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The Invisible War

The Invisible War

When we think of the relationship between a brain injury and the military we automatically assume that the cause would be from active service in a deadly war zone or hazardous situation. Studies have shown that between 15-28% of service personnel serving in Iraq and Afghanistan suffered concussions and of those, over 50% were caused by the blast of an Improvised Explosive Device (IED).

Statistics on brain injuries in the military supplied by DOD

In a recent article for the Journal of Military and Veterans' Health, Beran and Bhaskar (2018) stated that:


“Blast-related mild traumatic brain injury (mTBI) has been called the ‘signature injury’ of the wars in Iraq and Afghanistan due to the significantly high prevalence in veterans previously deployed in these regions. One in every 10 Australian Defence Force (ADF) personnel who have served in the Middle East reported post-concussive symptoms.”


However, evidence is now coming to light that a startling 80% of mild traumatic brain injuries (mTBI’s) happen in a non combat zone. Which is even more staggering when you consider that nearly 360, 000 US troops alone were diagnosed with having suffered a mTBI since 2010. It is clear that some of the activities carried out by service personnel in training and in their free time, also have a risk of brain injury involved. In this article, we look at the risk of concussion in the military in what medical clinicians are now calling the “invisible wound of war.”

TBI’s are caused by not only a blow to the head but by pressure waves caused by explosions. In fact, any type of pressure wave will induce a concussion effect within the brain. Training to fight, needs to be as realistic as possible and therefore, the training within the military should and will involve the use of live ammunition such as grenades and shoulder fired weapons.

The repetition of training is sometimes more frequent in nature that the actual realities of a war and as such, in training there is a much more likelihood of frequent exposure to these weapons. This is not a slight on the type of training carried out, in fact, it is the repetitious nature of this type of training that means that in the event of a highly stressful combat situation; training and skill becomes second nature and this could be the difference between life and death.

A recent report from the CNAS show how the frequent use of shoulder fired weapons in training increase the risk of concussion due to the weapons explosive release only inches away from the operators head. Further studies have shown that these repeated bouts of weapons training have resulted in short term memory loss and cognitive degradation.

The Role of Nutrition?

In 2011, the Institute of Medicine published a report summarizing nutrients that may play a role in resilience and recovery from TBI:

“Nutritional interventions could be important to augment mechanisms that defend against the effects of TBI and to serve as an integral component of multidisciplinary postinjury treatment to lessen the primary and secondary effects of TBI…Nutrition is potentially powerful adjunct to promote metabolic support during wound healing and may even exert neuroprotection if provided prior to injury”

Unfortunately, research has found that service members have dietary deficiencies in nutrients for mTBI recovery:  

  • Omega-3 fatty acid concentrations, especially DHA, are clinically low in service members.  Low DHA concentrations were associated with significantly increased the risk of suicide
  • 52-55% service members have deficient or insufficient vitamin D status. Vitamin D deficiency was associated with significantly increase risk of suicide
  • Frequent deployments reduce dietary quality in SOF operators

Traumatic brain injuries are complex, they cause molecular, cellular, and physiological changes in the brain.  Dietary interventions into mTBI management can minimize post-concussive symptoms and maximize return to duty progression.