Exploring Traumatic Brain Injury in the NFL and Military

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 Exploring Traumatic Brain Injury in the NFL and Military

Repeated hits to the head can cause serious issues over time. Find out what can be done to mitigate the damage.

This article is published with permission by HVMN and was originally published at HVMN.

Studies are continually showing unsettling results about brain injuries. Chronic traumatic encephalopathy (CTE), is a degenerative brain condition believed to be caused by repeated hits to the head.  In 2016, Dr. Ann McKee, director of Boston University’s CTE centre and her team concluded that there is increasing evidence that CTE affects amateur and professional athletes, as well as military veterans, citing CTE as a “major public health concern.”1

Hvmn, Keto diet, ketosis

Dr. Ann McKee, director of Boston University’s Chronic Traumatic Encephalopathy Center, who is a leading CTE researcher - via Boston University

While the spotlight on the NFL may have helped illuminate CTE, military professionals are also at risk, specifically those who have experienced blast injuries.2 TBI and CTE are both being studied in postmortem military veteran brains, linking blast exposure to persistent impairments in neurophysiological function, learning and memory.3

When analyzing symptoms of military veterans diagnosed with CTE, researchers found some individuals were also diagnosed with PTSD, drawing lines between commonalities in symptoms and possibly shared pathogenetic foundations.4 More research is needed to understand the connection, but the suggested linkage could exacerbate symptoms.

The bottom line? Concussions are more serious than we thought.5 These injuries, occurring on the battlefield of the football field (or even accidentally in everyday life), can change personality, cognitive performance and can increase the risk for suicide. They can change a life forever, or end it.

 Exploring Traumatic Brain Injury in the NFL and Military

The spread of tau in the brain, which has been linked to CTE

What Can be Done to Reduce Traumatic Brain Injuries (TBI) and CTE?

Not everyone in the military or NFL have CTE or other brain injuries. Since many of the brains are donated to research, they can’t provide a representative sample.

Still, research suggests that duration of exposure to hits can impair cognitive function. A study in former NFL players who started playing football before age 12 inconclusively demonstrated an association between preteen football and cognitive impairment later in life.6 Those results were supported by another study in deceased athletes linking early football play to cognitive and behavioral symptoms of CTE 13 years earlier on average (when compared to players who started later in their teenage years).7

One study, which looked at the link between cognitive impairment and depression of 65 year-olds who played football in the 1950s, didn’t illustrate a risk for symptoms later in life.8

Problem is–we’re not playing 1950s football anymore. Athletes are bigger, stronger and faster than they’ve ever been, and despite the technological advancements in gear, we’re still seeing an increased risk of brain injury.

The NFL is taking steps toward making the game safer: helmet-to-helmet hits are banned and penalized, kickoffs have been changed to limit full-speed collisions, the amount of contact in practices have been lessened, and the league is analyzing artificial playing surfaces to soften the impacts.

There’s even a concussion protocol, where players suspected of having a concussion are immediately removed from the field. If diagnosed, they can only return to play after completing the league’s concussion protocol, including a period of tests, supervised exercise and examinations from both team and independent doctors.

The league has even donated millions to concussion-related research.

But none of this changes the countless hits that can lead to brain injury on an NFL field.

It seems these are occupational hazards for football players, similar to military personnel.

For the military, head immobilization during blast exposure prevented side effects of learning and memory deficits.9 More research is needed, but some suggest TBI recovery practices might focus on mechanisms that promote innate neuroplasticity, like graded exercise, restorative sleep and nutritional support.10

There has also been growing research that suggests certain nutrients have emerged as a potential strategy to prevent or reduce the deleterious effects of concussions. Things like creatine and curcumin were used in a recent study,  along with omega-3 fatty acids, which are present in Kado-3 by HVMN.11

We at HVMN are dedicated to understanding traumatic brain injury. Exogenous ketones, like HVMN Ketone, could help.

Many studies have been done on animals, with research suggesting that the ketogenic diet could be useful for children suffering from TBI injuries.12 Similarly, fasting (which leads to ketosis) studies on rats showcased that, after moderate cortical impact, fasted subjects showed a significant increase in tissue sparing.

In patients with cerebral injury, one study found that administering ketones may provide a significant benefit.13 While dosage, timing, and administration methods all need further research, the results are exciting, as ketones could be employed to manage acute brain injury. Two to three days after an impact, there is a hypometabolism of glucose and the brain is starved of energy. Ketones can bypass glucose metabolism and maintain brain energy levels, thus potentially limited damage.

Despite different methods to achieve ketosis (both exogenously and endogenously), results indicate that the presence of elevated ketone levels in the blood can help recovery for those who suffered a brain injury.

The Future of Brain Injury

As science continues to explore the subject, we’ll continue learning about how brain injuries happen, how to treat them and hopefully, how to prevent them.

What’s clear now? They’re a problem in the NFL and the military, two occupations where some of the world’s elite performers push their bodies to the absolute limit. Sometimes, the result is a concussion or another type of TBI, and later down the line, the result is increasingly becoming CTE. These types of injuries aren’t exclusive to the NFL and military. You could slip, fall and hit your head. You could accidentally run into something. The possibility for brain injury is ever-present.

But they’re more susceptible than the rest of us, given the nature of their jobs. These athletes and military personnel are more than just elite performers; they’re heroes to many. They’re fathers and mothers and siblings and children, who put their bodies on the line for us (in one way or another).

The scientific community is committed to finding answers, and we hope to be part of the solution.

Citations

1. McKee AC, Alosco ML, Huber BR. Repetitive Head Impacts and Chronic Traumatic Encephalopathy. Neurosurg Clin N Am. 2016 Oct;27(4):529-35.

2.Mez J, Stern RA, McKee AC. Chronic Traumatic Encephalopathy: Where Are We and Where Are We Going? Curr Neurol Neurosci Rep. 2013 Dec; 13(12): 407.

3.Goldstein LE, Fisher AM, Tagge CA, et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012 May 16;4(134):134ra60. doi: 10.1126/scitranslmed.3003716.

4.McKee AC, Robinson ME. Military-related traumatic brain injury and neurodegeneration. Alzheimers Dement. 2014 Jun; 10(3 0): S242–S253. doi: 10.1016/j.jalz.2014.04.003.

5.Peskind ER, Brody D, Cernak I, McKee AC, Ruff RL. Military- and Sports-Related Mild Traumatic Brain Injury: Clinical Presentation, Management, and Long-Term Consequences. J Clin Psychiatry. 2013 Feb; 74(2): 180–188. doi: 10.4088/JCP.12011co1c.

6.Stamm JM, Bourlas AP, Baugh CM, et al. Age of first exposure to football and later-life cognitive impairment in former NFL players. American Academy of Neurology, Jan 28, 2015. doi: https://doi.org/10.1212/WNL.0000000000001358

7.Alosco ML, Mez J, Tripodis Y, et al.Age of first exposure to tackle football and chronic traumatic encephalopathy. Annals of Neurology. 2018; 83(5); 886-901.

8. Deshpande SK, Hasegawa RB, Rabinowitz AR, et al. Association of Playing High School Football With Cognition and Mental Health Later in Life. JAMA Neurol. 2017;74(8):909-918. doi:10.1001/jamaneurol.2017.1317

9.Goldstein LE, Fisher AM, Tagge CA, et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012 May 16;4(134):134ra60. doi: 10.1126/scitranslmed.3003716.

10.McKee AC, Robinson ME. Military-related traumatic brain injury and neurodegeneration. Alzheimers Dement. 2014 Jun; 10(3 0): S242–S253. doi: 10.1016/j.jalz.2014.04.003.

11.Oliver JM, Anzalone AJ, Turner SM. Protection Before Impact: the Potential Neuroprotective Role of Nutritional Supplementation in Sports-Related Head Trauma. Sports Med. 2018; 48(Suppl 1): 39–52. doi: 10.1007/s40279-017-0847-3

12.Hu ZG, Wang HD, Qiao L, Yan W, Tan QF, Yin HX. The protective effect of the ketogenic diet on traumatic brain injury-induced cell death in juvenile rats. Brain Injury, 23:5, 459-465, DOI: 10.1080/02699050902788469

13.White H, Venkatesh B. Clinical review: Ketones and brain injury. Critical Care. 2011;15(2):219. doi:10.1186/cc10020.