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

28:52We 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. He was in the room. The chairmen of this mild TBI committee, Ira Casson and colleagues, as well as some owners of teams. And how did it go? Well, it fell on deaf ears. It was pretty humiliating. They didn't believe me. I remember one of them said, is there somebody? Is there some other doctor that can address these findings? It was just massive denial and and dismissiveness.

29:41And you know, it felt humiliating is the best word. I didn't accomplish much. What did they think? I think it was because if you look at something like this, you know, advanced CTE in this brain that I have in front of me, I mean, clearly something is wrong. They thought I was mistaken. Something wrong was something else. It wasn't. It wasn't related to the play of football. How did you leave that day feeling? Very, very discouraged feeling like, you know, marginalized.

30:18I'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. And so it was just sort of a more focused experience of that. But it didn't stop you. 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. I just have to convince them. This is true. You mentioned the families alone. Yeah.

31:00Well, 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. I don't know how many idiots 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. But then after I do my analysis, I talk to the family. And I get to experience the reaction to it and how they feel. And, you know, obviously, it brings up the death. It brings up all the emotions of the loved one dying.

31:39It's a very often emotional call. But it's actually one of the most rewarding as a physician. 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. They just had brain damage. And they were limited. And they didn't, you know, their actions were 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. It brings them back to the person they were before the disease started.

32:30Why they married them. It brings their father back to the father that loved them, not the one that scorned them. 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. It's a lot for you to carry. 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. There hasn't been a lot of acceptance.

33:15I 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. I can't give up the work. Because who I 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. Was there a moment where the NFL started to change their mind? Because I read that in 2013, the NFL reached off $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.

34:03Yes. And they paid for CTE before 2015. So anyone who was diagnosed with CTE 2015 and before got compensated for CTE, but no one after. They also compensated for Alzheimer's disease, ALS and Parkinson's disease. But they don't, they do not compensate for CTE any longer. Anyone who's developed CTE has come into the brain, then diagnosed with CTE. That is not a reimbursable condition, according to that settlement. Why? They dodge, they're, you know, smart lawyers, they know how to dodge a bullet. But they still not getting sued. Presumably families are still trying to sue. Well, there's, I think families are, but in terms of that lawsuit, that was settled.

34:53And it was settled probably too quickly because it compensated the players who were suffering at that time, but it didn't compensate future players. The story of Owen Thomas. Yeah. I was reading that story to you. Can you, 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. 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 U pen player. 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.

35:41He took his own life. 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 and and think about things. And I remember looking at his brain and seeing very clear evidence of CTE and just being, you know, 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. These 21, 21, it just seems insane. And I remember talking to his parents and his parents were very surprised. They were surprised by his suicide.

36:24There hadn't been many warning signs. And they were very surprised that he had this, this disease that they'd never heard of. And what was the cause of that disease in your opinion? His years of playing football. Very clearly. 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. Yeah. And I think that's an older model. So I think they're thicker and heavier now. I mean, there's so much padding inside here. Yeah. Yeah. I mean, they look like they're completely protecting the person.

37:01But the, 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. And the brain is tethered by your spinal cord. But it actually, there's some fluids surrounding it. 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 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.

37:48And 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. So it protects the bone, but not the brain. Exactly. So that's pretty useless as it relates to CTE. Right. Because your brain is still going to be accelerating and decelerating. Yes. Well, okay. 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. The brown substance is a substance you use to sort of, I guess, highlight the towel.

38:39We identify towel. It's almost a chemical reaction if you think about how you develop a photograph. And so it tags the towel and it turns it brown so we can see it. Okay. So all of the brown areas are the areas where the towel has been identified. So what I was wondering is in this stage one, there's a couple of instances. And then in stage two, there's more and then stage three is quite drastic shift. There's a drastic shift. It's like bigger clusters. And then stage four, you've really got the whole brain or at least you're half or half of the brain has been engulfed by this towel substance.

39:11Right. Is the difference between stage one and stage four here, just more hits to the brain? Or is it if left alone, can it go from stage one to stage four without further impact? It can go from one to four with aging. Okay. 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. It's years of exposure and age of the individual at death that determines severity. Okay. So if I stopped at stage two, if I stop 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.

39:56Yeah. Okay. 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 towel. So the inflammation may feed the towel because there's a linear relationship between inflammation and towel. And once you have more towel, you get more inflammation so you can see you're sort of a vicious cycle. But we're looking into other things. Why does this disease become worse with aging? 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.

40:37And in terms of the young people that you've looked at, the brains you've looked at, and young people, what stage do you see? In the young people, it's almost all stage one and two. Okay. Except in unusual cases like Aaron Hernandez was 27 when he died. He had stage three. The story of Aaron Hernandez is widely known, but for those that don't know, could you give me a summary of? 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, he was given a $40 million contract, and he played, you know, with Tom Brady and and Rob Grunkowski on the Super Bowl winning teams.

41:19And he was really considered a superstar on the team. There was evidence that he was having some psychosocial difficulties, either 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. Charging defending Aaron Hernandez with murder, what say do you matter for a person? Guilty of murder in the first degree. I mean, that is more personal by which theory or theories, deliberate implementation and or extreme atrocity or cruelty. Extreme atrocity or cruelty.

42:07He 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. And what did you see when you looked at his brain? 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. 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.

42:50They were larger than they should have been, which means that there's brain 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. 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 fenestration. In anyone under the age of 45, 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's probably is going to have CTE.

43:32And then when I looked under the microscope, it was shocking. 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. 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. 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.

44:13You just don't have that extensive frontal lobe disease without seeing changes to your behavior and your decision making. Well, it debilitate his frontal lobe. Yeah, yeah. And what does that mean? So when you when you lose your frontal lobe, you lose your inhibition. It, you know, your frontal lobe sort of dampens, sort of inner urges. So if you become very frontal lobe, you you talk without thinking you don't have a filter. And you do aggressive, maybe impulsive acts with no with no filter either. And, and you have poor judgment, you have poor executive functioning. You don't can't focus very clearly.

44:53So to me, yes, many some of his symptoms indicated frontal lobe damage. I looked at the video of Mike Webster, who was a former NFL center, one of the greatest I'm told. No, I'm talking about no, I'm just trying to find yeah, well, probably everybody went through trauma as a kid. I've not treated I was different than that. I'm just saying the things we do to one another. Okay. Uh, hell, I didn't know what I'm saying. I'm just tired and confused right now. That's why I say, I can't really, I can't see it the way I want to see it. I could I could say I could answer it's really easy at other times.

45:40But right now, I'm just tired. He's clearly struggling. Oh, he's a mess. And, and I think that really for me brought it to life. What do we do about this? About the disease? 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. Yeah. What is the progress you want to see? The progress is taking hits to the head out of these sports as much as is possible. And, and really a concerted effort to keep these young athletes safe. I think team sports, contact sports, sports in general are extremely important to the psychosocial development of our children.

46:23I don't want these sports to go away. 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. You cut out the hits to the head. You cut out this disease. It's entirely preventable. Someone might say, but, you know, Dr. How do we take hits to the head out of soccer in the NFL? It's in an ever sport in rugby. We have to be hitting the head for the sports work. We need kids to learn how to head the ball. We need them to learn how to tackle, you know, boxing.

47:00How 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? No. It's very simple. We stand at a podium and someone smashes you in the head with their hand. Huge sports, exploding hundreds of millions of views across the internet. Dana White says it's going to be even bigger than UFC. We can't take hits to the head out of these sports. Surely this is just wishful thinking. Well, that and some of these sports are just downright dangerous. And people are going to choose to participate in these dangerous sports.

47:33But for young children, children in high school, children in or adults in college, 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. 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 limit when they can do full contact. We could, you don't have to play football all through high school to be a good football player in college, you know, you could develop ball skills and athletic skills without the head contacts.

48:21And probably, we just as good a player. We've turned our, you know, 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. You know, it is something you could play entirely with the foot. 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, you know, people, people would be discriminated against who didn't have the ball. Ice hockey, you can take the fights out. You can certainly limit checking and clearly, clearly dangerous behaviors.

49:05But, and you could also monitor the players. You could actually pay attention to how many times they're getting hit. 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 neural sites. We could be monitoring these athletes if to see if they're going down the wrong path. If things look like they're turning south, we 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, then, then, none of this will be real reality, but that's on how it works. Do you think people want you to go away?

49:43I think, I think people want all this science to go away. If you're an entrepreneur, you're probably going to want to listen to this. It's a message from one of our sponsors on this podcast, which is LinkedIn. If you've listened to me on this podcast for a while now, you'll know that I've been on a bit of an evolution as a business owner and entrepreneur. And one of those evolutions that has become clear and clear as I've matured is that the single most important thing in building a business, in building a company is hiring. The definition of the word company is actually group of people. And that is the first responsibility job that any entrepreneur has and should focus on.

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50:55And over the course of my career, I've learnt just how crucial having the right systems in places, one which has helped me across many of my investments is NetSuite. They're also a sponsor of this podcast. NetSuite is the number one cloud financial system through their streamlined platform. You'll find all of your accounting financial management inventory and HR in one place. Their technology has been a real game changer, especially for my team at Flight Studio. As over the last year, we've moved out of startup mode and into scale at mode. We no longer have to juggle multiple systems and having everything together has reduced the number of manual tasks and errors.

51:30Over 41 ,000 businesses have chosen to future proof their business with NetSuite. So if you'd like to learn how it can help your business, head to netsuite .com slash Bartlett and free download the CFO's guide to AI and machine learning. That's netsuite .com slash Bartlett. My last question is about Alzheimer's. 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? Yeah, it's a great question because everybody is confused. So dementia is sort of this general term.

52:02It's dementia, which means the loss of your mental abilities, you know, de -mentating. So loss of cognitive abilities, dementia. 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. But then under Alzheimer's, there's also Parkinson's disease with Lewy body disease. There's something called frontotemporal low bar degeneration. Then there's, you get into otter and rarer diseases, progressive superluclear palsy, gomini and dementia. And somewhere down there is also CTE. So CTE is a cause of dementia.

52:48Okay. And how do I avoid getting Alzheimer's? 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. 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, 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.

53:34So 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. Physical activity, fitness, but also mental fitness, challenging your brain, keeping an active, developing a high cognitive reserve. And then the other things you can do is, you know, stay fit, eat right. 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. Alcohol? Well, alcohol can damage your brain.

54:16And 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. 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. Are these diseases increasing? No, I think our awareness of these diseases is increasing. You know how we used to call it senile dementia? Like, oh, yeah, he's just getting old. So, you know, we sort of dismissed it as just old age.

54:55But there are some people that lived 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. 40 years ago, we really had no concept how common this disease was. Is there anything that you believe about the brain that most people disagree with still to this day? I can't think so. It 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? Well, I do. I have my own theories.

55:35I 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 nerdy generation. 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. And the other thing that I think is very important is small vessel disease, vascular disease, the health of these small blood vessels that are so important to in terms of giving oxygenating our brain.

56:17If they become damaged or injured through a variety of mechanisms, then we also see these diseases being accelerated. 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. And what kinds of things cause inflammation in the brain? 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 brain blood brain barrier is a very tight barrier.

56:56You 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, 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 nerdy generation. And the things that make those blood vessels become injured. Well, trauma, trauma, that back and forth, but also things that affect vascular health, like high blood pressure, cholesterol, blood sugar, exactly.

57:39High cortisol. Yeah. Yeah. So stress, I guess. Stress, you want to reduce stress, you want to stay physically fit, you want to eat, right? It's, it's, we all know that what you need to do, it's 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. 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, into your system so you can get rid of them. So sleep is also critically important.

58:14We probably have a few million parents listening at the moment. 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, I want to do hockey, all these kinds of things. What would you say to those parents? Well, you know, every parent is different, every child's different. You have to really understand your child. Is it, is it that they need to play that particular sport? Or could they be as 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.

58:49So I would promote all of those. And then if they're playing, they choose, if they think, you know, this is a decision that they want to make despite the risks, then, you know, make sure the coach is very, very well, you know, versed in some of the adverse consequences of concussions and those hits to the head, even the non -concussive hits. 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. I think you should delay it until the person's physically robust has, with a musculature, with a strong neck, they're able to, you know, resist hits.

59:35There's, you know, a blindsided hit is much more damaging than hit that you're expecting because you set your, your neck, you're, you're expecting the hit and it doesn't cause the whiplash that, that a blindsided hit caused. 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? Because I do know, because I speak to some of them, that there are people that some of the biggest sports teams in the world that listen, that are in charge of player performance and I actually had a meeting a couple of weeks ago with someone who's one of the biggest teams in the world who's in charge of player well -being.

1:00:11And they listen frequently to the podcast and talk to me about the episode. So what would you say to those individuals that have the power to make change? 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. Find ways to limit them a 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 sub -concussive, non -concussive hits are something to be limited and show leadership by showing that you're addressing these non -concussive hits effectively.

1:01:00We have a closing tradition on the podcast with the last guest leaves a question for the next guest. Oh, 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? What happened and what made it so dark?

1:01:17Well, 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.

1:01:39The 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. So I would say to the answer to that question is believe in yourself and take it to where it needs to go. 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. 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.

1:02:23Not just save their lives but ultimately extend their health span and make their lives more joyous. Not just their life as well but also the lives of their family. 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. But it's important that you know that it matters. Thank you. I appreciate that. And how can the people listening help? 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.

1:03:00And 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. It's a legacy that will continue to go forward many years after your death. I shall be donating my brain. Don't time Mickey, thank you so much. Thank you. 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 a sponsor of my podcast. I'm also an investor in the company which is important to say.

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1:04:43Q1 is often when businesses start implementing new systems and processes in hopes of creating efficiencies for the year ahead. And over the course of my career, I've learnt just how crucial having the right systems in places, one which has helped me across many of my investments is NetSuite. They're also a sponsor of this podcast. NetSuite is the number one cloud financial system through their streamlined platform. You'll find all of your accounting financial management inventory and HR in one place. Their technology has been a real game changer, especially for my team at Flight Studio. As over the last year, we've moved out of startup mode and into scale at mode.

1:05:18We no longer have to juggle multiple systems and having everything together has reduced the number of manual tasks and errors. Over 41 ,000 businesses have chosen to future proof their business with NetSuite. So if you'd like to learn how it can help your business, head to netsuite .com slash Bartlett and free download the CFO's guide to AI and machine learning. That's netsuite .com slash Bartlett.