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

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 Colgate - https://www.colgate.com/en-gb/colgate-total Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  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.

• 0:21Speaker 01

  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.

• 0:31Speaker 00

  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. 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.

• 1:07Speaker 02

  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.

• 1:14Steven Bartlett?

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

• 1:20Speaker 00

  Yeah. I saw multiple CTE lesions in many parts of his brain.

• 1:24Steven Bartlett?

  Caused by playing tackle football for several years.

• 1:27Speaker 00

  Yes. And every time you see it in a young person, you just can't get over it.

• 1:32Steven Bartlett?

  It's a lot for you to carry.

• 1:34Speaker 00

  There are some days that are darker than others, but we're not where I'd like us to be.

• 1:37Steven Bartlett?

  What do we do about this?

• 1:39Speaker 00

  We have to.

• 1:47Steven Bartlett?

  Dr. McKee,

• 1:50Steven Bartlett?

  what is the mission that you're on with your life and your professional endeavors?

• 1:54Speaker 00

  Well, my mission in life has taken abrupt change about 17 years ago. When I first saw 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. Forty-five 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.

• 2:35Speaker 00

  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 a 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.

• 3:09Steven Bartlett?

  What is CTE?

• 3:11Speaker 00

  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 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

• 3:54Speaker 00

  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 focally 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.

• 4:36Steven Bartlett?

  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?

• 4:48Speaker 00

  Fighting and ice hockey, certainly.

• 4:50Steven Bartlett?

  Boxing.

• 4:51Speaker 00

  Boxing, MMA, yeah.

• 4:54Steven Bartlett?

  The military?

• 4:56Speaker 00

  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.

• 5:11Steven Bartlett?

  Domestic violence?

• 5:12Speaker 00

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

• 5:38Steven Bartlett?

  I didn't realize the brain was so fragile.

• 5:40Speaker 00

  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.

• 6:13Steven Bartlett?

  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?

• 6:22Speaker 00

  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.

• 6:39Steven Bartlett?

  And how many brains have you seen?

• 6:41Speaker 00

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

• 6:47Steven Bartlett?

  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?

• 6:59Speaker 00

  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's 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.

• 7:43Speaker 00

  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 nerdy generation. And then it was some five years later that I had the opportunity

• 8:28Speaker 00

  to look at an American football player's brain. So I looked at the first case, John Grimsley, 45 when he died.

• 8:37Speaker 00

  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 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,

• 9:17Speaker 00

  is because trauma was 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. 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.

• 9:49Steven Bartlett?

  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.

• 9:57Speaker 00

  Yeah.

• 9:58Steven Bartlett?

  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.

• 10:10Speaker 00

  Yeah, it's all shriveled.

• 10:12Steven Bartlett?

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

• 10:25Speaker 00

  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%.

• 10:38Steven Bartlett?

  90%?

• 10:39Speaker 00

  90, yes.

• 10:40Steven Bartlett?

  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.

• 10:51Speaker 00

  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% had CTE. That is shocking news. That is, that is saying to me, we have to address this disease. These are kids. They, they had no reason for their lives to end so early. So we, 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

• 11:32Speaker 00

  kids to live long, productive lives. And this is a disease that cuts them down, cuts down their, their, their potential early in life.

• 11:43Steven Bartlett?

  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 what, 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 the, you know.

• 12:22Speaker 00

  So we can see symptoms quite early. We, 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 lability, irritability, impulsivity, poor judgment, 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.

• 13:04Speaker 00

  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.

• 13:30Steven Bartlett?

  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?

• 13:38Speaker 00

  Yeah, I mean, there was a 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.

• 14:06Speaker 02

  Hello. So what this is, this is me explaining what's wrong with me.

• 14:12Speaker 02

  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 Wyatt suffered from brain damage.

• 14:56Speaker 02

  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. Cause my life for the past four years has been living hell inside of my head. I love you and goodbye.

• 15:21Speaker 00

  It's the same story over and over with these with these young athletes. They 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 so they're dismissed. The symptoms are dismissed and and that also contributes to their despair and and deep depression.

• 15:55Steven Bartlett?

  As you were saying that, I just pulled up an article about Wyatt. And it is 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. 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?

• 16:20Speaker 00

  I did.

• 16:21Steven Bartlett?

  And what did you see?

• 16:22Speaker 00

  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, it, it, it stops you in your tracks. It, it, it, it just makes you stop everything and, and wonder why aren't people doing more to prevent this disease? This, we now have the knowledge. We just have to take action.

• 16:53Steven Bartlett?

  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.

• 17:13Speaker 00

  It's, it just breaks your heart. He was desperate. He was desperate and he wanted, 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.

• 17:40Steven Bartlett?

  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, 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, 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.

• 18:23Speaker 00

  Yeah.

• 18:24Steven Bartlett?

  We often see alcoholism.

• 18:25Speaker 00

  Hmm. A way to cope with their mental health issues.

• 18:28Steven Bartlett?

  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.

• 18:36Speaker 00

  Yes.

• 18:37Steven Bartlett?

  And they're, you know.

• 18:37Speaker 00

  We definitely have, uh, we have a collegiate soccer player with, with CTE. The first American collegiate, uh, first American case of CTE in a woman. Uh, we have, uh, we even have a high school soccer player with early CTE. So what we don't know about soccer, because we have fewer, uh, brain donations from soccer players. We still haven't, uh, developed the dose, you know, the years of play versus CTE that we have developed for these other sports. So, uh, you know, that is one of the studies that we're hoping to do is starting the brains of soccer players. Maybe, uh, collaborate with places like Brazil or the UK where soccer is a, is the predominant sport.

• 19:19Speaker 00

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

• 19:32Steven Bartlett?

  Have you seen the UFC?

• 19:35Speaker 00

  I have not.

• 19:36Steven Bartlett?

  It's like MMA.

• 19:37Speaker 00

  Yeah.

• 19:38Steven Bartlett?

  Makes me.

• 19:38Speaker 00

  But it's brutal, right?

• 19:39Steven Bartlett?

  It's brutal. Um, there's also, 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.

• 19:51Speaker 00

  Yes, yes. That was the original, that was the original report on CTE, uh, that was actually published in 1928 in Boxers. And it, 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, uh, 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, uh, and ultimately like American football players. But, uh, there was a circus clown that was. That had a lot of hits to the head that developed CTE.

• 20:34Speaker 00

  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.

• 20:54Steven Bartlett?

  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?

• 21:05Speaker 00

  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.

• 21:48Speaker 00

  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 CTE.

• 22:05Steven Bartlett?

  So if I'm constantly heading the ball, I'm playing soccer, constantly heading the ball forward like this. My brain is moving forward.

• 22:13Speaker 00

  And backward.

• 22:14Steven Bartlett?

  And backward.

• 22:14Speaker 00

  And it's just the stretch.

• 22:17Steven Bartlett?

  And when it stretches, something is happening there. Is it like a bruising or the chemicals show up to?

• 22:22Speaker 00

  It's like a, it's 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. It's going to snap some of the fibers and injure some of the blood vessels.

• 22:41Steven Bartlett?

  So how many times have I got to head a football for that to happen?

• 22:44Speaker 00

  I don't know. You know, we aren't able, if they had accelerometers and 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.

• 23:22Steven Bartlett?

  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 Astle, who was an ex-England striker. He was a 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.

• 23:48Speaker 00

  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.

• 23:57Steven Bartlett?

  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.

• 24:20Speaker 00

  Yeah.

• 24:23Steven Bartlett?

  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.

• 24:47Speaker 00

  Absolutely, yeah.

• 24:49Steven Bartlett?

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

• 24:54Speaker 00

  No, they weren't. And and also, it's America's favorite sport, and it 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. Football defines communities. It defines colleges and universities. So the love of football is is huge. And I think, you know, even in the in the UK, you know, you fanatical fans, right? It's it's quite something, even beyond the the financial aspects. We all just have these massively strong feelings about the play of these sports.

• 25:34Speaker 00

  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 to their death was was not met with any enthusiasm. And so there was a huge effort to really discredit me. And and those were difficult years because my integrity was was so questioned. It's hard to take. It's hard to take people challenging your 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.

• 26:18Speaker 00

  And I 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 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'd publish in enough journals and have enough science data,

• 27:03Speaker 00

  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.

• 27:22Steven Bartlett?

  I also read that 15 years ago, you got a call from the NFL. They contacted you and they wanted to talk. Why did they contact you?

• 27:32Speaker 00

  So our first case was in February of 2008. That's when I got my first brain. And we announced the findings 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, November of 2009, saying that they wanted me to come to New York and present my findings.

• 28:14Steven Bartlett?

  Who was in the room?

• 28:15Speaker 00

  The chairmans of this mild TBI committee, Ira Kass and colleagues, as well as some owners of teams.

• 28:24Steven Bartlett?

  And how did it go?

• 28:26Speaker 00

  Well, it fell on deaf ears. It was pretty humiliating. They didn't believe me. They sort of, 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 it felt humiliating is the best word.

• 28:50Speaker 00

  I didn't accomplish much.

• 28:52Steven Bartlett?

  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-

• 29:00Speaker 00

  Something is wrong. They thought I was misdiagnosing it. Something wrong with something else. It wasn't, it wasn't related to the play of football.

• 29:08Steven Bartlett?

  How did you leave that day feeling?

• 29:10Speaker 00

  Very, very discouraged, feeling like, you know,

• 29:17Speaker 00

  marginalized.

• 29:22Speaker 00

  I'll be honest, as a, as a woman in medicine, you know, I was one of the earlier women in medicine, you, you've, 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, a more focused experience of that.

• 29:44Steven Bartlett?

  But it didn't stop you?

• 29:46Speaker 00

  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.

• 30:01Steven Bartlett?

  You mentioned the families a lot.

• 30:03Speaker 00

  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 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. 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, you know, obviously it brings up the death, it brings up all the emotions of the, of the loved one dying. It's a very often emotional call. And, but it's actually one of the most-

• 30:48Speaker 00

  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.

• 31:30Speaker 00

  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.

• 31:58Steven Bartlett?

  It's a lot for you to carry.

• 32:00Speaker 00

  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.

• 32:45Steven Bartlett?

  Was there a moment where the NFL started to change their minds? 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.

• 33:06Speaker 00

  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.

• 33:41Steven Bartlett?

  Why?

• 33:43Speaker 00

  They dodged, you know, smart lawyers, they know how to dodge a bullet.

• 33:47Steven Bartlett?

  But they're still not getting sued? Presumably, families are still trying to sue.

• 33:51Speaker 00

  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.

• 34:08Steven Bartlett?

  The story of Owen Thomas.

• 34:10Speaker 00

  Yeah.

• 34:10Steven Bartlett?

  I was reading that story. Can you tell me about the story of Owen Thomas? He was an American football player at the University of Pennsylvania, who also took his life at a very young age.

• 34:18Speaker 00

  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 Penn 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 is quieted down to sort of just, you know, focus and think about things.

• 35:01Speaker 00

  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 this disease that they'd never heard of.

• 35:34Steven Bartlett?

  And what was the cause of that disease in your opinion?

• 35:37Speaker 00

  His years of playing football, very clearly.

• 35:40Steven Bartlett?

  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.

• 35:53Speaker 00

  Yeah, and I think that's an older model. So I think they're thicker and heavier now.

• 35:57Steven Bartlett?

  I mean, there's so much padding inside here.

• 36:00Speaker 00

  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 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.

• 36:41Speaker 00

  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.

• 37:03Steven Bartlett?

  Ah, so it protects the bone, but not the brain?

• 37:05Speaker 00

  Exactly.

• 37:07Steven Bartlett?

  Oh, so it's pretty useless as it relates to CTE?

• 37:12Speaker 00

  Right.

• 37:13Steven Bartlett?

  Because your brain is still going to be accelerating and decelerating?

• 37:16Speaker 00

  Yes.

• 37:18Steven Bartlett?

  Wow. Okay.

• 37:23Steven Bartlett?

  So I've got some

• 37:25Speaker 00

  Yeah.

• 37:25Steven Bartlett?

  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.

• 37:42Speaker 00

  We identify tau. It's a, it's almost a chemical reaction. If you think about how you develop a photograph.

• 37:48Steven Bartlett?

  Yeah.

• 37:48Speaker 00

  And so it tags the town and it, and it turns it brown. So we can see it.

• 37:53Steven Bartlett?

  Okay, so all of the brown areas are the

• 37:55Speaker 00

  Right.

• 37:55Steven Bartlett?

  areas where the tau's 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.

• 38:05Speaker 00

  It's a drastic shift.

• 38:06Steven Bartlett?

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

• 38:14Speaker 00

  Right.

• 38:14Steven Bartlett?

  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?

• 38:25Speaker 00

  It can go from one to four with aging.

• 38:28Steven Bartlett?

  Okay.

• 38:29Speaker 00

  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.

• 38:46Steven Bartlett?

  Okay, so if I, if I stopped at stage two, if I stopped playing sports at stage two, I stopped, you know, 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.

• 38:59Speaker 00

  Yeah.

• 39:00Steven Bartlett?

  Okay.

• 39:01Speaker 00

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

• 39:41Steven Bartlett?

  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?

• 39:48Speaker 00

  In the young people, it's almost all stage one and two.

• 39:51Steven Bartlett?

  Okay.

• 39:51Speaker 00

  Except in unusual cases, like Aaron Hernandez was 27 when he died. He had stage three.

• 39:59Steven Bartlett?

  The story of Aaron Hernandez is widely known, but for those that don't know it, could you give me a summary of?

• 40:03Speaker 00

  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 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. 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,

• 40:46Speaker 00

  also involving the murder of three people.

• 40:49Speaker 04

  Charging and defending Aaron Hernandez with murder. What say you, Madam foreperson?

• 40:54Speaker 05

  Guilty of murder in the first degree.

• 40:58Speaker 04

  Madam foreperson, by which theory or theories, deliberate premeditation and/or extreme atrocity or cruelty?

• 41:07Speaker 05

  Extreme atrocity or cruelty.

• 41:11Speaker 00

  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.

• 41:24Steven Bartlett?

  And what did you see when you looked at his brain?

• 41:26Speaker 00

  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 it looks good. There was no obvious damage. But then when we started doing the dissection, we 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 been 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.

• 42:08Speaker 00

  Those are called fenestrations, and that's a sign of brain trauma because the fluid is banging against that curtain and and ripping it and causing holes. And I'd never seen fenestrations in anyone under the age of 45. And that actually was a was a person with CTE that was a rugby player. So that was was shocking to me. And then I I thought when I saw that, oh, he's probably is going to have CTE. And then when I looked under the microscope, it was it was just shocking. It's like, you know, you think you've been amazed or floored by these brains that have come, and and then there's another one, and you're just, you know, you're just, you know,

• 42:52Speaker 00

  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 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.

• 43:24Steven Bartlett?

  Will it debilitate his frontal lobe?

• 43:26Speaker 00

  Yeah, yeah.

• 43:27Steven Bartlett?

  And what does that mean?

• 43:28Speaker 00

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

• 44:02Steven Bartlett?

  I looked at the video of Mike Webster. Who was a former NFL center, one of the greatest, I'm told.

• 44:11Speaker 05

  No, I'm talking about.

• 44:15Speaker 05

  No, I'm trying to find, yeah, well, Trump, everybody went through trauma as a kid. I'm not kidding, I was different than that. I'm just saying.

• 44:26Speaker 05

  The things we do to one another.

• 44:29Speaker 05

  Okay.

• 44:35Speaker 05

  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, I could say, I could answer, it's really easy at other times, but right now I'm just tired.

• 44:47Steven Bartlett?

  He's clearly struggling.

• 44:48Speaker 00

  Oh, he's a mess.

• 44:50Steven Bartlett?

  And, and I think that really for me brought it to life. What do we do about this?

• 44:54Speaker 00

  About the disease?

• 44:55Steven Bartlett?

  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.

• 45:01Speaker 00

  Yeah.

• 45:02Steven Bartlett?

  What is the progress you want to see?

• 45:03Speaker 00

  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. 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.

• 45:44Speaker 00

  You cut out the hits to the head, you cut out this disease, it's entirely preventable.

• 45:49Steven Bartlett?

  Someone might say, but, you know, doctor, how do we take hits to the head out of soccer? In 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?

• 46:12Speaker 00

  No.

• 46:13Steven Bartlett?

  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.

• 46:28Speaker 00

  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 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

• 47:07Speaker 00

  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 and probably you'd be just as good a player. We've we've turned our, you know, we we just have ignored the 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

• 47:49Speaker 00

  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.

• 48:08Speaker 00

  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 neuropsych. 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. 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. But that's not how it works.

• 48:45Steven Bartlett?

  Do you think people want you to go away?

• 48:46Speaker 00

  I think people want all this science to go away.

• 48:53Steven Bartlett?

  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 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% of my team have been hired from LinkedIn. And I think there's very few platforms, if any, in the world that can give you that diversity of candidate with that much information and data on their profiles. It usually costs

• 49:38Steven Bartlett?

  money. But for the entrepreneurs that are listening to me, I've got you a free job ad post for your company on LinkedIn. Just go to LinkedIn.com/DOAC to post your free job ad today. That's LinkedIn.com/DOAC. Terms and conditions apply. My last question's about Alzheimer's. You mentioned that you've looked at lots of brains of people that have Alzheimer's. A bit of a dumb question, but what is the difference between Alzheimer's and dementia? Or is it the same thing?

• 50:02Speaker 00

  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, dementating. 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 into other and rarer diseases, progressive suprachiasmatic palsy,

• 50:47Speaker 00

  Gommenian dementia, and somewhere down there is also CTE. So CTE is a cause of dementia.

• 50:54Steven Bartlett?

  Ah, okay. And how do I avoid getting Alzheimer's?

• 51:00Speaker 00

  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,

• 51:45Speaker 00

  the areas that aren't working well, and not experience the symptoms. So that's one thing. You know, 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, 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.

• 52:20Steven Bartlett?

  Alcohol?

• 52:21Speaker 00

  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, 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.

• 52:49Steven Bartlett?

  Are these diseases increasing?

• 52:51Speaker 00

  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. 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.

• 53:19Steven Bartlett?

  Is there anything that you believe about the brain that most people disagree with, still to this day?

• 53:24Speaker 00

  I don't, I can't think so.

• 53:26Steven Bartlett?

  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?

• 53:37Speaker 00

  Well, I do, I, you know, 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 what a lot of people would agree with me, though 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

• 54:20Speaker 00

  to, in terms of giving oxygenating our brain, if 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.

• 54:44Steven Bartlett?

  And what kinds of things cause inflammation in the brain?

• 54:47Speaker 00

  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. 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, you know, trying to keep out of our brain leak into the brain and promote inflammation, those changes can facilitate neurodegeneration.

• 55:30Steven Bartlett?

  And the things that make those blood vessels become injured?

• 55:33Speaker 00

  Well, trauma.

• 55:34Steven Bartlett?

  Trauma.

• 55:35Speaker 00

  That back and forth. But also, things that affect vascular health, like high blood pressure.

• 55:42Steven Bartlett?

  Sugar.

• 55:43Speaker 00

  High cholesterol, blood sugar, exactly.

• 55:45Steven Bartlett?

  High cortisol.

• 55:46Speaker 00

  Yeah, yeah.

• 55:47Steven Bartlett?

  So, stress, I guess.

• 55:48Speaker 00

  Stress, you want to reduce stress, you want to stay physically fit, you want to eat right. 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.

• 56:20Steven Bartlett?

  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, I want to do hockey," all these kinds of things. What would you say to those parents?

• 56:35Speaker 00

  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 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. 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 versed in, in some of the adverse consequences of concussions and, and those hits to the head, even the non-concussive hits. Make sure that there's

• 57:18Speaker 00

  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, hits. There's, you know, a blindsided hit is much more damaging than a hit that you're expecting because you set your, your neck, you, you're expecting the hit and it doesn't cause the whiplash that, that a blindsided hit costs.

• 57:55Steven Bartlett?

  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 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?

• 58:23Speaker 00

  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 sub-concussive, non-concussive hits are something to be limited. And show leadership by, by showing that you're addressing these non-concussive hits effectively.

• 59:06Steven Bartlett?

  We have a closing tradition on the podcast where the last guest leaves a question for the next guest.

• 59:11Speaker 00

  Oh.

• 59:11Steven Bartlett?

  Not knowing who they're leaving it for.

• 59:13Speaker 00

  Oh, my goodness.

• 59:14Steven Bartlett?

  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?

• 59:24Speaker 00

  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.

• 1:00:04Speaker 00

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

• 1:00:11Steven Bartlett?

  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.

• 1:00:49Speaker 00

  Thank you. I appreciate that.

• 1:00:52Steven Bartlett?

  And how can the people listening help?

• 1:00:54Speaker 00

  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.

• 1:01:27Steven Bartlett?

  I shall be donating my brain. Dr. Anne Meeke, thank you so much.

• 1:01:31Speaker 00

  Thank you.

• 1:01:34Steven Bartlett?

  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. I invested in the company because Zoe combines my health data with their world-class science. Using these two things, Zoe guides me to better health every single time I make a food choice and eat, which means I have more energy, better sleep, better mood, and I'm less hungry. And the best part about Zoe is that it's backed by their recent clinical trial, something called the Method Study, which is the gold standard of scientific research. I started Zoe just over a year ago now, and I've been able to track my progress week after week, so I can learn how to be even smarter the week after.

• 1:02:18Steven Bartlett?

  And if you haven't joined Zoe yet, I'm going to give you 10% off when you join Zoe now. Just use the code BARTLETTEN at checkout.