The Diary Of A CEO with Steven Bartlett - Brain Doctor: These Popular Sports Are Causing Brain Damage & The NFL Is Keeping This Devastating Disease Quiet!

Episode Date: October 24, 2024

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

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. 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. 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. These injuries are acceleration, deceleration

very rapidly and twisting of the brain and that frees 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 and we have lots of evidence that this is happening in contact sports, but also in military veterans, domestic violence, et cetera. And it causes depression, personality changes, aggressive and violent behaviors, or maybe the person takes their own life.

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. 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. He shot himself in the heart instead of the head because it was his dying wish to donate his brain.

Yeah. I saw multiple CTE lesions in many parts of his brain. Caused by playing tackle football for several years. Yes, and every time you see it in a young person, you just can't get over it. It's a lot for you to carry. There's some days that are darker than others, but we're not where I'd like us to be. What do we do about this? We have to... Dr. McKee, what is the mission that you're on with your life and your professional endeavors? 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 realized that the play of football was associated with a chronic and progressive neurodegenerative disease. 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. 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.

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, 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 that, those changes in the brains of American football players, I immediately just wanted to eradicate this disease. What is CTE?

So CTE stands for chronic traumatic encephalopathy. And it's a neurodegenerative disease of the brain, which means it over time, decades, usually, it gradually gradually robs you of your ability to think clearly or remember things and ultimately you end up with dementia. 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. Some of these hits result in concussion, but actually it's more importantly the subconcussive 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. 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. 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 folcally in very restricted areas starts spreading through the brain. It invades the areas that are important for memory and learning. It takes over the brain stem.

It causes motor problems, memory problems, cognitive problems. And it really destroys a person's life. 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? Fighting and ice hockey certainly. Boxing, certainly. Boxing, MMA.

You have seen? Yeah. The military? The military is also at risk after blast injury or combat related injuries. Also a very high percentage of military veterans played contact sports, this is same demographics, so they have a combined risk. Domestic violence?

Domestic violence is definitely one of the triggers for CTE. It may not be as risky, may not pose as greater risk as something with very sustained head impacts like football. But certainly if the domestic violence is long-standing and repetitive over years, yes, women have been reported with CTE. I didn't realize the brain was so fragile. It is. These injuries are acceleration, deceleration very rapidly and twisting of the brain with sefrencho. 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. 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.

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? 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. And how many brains have you seen? Oh, I was thinking about that earlier. I think it's very close to 10,000 at this point. 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? 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, 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, 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. 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. This guy had no beta amyloid plaques. You have to have them to make the diagnosis.

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. 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 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.

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. It just doesn't believe that a 45-year-old man could have this amount of tau in his brain, could have this amount of degeneration. It just doesn't happen that early. Neurodegenerative diseases are primarily diseases of aging.

So 70s, 80s, unless you maybe have a genetic component, it comes on in your 50s. But 45 is extraordinarily early. And I couldn't let go of it. 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 causing it, there was the possibility we could map it from the earliest trauma to its, you know, last manifestations. Then there's the emotional component of talking to the families and just wanting to be their

advocate. 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. 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. Yeah. 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. Yeah, it's all shriveled. 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? 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%. 90%? Yes. 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. Yeah, that was our study last August. And in that study, we started 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. 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. 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. 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? Because, you know, these children that are playing sports whether it's soccer or rugby or American football right now, 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? You've seen, you spoke to the families, you've seen the loss of their lives. So we can see symptoms quite early. We have found, you know, in that study of the 152 young athletes, they were all symptomatic. And those symptoms generally are depression, very common, emotional ability, irritability, impulsivity, poor judgement, making poor choices. There can be aggressive and violent behaviors,

physical and even verbal violence, 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. 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. 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. 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? 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. 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. 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.

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. 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. I feel like it'll be closure for me and it'll be closure for you guys to know that maybe why it suffered from

brain damage. Maybe that was the reason. So do that for yourself. I would like that to be done. 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. 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 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. 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, 18 years old, he took his own life. About a year later, researchers at your university diagnosed him with stage two CTE caused by playing tackle football for several years. So did you look at his brain?

I did. And what did you see? brain. I did. And what did you see? I saw multiple CTE lesions in many parts of his brain. You'd think I'd get, you know, used to it, but every time you see it in a young person, you just can't get over it. You just, it stops you in your tracks. 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. 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.

Christie 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. 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.

We have lots of evidence that this is happening in amateur sports, especially American football, but other sports as well. And yet, and this is a disease that is entirely preventable. 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, 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? 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.

We often see alcoholism. A way to cope with their mental health issues. Yeah. And other forms of compulsive behavior. And I wondered if there was a link at all. And if it can show up as soon as their 40s. Yes. We definitely have.

We have a collegiate soccer player with CTE, the first American collegiate, first American case of CTE in a woman. We even have a high school soccer player with early CTE. So what we don't know about soccer, because we have fewer brain donations from soccer players, we still haven't developed the years of play versus CTE that we have developed for these other sports. 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. 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. Have you seen the UFC? I have not. It's like MMA. Yeah, but it's brutal, right? It's brutal.

There's also boxing. When you were talking about CTE, 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. Yes, yes. 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 to individuals who had other causes of hits to the head, and ultimately

like American football players. But there was a circus clown that had a lot of hits to the head that developed CTE. So people started realizing that it's not exclusive to boxers. 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. And explain simply for someone like me who doesn't know anything about the brain, how

does CTE develop? Like what's going on? Is there a way to simply explain it to me? 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. So you could actually, they 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. 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 property and then the brain around it has another and so there's another

shearing force around the blood vessels. 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 one and stage two CGE. and around blood vessels. And that's exactly what you see in stage one and stage two CGE. So if I'm constantly heading the ball, I'm playing soccer, constantly heading the ball forward like this, my brain is moving forward and backward. And it's just the stretch.

And when it stretches, something is happening there. Is it like a bruising or the chemicals show up to...? 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. There's going to be damage that's caused by this sudden elongation that's going to snap some of the fibers and injure some of the blood vessels. So how many times have I got to head a football for that to happen? 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. 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. There's a somewhat lower risk. I can't remember exactly right now the number of years of 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. And this really is 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. He was a scorer for 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. I have met his family, yeah. And we also have in our bank at least five professional soccer players, all of whom have had CTE. 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. 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 realized why. The resistance you faced.

Yeah. Talk to me about the journey that you've been on to try and change people's minds. 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. Absolutely.

Yeah. So I can imagine people weren't happy with the message that you had to share in the research that you're doing. 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. People equate football with patriotism and loving the U.S. It has a lot of connotation.

Football defines communities. It defines colleges and universities. So the love of football is huge. I think even in the UK, fanatical fans, right? It's quite something. 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, 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. And those were difficult years because my integrity was so questioned. It's hard to take. It's hard to take people challenging your truthfulness. And people said I was a fraud and I was faking the data. And really, it goes on and on. The only thing that kept me going was knowing that I was speaking for the families.

And I was speaking for them. 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 a benign condition. All of those things were thrown at me

many, many times. In fact, I still hear them today sometimes. And over the years I kept thinking, well, if we have enough data in enough players and we publish in enough journals and have enough science data, 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. So it's easier now.

But there's still considerable controversy. 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? 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. 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 of 2009 saying that they wanted me to come to New York and present my findings. Who was in the room? The chairmen of this mild TBI committee, Ira Kasson 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 dismissiveness. And, you know, it felt, humiliating is the best word. I didn't accomplish much. 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 wrong. They thought I was misdiagnosing it. Something wrong with something else. It wasn't related to the play of football. How did you leave that day feeling? Very, very discouraged. Feeling like, you know, marginalized. 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. 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 can see the evidence. I could see the evidence. This is true.

I just have to convince them this is true. You mentioned the families a lot. 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. I don't know how many headaches 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, then I talk to the family.

And I get to experience the 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. It'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 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. 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. 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. 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. 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. 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. Yes, 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 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. Why? They dodge, they're dot, you know, smart lawyers, they know how to dodge a bullet. But they still not getting suits, presumably families are still trying to sue. Well, there's, 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. The story of Owen Thomas. Yeah. 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.

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. 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.

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 has quieted down to sort of just, you know, focus 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. He's 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. There hadn't been many warning signs and they were very surprised that he had 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 an 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. 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,

and the brain is tethered by your spinal cord, but it actually, there's some fluid 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. 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.

Ah, so it protects the bone, but not the brain. Exactly. So it'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 tau. 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. 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's more and then stage three is quite drastic shift.

It's a drastic shift. It's like bigger clusters and then stage four you've really got the whole brain or at least half or half of the brain has been engulfed by this tau substance. Right. 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 determine severity. Okay. So if I stopped at stage two, I stopped playing sports at stage two, I 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. Yeah.

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 tau. So the inflammation may feed the tau because there's 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? 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? Because if we could identify what makes it spread, what makes it get worse with time, we could prevent a lot of the ultimate devastation. 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? 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 it, could you give me a summary of? So he was a very high level, high functioning football player for the New England Patriots, from the New England area, which I'm from. He was given a $40 million contract, and he played with Tom Brady and Rab 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. 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. Charging defending 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. 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. 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 sliced through the brain coronally, and I could see that his ventricles, the chambers at the inside of the brain, they were dilated. 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. 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. 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 just 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 Tao.

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. You just don't have that extensive frontal lobe disease without seeing changes to your behavior and your decision making. Will it debilitate his frontal lobe? Yeah, yeah. And what does that mean?

So when you lose your frontal lobe, you lose your inhibition. You know, your frontal lobe sort of dampens sort of inner urges. So if you become very frontal lobe, you talk without thinking, you don't have a filter. 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. 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, everybody went through trauma as a kid. I'm not saying I things we do to one another, okay? Hell, I don'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 say it the way I want to say it.

I could say I could answer this really easy at other times, but right now I'm just tired. He's clearly struggling. Oh, he's a mess. 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. 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

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. I 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, doctor, how do we take hits to the head out of soccer and the NFL, it's an inevitable sport. In rugby, we have to be hitting the head for the sport to work. We need kids to learn how to head the ball. 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? No. 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. 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. But for young children, children in high school, 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, putting an age 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. 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. 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 have the ball. 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. 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 neu there's other neural psychs. We could be monitoring these athletes 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 real reality, but that's not how it works. Do you think people want you to go away and then then none of this will be real reality, but that's not how it works You think people want you to go away? I think I think people want all this science to go away If you're an entrepreneur you're probably gonna want to listen to this It's a message from one of our sponsors on this podcast Which is linked in 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 clearer and clearer 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 and job that any entrepreneur has and should focus on. But surprisingly, most don't. About 80 percent of my team have been hired from LinkedIn. And I think there's very few platforms, if any in the world, that could give you that diversity of candidate with that

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between Alzheimer's and dementia? Or is it the same thing? Yeah, it's a great question because everybody's 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. 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 lobar degeneration. Then there's, you know, you get to otter and rarer diseases, progressive supranuclear palsy, Guamian dementia, and somewhere down there is also CTE. So CTE is a cause of dementia. Ah, okay. 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. 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. 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. 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, 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. And we don't have any direct connection between alcohol and Alzheimer's, but 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 we sort of dismissed it as just old age. 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. Forty 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. 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. 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 a lot of people would agree with me,

inflammation is one of the key promoters of brain disease and neurodegeneration. 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 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. So 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 causes tremendous inflammation. The blood brain barrier is a very tight barrier. 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, they leak, and all those things that we are trying to keep out of our brain leak leak into the brain, and promote inflammation. Those changes can facilitate neurodegeneration. And the things that make all those blood vessels become injured? Well, trauma. Trauma, yeah.

That back and forth, but also things that affect vascular health, like high blood pressure, high cholesterol, blood sugar, exactly. High cortisol. Yeah, yeah. So stress, I guess. Stress, you want to reduce stress, you want to stay physically fit, you want to eat right. 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. 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. We probably have a few million parents listening at the moment in this conversation. And those parents, 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, every parent is different, every child is different.

You have to really understand your child. Is it that they need to play that particular sport? Or could they be just as easily happy? 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. 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.

Make sure that there's good education, good education of the player as well as the teammates, 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 with a musculature with a strong neck they're able to you know resist hits hits 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.

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 at some of the biggest sports teams in the world that listen, that are 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 at 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 at one of the biggest teams in the world who's in charge of player wellbeing.

And 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 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. And show leadership by showing that you're addressing these non-concussive hits effectively. 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? What happened and what made it so dark? 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. And 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. 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. Not 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. 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. It's a legacy that will continue to go forward many years after your death. I shall be donating my brain. Dr Anne-Mikki, 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.

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