The Brain Doctor: These Popular Sports Are Causing Brain Damage! Dr Ann Mckee

Intro (0s)

• A study of 152 young athletes found that most of them had brain damage from small, repetitive hits to the head, which can destroy a person's life (7s).
• Medical professionals often do not take this issue seriously, and the NFL initially discredited Dr. Ann McKee's findings on the topic (16s).
• Dr. Ann McKee is a leading brain scientist who runs the world's largest brain bank and has conducted groundbreaking research on the life-threatening consequences of playing sports (21s).
• The injuries caused by contact sports are a result of rapid acceleration, deceleration, and twisting of the brain, which can damage nerve cells and lead to disease progression over time (32s).
• A protein called tau stains brown and spreads through the brain, causing depression, personality changes, aggressive and violent behaviors, and even suicidal tendencies (40s).
• There is evidence that this condition affects not only contact sports athletes but also military veterans and victims of domestic violence (47s).
• The case of Aaron Hernandez and Wyatt Ramwell, an 18-year-old American football player who took his own life, highlights the devastating consequences of brain damage caused by playing tackle football (58s).
• Dr. Ann McKee found multiple CTE lesions in many parts of Wyatt Ramwell's brain, which were caused by playing tackle football for several years (1m20s).
• The issue of brain damage in young athletes is a significant concern, and more needs to be done to address it (1m36s).

Ann McKee's Mission on CTE (2m15s)

• Ann McKee's life mission took an abrupt change 17 years ago when she first saw Chronic Traumatic Encephalopathy (CTE) in the brain of a football player, realizing that playing football is associated with a chronic and progressive neurodegenerative disease (2m27s).
• Her first two cases were 45-year-old men, which is extremely young for a neurodegenerative disease, and she was stunned to see CTE in their brains (2m43s).
• Her third case was an 18-year-old high school player, where she saw the beginnings of CTE in the brain, which further solidified her mission (2m53s).
• McKee has spoken to families affected by CTE and has heard about the tragedy and heartache they experience as they see personality and mood changes in their loved ones, often resulting in accidental death or the person taking their own life (3m8s).
• After seeing the changes in the brains of American football players, McKee's immediate goal became eradicating the disease of CTE (3m34s).

What Is CTE? (3m38s)

• CTE stands for chronic traumatic encephalopathy, which is a neurodegenerative disease of the brain that develops over decades and can lead to dementia by impairing cognitive functions and memory. (3m38s)
• The disease is caused by environmental factors, specifically small repetitive hits to the head, which are common in contact sports. These hits may not always result in concussions but include subconcussive impacts that occur frequently in sports like football, ice hockey, rugby, and soccer. (4m2s)
• CTE begins with isolated areas of abnormality in the brain, typically in the cortex and frontal lobes, and progresses over time, even if the individual stops playing the sport. (4m28s)
• As CTE advances, it spreads through the brain, affecting areas responsible for memory, learning, and motor functions, ultimately leading to severe cognitive and motor problems that can significantly impact a person's life. (4m49s)

Sports Most Likely to Cause CTE (5m6s)

• American football, soccer (due to heading the ball), ice hockey, boxing, UFC, and MMA are sports associated with a risk of developing Chronic Traumatic Encephalopathy (CTE). (5m10s)
• Military personnel are also at risk of CTE, particularly after blast injuries or combat-related injuries, and a high percentage of military veterans have played contact sports, increasing their combined risk. (5m21s)
• Domestic violence is identified as a trigger for CTE, especially if the violence is longstanding and repetitive over years, although it may not pose as great a risk as sports with sustained head impacts. (5m39s)
• Women have been reported to develop CTE, indicating that the condition is not limited to male athletes or military personnel. (6m1s)

How Fragile Is the Human Brain? (6m7s)

• The human brain is extremely fragile and susceptible to injuries caused by rapid acceleration and deceleration, as well as twisting motions. (6m7s)
• These movements cause the brain to stretch in a linear direction and twist in a rotational direction, leading to the distortion and twisting of nerve cells. (6m12s)
• Such injuries also affect the blood vessels in the brain, particularly the small blood vessels, resulting in vascular injury and damage to nerve cells. (6m28s)

What Ann McKee Does in Her Research (6m42s)

• Ann McKee's research work involves a neuropathology lab specializing in brain banks, where she spends most of her time photographing and examining brains under a microscope (6m52s).
• The lab contains several brain banks, which are collections of brain tissue used for research purposes (6m55s).
• Ann McKee has examined nearly 10,000 brains throughout her 17 years of research (7m13s).

The First Time Ann Saw a Brain with CTE (7m16s)

• In 2003, a brain from a famous Boston boxer named Paul Pender was examined. Initially diagnosed with Alzheimer's disease, his brain showed no beta-amyloid plaques typical of Alzheimer's. Instead, it had an abnormal presence of the protein tau, particularly around small blood vessels and in brain regions not typically affected by Alzheimer's. This discovery sparked scientific interest in how boxing could lead to such neurodegeneration. (7m16s)
• Five years later, the brain of a 45-year-old American football player, John Grimley, was examined. It showed an unexpected amount of tau and degeneration for someone so young, as neurodegenerative diseases usually occur in older age. This finding highlighted the potential link between trauma and early-onset brain damage. (8m51s)
• The possibility of mapping brain damage from early trauma to its later stages was considered, contrasting with Alzheimer's disease. There was also an emotional aspect in advocating for families affected by such tragedies, as they experienced significant changes in their loved ones. (9m40s)
• Advanced CTE brain scans were described as horrific, with the brain appearing shriveled compared to a normal brain. This visual evidence underscores the severe impact of CTE on brain health. (10m16s)

How Many Athletes Have CTE? (10m40s)

• Over 95% of NFL players studied show early signs of neurodegenerative diseases, such as CTE. (10m54s)
• A study found that 90% of college football players also exhibit signs of these diseases. (11m3s)
• A 2023 study from Boston University revealed that more than 40% of brains from contact sport players who died before age 30 had CTE. This study examined 152 athletes and found that about 41% had early signs of CTE. (11m15s)
• The study highlights the need to address CTE, especially in young athletes, to prevent early deaths and ensure long, productive lives. (11m41s)
• Another study from the same university found that 92% of 376 former NFL players had CTE in their brains. (12m18s)

How CTE Affects Daily Life (12m27s)

• Children playing contact sports such as soccer, rugby, or American football may not initially show symptoms of brain damage, but symptoms can develop if they later develop Chronic Traumatic Encephalopathy (CTE). (12m29s)
• A study of 152 young athletes found that all were symptomatic, displaying signs such as depression, emotional lability, irritability, impulsivity, poor judgment, and making poor choices. (12m51s)
• Additional symptoms observed include aggressive and violent behaviors, both physical and verbal, as well as a short temper where minor infractions lead to exaggerated hostile responses. (13m8s)
• Young athletes can also experience memory loss and cognitive changes. (13m25s)
• Symptoms of CTE generally develop later, potentially four years to a decade after exposure, and manifest as behavioral and mood changes, personality changes, memory loss, difficulty thinking, cognitive decline, and ultimately dementia in severe cases. (13m31s)

Young Athletes Impacted by CTE (13m59s)

• A 2023 paper focused on young athletes highlighted the early and intense symptoms of brain damage. (14m0s)
• The paper included a deep dive into several players and their families, providing detailed insights into their experiences. (14m6s)
• A compelling video on the New York Times website features an 18-year-old named Wyatt Bramwell, who recorded a self-tape before taking his own life, illustrating the severe impact of brain damage. (14m21s)

Wyatt Bramwell’s Story: A Tragic Case of CTE (14m34s)

• Wyatt Bramwell, an 18-year-old high school graduate, took his own life in July 2019, and his brain was later diagnosed with stage two CTE caused by playing tackle football for several years (16m31s).
• Before his death, Wyatt left a message explaining that he had been depressed and experiencing brain damage due to the numerous hits and concussions he suffered while playing football, and he requested that his brain be donated to be studied after his death (14m36s).
• Researchers found multiple CTE lesions in many parts of Wyatt's brain, which is a heartbreaking and preventable disease (16m48s).
• Wyatt's mother, Christy Bramwell, suspects that her son knew what he was doing when he took his own life, as he shot himself in the heart instead of the head, and it was his dying wish to donate his brain to CTE research (17m26s).
• The only way to diagnose CTE is through an autopsy of the brain, and Wyatt's case highlights the disconnect between the evidence of CTE in amateur sports and the lack of understanding and prevention of the disease (17m37s).
• Wyatt's story is a tragic example of the devastating consequences of CTE, and it emphasizes the need for action to prevent this entirely preventable disease (17m19s).

When Do Signs of CTE First Appear? (18m9s)

• Chronic Traumatic Encephalopathy (CTE) can begin to show signs in individuals as early as their 40s, particularly in those who have played contact sports like soccer or American football from a young age. (19m2s)
• Mental health issues, alcoholism, and compulsive behaviors are often observed in retired athletes, which may be linked to CTE. (18m48s)
• There have been cases of CTE in collegiate and even high school soccer players, but research is limited due to fewer brain donations from soccer players compared to other sports. (19m18s)
• Studies are being planned to analyze the brains of soccer players, potentially in collaboration with countries where soccer is a predominant sport, to develop a dose-response curve relating years of play to CTE risk. (19m36s)
• The term "punch drunk" was originally used to describe CTE symptoms in boxers, first reported in 1928, and later renamed dementia pugilistica. (20m20s)
• Over time, it was recognized that CTE could occur in individuals with repetitive head trauma from various causes, not just boxing, including American football players and victims of domestic violence. (21m1s)

How Does CTE Develop in the Brain? (21m22s)

• CTE develops in the brain due to the physics of injury, specifically the acceleration and deceleration that causes the brain to stretch, leading to damage in areas that experience the most stress and strain, particularly the frontal lobes and crevices of the brain (21m33s).
• The earliest stages of CTE damage occur at the crevices of the brain, where there is the most shearing, and around blood vessels, due to the viscoelastic properties of blood vessels and the surrounding brain tissue (21m58s).
• The physics of traumatic acceleration and deceleration determine where the brain is injured first, with the crevices and areas around blood vessels being the most affected (22m19s).
• Repeatedly heading a soccer ball can cause the brain to move forward and backward, leading to a shearing force that can cause tissue damage, including bruising and chemical changes (22m39s).
• The repeated stretching of brain tissue can cause damage by breaking fibers and injuring blood vessels, although the exact number of times this needs to happen to cause CTE is unknown (22m49s).
• Research has shown that years of playing certain sports, such as American football, ice hockey, and rugby, are associated with an increased risk of developing CTE, with a dose-response relationship observed in these sports (23m25s).
• Specifically, every 2.6 years of playing American football doubles the risk of developing CTE, while the risk is somewhat lower for ice hockey and rugby, although the exact number of years required to double the risk is not specified (23m31s).

Jeff Astle: CTE in Soccer (23m49s)

• Jeff Astle, a former England striker, died from Chronic Traumatic Encephalopathy (CTE) in 2002 at the age of 59, highlighting the impact of CTE on soccer players (23m56s).
• Astle was a notable soccer player, having scored the winning goal in the 1968 FA Cup Final (24m2s).
• At least five professional soccer players with CTE are included in the brain bank, indicating that CTE is not exclusive to American football (24m17s).
• The doctor who examined Jeff Astle's brain was surprised by its condition, stating that it resembled the brain of a 90-year-old, rather than a 59-year-old (24m26s).
• Ten years before his death, Astle experienced symptoms such as memory loss, forgetfulness, depression, and anxiety, which were later attributed to CTE (24m34s).
• Astle's case has helped raise awareness about the risks of CTE in soccer players, despite initial resistance to acknowledging the issue (24m43s).

Challenges in Raising Awareness About CTE (24m46s)

• Changing people's minds about the dangers of popular sports like American football, ice hockey, boxing, and the UFC has been a challenging journey due to the threat it poses to the industries and their profit margins (24m50s).
• American football is deeply ingrained in American culture, often equated with patriotism, and defines communities and colleges, making it difficult for people to accept the risks associated with the sport (25m23s).
• The strong emotional attachment to these sports, beyond financial aspects, makes it hard for people to accept that playing them can cause brain damage and lead to death (25m56s).
• The message about the dangers of these sports was initially met with resistance, and efforts were made to discredit the research and the researcher's integrity (26m16s).
• The researcher faced personal attacks, with people questioning their truthfulness and accusing them of faking data, but the knowledge of speaking for the families affected and the obvious reality of the condition kept them going (26m21s).
• The condition, now recognized as Chronic Traumatic Encephalopathy (CTE), was initially compared to Alzheimer's disease, aging, and benign conditions, but the accumulation of data and scientific evidence has helped to establish it as a distinct disease (27m2s).
• Over time, the research has gained recognition, and CTE is now taken more seriously, with the scientific community acknowledging it as a disease (27m38s).

The NFL's Contact With Ann McKee (27m43s)

• The National Institutes of Health has made it easier to study brain damage, but considerable controversy still exists (27m43s).
• Around 15 years ago, the NFL contacted Ann McKee, wanting to discuss her work (27m51s).
• Ann McKee's first case of brain damage was in February 2008, and the findings were announced later that year (28m3s).
• Between 2008 and 2009, Ann McKee accumulated more cases of brain damage, with a total of an unspecified number of cases by the end of that period (28m17s).

The NFL’s Early Reactions to CTE (28m18s)

• A paper on CTE was published in September 2009, and in November of the same year, the NFL contacted the author to present the findings in New York (28m33s).
• The presentation was attended by the chairman of the mild TBI committee, Ira Hassen, colleagues, and some team owners, but it was met with massive denial and dismissiveness (28m42s).
• The NFL representatives did not believe the findings and questioned if another doctor could address them, showing a lack of acceptance of the research (29m2s).
• The NFL thought the author was misdiagnosing the condition, believing it was not related to playing football, despite clear evidence of brain damage (29m28s).
• The author left the meeting feeling very discouraged, marginalized, and humiliated, which was not a new experience as a woman in medicine who had faced dismissal and being talked over (29m49s).

The Impact of CTE on Families (30m2s)

• Families of individuals affected by CTE experience tragedy after tragedy, which can be a difficult and emotional process to go through (30m17s).
• Despite the challenges and emotional toll, the evidence of CTE's impact on families is clear and compelling, driving efforts to raise awareness and understanding (30m24s).
• The experience of working with families affected by CTE can be intense and focused, with a sense of urgency to convince others of the reality of the condition (30m8s).
• The accumulation of evidence from numerous brains donated for research serves as a powerful motivation to continue advocating for CTE awareness and education (30m15s).

Why Ann McKee Cares About the Families (30m30s)

• Analysis of brain damage is done without prior knowledge of the individual's clinical state, including the number of head hits, years of football play, or presence of depression, to ensure unbiased results (30m37s).
• After the analysis, discussions with the families provide insight into the individual's clinical symptoms and allow for a deeper understanding of their condition (30m54s).
• These conversations with families can be emotionally challenging, but also highly rewarding as they provide comfort and help the families heal by explaining the individual's behavior and actions (31m14s).
• The knowledge gained from the analysis can help families understand that their loved one's behavior was a result of brain damage, rather than a personal choice, which can be comforting and help them remember their loved one in a more positive light (31m34s).
• This understanding can be especially helpful for families who experienced negative behavior from their loved one, such as scorn, and can help them recall the person they were before the disease took hold (32m2s).
• For parents, this knowledge can also provide comfort in understanding why their child may have made poor choices or contributed to an accidental injury or taken their own life (32m11s).
• Ultimately, the knowledge gained from the analysis can help families heal and find closure, making it a crucial part of the process (32m25s).

The Pressure of Studying CTE (32m27s)

• The study of Chronic Traumatic Encephalopathy (CTE) is challenging and can be emotionally taxing, with some days feeling particularly difficult. (32m28s)
• Despite incremental progress over the past 17 years, there is still a lack of widespread acceptance and understanding of CTE, which can be frustrating for researchers. (32m42s)
• Although significant advancements have been made compared to 17 years ago, the current state of knowledge and acceptance is not where researchers would like it to be. (32m49s)
• There is a strong commitment to continue the research and advocacy for CTE, despite the challenges and slow progress. (32m54s)

The NFL's Shift on CTE and Lawsuits (32m59s)

• In 2013, the NFL reached a $765 million settlement with thousands of retired players and families affected by concussion-related brain injuries, promising compensation for those who developed brain diseases linked to concussions. (33m19s)
• The settlement included compensation for conditions such as Alzheimer's disease, ALS, and Parkinson's disease, but only covered Chronic Traumatic Encephalopathy (CTE) diagnoses made before 2015. (33m40s)
• The settlement does not provide compensation for CTE diagnoses made after 2015, and this exclusion is attributed to strategic legal maneuvering. (34m7s)
• Although the initial lawsuit was settled, families continue to pursue legal action, as the settlement did not account for future players who might develop these conditions. (34m21s)

Owain Thomas: CTE Case Study (34m37s)

• Owain Thomas was an American football player at the University of Pennsylvania who took his life at a young age (34m40s).
• Thomas had no known concussions, was an excellent student, but was having trouble focusing on his studies before his death (35m0s).
• An examination of Thomas' brain revealed clear evidence of Chronic Traumatic Encephalopathy (CTE) (35m30s).
• The discovery of CTE in Thomas' brain was surprising, especially given his young age of 21 (35m41s).
• Thomas' parents were surprised by his suicide and the discovery of CTE, as there had been few warning signs and they were unfamiliar with the disease (35m49s).
• The cause of Thomas' CTE is attributed to his years of playing football (36m5s).

NFL Helmet Safety and CTE (36m9s)

• Helmets, particularly older models, are thick and heavy with substantial padding, designed to protect the skull. (36m11s)
• Despite the protective design of helmets, brain injuries occur inside the helmet and skull, as the brain moves within the skull due to its soft nature. (36m30s)
• Helmets were originally developed to prevent skull fractures, which can lead to brain hemorrhages and sudden death, thus protecting the bone but not the brain itself. (37m13s)
• Helmets are ineffective in preventing Chronic Traumatic Encephalopathy (CTE) because they do not stop the brain from accelerating and decelerating inside the skull. (37m31s)

The Four Stages of CTE Explained (37m52s)

• The four stages of Chronic Traumatic Encephalopathy (CTE) are characterized by the presence of abnormal tau protein, which appears as brown spots in the brain, with the number and size of these spots increasing in severity from stage one to stage four (37m54s).
• Stage one CTE is marked by a few instances of abnormal tau protein, while stage two has more, and stage three has a drastic shift with bigger clusters, and stage four has the whole brain or at least half of it engulfed by the tau substance (38m34s).
• The difference between stage one and stage four is not just the number of hits to the brain, but also the effect of aging, as the disease can progress from stage one to stage four without further impact if left alone (38m49s).
• The severity of CTE is determined by the number of years of exposure to head trauma and the age of the individual at death, with older players being more likely to have severe CTE (39m0s).
• Even if an individual stops playing sports or is no longer exposed to head trauma, CTE can still progressively get worse, and researchers believe that inflammation in the brain may play a role in this progression (39m25s).
• There is a linear relationship between inflammation and the presence of abnormal tau protein, creating a vicious cycle, and researchers are looking into why CTE becomes worse with aging (39m44s).
• In young people, CTE is typically seen in stages one and two, except in unusual cases like that of Aaron Hernandez, who was 27 when he died and had advanced CTE (40m17s).

Aaron Hernandez: The Link to CTE (40m23s)

• Aaron Hernandez was a high-functioning football player for the New England Patriots, given a $40 million contract, and played with Tom Brady and Rob Gronkowski on Super Bowl-winning teams, but he had psychosocial difficulties and was charged with murder (40m26s).
• Hernandez was found guilty of murder in the first degree and took his own life at the age of 27 while in jail, and his family donated his brain to the research center (41m41s).
• Upon examining Hernandez's brain, it was found to be large, with an externally normal appearance, but with dilated ventricles and a membrane with giant holes, indicating brain trauma and shrinkage of brain tissue (41m53s).
• The brain showed signs of Chronic Traumatic Encephalopathy (CTE), including fenestrations, which are holes in the membrane dividing the brain's two halves, typically seen in people over 45, but Hernandez was only 27 (42m36s).
• Under the microscope, Hernandez's brain showed extensive damage to the frontal lobe, which was riddled with tau, indicating a non-functioning frontal lobe, and likely contributing to changes in his behavior and decision-making (43m4s).
• The damage to Hernandez's frontal lobe would have led to a loss of inhibition, poor judgment, poor executive functioning, and impulsive acts, which may have contributed to his actions (43m44s).
• The frontal lobe damage would have caused Hernandez to talk without thinking, act aggressively, and have poor focus, indicating that his CTE likely played a role in his behavior and decision-making (44m7s).

Mike Webster's Battle with CTE (44m29s)

• Mike Webster, a former NFL center, is discussed as one of the greatest players in his position. (44m29s)
• Webster is shown to be struggling with confusion and fatigue, indicating possible cognitive issues. (45m2s)
• He expresses difficulty in articulating his thoughts and acknowledges feeling tired and confused. (45m4s)

The Progress Ann McKee Wants to See in CTE Research (45m15s)

• The goal is to remove hits to the head from sports as much as possible and make a concerted effort to keep young athletes safe (45m31s).
• Team sports and contact sports are crucial for the psychosocial development of children, and the objective is not to eliminate these sports but to acknowledge the fragility of the brain (45m43s).
• The brain can be severely affected if the number of hits to the head is not monitored, and this is a critical consideration for preventing brain damage (46m1s).
• Reducing or eliminating hits to the head can prevent the development of brain diseases, such as CTE, which is entirely preventable (46m12s).

Do We Really Need Contact in Sports? (46m18s)

• Removing hits to the head from sports like soccer, NFL, and rugby is challenging, as they are integral to the sports, but it's essential to educate participants, especially young children, about the risks of brain damage associated with these sports (46m19s).
• Sports like boxing and UFC cannot eliminate hits to the head, but measures can be taken to reduce the risks, such as monitoring athletes and limiting full-contact activities (46m30s).
• Power slap, a growing sport, involves participants being hit in the head with a hand, which is a significant concern for brain damage (46m37s).
• To mitigate the risks, age limits can be implemented for full-contact activities, and athletes can develop skills without head contacts, potentially making them just as good players (47m31s).
• Heading can be removed from soccer, as it is primarily a foot-based sport, but this would require a significant change in the game (48m4s).
• In ice hockey, fights and checking can be limited, and players can be monitored for hits to the head, with scans and neuroses used to track brain health (48m27s).
• Currently, there is a lack of monitoring and action taken to address the risks of brain damage in contact sports, with a need for education and awareness among parents, coaches, and athletes (49m2s).

Preventing Alzheimer’s Through Brain Health (50m19s)

• Dementia is a general term for the loss of mental abilities, including cognitive function, and has various subcategories. Alzheimer's disease is the most common age-related cause of dementia. Other causes include Parkinson's disease with Lewy Body Disease, frontotemporal lobar degeneration, and Chronic Traumatic Encephalopathy (CTE) among others. (50m27s)
• Alzheimer's disease is prevalent, with over 50% of people aged 85 having the pathology, although not all exhibit symptoms. (51m28s)
• To lessen the symptoms of Alzheimer's, it is important to stay socially connected and mentally active, which helps build cognitive reserve and brain resilience. This can help circumvent areas of brain injury and reduce symptom manifestation. (51m46s)
• Physical fitness and mental fitness are crucial for brain health. Engaging in activities that challenge the brain and maintaining cardiovascular health are important preventive measures. (52m16s)
• Avoiding high blood sugar and diabetes is essential, as they can hasten the onset of Alzheimer's disease. (52m33s)
• Alcohol consumption can damage the brain in ways different from Alzheimer's or CTE, and while there is no direct link between alcohol and Alzheimer's, it can exacerbate symptoms and lead to cognitive problems. (52m45s)

Are Brain Diseases Like CTE Increasing? (53m17s)

• Awareness of brain diseases like CTE is increasing, and this rise in awareness is contributing to the perceived increase in the prevalence of these diseases (53m19s).
• In the past, conditions such as dementia were often attributed to normal aging, but it is now understood that these conditions can be the result of abnormal or pathological aging (53m23s).
• Some individuals remain mentally intact well into old age, which highlights that certain brain diseases are not a normal part of the aging process (53m30s).
• The understanding and awareness of brain diseases have improved significantly over the past 40 years, during which time the commonality of these diseases has become more apparent (53m40s).

How Inflammation in the Brain Worsens Diseases (53m47s)

• Inflammation in the brain is considered a key promoter of brain disease and neurodegeneration, with tremendous inflammation present in Alzheimer's disease and CTE (54m18s).
• Small vessel disease, or vascular disease, is also crucial, as the health of small blood vessels is essential for oxygenating the brain, and damage to these vessels can accelerate diseases (54m42s).
• The earliest changes associated with these diseases are vascular changes and inflammation, which need more attention (55m5s).
• Various insults to the brain can cause inflammation, including damage to blood vessels, which can lead to substances leaking into the brain and irritating it (55m15s).
• The blood-brain barrier is a tight barrier that keeps toxins out of the brain, but injury to blood vessels can cause it to leak and allow noxious substances to enter the brain, promoting inflammation (55m28s).
• Factors that can injure blood vessels and lead to inflammation include trauma, high blood pressure, high cholesterol, high blood sugar, and high cortisol levels, which are often associated with stress (56m2s).
• Reducing stress, staying physically fit, eating a healthy diet, and getting adequate sleep are essential for maintaining vascular health and reducing inflammation (56m17s).
• Sleep is critical for clearing bad substances out of the brain, as the brain's clearance system is most active during sleep, pulling out noxious chemicals and draining them into the system (56m34s).

Ann McKee’s Advice for Parents of Young Athletes (56m51s)

• Parents should consider whether their child truly needs to play a particular contact sport or if they could be just as happy participating in a non-contact sport, which carries a lower risk of injury. (56m51s)
• If a child decides to play a contact sport despite the risks, it is important to ensure that the coach is knowledgeable about the adverse consequences of concussions and non-concussive hits to the head. (57m31s)
• Education about the risks of head injuries should be provided to the player, their teammates, and the coach. (57m43s)
• It is advisable to delay playing full-contact sports until the child is physically robust, with strong musculature and neck strength, to better withstand hits. (57m52s)
• Anticipating a hit can reduce the risk of whiplash compared to being blindsided by an unexpected hit. (58m11s)

Ann’s Message to the NFL and Sports Organisations (58m23s)

• Individuals in leadership positions within major sports organizations, including the NFL, are encouraged to address the issue of non-concussive hits, which are impacts that do not cause immediate symptoms but can still be harmful. (58m25s)
• There is already significant awareness and management of concussions, but more attention needs to be given to limiting the number of non-concussive hits in sports. (58m50s)
• Recommendations include reducing head impacts during practice sessions, encouraging players to begin full contact at a later stage, and demonstrating leadership by effectively addressing the issue of non-concussive hits. (59m10s)

The Final Question: What's Next for CTE Research (59m34s)

• A tradition involves the last guest leaving a question for the next guest, without knowing who it will be. The question asked was about the darkest day experienced and what made it so challenging. The response highlighted self-doubt and the importance of believing in oneself to overcome limitations and achieve success. (59m34s)
• The work discussed has significantly impacted global awareness and opinions on previously overlooked subjects, potentially saving and improving many lives. The research is acknowledged for extending health spans and enhancing the quality of life for individuals and their families. (1h0m43s)
• Listeners are encouraged to focus on their brain health and to seek medical attention for themselves or others if needed. Brain donation is emphasized as crucial for advancing the understanding of diseases like CTE, Alzheimer's, and Parkinson's, offering a lasting legacy. (1h1m20s)
• A personal endorsement of Zoe, a company that combines health data with scientific research to guide better health choices, is shared. The speaker is both an investor and user, noting improvements in energy, sleep, mood, and hunger. A discount code is offered for new users. (1h2m1s)