Brain Doctor: These Popular Sports Are Causing Brain Damage & The NFL Is Keeping This Devastating Disease Quiet! AI transcript and summary - episode of podcast The Diary Of A CEO with Steven Bartlett

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Episode: Brain Doctor: These Popular Sports Are Causing Brain Damage & The NFL Is Keeping This Devastating Disease Quiet!

Author: DOAC
Duration: 01:04:19

Episode Shownotes

What is killing young athletes at the peak of physical performance? A medical bank of over 1,000 brains and 30 years of study shine a spotlight on the cause Dr Ann McKee is a world-renowned neurologist and the Director of Boston University’s CTE and Alzheimer’s Disease Research Centres. She leads

groundbreaking research on the fatal neurodegenerative disease known as Chronic Traumatic Encephalopathy (CTE). In this conversation, Dr Ann and Steven discuss topics such as, the devastating symptoms of CTE, how young athletes are at risk of CTE, why the NFL are keeping the disease a secret, and the health risks of heading a football. 00:00 Intro 02:14 Ann McKee's Mission on CTE 03:37 What Is CTE? 05:05 Sports Most Likely to Cause CTE 06:06 How Fragile Is the Human Brain? 06:41 What Ann McKee Does in Her Research 07:15 The First Time Ann Saw a Brain with CTE 10:39 How Many Athletes Have CTE? 12:26 How CTE Affects Daily Life 13:58 Young Athletes Impacted by CTE 14:33 Wyatt Bramwell’s Story: A Tragic Case of CTE 18:08 When Do Signs of CTE First Appear? 21:21 How Does CTE Develop in the Brain? 23:48 Jeff Astle: CTE in Soccer 24:45 Challenges in Raising Awareness About CTE 27:42 The NFL's Contact With Ann McKee 28:17 The NFL’s Early Reactions to CTE 30:01 The Impact of CTE on Families 30:29 Why Ann McKee Cares About the Families 32:26 The Pressure of Studying CTE 32:58 The NFL's Shift on CTE and Lawsuits 34:36 Owain Thomas: CTE Case Study 36:08 NFL Helmet Safety and CTE 37:51 The Four Stages of CTE Explained 40:22 Aaron Hernandez: The Link to CTE 44:28 Mike Webster's Battle with CTE 45:14 The Progress Ann McKee Wants to See in CTE Research 46:17 Do We Really Need Contact in Sports? 50:18 Preventing Alzheimer’s Through Brain Health 53:16 Are Brain Diseases Like CTE Increasing? 53:46 How Inflammation in the Brain Worsens Diseases 56:50 Ann McKee’s Advice for Parents of Young Athletes 58:22 Ann’s Message to the NFL and Sports Organisations 59:33 The Final Question: What's Next for CTE Research? Follow Dr Ann: Twitter - https://g2ul0.app.link/NF8SldoeUNb Boston University’s CTE Center - https://g2ul0.app.link/tXabKUpeUNb You can view the brain scan of advanced CTE, here: https://linktr.ee/diaryofaceostudies Watch the episodes on Youtube - https://g2ul0.app.link/DOACEpisodes My new book! 'The 33 Laws Of Business & Life' is out now - https://g2ul0.app.link/DOACBook You can purchase the The Diary Of A CEO Conversation Cards: Second Edition, here: https://g2ul0.app.link/f31dsUttKKb Follow me: https://g2ul0.app.link/gnGqL4IsKKb Sponsors: Linkedin Jobs - linkedin/doac ZOE - http://joinzoe.com with code BARTLETT10 for 10% off Learn more about your ad choices. Visit megaphone.fm/adchoices

Full Transcript

00:00:00 Speaker_02
In a study of 152 young athletes, most of them had brain damage from small repetitive hits to the head. And it really destroys a person's life. That is shocking news. But medical professionals don't take it seriously.

00:00:13 Speaker_02
And the NFL wanted me to present my findings, but they didn't believe me. And so there was a huge effort to really discredit me.

00:00:21 Speaker_00
Dr. Anne McKee is the world-leading brain scientist who runs the world's biggest brain bank. She's revealing groundbreaking research on the serious life-threatening consequences of playing sport.

00:00:31 Speaker_02
These injuries are acceleration, deceleration, very rapidly, and twisting of the brain, and that frays the nerve cells. And then over time, the disease progresses. And this protein called tau, it stains brown, and it starts spreading through the brain.

00:00:44 Speaker_02
And we have lots of evidence that this is happening in contact sports, but also in military veterans' domestic violence. etc. And it causes depression, personality changes, aggressive and violent behaviors, or maybe the person takes their own life.

00:00:58 Speaker_02
Look at Aaron Hernandez and Wyatt Bramwell, 18 years old. He was an American football player and he videotaped himself before taking his own life.

00:01:07 Speaker_04
My head is pretty messed up and damaged. The voices and demons in my head just started to take over everything I wanted to do.

00:01:14 Speaker_01
He shot himself in the heart instead of the head because it was his dying wish to donate his brain.

00:01:20 Speaker_02
Yeah, I saw multiple CTE lesions in many parts of his brain.

00:01:24 Speaker_01
Caused by playing tackle football for several years.

00:01:27 Speaker_02
Yes, and every time you see it in a young person, you just can't get over it.

00:01:32 Speaker_01
It's a lot for you to carry.

00:01:34 Speaker_02
There's some days that are darker than others, but we're not where I'd like us to be.

00:01:37 Speaker_01
What do we do about this?

00:01:39 Speaker_02
We have to... Dr. McKee,

00:01:50 Speaker_01
What is the mission that you're on with your life and your professional endeavours?

00:01:54 Speaker_02
Well, my mission in life has taken abrupt change about 17 years ago when I first saw a CTE in the brain of a football player. And I realised that the play of football was associated with a chronic and progressive neurodegenerative disease.

00:02:12 Speaker_02
So my first two cases in football players were 45-year-old men, and I was stunned to see CTE in their brains. 45 is extremely young for a neurodegenerative disease.

00:02:24 Speaker_02
And then my third case was actually an 18-year-old where I saw the beginnings of CTE in the brain of a high school player, and I've never looked back since then.

00:02:35 Speaker_02
When you talk to the families and you hear the tragedy that they experience, the heartache of living with these people who change before their eyes, their personality changes, their mood changes, they become people they don't recognize.

00:02:51 Speaker_02
And then they live through often an accidental death or maybe the person takes their own life. And it's the result of almost a coincidence of seeing those changes in the brains of American football players.

00:03:05 Speaker_02
I immediately just wanted to eradicate this disease.

00:03:09 Speaker_01
What is CTE?

00:03:11 Speaker_02
So CTE stands for chronic traumatic encephalopathy, and it's a neurodegenerative disease of the brain, which means over time, decades usually, it gradually robs you of your ability to think clearly or remember things, and ultimately you end up with dementia.

00:03:30 Speaker_02
What's interesting about CTE is that there's a cause, an environmental cause. It's triggered by trauma. specifically small repetitive hits to the head, the kind that people don't even notice when they're playing contact sports.

00:03:44 Speaker_02
Some of these hits result in concussion, but actually it's more importantly the sub-concussive or non-concussive hits that happen routinely in the play of football and very often in the play of other contact sports like ice hockey, rugby, and soccer.

00:04:00 Speaker_02
The disease starts out as isolated areas of abnormality in the brain, sort of spots in the brain, in the cortex, usually in the frontal lobes.

00:04:09 Speaker_02
And then over time, as the person ages, even if they stop playing the sport, stop getting hit in the head, the disease progresses. The tau that started very focally in very restricted areas starts spreading through the brain.

00:04:24 Speaker_02
It invades the areas that are important for memory and learning, it takes over the brainstem, it causes motor problems, memory problems, cognitive problems, and it really destroys a person's life.

00:04:37 Speaker_01
And some of those sports and lifestyle choices that are likely to encourage CTE, you mentioned the NFL, sort of American football, you mentioned soccer, which is heading the ball, fighting.

00:04:49 Speaker_02
Fighting and ice hockey, certainly.

00:04:51 Speaker_01
Boxing, certainly. Boxing.

00:04:53 Speaker_02
UFC. MMA. Yeah.

00:04:55 Speaker_01
The military?

00:04:56 Speaker_02
The military is also at risk after blast injury or combat-related injuries. Also, a very high percentage of military veterans played contact sports. It's the same demographic, so they have a combined risk.

00:05:11 Speaker_01
Domestic violence?

00:05:12 Speaker_02
Domestic violence is definitely one of the triggers for CTE. It may not be as risky, may not pose as great a risk as something with very sustained head impacts like football.

00:05:28 Speaker_02
But certainly if the domestic violence is longstanding and repetitive over years, yes, women have been reported with CTE.

00:05:39 Speaker_01
I didn't realise the brain was so fragile.

00:05:41 Speaker_02
It is. These injuries are acceleration, deceleration, very rapidly, and twisting of the brain. And the brain stretches as it's going in a linear direction, and it twists as it's going in a rotational direction. And that actually frays the nerve cells.

00:05:58 Speaker_02
They are actually twisted and distorted. And it also injures the blood vessels, these long elements in the brain. So we see vascular injury usually to the small blood vessels and we see damage to the nerve cells.

00:06:13 Speaker_01
So what you do on a day-to-day basis, what have you been doing for the last 17 years? If I was to come and see you at work, what would I see and where would I see you working?

00:06:22 Speaker_02
So we have a lab, it's the neuropathology lab, and we specialize in, we have several brain banks. You would see me dissecting brains, photographing brains, and then most likely you'd see me looking under the microscope at brains.

00:06:39 Speaker_01
And how many brains have you seen?

00:06:41 Speaker_02
Oh, I was thinking about that earlier. I think it's very close to 10,000 at this point.

00:06:47 Speaker_01
So take me to that day that changed your career where you got to look at that first brain that had signs of CTE in it. What did you see? Who was that person? And why was that such a pivotal moment for you?

00:07:00 Speaker_02
I was studying Alzheimer's disease. I'd been looking at Alzheimer's disease brains. And we had a man that came into the bank in 2003 who was named Paul Pender. He was a boxer, a famous boxer in the Boston area.

00:07:13 Speaker_02
And he'd twice fought Sugar Ray Robinson for the world title. So he came in with a diagnosis of Alzheimer's disease into our Alzheimer bank.

00:07:22 Speaker_02
And everybody thought it was Alzheimer's disease because he'd retired from boxing about 40 years before he died. And everyone felt, well, if this were related to boxing, it would have shown up earlier.

00:07:33 Speaker_02
So when I looked at that brain, it was very obvious right from the minute I looked at it that it was an Alzheimer's disease. because Alzheimer's has beta amyloid plaques. You have to have them to make the diagnosis.

00:07:45 Speaker_02
This guy had no beta amyloid plaques. But what he did have was this protein called tau. And using our stains, it stains brown. And this tau was all over his brain and in the most peculiar regions. It was circling around small blood vessels.

00:08:02 Speaker_02
It was clustered at the crevices of the brains. It was involving nuclei in the brain that are not involved in Alzheimer's. It was involving the cerebellum. It was the most curious disease.

00:08:14 Speaker_02
And I scientifically became extremely interested in finding out more about how boxing could promote this kind of neurodegeneration. And then it was some five years later that I had the opportunity to look at an American football player's brain.

00:08:32 Speaker_02
So I looked at the first case, John Grimsley, 45 when he died. And I looked at it, and I couldn't believe my eyes. I couldn't believe that a 45-year-old man could have this amount of tau in his brain, could have this amount of degeneration.

00:08:47 Speaker_02
It just doesn't happen that early. Neurodegenerative diseases are primarily diseases of aging. So 70s, 80s, unless you maybe have a genetic component that comes on in your 50s, But 45 is extraordinarily early and I couldn't let go of it.

00:09:04 Speaker_02
It was monumentally interesting from a scientific point of view that an exposure to trauma could cause this kind of brain damage. And then what was really interesting, as opposed to Alzheimer's disease, is because trauma was

00:09:19 Speaker_02
causing it, there was the possibility we could map it from the earliest trauma to its last manifestations. Then there's the emotional component of talking to the families and just wanting to be their advocate.

00:09:34 Speaker_02
I realized very quickly that if I didn't speak out for these families who were experiencing this tragedy, this devastation, this death of their loved one who had changed before their eyes, nobody else was.

00:09:49 Speaker_01
I've got some of the brain scans of someone who has advanced CTE here in front of me and it is quite frankly horrific.

00:09:57 Speaker_02
Yeah.

00:09:58 Speaker_01
Versus the normal brain on the left which we'll put on the screen for everybody to see and link down below for anyone that's just listening on audio. But I mean the only way I can describe it is it looks like the brain has died.

00:10:10 Speaker_02
Yeah, it's all shriveled.

00:10:12 Speaker_01
Have there been any studies done to figure out how many football players, soccer players, etc, etc, people that are playing these sort of high contact sports, have the early signs of these neurodegenerative diseases showing up already in their brain?

00:10:25 Speaker_02
Oh, if they're NFL players, it's over 95%. It varies, you know, it's 95% and up. The last time we looked at college players, it was 90%. Yes.

00:10:38 Speaker_01
I read a stat that said a 2023 study found that more than 40% of brains from contact sport players who died before age 30 had CTE, which came out of Boston University.

00:10:51 Speaker_02
Yeah, that was our study last August. And in that study, we studied 152 athletes, and we found like 63 had signs of CTE, early CTE, so about 41% of CTE. That is shocking news. That is saying to me we have to address this disease. These are kids.

00:11:12 Speaker_02
They had no reason for their lives to end so early. So we have to address this, even if the risk is small. for high school players or college players, which I don't think is true. I think for college, it's actually quite substantial.

00:11:27 Speaker_02
We have to address this to keep our kids safe. Most people, most parents want their kids to live long, productive lives. And this is a disease that cuts them down, cuts down their potential early in life.

00:11:43 Speaker_01
And a study done from your university as well said that 345 out of the 376 former NFL players, which is 92%, who were studied had CTE in their brains. And how does this disease impact that person's life?

00:12:05 Speaker_01
Because, you know, these children that are playing sports, whether it's soccer or rugby or American football right now,

00:12:12 Speaker_01
they're probably not seeing the symptoms in their everyday life, but you're telling me that the symptoms will show up potentially if they do develop CTE. What are those symptoms?

00:12:19 Speaker_01
You've seen, you spoke to the families, you've seen the loss of their, you know.

00:12:22 Speaker_02
So we can see symptoms quite early. We have found, you know, in that study of the 152 young athletes, they were all symptomatic.

00:12:32 Speaker_02
And those symptoms generally are depression, very common, emotional lability, irritability, impulsivity, poor judgment, making poor choices. There can be aggressive and violent behaviors, physical and even verbal violence.

00:12:49 Speaker_02
And a short fuse, so a small infraction, causes them to have sort of an exaggerated hostile response. And then you can even develop memory loss and cognitive change, even in these young athletes.

00:13:04 Speaker_02
In general, the symptoms develop later, maybe four years later, a decade later, and they generally show up again as these behavioral and mood symptoms, a personality change.

00:13:18 Speaker_02
And as the person gets older, they start to be memory loss, difficulty thinking, cognitive loss, and then ultimately dementia in almost everyone who has severe disease.

00:13:30 Speaker_01
Can you give me some case studies that have really stood out to you as it relates to the symptoms showing up early, but also showing up in a really intense way?

00:13:37 Speaker_02
Yeah, I mean, there was, we actually did a deep dive into several of the players and families that were in that 2023 paper about the young athletes. And there's a very compelling video on the New York Times website of an 18-year-old Wyatt Bramwell.

00:13:57 Speaker_02
What he tells you in this self-tape, he actually videotaped himself before taking his own life, and it's a very tough tape to watch.

00:14:06 Speaker_04
Hello. So what this is, this is me explaining what's wrong with me. I've been depressed for a long time. My head is pretty messed up and damaged. The voices and demons in my head just started to take over everything I wanted to do.

00:14:24 Speaker_04
I took a lot of hits through football, a lot of hits through football, took a lot of concussions, and a lot of times I never told anybody about how I was feeling in my head after a hit.

00:14:34 Speaker_04
You know, I just kind of kept playing, which was not smart on my end, I know that. Dad, I know you're capable of doing this, and I want you to do it. After my funeral, which will be an open casket, I want my brain donated to be studied.

00:14:50 Speaker_04
I feel like it'll be closure for me and it'll be closure for you guys to know that maybe Wyatt suffered from brain damage. Maybe that was the reason. So do that for yourself. I would like that to be done.

00:15:01 Speaker_04
I want you all to be happy that I'm free and that I can rest easy because my life for the past four years has been living hell inside of my head. I love you and goodbye.

00:15:21 Speaker_02
It's the same story over and over with these young athletes. There's something wrong. They're not thinking clearly. They can't really easily put their finger on it. And if they go to seek help, a lot of times the medical professionals

00:15:36 Speaker_02
don't take it seriously or don't think it could possibly be related to the playing of football or other contact sports. And so they're dismissed, the symptoms are dismissed and that also contributes to their despair and deep depression.

00:15:55 Speaker_01
As you were saying that, I just pulled up an article about Wyatt. And it is heartbreaking. The article says in July 2019, just months after graduating from high school at 18 years old, he took his own life.

00:16:10 Speaker_01
About a year later, researchers at your university diagnosed him with stage 2 CTE caused by playing tackle football for several years. So did you look at his brain?

00:16:20 Speaker_02
I did.

00:16:21 Speaker_01
And what did you see?

00:16:22 Speaker_02
I saw multiple CTE lesions in many parts of his brain. You'd think I'd get used to it, but every time you see it in a young person, you just can't get over it. It stops you in your tracks.

00:16:40 Speaker_02
It just makes you stop everything and wonder why aren't people doing more to prevent this disease? We now have the knowledge, we just have to take action.

00:16:53 Speaker_01
Wyatt's mother suspects he knew what he was doing when he took his own life. He shot himself in the heart instead of the head.

00:17:03 Speaker_01
Christy Bramwell, his mother said, it was her son's dying wish to donate his brain to CTE research and the only way to diagnose the disease is through an autopsy of the brain.

00:17:13 Speaker_02
It just breaks your heart. He was desperate. He was desperate, and he wanted people to know. If he did seek help, I'm not sure he did, but if he had, I don't think anyone would have understood what was causing it. And this is the disconnect.

00:17:29 Speaker_02
We have lots of evidence that this is happening in amateur sports, especially American football, but other sports as well. And this is a disease that is entirely preventable.

00:17:40 Speaker_01
If I started playing American football or some kind of sport that involved a lot of sort of head trauma when I was younger, you know, I started playing soccer when I was, gosh, I must have been 10 years old when I started playing in a competitive team.

00:17:55 Speaker_01
And then I played up until I was maybe sort of 18, roughly, years old. If I carried on doing that, at what age would in your opinion, if I was the average player, the first signs of this traumatic brain injury, the CTE, start to show.

00:18:11 Speaker_01
Because I'm thinking about Premier League football players in the UK, soccer players in the UK, they often start at five years old, they play until maybe they're 35 years old. And then what we do tend to see is we see mental health issues.

00:18:23 Speaker_02
Yeah.

00:18:24 Speaker_01
We often see alcoholism.

00:18:26 Speaker_02
A way to cope with their mental health issues.

00:18:28 Speaker_01
Yeah. And other forms of compulsive behavior. And I wondered if there was a link at all in and if it's if it's can show up as soon as their 40s. Yes.

00:18:37 Speaker_02
We definitely have. We have a collegiate soccer player with CTE, the first American case of CTE in a woman. We even have a high school soccer player with early CTE.

00:18:52 Speaker_02
So what we don't know about soccer, because we have fewer brain donations from soccer players, we still haven't developed the dose, you know, the years of play versus CTE that we have developed for these other sports.

00:19:06 Speaker_02
So, you know, that is one of the studies that we're hoping to do is study the brains of soccer players, maybe collaborate with places like Brazil or the UK where soccer is the predominant sport.

00:19:19 Speaker_02
And if these people were to die, you know, analyze their brain and that would enable us to develop a response, a dose-response curve with the number of years played and risk for CTE.

00:19:32 Speaker_01
Have you seen the UFC?

00:19:35 Speaker_02
I have not.

00:19:36 Speaker_01
It's like MMA. Yeah, but it's brutal, right? It's brutal. There's also boxing.

00:19:42 Speaker_01
When you were talking about CT, I thought about the term they used to say when people retired from boxing, or even when they got later in their career in boxing, they used to call it being punch drunk.

00:19:51 Speaker_02
Yes, yes.

00:19:52 Speaker_02
That was the original report on CTE that was actually published in 1928 in Boxers and it described the symptoms that boxers developed if they stayed in the ring too long and that was called punch drunk and then later that nomenclature got changed to dementia pugilistica because they thought it happened primarily in pugilists or boxers and then through the years there's slow recognition that it could happen

00:20:21 Speaker_02
to individuals who had other causes of hits to the head, ultimately like American football players. There was a circus clown that had a lot of hits to the head that developed CTE. People started realizing that it's not exclusive to boxers.

00:20:38 Speaker_02
It's actually anyone who gets repetitive hits to the head. It was described in an older woman who was a product of domestic violence. and that's why they had to sort of make it a broader term and that was when CTE was really accepted as a term.

00:20:54 Speaker_01
And explain simply for someone like me who doesn't know anything about the brain, How does CT develop? What's going on? Is there a way to simply explain it to me?

00:21:05 Speaker_02
Yeah, well it is based on the physics of the injury, that acceleration-deceleration, the stretch of the brain, it causes the brain to be damaged in the parts of the brain that get the most stress, the most strain.

00:21:17 Speaker_02
So you could actually get the most physical displacement. That's where you see the damage to the brain. And it almost always is in the frontal lobes, but at the crevices of the brain is where it starts.

00:21:31 Speaker_02
So we see the earliest stages at the crevices because those get the most shearing. And it also starts around blood vessels because the blood vessels have a certain viscoelastic

00:21:42 Speaker_02
property, and then the brain around it has another, and so there's another shearing force around the blood vessels.

00:21:48 Speaker_02
So the physics of the injury, the physics of the traumatic acceleration, deceleration, determine where the brain is injured first, and that's crevices and around blood vessels. And that's exactly what you see in Stage 1 and Stage 2 CTE.

00:22:05 Speaker_01
So if I'm constantly heading the ball and playing soccer, constantly heading the ball forward like this, my brain is moving forward and backward.

00:22:15 Speaker_02
And it's just the stretch.

00:22:17 Speaker_01
And when it stretches, something is happening there. Is it like a bruising or the chemicals show up to hurt?

00:22:22 Speaker_02
It's like a shearing force. So you have a tissue that's being stretched, the elements inside the tissue are also being stretched, and they're going to break.

00:22:31 Speaker_02
There's going to be damage caused by this sudden elongation that's going to snap some of the fibres and injure some of the blood vessels.

00:22:41 Speaker_01
So how many times have I got to head a football for that to happen?

00:22:44 Speaker_02
I don't know. You know, we aren't able—if they had accelerometers in headbands with soccer players, we might know the answer to that question, but obviously we don't.

00:22:54 Speaker_02
And so—but we do know that, you know, years of play in football is associated with risk. In fact, for every 2.6 years of American football, it doubles your risk for CTE.

00:23:08 Speaker_02
There's a somewhat lower risk—I can't remember exactly right now the number of years Ice hockey that you need to play to double your risk for CTE, it's somewhat lower. And rugby also has a dose-response relationship.

00:23:22 Speaker_01
And this really is, you know, an issue that does impact soccer and American football. I was reading about a case of a guy called Jeff Astell, who was an ex-England striker.

00:23:35 Speaker_01
He was the scorer of a winning goal in the 1968 FA Cup final, and he died from CTE in 2002, aged 59. So this is a condition that impacts soccer players as well, and I believe you've met his family.

00:23:48 Speaker_02
I have met his family, yeah. And we also have in our bank at least five professional soccer players, all of whom have had CDE.

00:23:57 Speaker_01
The doctor who examined Jeff's brain said he couldn't believe that he was looking at the brain of a 59-year-old. He thought it was the brain of a 90-year-old.

00:24:07 Speaker_01
And 10 years before Jeff died, he was struggling with memory loss, forgetfulness, depression and anxiety. And obviously, once he'd passed away and they got to dissect his brain, they realised why. The resistance you faced.

00:24:20 Speaker_05
Yeah.

00:24:23 Speaker_01
Talk to me about the journey that you've been on to try and change people's minds.

00:24:27 Speaker_01
Because if I was running the NFL or even the Premier League or the, I don't know what the ice hockey league is called or boxing or the UFC, the news that you're telling me today and the research that you've done is a threat to me, my industry, my business and my profit margins.

00:24:47 Speaker_02
Absolutely. Yeah.

00:24:49 Speaker_01
So I can imagine people weren't happy with the message that you had to share in the research that you're doing.

00:24:54 Speaker_02
No, they weren't. And also it's America's favorite sport and it defines culture. Football is almost a religion in the United States. You know, people equate football with patriotism and, you know, loving the US. You know, it has a lot of connotation.

00:25:10 Speaker_02
Football defines communities. It defines colleges and universities. So the love of football is I think, you know, even in the UK, you know, fanatical fans, right? It's quite something.

00:25:26 Speaker_02
Even beyond the financial aspects, we all just have these massively strong feelings about the play of these sports. And so coming up and saying, you know,

00:25:38 Speaker_02
the play of these sports in some people is damaging their brains and actually leading to their death, was not met with any enthusiasm. And so there was a huge effort to really discredit me.

00:25:53 Speaker_02
And those were difficult years because my integrity was so questioned. It's hard to take. It's hard to take people challenging your

00:26:02 Speaker_02
your truthfulness and, you know, people said I was a fraud and I was faking the data and, you know, all really it goes on and on. The only thing that kept me going was knowing that I was speaking for the families and I I was speaking for them.

00:26:21 Speaker_02
I was their advocate. And I also knew that this was blatantly real. I could see it under the microscope. It was obvious to me. It's not something that happens normally. It's not something that happens with aging. It's not Alzheimer's disease. It's not

00:26:43 Speaker_02
a benign condition. All of those things were thrown at me many, many times. In fact, I still hear them today sometimes.

00:26:51 Speaker_02
And over the years, I kept thinking, well, if we have enough data in enough players, and we'd publish in enough journals, and, you know, have enough science data

00:27:02 Speaker_02
you know, we are gradually going to be able to wear this down to the point where people take it seriously. And we have gotten to that point. We are taken more seriously. Our CTE is now a disease that's recognized by the National Institutes of Health.

00:27:17 Speaker_02
So it's easier now. But there's still considerable controversy.

00:27:22 Speaker_01
I also read that sort of 15 years ago, you got a call from the NFL. They contacted you and they wanted to talk. Why did they contact you?

00:27:32 Speaker_02
So our first case was in February of 2008. That's when I got my first brain, and we announced the findings in Later in the year, in 2008, over the next year from 2008 to 2009, we accumulated more cases. I believe it was around 10.

00:27:53 Speaker_02
And we had published a paper. We published a paper of our experience on CTE. So after that paper was published in September, I got a call from the NFL in November, November of 2009, saying that they wanted me to come to New York and present my findings

00:28:14 Speaker_01
He was in the room.

00:28:15 Speaker_02
the chairmen of this mild TBI committee, Ira Kass and colleagues, as well as some owners of teams.

00:28:24 Speaker_01
And how did it go?

00:28:26 Speaker_02
Well, it fell on deaf ears. It was pretty humiliating. They didn't believe me. I remember one of them said, is there some other doctor that can address these findings? It was just massive denial and dismissiveness.

00:28:45 Speaker_02
You know, it felt humiliating is the best word. I didn't accomplish much.

00:28:52 Speaker_01
What did they think it was? Because if you look at something like this, you know, advanced CT in this brain that I have in front of me, I mean, clearly something is... Something is wrong.

00:29:01 Speaker_02
They thought I was misdiagnosing it. Something wrong with something else. It wasn't related to the play of football.

00:29:08 Speaker_01
How did you leave that day feeling?

00:29:11 Speaker_02
very, very discouraged, feeling like, you know, marginalized.

00:29:22 Speaker_02
I'll be honest, as a woman in medicine, I was one of the earlier women in medicine, you've experienced being dismissed, you've experienced being talked over, you've experienced having your opinion belittled.

00:29:38 Speaker_02
And so it was just sort of a more focused experience of that.

00:29:44 Speaker_01
But it didn't stop you.

00:29:46 Speaker_02
No, it didn't stop me because the brains kept coming in. You know, it's tragedy. You see tragedy after tragedy after tragedy. You're going to keep going. And you could see the evidence. I could see the evidence. This is true.

00:29:59 Speaker_02
I just have to convince them this is true.

00:30:01 Speaker_01
You mentioned the families a lot.

00:30:03 Speaker_02
Yeah. Well, we talked to the families. I do my analysis. I then find out, you know, what they were like clinically, because the analysis is always done not knowing anything about their clinical state.

00:30:15 Speaker_02
I don't know how many head hits they had, how long they played football. I don't know if they were depressed. I don't know anything about that. So I do it unbiased, blinded to the clinical symptoms.

00:30:27 Speaker_02
But then after I do my analysis, then I talk to the family. And I get to experience their reaction to it and how they feel. And obviously, it brings up the death. It brings up all the emotions of the loved one dying. And it's a very often emotional call.

00:30:46 Speaker_02
But it's actually one of the most rewarding as a physician.

00:30:51 Speaker_02
It's one of my most rewarding times because I get to, I can't heal the living, but I can heal the families that are the survivors and I can help them with the knowledge that is often comforting to them. It explains things. The person didn't hate them.

00:31:09 Speaker_02
They just had brain damage and they were They were limited, and their actions weren't because they felt negatively towards them. They just couldn't control it. And somehow, that brings their loved one back to where they remember them best.

00:31:30 Speaker_02
It brings them back to the person they were before the disease started, why they married them. It brings their father back to the father that loved them, not the one that scorned them.

00:31:41 Speaker_02
And it explains for parents why a child might have done terrible things, including maybe it had contributed to an accidental injury or taking his life. And that knowledge is very comforting. It helps the family heal.

00:31:58 Speaker_01
It's a lot for you to carry.

00:32:00 Speaker_02
Yeah, it is. It is a lot. It's very, very hard year after year to keep on. And there's some days that are darker than others. There's many days where I feel it's just too much. It's too much because we're not making much progress.

00:32:15 Speaker_02
You know, there hasn't been a lot of acceptance. I mean, incrementally, we're light years ahead of where we were 17 years ago, but we're not where I'd like us to be. And it can be very frustrating. But I can't give up the torch.

00:32:30 Speaker_02
I can't give up the work. Because who will do it? Who will do it? And I think at this point, we have the most experience with it. We can do it best.

00:32:45 Speaker_01
Was there a moment where the NFL started to change their mind?

00:32:50 Speaker_01
Because I read that in 2013 the NFL reached a $765 million settlement with thousands of retired players and families affected by concussion-related brain injuries, promising to pay every former player who developed brain disease linked to concussions.

00:33:06 Speaker_02
Yes, and they paid for CTE before 2015. So anyone who was diagnosed with CTE in 2015 and before got compensated for CTE, but no one after. They also compensated for Alzheimer's disease, ALS, and Parkinson's disease.

00:33:26 Speaker_02
But they don't, they do not compensate for CTE any longer. Anyone who's developed CTE, has come into the brain bank and diagnosed with CTE, that is not a reimbursable condition according to that settlement.

00:33:41 Speaker_01
Why?

00:33:43 Speaker_02
They dodge, they're, you know, smart lawyers, they know how to dodge a bullet.

00:33:48 Speaker_01
Are they still not getting suits? Presumably families are still trying to sue.

00:33:51 Speaker_02
Well, I think families are, but in terms of that lawsuit, that was settled and it was settled probably too quickly because it compensated the players who were suffering at that time, but it didn't compensate future players.

00:34:08 Speaker_01
The story of Owen Thomas.

00:34:10 Speaker_02
Yeah.

00:34:10 Speaker_01
I was reading that story too. Can you tell me about the story of Owen Thomas? He's an American football player at the University of Pennsylvania who also took his life at a very young age.

00:34:18 Speaker_02
Exactly, yeah. I mean, all of these cases I remember so well, even though it was a long time ago now. Yes, Owen Thomas was a UPenn player.

00:34:31 Speaker_02
He had no concussions that they knew about, and he was apparently an excellent student, but was having some troubles with his studies, was not focusing. Quite unexpectedly, he took his own life.

00:34:46 Speaker_02
And I examined that brain, and I remember it was late at night. I was preparing to go home, but sometimes I like to look at the cases after the lab is quieted down to sort of just, you know, focus and think about things.

00:35:01 Speaker_02
And I remember looking at his brain and seeing very clear evidence of CTE and just being You know, you just, you're just blown away. You're sort of, it's sort of like the air goes out of you. You just sort of can't believe it. He's 21, 21.

00:35:17 Speaker_02
It just seems insane. And I remember talking to his parents and his parents were very surprised. They were surprised by his suicide.

00:35:26 Speaker_02
There hadn't been many warning signs and they were very surprised that he had this, this disease that they'd never heard of.

00:35:34 Speaker_01
And what, what was the cause of that disease in your opinion?

00:35:37 Speaker_02
his years of playing football very clearly.

00:35:40 Speaker_01
I've got a American football helmet over here in the corner. I've never actually seen one before. But when I was looking at earlier before we started recording, I was shocked by how thick and heavy it is.

00:35:53 Speaker_02
Yeah, and I think that's an older model, so I think they're thicker and heavier now.

00:35:57 Speaker_01
I mean, there's so much padding inside here.

00:36:00 Speaker_02
Yeah, yeah. I mean, they look like they're completely protecting the person. But the injury for this disease is happening inside the helmet and inside your skull. If you think about it, the skull is nature's helmet.

00:36:14 Speaker_02
And the brain is tethered by your spinal cord, but it actually, there's some fluid surrounding it.

00:36:20 Speaker_02
So your brain is moving inside the skull, and no matter how big and thick and protective that helmet is, it's not changing the movement of your brain, which is a

00:36:33 Speaker_02
a soft substance, not exactly like cello, but it elongates, it can twist and turn, and that is happening beneath the helmet, beneath the skull. What that does, what the helmets were designed for, was to prevent skull fractures.

00:36:52 Speaker_02
And skull fractures lead to hemorrhages in the brain, bleeds in the brain, and sudden death. And that's why a helmet was developed. So people would stop dying on the American football field.

00:37:03 Speaker_01
So it protects the bone, but not the brain.

00:37:05 Speaker_02
Exactly.

00:37:06 Speaker_01
So it's pretty useless as it relates to CTE.

00:37:12 Speaker_02
Right.

00:37:13 Speaker_01
Because your brain is still going to be accelerating and decelerating.

00:37:16 Speaker_02
Yes.

00:37:18 Speaker_01
Well, OK. So I've got some diagrams in front of me here of the four stages of CTE and on the left hand side I've got this stage one where you've got the odd spot of this sort of brown substance.

00:37:37 Speaker_01
The brown substance is a substance you use to sort of I guess highlight the tau.

00:37:42 Speaker_02
We identify tau. It's almost a chemical reaction if you think about how you develop a photograph and so it tags the tau and it turns it brown so we can see it.

00:37:53 Speaker_01
Okay so all of the brown areas are the areas where the tau has been identified. So what I was wondering is in this stage one there's a couple of instances and then stage two there's more and then stage three is quite drastic shift.

00:38:05 Speaker_02
There's a drastic shift.

00:38:06 Speaker_01
It's like bigger clusters and then stage four you've really got the whole brain or at least you know half or a quarter of the brain has been engulfed by this tau substance.

00:38:14 Speaker_02
Right.

00:38:14 Speaker_01
Is the difference between stage 1 and stage 4 here just more hits to the brain or is it if left alone can it go from stage 1 to stage 4 without further impact?

00:38:25 Speaker_02
It can go from one to four with aging. So it's a disease of aging. So the older the player, the more likely they are to have severe CTE, but it's also the number of years of play. So years of exposure does play into it.

00:38:41 Speaker_02
It's years of exposure and age of the individual at death that determine severity.

00:38:46 Speaker_01
Okay, so if I stopped at stage two, if I stopped playing sports at stage two, I stopped, you know, it wasn't in the military anymore, no domestic violence or anything else that might cause it, it will progressively get worse even if there's no further contact?

00:38:59 Speaker_02
Yeah.

00:39:00 Speaker_01
Okay.

00:39:01 Speaker_02
And we think that's, you know, so obviously we need to know why that is and some of the theories are there's tremendous inflammation in the brain even after just the hits before the tau, so the inflammation may feed the tau because there's a

00:39:15 Speaker_02
a linear relationship between inflammation and tau. And once you have more tau, you get more inflammation, so you can see there's sort of a vicious cycle. But we're looking into other things. Why does this disease become worse with aging?

00:39:27 Speaker_02
Because if we could identify what makes it, you know, spread, what makes it get worse with time, we could, you know, prevent a lot of the ultimate devastation.

00:39:41 Speaker_01
And in terms of the young people that you've looked at, the brains you've looked at in young people, what stage do you see?

00:39:48 Speaker_02
In the young people it's almost all stage one and two.

00:39:50 Speaker_01
Okay.

00:39:51 Speaker_02
Except in unusual cases like Aaron Hernandez was 27 when he died. He had stage three.

00:39:59 Speaker_01
The story of Aaron Hernandez is widely known but for those that don't know could you give me a summary of

00:40:03 Speaker_02
So he was a very high-level, high-functioning football player for the New England Patriots, you know, from the New England area, which I'm from.

00:40:13 Speaker_02
He was given a $40 million contract, and he played, you know, with Tom Brady and Rob Gronkowski on the Super Bowl-winning teams. And he was really considered a superstar on the team. There was evidence that he was having some psychosocial difficulties.

00:40:33 Speaker_02
There were rumors of criminal activity. And he ultimately was charged with murder and went to trial for murder. And then he, I believe, you know, he had another trial also involving the murder of three people.

00:40:48 Speaker_05
Charging defendant Aaron Hernandez with murder. What say you, Madam Foreperson? Guilty of murder in the first degree. Madam Foreperson? by which theory or theories deliberate premeditation and or extreme atrocity or cruelty. Extreme atrocity or cruelty.

00:41:11 Speaker_02
He ended up, while he was in jail for the first criminal trial, taking his own life at the age of 27. And he did donate his brain to my center. His family did.

00:41:24 Speaker_01
And what did you see when you looked at his brain?

00:41:26 Speaker_02
He had a large brain, which is not uncommon for football players. The external surface looked perfectly normal. I mean, when I first saw it, I thought, he's not going to have it. You know, it looks good. There was no obvious damage.

00:41:40 Speaker_02
But then when we started doing the dissection, we slice through the brain coronally, and I could see that his ventricles, the chambers at the inside of the brain, they were dilated.

00:41:53 Speaker_02
They were larger than they should have been, which means that there's shrinkage of the brain tissue. And then there was a membrane that divides the two halves of the brain, and instead of being a nice membrane, it had giant holes in it.

00:42:08 Speaker_02
Those are called fenestrations, and that's a sign of brain trauma, because the fluid is banging against that curtain and ripping it and causing holes. And I'd never seen fenestrations in anyone under the age of 45.

00:42:23 Speaker_02
And that actually was a person with CTE that was a rugby player. So that was shocking to me. And then I thought when I saw that, oh, He probably is going to have CTE. And then when I looked under the microscope, it was... It was just shocking.

00:42:41 Speaker_02
It's like, you know, you think you've been amazed or floored by these brains that have come and then there's another one and you're just, you know, you're just, you know, you're just always astonished by what can happen.

00:42:56 Speaker_02
So his frontal lobe, really, his frontal lobe from the back to the front was really riddled with tau. It was almost as though he had a non-functioning frontal lobe.

00:43:06 Speaker_02
And, you know, so I can't say that his actions were related to the CTE that he had in his brain, but it's impossible for me to conceive that it didn't contribute in some way.

00:43:17 Speaker_02
You just don't have that extensive frontal lobe disease without seeing changes to your behavior and your decision making.

00:43:24 Speaker_01
Will it debilitate his frontal lobe?

00:43:26 Speaker_02
Yeah, yeah.

00:43:27 Speaker_01
And what does that mean?

00:43:28 Speaker_02
So when you lose your frontal lobe, you lose your inhibition. Your frontal lobe sort of dampens inner urges. So if you become very frontal lobe, you talk without thinking, you don't have a filter.

00:43:44 Speaker_02
and you do aggressive, maybe impulsive acts with no filter either. And you have poor judgment, you have poor executive functioning, you can't focus very clearly. So to me, yes, some of his symptoms indicated frontal lobe damage.

00:44:01 Speaker_01
— I looked at the video of Mike Webster, who was a former NFL center, one of the greatest, I'm told.

00:44:11 Speaker_03
— No, I'm talking about No, I'm just trying to find, yeah, well, trauma, everybody went through trauma as a kid. I'm not saying I was different than that. I'm just saying the things we do to one another, okay, Hell, I don't know what I'm saying.

00:44:36 Speaker_03
I'm just tired and confused right now. That's why I say I can't really, I can't say it the way I want to say it. I could say, I could answer this real easy at other times, but right now I'm just tired.

00:44:47 Speaker_01
He's clearly struggling.

00:44:48 Speaker_02
Oh, he's a mess.

00:44:50 Speaker_01
And I think that really, for me, brought it to life. What do we do about this?

00:44:54 Speaker_02
about the disease?

00:44:55 Speaker_01
About everything you've said, you know, you said you've done this for 17 years and you still haven't seen the progress that you want to see.

00:45:01 Speaker_02
Yeah.

00:45:02 Speaker_01
What is the progress you want to see?

00:45:03 Speaker_02
The progress is taking hits to the head out of these sports as much as is possible and really a concerted effort to keep these young athletes safe.

00:45:17 Speaker_02
I think team sports, contact sports, sports in general are extremely important to the psychosocial development of our children. I don't want these sports to go away.

00:45:28 Speaker_02
But I do want us to acknowledge that the brain is fragile, that the brain can be very adversely affected if we don't pay attention to how many times we're hitting these kids in the head. And that's the bottom line.

00:45:44 Speaker_02
You cut out the hits to the head, you cut out this disease. It's entirely preventable.

00:45:50 Speaker_01
Someone might say, but, you know, doctor, how do we take hits to the head out of soccer and the NFL? It's an inevitable. In rugby, we have to be hitting the head for the sport to work. We need kids to learn how to head the ball.

00:46:01 Speaker_01
We need them to learn how to tackle, you know, boxing. How do we take, we can't take hits out of the head out of boxing. The UFC, hugely. Power slap, one of the fastest growing sports at the moment. Have you seen power slap?

00:46:12 Speaker_02
No.

00:46:13 Speaker_01
It's very simple. You stand at a podium and someone smashes you in the head with their hand. Huge sport, exploding hundreds of millions of views across the internet. Dana White says it's going to be even bigger than UFC.

00:46:24 Speaker_01
We can't take hits to the head out of these sports, surely. This is just wishful thinking.

00:46:28 Speaker_02
Well, that and some of these sports are just downright dangerous and and people are going to choose to participate in these dangerous sports. But for young children, children in high school, children and adults in college,

00:46:44 Speaker_02
They need to know the risks and we need to tell them and they need to be able to, you know, think that the risks are acceptable.

00:46:54 Speaker_02
And we need to educate parents and coaches and the athletes that this can be a consequence of playing a long career in these contact sports. We can take the hits out by changing full contact, you know, putting an age

00:47:11 Speaker_02
limit when they can do full contact. You don't have to play football all through high school to be a good football player in college. You could develop ball skills and athletic skills without the head contacts and probably be just as good a player.

00:47:28 Speaker_02
We just have ignored the clearly risky behavior that's in these sports. We could take heading out of soccer. It is football, after all. It is something you could play entirely with the foot.

00:47:44 Speaker_02
Now, that may not please the fans or the current players, but it's not inconceivable that we could take heading out of soccer. But we'd have to take it out for everyone. Otherwise, people would be discriminated against who didn't head the ball.

00:48:00 Speaker_02
Ice hockey, you can take the fights out. You can certainly limit checking and clearly dangerous behaviors. And you can also monitor the players. You could actually pay attention to how many times they're getting hit.

00:48:15 Speaker_02
We could start monitoring athletes from beginning of season to end of season. There are ways to look at the brain. There's scans. There's other neuropsychs. We could be monitoring these athletes.

00:48:29 Speaker_02
if, to see if they're going down the wrong path, if things look like they're turning south. Right now, we're turning a blind eye to it. We're doing nothing, hoping it'll all go away. I'll go away. And then none of this will be reality.

00:48:44 Speaker_02
But that's not how it works.

00:48:45 Speaker_01
SIMON Do you think people want you to go away?

00:48:46 Speaker_02
RISA I think people want all this science to go away.

00:48:53 Speaker_01
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00:48:59 Speaker_01
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head to netsuite.com slash Bartlett and you can get a free download of the CFO's guide to AI and machine learning. That's netsuite.com slash Bartlett. My last question is about Alzheimer's.

00:50:47 Speaker_01
You mentioned that you've looked at lots of brains of people that have Alzheimer's. Bit of a dumb question, but what is the difference between Alzheimer's and dementia, or is it the same thing?

00:50:56 Speaker_02
Yeah, it's a great question because everybody is confused. So dementia is sort of this general term. It's dementia, which means the loss of your mental abilities, you know, de-mentating. So loss of cognitive ability is dementia.

00:51:12 Speaker_02
There are many subcategories of dementia, causes of dementia. The most common cause of dementia is Alzheimer's disease. It's the most common age-related cause of dementia.

00:51:24 Speaker_02
But then under Alzheimer's, there's also Parkinson's disease with Lewy body disease. There's something called frontotemporal lobar degeneration.

00:51:33 Speaker_02
Then there's, you know, you get into odder and rarer diseases, progressive supranuclear palsy, gaumian dementia. And somewhere down there is also CTE. So CTE is a cause of dementia.

00:51:48 Speaker_01
Ah, okay. And how do I avoid getting Alzheimer's?

00:51:54 Speaker_02
Well, you know, it's a very common disease. It's supposedly in over 50% of people that live to the age of 85. If you looked at their brains, half of them would have Alzheimer's disease.

00:52:07 Speaker_02
Not everyone gets the symptoms of Alzheimer's disease at 85, but they'd have the pathology. Now, things you can do to lessen the symptoms of Alzheimer's disease are

00:52:18 Speaker_02
you know, staying socially connected, using your brain, challenging your brain, because high cognitive reserve, high cognitive ability gives you strength, brain strength, brain resilience against these diseases.

00:52:33 Speaker_02
So even if you have pathology, you can circumvent the areas of injury, the areas that aren't working well, and not experience the symptoms. So that's one thing.

00:52:44 Speaker_02
physical activity, fitness, but also mental fitness, challenging your brain, keeping it active, developing a high cognitive reserve. And then the other things you can do is stay fit, eat right.

00:52:58 Speaker_02
Cardiovascular health is intimately connected to Alzheimer's disease. You want to avoid high blood sugar, diabetes, because that can definitely hasten Alzheimer's disease. So it's really a story of staying healthy.

00:53:13 Speaker_01
Alcohol?

00:53:14 Speaker_02
Well, alcohol can damage your brain, and alcohol damages it in entirely different ways than Alzheimer's or CTE. But if you do drink alcohol, it can exacerbate your symptoms. It can make your symptoms worse.

00:53:28 Speaker_02
And, you know, we don't have any direct connection between alcohol and Alzheimer's, but, you know, we do know that it's not good for your brain health. It damages parts of the brain that can lead to cognitive problems.

00:53:42 Speaker_01
Are these diseases increasing?

00:53:44 Speaker_02
No, I think our awareness of these diseases is increasing. You know how we used to call it senile dementia? Like, oh, yeah, it's just getting old. So, you know, we sort of dismissed it as just old age.

00:53:55 Speaker_02
But there are some people that live to very old ages that are perfectly intact. So, these are abnormal aging. These are pathological aging. And we're much more aware of it than we were, say, 40 years ago.

00:54:08 Speaker_02
40 years ago, we really had no concept how common this disease was.

00:54:12 Speaker_01
Is there anything that you believe about the brain that most people disagree with still to this day?

00:54:17 Speaker_02
I don't, I can't think so.

00:54:19 Speaker_01
As it relates to Alzheimer's and CTE, is there any sort of fundamental beliefs that you're currently trying to prove out through your testing and the things you're doing at Boston University?

00:54:31 Speaker_02
Well, I do. I, you know, I have my own theories.

00:54:35 Speaker_02
I don't know if other people don't believe them, but I do feel that inflammation, anything that causes inflammation in your brain, and I think what a lot of people would agree with me, though inflammation is one of the key promoters of brain disease and neurodegeneration.

00:54:50 Speaker_02
So there's tremendous inflammation in Alzheimer's disease, tremendous inflammation in CTE, and if we could figure out sort of this bad inflammation, we might be able to prevent or at least stave off these terrible diseases.

00:55:04 Speaker_02
And the other thing that I think is very important is small vessel disease, vascular disease.

00:55:10 Speaker_02
The health of these small blood vessels that are so important in terms of oxygenating our brain, if they become damaged or injured through a variety of mechanisms, then we also see these diseases being accelerated.

00:55:26 Speaker_02
So, you know, I think there needs to be a lot more attention to the earliest changes that are associated with these diseases. And in my mind, those are vascular changes and inflammation.

00:55:37 Speaker_01
And what kinds of things cause inflammation in the brain?

00:55:40 Speaker_02
Really, any insult to the brain. Certainly if the blood vessels are damaged and they become leaky, you get substances leaking into the brain that irritate the brain and cause tremendous inflammation. The blood-brain barrier is a very tight barrier.

00:55:56 Speaker_02
You can have all sorts of toxins in your blood, but they're not getting into your brain because you have such a tight barrier between the blood and the brain. We keep out all sorts of noxious substances. But if you injure the blood vessels,

00:56:10 Speaker_02
They leak, and all those things that we are, you know, trying to keep out of our brain leak into the brain and promote inflammation. Those changes can facilitate neurodegeneration.

00:56:23 Speaker_01
And the things that make all those blood vessels become injured?

00:56:26 Speaker_02
Well, trauma.

00:56:27 Speaker_01
Trauma, yeah.

00:56:27 Speaker_02
That back and forth, but also things that affect vascular health, like high blood pressure, high cholesterol, blood sugar, exactly.

00:56:38 Speaker_01
high cortisol.

00:56:39 Speaker_02
Yeah, yeah. So stress, I guess, stress, you want to reduce stress, you want to stay physically fit, you want to eat right.

00:56:46 Speaker_02
It's, it's, we all know that what you need to do is just the things that sleep, you know, sleep is so important for, because at the end of the day, your sleep you're actually clearing bad substances out of your brain.

00:57:00 Speaker_02
You have a clearance system in your brain that is most active when you sleep. And so when you're sleeping, it's pulling out the noxious chemicals. It's draining them into your system so you can get rid of them. So sleep is also critically important.

00:57:13 Speaker_01
We probably have a few million parents listening at the moment to this conversation. And those parents, you know, their kids are saying, I want to play rugby. I want to play soccer. I want to play American football.

00:57:23 Speaker_01
I want to do hockey, all these kinds of things. What would you say to those parents?

00:57:29 Speaker_02
Well, you know, every parent is different. Every child's different. You have to really understand your child. Is it that they need to play that particular sport?

00:57:38 Speaker_02
Or could they be just as easily, you know, could they be just as happy in a non-contact sport? There are plenty of non-contact sports. There are plenty of sports that have low risk. So I would promote all of those.

00:57:51 Speaker_02
And then if they choose, if they think this is a decision that they want to make despite the risks, then make sure the coach is very, very well versed in some of the adverse consequences of concussions and those hits to the head, even the non-concussive hits.

00:58:10 Speaker_02
Make sure that there's good education, good education of the player as well as the teammates, as well as the coach. and then, you know, try to delay playing full contact as long as possible.

00:58:23 Speaker_02
I think you should delay it until the person's physically robust, with a musculature, with a strong neck, they're able to, you know, resist hits.

00:58:34 Speaker_02
There's, you know, a blindsided hit is much more damaging than a hit that you're expecting because you set your neck, you're expecting the hit, and it doesn't cause the whiplash that a blindsided hit causes.

00:58:48 Speaker_01
And what if the owner of the NFL is listening right now, the chairman of the NFL, the person that's in charge of these sort of leagues around the world?

00:58:56 Speaker_01
Because I do know, because I speak to some of them, that there are people at some of the biggest sports teams in the world that listen, that are in charge of player performance.

00:59:03 Speaker_01
And I actually had a meeting a couple of weeks ago with someone who's at one of the biggest teams in the world who's in charge of player well-being. And they listen frequently to the podcast and talk to me about the episode.

00:59:13 Speaker_01
So what would you say to those individuals that have the power to make change?

00:59:17 Speaker_02
I'd say do more about the non-concussive hits. There's been a lot of awareness of concussion, a lot of awareness of concussion management, but the important hits are the hits that don't cause symptoms, are not considered concussion.

00:59:33 Speaker_02
Find ways to limit the number of hits to the head in the sport. Take hits out of practice. Encourage players to start full contact later. Lead by example. Show that the subconcussive, non-concussive hits are something to be limited.

00:59:52 Speaker_02
And show leadership by showing that you're addressing these non-concussive hits effectively.

01:00:00 Speaker_01
We have a closing tradition on the podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. Oh my goodness. And we'll ask you to do the same. Can you take me to your darkest day?

01:00:12 Speaker_01
What happened and what made it so dark?

01:00:17 Speaker_02
Well, my darkest day, probably many days, is when I don't have complete confidence in myself and I doubt myself and I don't want to go forward because I think I'm not capable.

01:00:40 Speaker_02
The contrary of that is that this work came about because I believed in myself. I believed I was seeing the truth. I believed it was true and actual. And it wouldn't have happened if I'd let my doubts and myself limit me.

01:00:57 Speaker_02
So I would say to—the answer to that question is believe in yourself and take it to where it needs to go.

01:01:06 Speaker_01
Thank you so much. You're a pioneer and you've started a conversation over the last decade or so that has really had a huge impact on the world and people's opinion about a subject matter that before then was so invisible to many.

01:01:19 Speaker_01
The research you've done and continue to do are going to save a lot of people's lives that you're never going to get to meet. Not just save their lives, but ultimately extend their health span and make their lives more joyous.

01:01:28 Speaker_01
Not just their life as well, but also the lives of their family.

01:01:31 Speaker_01
So I know I can imagine it feels very frustrating when you're staring at reality and truth every single day, but then you're looking into a world that can't see or appreciate the same truth that you see.

01:01:41 Speaker_01
But it's important that you know that it matters.

01:01:44 Speaker_02
Thank you. I appreciate that.

01:01:46 Speaker_01
And how can the people listening help?

01:01:48 Speaker_02
Well, they can pay attention to their own brain health, they can promote brain health, and if they know of someone who's struggling, bring it to attention, bring it to a medical professional's attention.

01:02:00 Speaker_02
And if someone were to, very unfortunately, die, of course brain donation has been absolutely critical to our understanding these diseases. not just CTE but Alzheimer's disease, Parkinson's disease, make a brain donation.

01:02:15 Speaker_02
It's a legacy that will continue to go forward many years after your death.

01:02:21 Speaker_01
I shall be donating my brain. Dr. Anne McKee, thank you so much.

01:02:25 Speaker_02
Thank you.

01:02:27 Speaker_01
Every single time you eat, you have an opportunity to improve your health. That's why I love ZOE, because it helps me to make the smartest food choices for my body. As you guys probably know, ZOE is the sponsor of my podcast.

01:02:38 Speaker_01
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01:02:46 Speaker_01
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01:02:55 Speaker_01
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01:03:04 Speaker_01
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01:03:15 Speaker_01
Just use the code BARTLET10 at checkout. Quick one, I want to say a few words from our sponsor NetSuite.

01:03:45 Speaker_01
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01:03:52 Speaker_01
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01:04:27 Speaker_01
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