Mild Traumatic Brain Injury? Don’t forget the Sugar!

Take Home Message:

  • A 2015 study of cerebral metabolism post traumatic brain injury reported the need for glucose intake following injury due to disruption in mitochondrial glycolysis and attempts at compensatory increased gluconeogenesis .
  • Earlier studies demonstrated mitochondrial dysfunction and decreased ATP synthesis.  This accounts for the decreased train of thought and cognitive fatigue.
  • Advising patients of the need for keeping glucose levels at a normal level will prevent secondary cellular death and sequel.


SugarBecause it is the product of glycolysis and main substrate for mitochondrial respiration, lactate is the central metabolic intermediate in cerebral energy substrate delivery. Our recent studies on healthy controls and patients following traumatic brain injury (TBI) using [6,6(2)H2]glucose and [3(13)C]lactate, along with cerebral blood flow (CBF) and arterialvenous (jugular bulb) difference measurements for oxygen, metabolite levels, isotopic enrichments and (13)CO2 show a massive and previously unrecognized mobilization of lactate from corporeal (muscle, skin, and other)glycogen reserves in TBI patients who were studied 5.7 ± 2.2 days after injury at which time brain oxygen consumption and glucose uptake (CMRO2 and CMRgluc, respectively) were depressed. By tracking the incorporation of the (13)C from lactate tracer we found that gluconeogenesis (GNG) from lactate accounted for 67.1 ± 6.9%, of wholebody glucose appearance rate (Ra) in TBI, which was compared to 15.2 ± 2.8% (mean ± SD, respectively) in healthy, well nourished controls. Standard of care treatment of TBI patients in state of the art facilities by talented and dedicated heath care professionals reveals presence of a catabolic Body Energy State (BES).

Results are interpreted to mean that additional nutritive support is required to fuel the body and brain following TBI. Use of a diagnostic to monitor BES to provide health care professionals with actionable data in providing nutritive formulations to fuel the body and brain and achieve exquisite glycemic control are discussed. In particular, the advantages of using inorganic and organic lactate salts, esters and other compounds are examined. To date, several investigations on brain injured patients with intact hepatic and renal functions show that compared to dextrose + insulin treatment, exogenous lactate infusion results in normal glycemia.


Brooks GA, Martin NA. Cerebral metabolism following traumatic brain injury: new discoveries with implications for treatment. Front Neurosci. 2015 Feb 9;8:408

 Link to the article in Pub Med

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About David Taylor

Dr. Taylor is a graduate of NUHS. He became board certified in neurology in 1992 and has 30 years of clinical experience as the director of an interdisciplinary clinic in Massachusetts. He has served as Director of Clinics and Attending Clinician at TCC and currently serves on faculty there. In addition he was appointed by 2 governors and served as secretary on the Massachusetts Chiropractic Licensing Board. He is a fellow of the FCLB, served as test evaluator and examiner for the NBCE, and has participated in the generation of the Chiropractic Best Practices document as a member of the CCGPP. He is published in many peer reviewed and professional trade journals and has lectured nationally and internationally. He was 1 of only 2 DC’s in the state of Massachusetts credentialed as an impartial examiner for the Industrial Accidents Board and currently is one of a handful of health care practitioners in Houston that is Certified as a Medical Examiner by the federal DOT. In addition, he continues as president of Healthcare Review & Consulting, Inc. His interests are in pain management, concussion management, quality assurance and standards of care.