Best selling author and Columnist for 'The New Yorker' Malcolm Gladwell has, for the past few years, been forming an assault on one of USA’s most heart held passions – Football. I say assault; really he is just pointing out a fairly obvious issue with a fundamental feature of the game; that feature being collisions, more precisely head collisions.
Malcolm Gladwell has been exploring the link between the repetitive sub-concussive blows players experience on the field during games and practice and Chronic Traumatic Encephalopathy (CTE); a progressive neurological disorder. Malcolm Gladwell is not ‘making’ this connection; he isn’t qualified in the relevant areas. As a very popular journalist he is however in a very powerful position to highlight what a body of research, which is currently growing rapidly, is suggesting. That suggestion is that repeated head trauma (even very slight trauma such as gently banging your head against a brick wall) causes the brain to be injured which results in the aforementioned umbrella term CTE.
CTE manifests as a reduction in brain mass across a broad range of regions. As well as atrophy (degeneration) of brain tissue due to neuronal loss, CTE also presents as dysfunctional neurofibrally tangles formed by a defective form of tau protein and as the accumulation of plaque formed by beta-amyloid, both of which prevent the brain from communicating as the neurons are unable to effectively relay information. If these sound familiar, you’d be right, they are two of the changes that are present in brains of those with Alzheimer’s.
Others with CTE have symptoms of motor neuron disease symptoms which appear to mimic Amyotrophic Lateral Sclerosis ((ALS) also known as Lou Gehrig’s disease) and also Huntington’s disease. Progressive muscle weakness, balance and gait problems are some of the earlier symptoms of individuals who had verified CTE, so here we’re looking at overlaps with individuals who develop Parkinson’s and similarly related degenerative diseases such as progressive supra-nuclear palsy which is often misdiagnosed as Parkinson’s.
As you can imagine damage to the brain not only results in physical functional issues, but also cognitive, behavioural and emotional changes too. These symptoms are diverse, including depression, anxiety, aggression, memory, and executive function deficit to name but a few. Which symptoms appear depends on which area of the brain is most affected by the damage, although they often co-present in various ratios due to the often global effect of the process.
Malcolm’s choice of football isn’t, I believe, because of a deep seated hatred for the sport, but more because of the very obvious evidence of head collisions, and in part because using football as the focal point of the discussion will emotionally gain more attention due to the deep love of the game in the U.S. He could have chosen any sport where similar incidences of collisions and especially head trauma are an integral part of the activity such as ice hockey and combat sports; in fact CTE was previously known as dementia pugilistica, due to its prevalence in those who participate in boxing. Combat outside of sport, such as those serving in the armed forces are also at risk of CTE, especially, but as we’ll see probably not the main reason (this will in all likelihood hold true for the football players and other athletes too), via blast injuries. In fact, you don’t have to be physically insulted at all to initiate the process that is part of the CTE condition, in which case even the less physically combative of us may also be at risk.
If you receive a blow to the head, even one that doesn’t seem particularly offensive such as heading a football (soccer), your body will switch on specific genes to defend itself from the stress. The switching on of these genes increases the production of messenger signals called cytokines which initiate an inflammatory state to deal with the damage caused by the physical trauma. The cytokines then proceed to stimulate specialised cells in your brain called ‘Glia’ which have multiple roles in maintaining the function of the brain. One of their roles is to produce nitric oxide, which is a vital chemical for health especially of the brain as it is a necessary messenger for the flow of transmissions through neurons. The problem is when levels of nitric oxide become excessive such as when it is induced by stress (physical, chemical or emotional), and the chronic inflammation that accompanies this environment.
Although taking multiple (or even a single hit to the head if it’s sufficiently hard enough) can create this nitric oxide tsunami, there are other situations that cause this too, and I think this is where the perfect storm that is contact sports becomes problematic.
As mentioned above, there doesn’t need to be a physical insult to cause an increased production of nitric oxide, you can do it with a simple, and even unconscious, thought. Heightened feelings such as rage or fear cause the brain to produce increased levels of nitric oxide; the reason is fairly simple when you think about it in the right context. During our evolutionary past, throughout the lineage, right back to our distant reptilian forebears, our ancestors had to develop processes that would allow them to survive in a much more hostile environment than we do today. Nitric oxide was built into this system to speed the signals in the brain when our ancestors needed to fight or take flight, hmmm….just the kind of emotions and circumstances that are heightened on the field of play and war.
We still have the legacy of this design today which continues to serve us very well in the right circumstances, such as when are in actual physical danger or when we use this increased processing horsepower in sport. Problem is most of us tap into the system on a daily basis, generally when we are not even in immediate danger. As Spidey’s Uncle Ben (Parker) said ‘with great power, comes great responsibility’, and the nitric oxide system is very powerful, so we need to be very responsible in how we use it, otherwise it will result in brain deterioration on an accelerated scale. And that’s not even taking into account the even bigger problem caused by excess glutamate, which is even more damaging, and like nitric oxide is released by strong negative emotions.
I’ve shown in previous articles* how your perception of the world governs to a large extent your reality, so even if you don’t put yourself in harms way, those amongst us who are quick to become annoyed, enraged or can’t let things go, are simply hastening their own demise, as well as not enjoying the little time they have here on Earth to boot. We're getting pretty good at keeping bodies patched together, even after we've allowed them to become diseased. Brains, not so much. If you'd like to maintain your brain lifelong, you’d be wise to learn how to change that situation**.
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** There are ways to reduce the damage caused by the fall-out of excess nitric oxide beyond limiting the amount of knocks you take to the head, however I’m unable to give a blanket account of the methods used due to the wide range of individual differences in, not only your brain structure, but also your personal lifestyle dynamics and history; a one-sized fits all approach is really a one-sized fits none.
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