, “said Ritz. “My initial proposal was to investigate and take blood samples from 50 of my athletes at Virginia Tech to learn more about their overall omega-3 status.”
Ultimately, Ritz received funding from the Collegiate and Professional Sports Dietitians Association and his project ended up involving 1,500 athletes at eight other Power 5 schools across the country. This project, published in PLoS One in 2020, helped demonstrate that athletes were not getting adequate levels of omega-3s in their diets, and ultimately the NCAA changed the rules regarding omega-3 supplements during the research process.
âI volunteered to help with this project after completing my masters as a side job because I am passionate about sports science research and I see how important it could be for health and well-being. long be thousands of athletes, âsaid Ritz. âOne of the things I love most about Michelle is that she treats everyone, regardless of their level of education, like an equal member of the research team. She truly believes in every student she comes in contact with and wants to see them succeed.
Ritz first helped set up the project within Virginia Tech’s athletic department, gaining approval from coaches, administration, and sports medicine staff. Most recently, he has focused on data analysis and helped Rockwell plan and write results publications.
âEssentially, what started out asking Michelle to be one of my masters committee members has turned into the most impactful professional relationship I’ve ever had,â said Ritz, now a sports football dietitian. at Northwestern University.
A proof of concept study
The research is in the final phase: the analysis of the results. And so far, said Rockwell, these results are promising. For example, some biomarker concentrations and neurocognitive measures were better in participants who took DHA supplements compared to those who took a placebo.
âSometimes we make recommendations to athletes on nutritional supplements that are in the ‘probably helpful’ category and unlikely to be harmful. Our current evidence certainly points in that direction, âsaid Rockwell.
Important next steps in the research involve the full analysis of the results, including the MRI results, which are expected next month. The research team will then submit the results to peer-reviewed journals while designing future work to repeat the study on a much larger group of athletes to confirm the results.
This research, in particular, could apply to all athletes and all sports. To that hockey player who makes repeated hits or bumps on the boards. This basketball player with a physical style of play. And the volleyball player who constantly hits the ground.