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Impact Shield

Evidence-Based Neuroprotection Protocol
v2.1 January 2026 Contact & Combat Athletes
Select Your Protocol

Acute Phase: Days 0–28 Post-Concussion

Start ASAP (ideally within 24 hours). Tier 1 compounds deliver maximum impact during this critical window. Adjust based on symptom response and medical clearance.

Hours 0–2 (IMMEDIATE)
Diagnosis & Emergency Initiation
NAC (Loading): 4 g oral (stat)
Riboflavin: 400 mg with food
⚡ Goal: Initiate Tier 1 antioxidant defense within golden window
Hours 2–24
Full Acute Tier 1 Stack
NAC: 2 g AM + 2 g PM (Days 1–4)
Riboflavin: 400 mg daily (continue)
BCAAs: 30–54 g/day (divided doses, e.g., 15 g BID)
Magnesium: 400 mg elemental (evening)
🎯 Goal: Complete Tier 1 + begin Tier 2 support; start PCSS daily tracking
Days 2–3
Expand Tier 2 Support
Continue all above +
Omega-3 (DHA+EPA): 2–4 g/day combined
Vitamin D3: 5000 IU daily (if baseline deficient)
🔥 Goal: Activate full neuroinflammation suppression; monitor symptoms daily
Days 5–7
Transition NAC; Maintain Tier 1/2
NAC: Taper to 1.5 g AM + 1.5 g PM (Days 5–7)
Continue all other compounds
Reassess: PCSS score trends, symptom resolution rate
📈 Expected: 86% symptom resolution if started ≤24h; assess need for Tier 3
Days 8–14
NAC Complete; Continue Tier 1/2
NAC: STOP (7-day course complete)
Riboflavin: 400 mg daily (continue through day 14)
BCAAs: 30–54 g/day (continue through day 14)
Magnesium, Omega-3, Vitamin D3: Continue as above
✅ Goal: Monitor recovery trajectory; graduated return-to-activity planning
Days 15–28 (Subacute)
Extended Tier 1/2; Consider Tier 3 if Persistent
Riboflavin: 400 mg daily (continue through day 28)
BCAAs: Reduce to 15–30 g/day if symptom-free
Magnesium, Omega-3, Vitamin D3: Continue at baseline doses
If persistent symptoms: Consider Taurine 1–3 g/day OR Curcumin 500 mg daily
🏅 Goal: Safe return-to-play progression with full medical clearance

All Compounds (Acute & Baseline)

Tier 1 — RCT Proven
Riboflavin (Vitamin B2)
55% Faster Recovery (9.9 vs 22.2 days)
Acute Dose: 400 mg daily × 14 days
Baseline Dose: 100–200 mg daily
Timing: Start ≤24h post-injury (critical)
Mechanism: Mitochondrial ATP support, headache control
Tier 1 — RCT Proven
N-Acetylcysteine (NAC)
86% Symptom Resolution by Day 7 (if ≤24h)
Acute Dose: 4g load, then 2g BID ×4d, 1.5g BID ×3d
Baseline Dose: 1 g daily
Timing: Within 24–72h (efficacy drops 28% per day delayed)
Mechanism: Glutathione replenishment, neuroinflammation
Tier 1 — RCT Proven
BCAAs (Branched-Chain Amino Acids)
Dose-Dependent Symptom Reduction
Acute Dose: 30–54 g/day (divided, e.g., 15g BID)
Baseline Dose: 7 g daily
Timing: Start within 72h; split doses
Mechanism: Neurotransmitter balance (GABA, glutamate)
Tier 2 — TBI RCT + Athlete Studies
Magnesium Glycinate
PCSS Reduction at 48h; Sleep Support
Acute Dose: 400 mg elemental daily × 4–6 weeks
Baseline Dose: 400 mg elemental (evening)
Form: Glycinate complex (≈2.8g powder)
Mechanism: Neuronal excitability, headache, sleep
Tier 2 — TBI RCT + Athlete Studies
Omega-3 (EPA+DHA)
↓ Neuroinflammation; Synaptic Support
Acute Dose: 2–4 g/day combined (Days 2+)
Baseline Dose: 3g powder (≈1.5g EPA+DHA)
Timing: Spread throughout day
Mechanism: Membrane fluidity, IL-6 reduction
Tier 2 — TBI RCT + Athlete Studies
Vitamin D3
Cognitive Recovery (if Deficient)
Acute Dose: 5000 IU daily (if baseline deficient)
Baseline Dose: 2000–4000 IU daily
Timing: With breakfast
Mechanism: Neuromuscular & cognitive function
Tier 2 — Athlete Evidence
Creatine Monohydrate
Brain Energy Buffering & Neuroprotection
Baseline Dose: 5 g daily
Loading: Optional 20 g/day × 5–7d preseason
Mechanism: Phosphocreatine system, ATP buffering
Note: Not acute-specific; for baseline
Tier 3 — Preclinical
Taurine
Preclinical TBI Support (Not RCT-Proven)
Baseline Dose: 1 g daily
Acute Dose: 1–3 g/day (if persistent symptoms)
Safety: Excellent; EFSA-approved
Mechanism: ROS scavenging, osmotic support
Tier 3 — Preclinical
Curcumin (95%) + Piperine
Neuroinflammation (Animal Data Strong)
Baseline Dose: 500 mg + 10 mg daily
Acute Dose: As adjunct (Days 3+) if persistent
Timing: With fat/meal for bioavailability
Mechanism: NF-κB inhibition, TNF-α reduction
Tier 2 — Athlete Evidence
Zinc Glycinate
Synaptic & Immune Function
Baseline Dose: 15 mg elemental daily
Form: Glycinate chelate (low excess risk)
Timing: Evening (absorption optimized)
Mechanism: NMDA receptor, synaptic plasticity

Evidence Hierarchy: Why Tier 1 Compounds Matter First

Tier 1 compounds have been tested directly in concussed athletes or military personnel with quantified recovery outcomes. Tier 2 compounds have good mechanistic support and RCT evidence in TBI or athletes. Tier 3 compounds are promising but lack human concussion RCTs—use only if Tier 1/2 inadequate.

🥇 TIER 1: RCT-PROVEN IN SPORT CONCUSSION
Riboflavin • NAC • BCAAs
Direct human trials, quantified outcomes, highest evidence
🥈 TIER 2: TBI RCT + ATHLETE EVIDENCE
Creatine • Omega-3 • Magnesium • Vitamin D3 • Zinc
Good mechanistic overlap, RCT data in related populations
🥉 TIER 3: PRECLINICAL ONLY
Taurine • Curcumin
Strong animal data, NO human concussion RCT yet

Key Takeaway: Timing Matters

Start ≤24h: NAC Efficacy
86% symptom resolution (if loaded within 24h)
58% if started 26–72h
<30% if started >72h
Riboflavin: Consistent Impact
9.9 days recovery (Riboflavin)
22.2 days recovery (Placebo)
55% faster overall
⚠️ Honest Research Gap:
No single RCT has tested ALL compounds together in one athlete. Interactions unknown. Multimodal RCTs expected 2026–2027. This protocol represents best current evidence, but individual efficacy will vary.

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Peer-Reviewed Evidence by Ingredient

Evidence disclaimer: This section summarizes representative studies from peer-reviewed literature. It does not capture all available data or fully describe study limitations (sample sizes, heterogeneous populations, risk of bias). Clinical decisions must be individualized and made by licensed clinicians familiar with each athlete. This protocol is adjunctive and experimental – not standard of care.
Tier 1 • Mild TBI / Postconcussive Symptoms

N-Acetylcysteine (NAC)

• In a quasi-randomized study of adults with mild TBI, oral NAC (4 g load then 2 g twice daily for 4 days and 1.5 g twice daily for 3 days) added to standard care was associated with significantly lower Rivermead Postconcussion Questionnaire scores at 7 and 30 days versus standard care alone, supporting NAC as an early neuroprotective adjunct in mild TBI.

• Preclinical and battlefield data (including a PLOS One trial in blast-exposed soldiers) suggest that early NAC use can reverse cognitive and vestibular deficits and reduce oxidative injury after blast and blunt mTBI, providing mechanistic plausibility for its use in sports concussion.

Tier 1 • Sport-Related Concussion

Riboflavin (Vitamin B2)

• A double-blind randomized controlled trial in collegiate athletes with sport-related concussion found that riboflavin 400 mg daily for 14 days shortened mean time to clinical recovery from 22.2 days with placebo to 9.9 days with riboflavin, without major safety signals.

• Clinical trial registrations and follow-up analyses in concussion and post-traumatic headache further support riboflavin's role in mitochondrial support and headache reduction in this population.

Tier 1 • Human Concussion

Branched-Chain Amino Acids (BCAAs)

• A multi-year pilot study in adolescents and young adults (ages 11–34) with concussion reported a dose–response relationship between BCAA intake and symptom improvement, with higher doses linked to greater reductions in symptom scores and improvements in physical activity and sleep measures.

• The Minds Matter program at CHOP describes BCAAs as a targeted pharmacologic tool in concussion care, not just a sports supplement, emphasizing their role in neurotransmitter balance and recovery of function after concussion.

Tier 2 • Post-Concussion & TBI

Magnesium

• A randomized study of adolescents with acute concussion found that oral magnesium supplementation, when added to standard care, improved post-concussion symptom severity over a 5‑day period compared to standard care alone, suggesting benefit in the early symptomatic phase.

• Reviews and NIH monographs on nutrition and TBI highlight that serum and brain magnesium decline rapidly after injury and that replacement may attenuate excitotoxic damage and migraine-like headache after TBI.

Tier 2 • Subconcussive Impacts / TBI

Omega‑3 Fatty Acids (EPA + DHA)

• Preclinical TBI models show that DHA-rich omega‑3 supplementation preserves axonal structure, reduces β-APP–positive injured axons, and improves cognitive outcomes after experimental brain injury.

• Emerging human work in contact sports (e.g., American football) suggests that omega‑3 supplementation over a season may blunt increases in serum neurofilament light chain and other neurotrauma biomarkers associated with repetitive head impacts.

Tier 2 • TBI Prognosis and Supplementation

Vitamin D3

• Multi-center observational data indicate that vitamin D deficiency at the time of TBI is associated with worse functional recovery and higher mortality, suggesting that adequate vitamin D status may influence resilience and outcome after brain injury.

• Preclinical studies and small clinical trials suggest that vitamin D can attenuate post-TBI neuroinflammation and neuronal loss, and supplementation has been associated with improvements in inflammatory markers and early neurological scores in some brain injury cohorts.

Tier 2 • Neuroenergetic Support

Creatine Monohydrate

• Animal models of TBI demonstrate that chronic creatine supplementation reduces cortical damage by roughly 36–50%, preserves ATP, and stabilizes mitochondrial function, indicating a strong neuroprotective effect at the tissue level.

• A 2025 scoping review of creatine in TBI and collision-sport athletes concluded that creatine appears to reduce tissue damage and support energy metabolism after brain injury, with early human data in moderate–severe TBI and athletes supporting further trials.

Tier 2 • TBI Outcome and Resilience

Zinc

• A clinical trial in patients with moderate–severe TBI showed that zinc supplementation (initial parenteral then enteral) improved Glasgow Coma Scale scores, visceral protein markers, and 1‑month survival compared with patients receiving only adequate zinc, suggesting zinc as a therapeutic adjunct.

• Preclinical and translational work indicates that zinc deficiency worsens neuronal death and behavioral deficits after TBI, whereas appropriate supplementation improves resilience and may protect against subsequent brain insults.

Tier 3 • Preclinical Neuroprotection

Taurine

• Experimental models of TBI and ischemic brain injury show that taurine supplementation improves neurological scores, reduces brain edema, and attenuates microglia-driven neuroinflammation, consistent with a broad neuroprotective role.

• Mechanistic studies demonstrate that taurine reduces oxidative stress in neurons in part by inhibiting NADPH oxidase–mediated reactive oxygen species production, supporting its use as an adjunct antioxidant.

Tier 3 • Preclinical TBI Studies

Curcumin (95%) + Piperine

• Multiple animal TBI models show that curcumin reduces oxidative stress, edema, and neuronal apoptosis and improves histologic and behavioral outcomes, acting through NF‑κB, Nrf2, and other inflammatory pathways.

• A systematic review of curcumin-based delivery systems for TBI-related conditions concludes that curcumin is mechanistically promising but human concussion trials are still lacking; recent murine models of repetitive TBI with turmeric/curcumin pretreatment further support this biologic plausibility.

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