Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition that affects millions of children and adults worldwide. While medications and behavioral therapies remain the standard treatments, many families seek alternative or complementary approaches to help manage symptoms. One such approach gaining attention is the Low Salicylate Diet. But what exactly is it, and can it really help with ADHD?

What Is the Low Salicylate Diet?

The low salicylate diet is a food plan that reduces or eliminates salicylates. Salicylates are naturally occurring chemicals found in many fruits, vegetables, and other plant-based foods. Salicylates are also present in artificial additives and preservatives. They are chemically similar to aspirin (acetylsalicylic acid), and some people such as certain children with ADHD can be sensitive to them.

This diet became popular through the Feingold Diet, which was developed by Dr. Benjamin Feingold in the 1970s. His theory was that removing salicylates, artificial colors, flavors, and certain preservatives could reduce hyperactivity in children with ADHD.

Foods to Avoid on a Low Salicylate Diet

Salicylates are found in high amounts in many healthy foods, which makes this diet challenging to follow. Some of the common high-salicylate foods to avoid include:

• Apples
• Berries (especially strawberries, raspberries)
• Grapes
• Oranges and citrus fruits
• Tomatoes
• Cucumbers
• Peppers
• Almonds
• Herbs and spices (like curry, turmeric, cinnamon, peppermint)
• Honey
• Vinegar
• Fruit juices and sauces (especially from high-salicylate fruits)
• Certain teas (peppermint, green tea)

Also, many artificial additives and flavor enhancers contain salicylates and should be eliminated.

Foods to Include on a Low Salicylate Diet

Though restrictive, there are still many safe foods that are low in salicylates. These include:

• Pears (fresh and peeled)
• Bananas (just ripe)
• Cabbage
• Broccoli
• Cauliflower
• White potatoes
• Rice
• Lentils
• Turkey and most unprocessed meats
• Dairy products (without additives)
• Olive oil and sunflower oil

The key is to stick to whole, unprocessed foods and check labels carefully.

How Long Should You Follow the Diet?

The low salicylate diet is typically done in two phases:

1. Elimination Phase (3-6 weeks): All high-salicylate foods and additives are removed from the diet. This phase is crucial to assess whether salicylates are contributing to ADHD symptoms.
2. Reintroduction Phase: Foods are slowly added back one at a time, while symptoms are monitored. This helps identify specific triggers.

For best results, this diet should be followed under the guidance of a dietitian or nutritionist familiar with ADHD and food sensitivities.

Scientific Research: Does It Really Help ADHD?

The link between salicylates and ADHD isn’t fully understood, but there is some promising research.

• A 2004 review in Pediatrics noted that removing synthetic food additives and salicylates can lead to improvements in behavior in some children with ADHD, particularly those with sensitivities (Schab & Trinh, 2004).
• A randomized controlled trial published in The Lancet (Pelsser et al., 2011) found that a restricted elimination diet, similar to the low salicylate diet, resulted in a 64% reduction in ADHD symptoms in children who responded to the diet.
• The Feingold Association has collected anecdotal and survey-based evidence for decades, reporting improvements in attention, hyperactivity, and impulsiveness in many children who follow the program.

While not all children with ADHD benefit from the low salicylate diet, a subset with food sensitivities seems to respond well. The diet may be especially helpful for children with eczema, asthma, or other allergic-type symptoms in addition to ADHD.

Potential Benefits of the Low Salicylate Diet

1. Reduction in Hyperactivity and Impulsivity Many parents report a significant improvement in behavior, attention span, and sleep after removing salicylates.
2. Improved Gut Health Since the diet removes artificial additives and processed foods, gut health may improve, which can influence brain function via the gut-brain axis.
3. Less Need for Medication Some children may experience enough symptom relief that they can reduce or avoid ADHD medications (always under medical supervision).
4. Better Overall Nutrition Awareness Following this diet promotes reading food labels, eating whole foods, and avoiding synthetic ingredients — healthy habits for the whole family.

Drawbacks and Considerations

1. Restrictive and Challenging to Follow The diet eliminates many healthy fruits and vegetables. This may lead to nutritional deficiencies if not carefully managed.
2. Time-Consuming Planning, preparing, and monitoring foods can be overwhelming, especially for busy families.
3. Limited Scientific Consensus While some studies support it, the low salicylate diet is still considered controversial by many healthcare professionals.
4. Not a Cure-All The diet is not a replacement for therapy or medication. It works best as part of a multi-faceted treatment plan.

Tips for Getting Started

• Keep a food and symptom diary to track progress and potential triggers.
• Consult with a nutrition practitioner specialised in this area to avoid deficiencies and ensure a balanced diet.
• Start slowly and don’t try to change everything at once.
• Involve your child in meal planning to increase compliance.
• Look for low-salicylate recipes and support groups online or through the Feingold Association.

Final Thoughts

The low salicylate diet may offer relief for some children with ADHD, especially those with food sensitivities or co-occurring allergic conditions. While it’s not a guaranteed solution, it can be a valuable tool in your ADHD management tool kit and may be a worth while diet to implement to see if your child expereinces the improvements that you are looking for to help optimise their performance in school and day to day life.

If you’re considering this diet, do it with professional guidance and a clear plan for tracking changes. For families who see results, the benefits — calmer behavior, improved focus, and better sleep can be life-changing.

References

1. Schab, D. W., & Trinh, N. H. (2004). Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. Pediatrics, 114(6), e755-e766.
2. Pelsser, L. M., et al. (2011). Effects of a restricted elimination diet on the behavior of children with attention-deficit hyperactivity disorder (INCA study): a randomized controlled trial. The Lancet, 377(9764), 494-503.
3. Feingold Association of the United States. https://feingold.org

In today’s fast-paced digital world, more people than ever are feeling alone. Despite being constantly connected through phones and social media, loneliness is on the rise—and it’s not just an emotional issue. Studies now show that chronic loneliness is a serious public health concern, with impacts as damaging as smoking or obesity.

In 2023, the U.S. Surgeon General issued an advisory calling loneliness and social isolation a public health crisis. Countries like the U.K. and Japan have even appointed Ministers of Loneliness to address the issue at a national level.

That tells us something: loneliness isn’t just a personal problem—it’s a societal one.

So, why are we becoming lonelier? Who is affected the most? And what does this mean for our health and future? Let’s dive into what the science says—and what we can do about it.

What Is Loneliness?

Loneliness is the feeling of being alone or disconnected, even if you’re surrounded by people. It’s different from social isolation, which refers to actually having few social contacts. You can feel lonely in a crowd—or feel content while living alone.

Psychologist John Cacioppo, a pioneer in loneliness research, described it as “the social equivalent of physical pain.” It’s your brain signaling a need for connection, much like hunger signals a need for food.

One landmark study showed that lack of social connection is a greater detriment to health than obesity, smoking and high blood pressure. (2) On the other hand, strong social connection has been shown to:

• lead to a 50% increased chance of longevity
• strengthen your immune system (certain genes impacted by loneliness also code for immune function and inflammation)
• helps you recover from disease faster

Loneliness is on the rise. Despite its clear importance for health and survival, research shows that social connectedness is waning at an alarming rate. A revealing sociological study showed that the number of people that feel close to others and the number of people they are close to (i.e., people with whom one feels comfortable sharing a personal problem) has significantly reduced.

American individuals claimed in 1985 to have 3 people that they felt close to. In 2004, it dropped to 0, with over 25% of Americans saying that they have no one to confide in. This survey suggests that 1 in 4 people have no one they call a close friend. (3) Another study found that 61% of those surveyed experienced loneliness. Since 2018, there has been a nearly 13% rise in loneliness, when the survey was first conducted.

Why Are We Becoming More Lonely?

There are several reasons why loneliness is increasing around the world:

1. Technology and Social Media

While social platforms connect us virtually, they often reduce real-world interactions. A 2017 study from the University of Pittsburgh found that heavy social media users were more than twice as likely to feel socially isolated compared to those with limited use.

2. Urbanization and Individualism

Many people live in cities where community ties are weaker. There’s also been a cultural shift toward independence and individual success, sometimes at the expense of relationships.

3. Remote Work and Lifestyle Changes

The COVID-19 pandemic forced a massive shift to remote work and online communication. For many, those changes never fully reversed, leading to fewer in-person connections.

4. Changing Family Structures

People are getting married later, having fewer children, and living alone more often. In countries like the U.S., nearly one in three people over 65 live alone, according to the U.S. Census Bureau.

Who Is Affected Most by Loneliness?

While anyone can feel lonely, some groups are especially vulnerable:

1. Older Adults

Social circles shrink with age due to retirement, death of spouses or friends, and health limitations. A 2020 report from the National Academies of Sciences, Engineering, and Medicine found that over one-third of adults aged 45+ report feeling lonely.

2. Young Adults

Surprisingly, Gen Z and Millennials report high levels of loneliness too. A 2021 Cigna survey found that people aged 18–24 were the loneliest age group in the U.S. Factors include social media pressures, transitions like moving for college or work, and economic uncertainty.

3. People with Chronic Illness or Disabilities

Chronic health issues can limit social opportunities. The CDC notes that people with disabilities are more than twice as likely to report feeling isolated.

4. Caregivers and Single Parents

Those caring for others may neglect their own social needs. Single parents, especially mothers, often report feeling emotionally isolated.

5. Minority and Marginalized Groups

People from racial, ethnic, or LGBTQ+ minorities may face exclusion or discrimination, increasing their risk for social isolation and loneliness.

The Health Effects of Loneliness

Loneliness isn’t just uncomfortable—it’s dangerous and here is why..

1. Mental Health

Loneliness is strongly linked with depression, anxiety, and even suicidal thoughts. According to the CDC, feelings of loneliness are a major risk factor for poor mental well-being.

2. Cognitive Decline and Dementia

A study published in The Journals of Gerontology (2018) found that chronic loneliness increases the risk of dementia by up to 40%. Social engagement helps keep the brain active.

3. Heart Disease and Stroke

According to the American Heart Association (2023), social isolation and loneliness are associated with a 30% increased risk of heart disease and stroke.

4. Weakened Immune System

Lonely individuals have higher levels of stress hormones like cortisol, which can weaken the immune system. A UCLA study found that loneliness alters gene expression in immune cells, making the body more prone to inflammation.

5. Early Death

One of the most cited studies on this topic, published in Perspectives on Psychological Science (2015), found that loneliness increases the risk of premature death by 26%. That’s about the same risk as smoking 15 cigarettes a day.

What Can We Do About Loneliness?

The good news: loneliness is preventable—and reversible.

1. Build Real-Life Connections

• Make time for face-to-face interactions, even brief ones.
• Join clubs, volunteer groups, or attend community events.
• Reconnect with old friends or relatives.

2. Strengthen Existing Relationships

• Prioritize meaningful conversations.
• Practice active listening.
• Schedule regular check-ins with close friends or family.

3. Use Technology Wisely

• Don’t replace real interactions with digital ones.
• Use social media to facilitate in-person meetups, not as a substitute.

4. Seek Professional Help

• Therapists and counselors can help manage feelings of loneliness and build social skills.
• Cognitive-behavioral therapy (CBT) has been shown to reduce loneliness effectively.

5. Community and Policy Solutions

• Public health agencies can create programs to encourage social connection.
• Cities can design public spaces that promote interaction.
• Schools and workplaces can offer mental health support and team-building activities.

Ways to Connect with People

1. Find common ground.

Just be on the lookout for things that the person says during the course of a casual conversation to see if it can lead to some common ground, such as a favorite sports team, band, or even the fact that you and the person both have five siblings. The key here is to really listen to people and to see if you can spot something that can help you bond.

2. Give people sincere compliments.

This means that you should find something about them that is truly admirable and make them feel good about themselves in a sincere way, Just giving one good compliment per conversation will do just fine.

3. Follow up about something the person mentioned before.

This is a great trick for connecting with people you already know and care about. If the last time you hung out with your friend, she was talking about a big job interview coming up or about a new guy she was really excited about, then you better make sure to follow up about it when you see her next.

4. Make other people comfortable.

Just take down your guard, be friendly, compliment them, and make them feel at ease in your presence. Don’t be judgmental about what they say, give them confused looks, or generally act like there’s something wrong with the person.

5. Open up.

Some people aren’t able to connect with others because they are too guarded or too afraid to really be vulnerable with other people. You don’t want people to think that you’re too closed off or too private; though you don’t have to let them know every little thing about yourself, as you get to know people, you should work on revealing some personal information so they feel that you’re more human and that they can really connect with you.

6. Thank people.

This makes them feel appreciated, like you’re paying attention, and like you’re aware that they’re adding value to your life. Make sure people feel appreciated and be honest and open about how much they mean to you. Even if you’re just thanking a coworker for giving you a helpful piece of advice or thanking your neighbor for looking after your cat.

7. Make an effort to continue your relationships.

Many people aren’t able to truly connect with people because they don’t follow up and continue their relationships with them, even if they do truly like the person. This is either because of laziness, shyness, or because people feel like they’re too busy.

8. Be present.

If you really want to connect with people, then you have to work on being present in the conversation. If you’re already thinking about what you’re going to have for dinner or whom you’re going to talk to next, then the person you’re talking to will know. Work on making eye contact, really listening to what the person is saying, avoiding your phone or people walking by, and making the person see that you’re only focused on being in the moment.

9. Smile and make eye contact.

If you want to connect with someone immediately, then smiling and making eye contact, which go hand in hand, are absolutely key as you introduce yourself and start the conversation. Research has proven than smiling is actually contagious, and your smile will make the person more likely to smile and to be open to you. Sustained eye contact can make the person feel like you really care about what he or she has to say and can make him or her much more likely to like you.

10. Use the person’s name.

Using a person’s name can make that person feel important—or at least important enough for you to remember his or her name. Just saying something like, “It was great to meet you, Amy,” at the end of the conversation can really make the person feel much more connected to you.

11. Have open body language.

Your body language can help you look more approachable and more open, which will instantly make people like you more. If you want a new person to connect with you immediately, then you should turn your body toward that person, stand tall, avoid fidgeting or crossing your arms over your face, and direct your energy toward that person without coming on too strong.

12. Don’t underestimate the value of good small talk.

You may think that small talk is meaningless and only meant for people who want to make superficial connections, but making good small talk will actually allow you to make real connections and build toward deeper relationships with people. When you start connecting with people you first ease into talking about lighthearted subjects and getting to know people little by little.

13. Ask questions.

Another way to get a person to like you right away is to focus on being interested instead of interesting. Don’t ask taboo or personal questions – this may offend the person. Though you can try to impress the person by being utterly fascinating or entertaining, it’s much easier to show a genuine interest in the person and to show that you actually care about who the person is and what he has to offer to the world. You don’t need to make it seem like an interrogation, just a few simple well-timed questions can make the person much more likely to connect with you.

14. Keep things positive.

People like to feel happy and upbeat more than they like to feel sad or upset; it’s only logical that people are much more likely to connect with you and to want to spend more time around you if you keep things positive and work on talking about the things that excite you and make you happy. Though everyone likes to complain, you should focus on being positive and only complaining a bit when you know the person, and if you really need to.

15. Find a way to help the person out.

You may have to think outside the box a bit and to find something you can do that doesn’t directly have to do with your career, you can offer to babysit their child or animal if they need a break or go on vacation.

From this list think of the strategies that you already apply in your day to day interactions, and also strategies that you haven’t used and give it a try.

Final Thoughts

Loneliness may be invisible, but its effects are real and wide-reaching. From mental health to heart disease, it’s clear that human connection is as essential as food or water.

Whether you’re feeling lonely yourself or know someone who might be, small steps can make a big difference. Prioritize relationships, reach out to others, and don’t be afraid to seek support.

Because when we connect with others, we don’t just feel better—we live longer, too.

References

• Holt-Lunstad J, et al. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science.
• Cigna (2021). U.S. Loneliness Index.
• CDC (2023). Loneliness and Social Isolation Linked to Serious Health Conditions.
• American Heart Association (2023). Scientific statement on social isolation and cardiovascular health.
• University of Pittsburgh (2017). Social media use and perceived social isolation.
• National Academies of Sciences (2020). Social Isolation and Loneliness in Older Adults.
• UCLA (2015). Loneliness and gene expression.
• The Journals of Gerontology (2018). Loneliness and risk of Alzheimer’s Disease.

Ozempic, also known by its generic name semaglutide, has become a household name in recent years. Originally approved for managing type 2 diabetes, it has gained massive attention for its impressive weight loss effects. But with all the buzz, it’s important to look at both the benefits and risks.

So, is Ozempic a breakthrough medication—or just another trend with hidden downsides? Let’s take a closer look, using the latest research to guide us.

What Is Ozempic and How Does It Work?

Ozempic is a GLP-1 receptor agonist—a fancy term for a drug that mimics a natural hormone in your body called GLP-1. This hormone helps regulate blood sugar, makes you feel full, and slows how fast food leaves your stomach. That combination can lead to better blood sugar control and, in many cases, significant weight loss.

It’s given as a once-weekly injection, and it’s also related to Wegovy, which is approved specifically for weight loss.

The Benefits of Taking Ozempic

 

1. Weight Loss

One of the biggest reasons people talk about Ozempic is its impact on weight. In a large clinical trial called STEP-1, participants lost an average of 15% of their body weight over about 68 weeks (Wilding et al., 2021, New England Journal of Medicine). That’s significantly more than what’s typically seen with diet and exercise alone.

A recent 2024 meta-analysis reviewing data from over 7,000 people also showed average weight loss of about 7.5 kg (over 16 pounds) compared to placebo.

2. Better Blood Sugar Control

Originally designed for type 2 diabetes, Ozempic helps lower blood sugar by increasing insulin when you need it and reducing the hormone glucagon, which raises blood sugar. Studies from the SUSTAIN trial series found that people saw a drop in HbA1c (a marker of long-term blood sugar) by up to 1.8%.

3. Heart Health Benefits

The SUSTAIN-6 trial found that people with type 2 diabetes who were at high risk for heart disease had a 26% lower risk of major heart problems, including heart attack and stroke. More recently, the SELECT trial (2023) showed that even people without diabetes but with heart disease lost weight and reduced their risk of death and cardiovascular events.

4. Anti-Inflammatory Effects

Emerging research suggests that semaglutide might also reduce inflammation—linked to diseases like Alzheimer’s, fatty liver disease, and even some cancers. A 2024 article in Time magazine highlighted how GLP-1 drugs could play a role beyond diabetes and weight loss.

The Risks and Side Effects of Ozempic

While the benefits are impressive, Ozempic isn’t risk-free.

1. Digestive Problems

The most common side effects include:

• Nausea
• Vomiting
• Diarrhea
• Constipation

These often happen when you first start the medication or increase the dose, but they usually improve over time. According to clinical trials, nausea affects up to 36% of users, though for most, it’s manageable.

2. Risk of Pancreatitis

There have been reports of pancreatitis (inflammation of the pancreas) in some people taking Ozempic. While the risk appears low, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) is investigating over 500 reported cases, including a few deaths.

3. Eye Problems

One concern is worsening diabetic eye disease (retinopathy). In one study (SUSTAIN-6), some people with pre-existing eye issues experienced worsening symptoms, especially when their blood sugar dropped too quickly.

More recently, a U.S. study found a possible link to a rare eye condition called non-arteritic anterior ischemic optic neuropathy (NAION)—which can cause sudden vision loss. Although rare, it’s something doctors are watching closely.

4. Gallbladder Issues

Some people develop gallstones while on Ozempic. In one study, about 1.5% of participants on a 0.5 mg dose developed gallbladder problems, which may relate to how the drug affects digestion and fat metabolism.

5. Muscle Loss

There’s growing concern that some of the weight loss caused by Ozempic may come from lean muscle, not just fat. A 2023 study published in The Lancet found that up to 40% of the weight loss from semaglutide might be muscle loss if users don’t incorporate resistance training and adequate protein into their routine.

6. Thyroid Concerns

Animal studies showed that semaglutide could increase the risk of a rare type of thyroid cancer (medullary thyroid carcinoma). While this hasn’t been proven in humans, the FDA included a warning, and people with a family history of thyroid cancer should avoid Ozempic.

Who Should (and Shouldn’t) Consider Ozempic?

Ozempic may be a good option for you if:

• You have type 2 diabetes that isn’t well-controlled
• You’re struggling with obesity and have health risks like high blood pressure or cholesterol
• You’ve tried diet and exercise but need more support

Ozempic is NOT recommended if:

• You have a history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome
• You have severe gastrointestinal issues or a history of pancreatitis
• You are pregnant or breastfeeding

It’s also important to talk to your doctor about your eye health, family medical history, and whether you’re willing to commit to lifestyle changes alongside the medication.

Lifestyle Still Matters

While Ozempic can be powerful, it works best when paired with healthy habits. Experts recommend:

• Eating a high-protein diet to preserve muscle mass
• Doing resistance training at least 2–3 times per week
• Staying hydrated and managing stress
• Regular follow-ups with your healthcare team

What About After You Stop Taking It?

One big question is: what happens when you stop Ozempic? Studies show that most people regain the weight once they stop taking it—often within a year. This suggests that for many, Ozempic might be a long-term commitment.

That’s why it’s so important to build sustainable habits during treatment. It’s not just about losing weight—it’s about keeping it off.

Final Thoughts: Is Ozempic Worth It?

Ozempic is a powerful tool for weight loss and diabetes management. For many, it offers life-changing results: better blood sugar, reduced heart risks, and significant weight loss. But like any medication, it’s not for everyone.

If you’re considering Ozempic, talk to your doctor about:

• Your personal health risks
• How to manage side effects
• What kind of monitoring you’ll need
• Whether you’re ready for a long-term plan

In short: Ozempic can be a game-changer—but it’s not a magic fix. With the right support and lifestyle, it could be a big step toward better health.

Sources:

• Wilding JPH, et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine.
• Marso SP, et al. (2016). Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. New England Journal of Medicine.
• Douros A, et al. (2024). Adverse effects of semaglutide: a real-world review. Lancet Diabetes & Endocrinology.
• SELECT trial (2023). Semaglutide and Cardiovascular Outcomes. American Heart Association.
• TIME Health (2024). GLP-1 drugs and inflammation.
• UK MHRA reports on semaglutide side effects (2024).
• Lancet (2023). Muscle loss during weight reduction with GLP-1 receptor agonists.

Introduction

Traumatic brain injury (TBI) and concussion, has far-reaching physiological effects beyond immediate cognitive and neurological impairment. One of the most underrecognized yet clinically significant consequences of brain injury is its impact on the endocrine system. The brain, especially the hypothalamus and pituitary gland, plays a central role in regulating hormonal balance. Damage to these areas—commonly referred to as the hypothalamic-pituitary axis (HPA)—can disrupt hormone production, secretion, and regulation, often leading to persistent symptoms that are mistakenly attributed to psychological or structural causes alone.

This article explores the hormonal disturbances that can result from brain injury, the prevalence and mechanisms behind post-traumatic hypopituitarism (PTHP), and provides guidance on which hormones should be assessed in clinical practice.

The Hypothalamic-Pituitary Axis and Brain Injury

The hypothalamus and pituitary gland act as master regulators of the endocrine system. They coordinate the release of multiple hormones critical to metabolism, growth, stress response, mood, sexual function, and fluid balance. TBI can impair these regulatory functions through direct trauma, inflammation, edema, vascular damage, or delayed regeneration of the HPA structures.

Types of Brain Injury That Affect Hormonal Balance

• Mild TBI (Concussion)
• Moderate to Severe TBI
• Repetitive Head Trauma (e.g., athletes, military personnel)

Even mild injuries can lead to significant hormonal disruption, especially if repeated over time (e.g., in contact sports) [1].

Prevalence of Post-Traumatic Hormonal Imbalances

Numerous studies show that hormonal imbalances occur in 15–68% of individuals after TBI, depending on injury severity, timing of testing, and diagnostic criteria [2][3].

• Acute phase (first 2 weeks post-injury): transient hormonal changes are common.
• Chronic phase (3 months to several years): permanent dysfunction may persist in up to 25–50% of individuals [4].

A systematic review by Schneider et al. (2007) found that approximately 30% of TBI survivors develop some form of hypopituitarism, with growth hormone deficiency being the most prevalent [2].

Key Hormonal Systems Affected

1. Growth Hormone (GH)

• Prevalence: 15–20% in moderate/severe TBI, 10% in mild TBI [4].
• Symptoms: fatigue, reduced muscle mass, poor exercise tolerance, depression, and cognitive dysfunction.
• Pathophysiology: The somatotropic axis is highly sensitive to injury; the GH-releasing hormone pathway is vulnerable to shear stress.
• Assessment: Serum IGF-1 is a screening tool, but dynamic stimulation tests (e.g., insulin tolerance test or GHRH-arginine test) are more reliable [5].

2. Adrenocorticotropic Hormone (ACTH) and Cortisol

• Prevalence: ACTH deficiency is found in up to 10–20% of individuals [6].
• Symptoms: fatigue, hypotension, nausea, poor stress tolerance, and hyponatremia.
• Timing: Cortisol levels can be acutely suppressed due to stress or permanently due to HPA axis disruption.
• Assessment: Morning serum cortisol; if borderline, perform ACTH stimulation test.

Acute cortisol insufficiency can be life-threatening and requires prompt treatment [7].

3. Thyroid Stimulating Hormone (TSH) and Free T4

• Prevalence: Central hypothyroidism is seen in 5–10% of cases post-TBI [8].
• Symptoms: fatigue, cold intolerance, weight gain, depression, and bradycardia.
• Assessment: TSH and free T4 (note that TSH may be inappropriately normal or low in central hypothyroidism).

Thyroid dysfunction may worsen cognitive outcomes and mood, so screening is essential even for mild TBI.

4. Gonadotropins (LH/FSH) and Sex Hormones (Testosterone, Estradiol)

• Prevalence: Gonadotropin deficiency in up to 20% of men; less frequently studied in women [9].
• Symptoms in Men: low libido, erectile dysfunction, reduced facial/body hair, and muscle loss.
• Symptoms in Women: menstrual irregularities, infertility, low libido, and hot flashes.
• Assessment: LH, FSH, total testosterone (in men), estradiol (in women), and sex hormone-binding globulin (SHBG).

Hormonal imbalance in this axis is associated with depression and reduced quality of life post-injury [10].

5. Prolactin

• Prevalence: Hyperprolactinemia is occasionally observed.
• Mechanism: May occur due to pituitary stalk damage or hypothalamic inhibition of dopamine.
• Symptoms: galactorrhea, infertility, sexual dysfunction.

Testing for prolactin levels is useful in the presence of menstrual or sexual symptoms post-TBI.

6. Antidiuretic Hormone (ADH) and Sodium Balance

• Disorders:
  • Diabetes Insipidus (DI) – deficiency of ADH
  • Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) – excess ADH
• Symptoms: Polyuria, polydipsia, dehydration (DI); hyponatremia, fluid retention (SIADH).
• Assessment: Serum sodium, urine osmolality, plasma osmolality, ADH levels.

These imbalances often occur in the acute phase and can be life-threatening if unrecognized [11].

7. Insulin and glucose metabolism

Following a traumatic brain injury (TBI), including mild forms such as concussions, significant alterations in insulin regulation and glucose metabolism can occur, contributing to both acute and chronic neurological and metabolic consequences. The brain plays a critical role in regulating systemic metabolism, and damage to regions such as the hypothalamus or pituitary gland can disrupt insulin sensitivity and secretion.

Studies have shown that after a TBI, patients may develop insulin resistance, even in the absence of pre-existing metabolic disease. This insulin resistance is thought to arise from neuroinflammation, oxidative stress, and impaired neuronal insulin signaling pathways (15,16).

Prevalence of insulin resistance and dysregulated glucose metabolism: Research indicates that up to 50% of moderate-to-severe TBI patients develop some form of glucose metabolism disturbance, including hyperglycemia or insulin resistance in the acute phase post-injury (17). Moreover, even in cases of mild TBI or concussion, subtle but persistent changes in insulin function have been observed, particularly in individuals with repetitive head injuries, such as athletes.

Long term impact: These changes are associated with increased risk for long-term cognitive decline and neurodegenerative diseases like Alzheimer’s, which are themselves linked to insulin resistance in the brain (18).

Timing of Hormonal Assessment

• Acute phase (first 2–4 weeks): Focus on cortisol and ADH abnormalities.
• Subacute phase (1–3 months): GH, TSH, gonadal hormones should begin to normalize or demonstrate deficiency.
• Chronic phase (>3 months): Full endocrine workup recommended, especially in symptomatic patients.

Repeat testing is important, as some deficiencies are transient while others develop over time [12].

Clinical Symptoms That May Indicate Hormonal Dysfunction

Because symptoms of hormonal deficiency can overlap with post-concussive syndrome (e.g., fatigue, poor concentration, mood swings), clinicians must maintain a high index of suspicion. Red flags include:

• Persistent fatigue and malaise unresponsive to rest
• Sexual dysfunction or amenorrhea
• Weight gain or loss with no lifestyle explanation
• Depression or anxiety that worsens over time
• Cold intolerance, dry skin, or hair thinning
• Hypoglycemia or hypotension

Populations at Higher Risk

• Moderate to severe TBI patients
• Individuals with skull fractures, especially basilar
• Those requiring neurosurgery or ICU admission
• Patients with repetitive mild TBIs (e.g., athletes, veterans)
• Children and adolescents (disruption of growth and puberty)

Athletes with repeated concussions may develop chronic traumatic encephalopathy (CTE), which also involves hormonal changes, particularly low testosterone and GH deficiency [13].

Recommended Hormonal Panel After TBI/Concussion

Hormone	Test	When to Assess
Cortisol	8am serum cortisol ± ACTH stimulation	Acute and chronic
GH axis	IGF-1, GHRH-arginine test	Chronic (>3 months)
Thyroid	TSH, Free T4	Subacute and chronic
Gonadal	LH, FSH, Testosterone/Estradiol	Subacute and chronic
Prolactin	Serum prolactin	If symptoms suggest
ADH	Sodium, osmolality, ADH	Acute phase, if symptomatic
Insulin	Insulin, glucose fasting, HBA1C	Chronic

 

Treatment and Follow-Up

Hormone replacement, nutraceuticals (herbs, supplements, glandulars), diet and lifestyle can significantly improve quality of life and neurocognitive recovery in TBI individuals. Individualized therapy is guided by deficiency severity, patient symptoms, and comorbidities. Referral to an Endocrinologist or Naturopath Doctor is essential for proper diagnosis and dynamic testing.

• GH replacement improves energy, mood, cognition, and body composition [14].
• Cortisol therapy may be life-saving in adrenal insufficiency.
• Thyroid and sex hormone replacement alleviates fatigue, mood issues, and sexual dysfunction.
• Glandulars, herbs and nutrient supplementation can help to balance hormones
• Nutrition and Lifestyle strategies can help to mitigate issues

Conclusion

Brain injury—even mild concussion—can disrupt multiple hormonal pathways, contributing to prolonged or unexplained symptoms. The hypothalamic-pituitary axis is especially vulnerable, and damage may lead to deficiencies in growth hormone, cortisol, thyroid hormones, gonadal hormones, insulin, prolactin, and antidiuretic hormone. Timely endocrine evaluation is critical for optimal management. In patients with persistent symptoms post-concussion, hormonal assessment should be part of the routine workup to prevent misdiagnosis and to enhance recovery outcomes.

If you or you client is interested in completing hormonal testing please reach out to Koru Nutrition for a free discovery call or book in with one of our naturopath doctors.

Or, if you or your client was involved in a motor vehicle accident, then please complete our online referral form so we can complete the OCF-18.

References

 

1. Zgaljardic DJ, et al. (2008). “Neuroendocrine dysfunction after traumatic brain injury: an update on diagnosis and treatment.” Current Opinion in Endocrinology, Diabetes and Obesity, 15(4):301-307. doi:10.1097/MED.0b013e3283064a4f
2. Schneider HJ, et al. (2007). “Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review.” JAMA, 298(12):1429–1438. doi:10.1001/jama.298.12.1429
3. Klose M, et al. (2007). “Prevalence and predictive factors of post-traumatic hypopituitarism.” Clinical Endocrinology, 67(2):193–201. doi:10.1111/j.1365-2265.2007.02873.x
4. Aimaretti G, et al. (2005). “Hormonal deficiencies after traumatic brain injury in humans.” Horm Res, 64(6):293–299. doi:10.1159/000088786
5. Tanriverdi F, et al. (2010). “Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach.” Endocrine Reviews, 31(2): 244–277. doi:10.1210/er.2009-0008
6. Bondanelli M, et al. (2004). “Hypopituitarism after traumatic brain injury.” European Journal of Endocrinology, 152(5):679–691. doi:10.1530/eje.0.1520679
7. Agha A, et al. (2005). “The natural history of post-traumatic hypopituitarism: implications for assessment and treatment.” American Journal of Medicine, 118(12):1416.e1–1416.e7. doi:10.1016/j.amjmed.2005.01.073
8. Schneider M, et al. (2013). “Endocrine dysfunction following TBI: a review.” Journal of Neurotrauma, 30(11):1017–1030. doi:10.1089/neu.2012.2602
9. Urban RJ, et al. (2005). “Hypogonadism after TBI.” Journal of Neurotrauma, 22(11):1141–1147. doi:10.1089/neu.2005.22.1141
10. Wagner AK, et al. (2010). “Biopsychosocial correlates of hypopituitarism after traumatic brain injury.” Brain Injury, 24(3): 297–305. doi:10.3109/02699050903421119
11. Kristof RA, et al. (2009). “Acute changes of the hypothalamic–pituitary–adrenal axis after traumatic brain injury.” European Journal of Endocrinology, 160(1):137–143. doi:10.1530/EJE-08-0612
12. Krahulik D, et al. (2010). “Dynamic changes in hormonal levels in acute phase of TBI.” J Neurosurg Sci, 54(3):77–83.
13. Kelly DF, et al. (2000). “Neuroendocrine dysfunction after traumatic brain injury: a critical review.” Neurosurgery, 47(6):1343–1352. doi:10.1097/00006123-200012000-00003
14. High WM, et al. (2010). “Effect of growth hormone replacement therapy on cognition after traumatic brain injury.” Journal of Neurotrauma, 27(9): 1687–1695. doi:10.1089/neu.2010.1312
15. Bhowmick, S., D’Mello, V., Ponery, N., & Chatterjee, S. (2018). Brain insulin resistance and its link to cognitive dysfunction: Potential implications in traumatic brain injury. Neuropharmacology, 136(Pt B), 190–197. https://doi.org/10.1016/j.neuropharm.2017.11.009
16. Jalloh, I., Helmy, A., Shannon, R. J., Gallagher, C. N., Menon, D. K., & Hutchinson, P. J. (2015). Lactate uptake by the injured human brain: Evidence from an arterio-venous gradient and cerebral microdialysis study. Journal of Neurotrauma, 32(9), 689–699. https://doi.org/10.1089/neu.2014.3675
17. Wagner, A. K., Sokunbi, O. F., Ren, D., Chen, X., Li, Y., & Conley, Y. P. (2017). Controlled cortical impact injury influences insulin signaling pathway gene expression in the brain. Journal of Neurotrauma, 34(5), 1041–1049. https://doi.org/10.1089/neu.2015.4272
18. De Felice, F. G., & Ferreira, S. T. (2014). Inflammation, defective insulin signaling, and mitochondrial dysfunction as common molecular denominators connecting type 2 diabetes to Alzheimer disease. Diabetes, 63(7), 2262–2272. https://doi.org/10.2337/db13-1954