Nutrition and Supplements After Concussion

The ANZ Concussion Guidelines make no recommendation about nutrition, diet or dietary supplements. Their management sections cover education, activity, alcohol, analgesia, sleep, follow-up and referral. Supplementation is simply not in them. That is not an oversight to be worked around — it reflects the fact that the trial evidence has not reached the standard a national guideline requires.

The principal source for this page is a 2024 narrative review in Nutrients by Conti, McCue, DiTuro, Galpin and Wood. It is a careful and useful piece of work, and it is a narrative review — the authors searched for systematic reviews and meta-analyses, then included human and animal evidence as needed, and set out to identify compounds that are low-risk and plausibly beneficial. That is a legitimate and explicitly stated aim, and it is a different exercise from establishing that something works.

The distinction matters, so it is worth being blunt about it. Nothing on this page is standard of care. Nothing here substitutes for the things that are established — the graded return, sleep, load management, and treating the neck, mood and headache contributors that actually drive prolonged recovery. If a supplement is being offered to you instead of those, the priorities are the wrong way round.

Good reviews declare their own weaknesses, and this one does. Reading its limitations is more informative than reading its conclusions.

The two with the most substantial supporting rationale are creatine monohydrate and the long-chain omega-3 fatty acids. Creatine is proposed to help maintain cellular energy supply during the period of high metabolic demand after injury; the animal work reports meaningful reductions in damage, and there is a small paediatric trial in severe TBI — 39 children with Glasgow Coma Scale scores of 3 to 9, started within hours of injury — reporting better outcomes over six months. Doses discussed for athletes are a loading protocol around 20 g per day, roughly 0.3 g/kg, split through the day. Note what that trial population is: hospitalised children with severe brain injury, not a footballer with a concussion.

Omega-3 has the most interesting sport-specific signal. College footballers taking 2 g of DHA daily showed an attenuated rise in serum neurofilament light, a blood marker of axonal injury, across a season of repeated head impacts. That is a biomarker outcome rather than a clinical one — it tells you something is happening biologically, not that anyone recovered faster or played better.

Beyond those: choline, magnesium, riboflavin, branched-chain amino acids, berry anthocyanins, Boswellia serrata, N-acetylcysteine and melatonin each have a proposed mechanism and one to three small trials. Melatonin's evidence is for sleep after brain injury rather than for concussion recovery itself, which is a narrower and more defensible claim.

The review also emphasises things that are not supplements at all and are easy to overlook: a person's nutritional and metabolic status before the injury, blood glucose regulation, thermoregulation in the period immediately after impact, caffeine intake, and sleep behaviour.

Enzogenol is a flavonoid-rich extract of Pinus radiata bark. It is included here in more detail than the others for two reasons: the trial that supports it is the one most directly relevant to the people this page is written for, and it can be supplied through this clinic, which is disclosed below.

The evidence is a single phase II, double-blind, placebo-controlled pilot trial — Theadom and colleagues, European Journal of Neurology, 2013. Sixty adults who had sustained a mild traumatic brain injury three to twelve months earlier and still had cognitive difficulties took 1000 mg per day of Enzogenol or a matched placebo for six weeks. The primary finding was a reduction in self-reported cognitive failures at six weeks, with a mean difference on the Cognitive Failures Questionnaire of −6.9 (95% CI −10.8 to −4.1). It was safe and well tolerated. The other outcomes — working and episodic memory, post-concussive symptoms and mood — moved in the same direction but did not reach statistical significance. The authors themselves graded it Class IIB.

What that means in practice: one small pilot trial, in a specific population — persisting cognitive symptoms months after a mild injury, not acute concussion and not return-to-play — with a positive result on a subjective questionnaire and non-significant results on the objective measures, not since replicated in a larger trial. The study's later phases, where everyone received the supplement, were not placebo-controlled, so the reported continued improvement after week six cannot be attributed to the supplement with any confidence.

That is a reasonable basis for a considered discussion with someone whose cognitive symptoms have persisted for months and who has already had the treatable contributors addressed. It is not a basis for taking it after a weekend head knock, and it is not a substitute for the graded return.

If the interest in this page is recovering well, the interventions with the strongest evidence are not on a shelf. Sleep is the single most important one, and it is also the one most often disrupted after concussion — addressing insomnia and fatigue changes headache, mood and cognition together. Then a graded, structured return to cognitive and physical load rather than rest or overreach. Then removing what is making things worse, which most commonly means alcohol and analgesic overuse.

On food, the guidance from Sport Integrity Australia applies as much here as anywhere: food first. Adequate energy intake, adequate protein, and oily fish two or three times a week deliver the omega-3 rationale above without a capsule, a cost or a contamination risk. An athlete who is under-fuelling has a bigger and better-evidenced problem to solve than which supplement to add.

Any athlete in a tested sport needs to treat this as a compliance question rather than a nutrition one. Sport Integrity Australia's position is that athletes are wholly responsible for any substance found in their body, however it got there. Contamination is not a defence. Their testing of more than 200 non-batch-tested supplements found banned substances, frequently undeclared on the label, including in products marketed as all-natural.

Their recommended sequence, before any supplement: talk to an accredited medical professional or sports dietitian; consider whether food or a training change addresses the need instead; check whether a registered medicine is a lower-risk option, verifiable through Global DRO; check the product in the Sport Integrity App for batch-tested status; and keep a record of the batch number, expiry date and your checks. Rugby Australia maintains its own sports supplement policy in addition.

This is worth raising even for community athletes who are unlikely to be tested, because the same batch-testing that reduces doping risk is also the only meaningful assurance that what is in the bottle is what is on the label.

Low risk is not no risk, and several of these interact with things people are already taking. Fish oil at supplement doses adds to the bleeding risk of anticoagulants and antiplatelets — which matters particularly after a head injury, and is the same reason anti-inflammatories are avoided in that group. Melatonin's role in adolescents should be a considered decision rather than a default. High-dose creatine has predictable gastrointestinal effects and warrants attention to hydration. N-acetylcysteine and Boswellia both have interaction profiles worth checking against existing medication.

Anyone pregnant or breastfeeding, anyone with liver or kidney disease, and anyone on multiple medications should have supplements reviewed rather than assumed safe. Children are not small adults here — most of this evidence is in adults, the one paediatric creatine trial was in severe hospitalised injury, and extrapolating either to a junior athlete is not supported.

The plain version: bring what you are taking, including anything bought online, to the appointment. The interactions that cause problems are usually the ones nobody mentioned because it was 'just a supplement'.

Evidence, inference and opinion are worth separating. The evidence is that no Australian guideline recommends nutritional supplementation after concussion, and that a handful of compounds have small, mostly indirect trial support summarised in a 2024 narrative review. The inference is that a few of these — creatine and omega-3 in particular — have a plausible mechanism, a good safety profile and a low cost, which makes them defensible to discuss with an informed adult who understands the evidence is preliminary. The opinion is that they are worth a conversation in prolonged recovery, and are not worth much attention in a straightforward one.

What that means at an appointment: the foundations get dealt with first, and if sleep, load, alcohol, analgesia, neck and mood have not been addressed then that is the conversation. If they have, and symptoms persist, supplementation can be discussed on the basis set out on this page — with the evidence as it actually is, the anti-doping implications if you compete, and an interaction check against what you already take.