Episode 108 – What everyone should know about brain injury with Dr. Chris Nowinski

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Chris Nowinski, Ph.D., is co-founder and CEO of the Concussion Legacy Foundation, a non-profit organization dedicated to solving the sports concussion crisis through education, policy, and research.

A former collegiate football player and professional wrestler, Chris suffered a serious concussion in June, 2003, but due to a lack of understanding, was not honest about his symptoms and continued to wrestle and work out for five weeks while symptomatic. He developed post-concussion syndrome and was forced to retire.

It wasn’t until he visited the renowned neurosurgeon Dr. Robert Cantu that Chris was first exposed to medical research that revealed to him that concussions and brain trauma were misunderstood in the sports world. Chris realized that this lack of awareness among athletes, coaches, and even medical professionals not only cost him his career, but also threatened the health and well-being of athletes of all ages.

This led him to write the critically acclaimed book Head Games: Football’s Concussion Crisis, originally published in 2006, in an effort to educate the world about this serious public health issue. In 2012, the book was adapted for the documentary film of the same name, Head Games, directed by Steve James, and the book was updated to coincide with the film’s release.

In 2007, Chris co-founded Concussion Legacy Foundation and is a leading force in changing the way we think about brain injury in America.

In this episode we discuss:

• The different types of brain injury

• How sports are changing, and why it’s important

• Why it’s critical to monitor impact in the brains of children

• How to donate your brain, and the current state of research

• For veterans, join Project Enlist here.



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Intro: 00:01 This is the Eagle Nation podcast where we talk about building richer lives and stronger communities. We have inspiring guests to have real conversations about things that you care about.

JJ Pinter: 00:13 Hey, well, welcome back to the Eagle Nation podcast. My name is JJ Pinter and I’m going to be your host again today for a super cool episode with a super cool guest and I’m going to let him introduce himself, but I wanted to take a moment and just to welcome Dr Chris [inaudible] Lewinsky to the podcast. So Chris, thanks so much for joining us. Thank you. And I’m going to do my best because we have a family, friends whose last name is Nowitski, which is strangely familiar, but lots of, I assume you were of Polish descent. Lots of Polish people where I grew up in southern Michigan. So I’m gonna do my best to get your last name correct. I appreciate the USR Lewinsky settled in Milwaukee, but I know the area well. Yes, absolutely. So Chris is a really interesting guy. He and I, I had heard about him for years, but we met last fall at an event in New York City, I think it was maybe in December, and it was a dinner for a partner organization of both of ours.

JJ Pinter: 01:11 I think the infinite hero foundation. And you were one of the speakers I believe, right? Uh, yes. I was surprised to be asked to speak, but yes, it was a room of amazing people, but I gave a few words and that was the point. I thought, man, if he’d be willing, I would love to have him on the podcast and you know, we’re, we’re both busy and we played a little bit of calendar Jenga, but we’re finally able to make it happen. I’m also incredibly thankful because Chris is about to have his first child at any point, like literally at any point here. And so he was willing to kind of thread the needle on this podcast. So if it ends up roughly, that means he had to make a quick trip to the hospital. So this is one of the things, I don’t know.

JJ Pinter: 01:53 Do you remember the old dos equis commercials where you have kind of the most interesting man in the world? I forget what his name was. I feel like you’re kind of like the modern day equivalent of that with all of the things that you’ve done. I don’t want to do your bio injustice, but had, you’ve had a really interesting and meaningful kind of career to this point and I normally don’t like to ask the uh, hey, like I feel like it’s kind of a cheap question to say like, hey, tell us about yourself, but I don’t, I want to. I want to do it justice. So if you could maybe I would love to hear just a little bit about how you would summarize the various kind of twists and turns that you’ve taken in your life and your career, kind of up to what you’re doing right now at the concussion legacy foundation. Yes, I will. I will do my best and I’ll try to keep it to things that are relevant or interesting. Story starts. Grew up in Chicago, was going to be recruited to play football at Harvard University. The people that went to but had a wonderful time there, studied sociology, got what was supposed

Chris Nowinski: 03:00 to be a typical Harvard job afterwards as a consultant to the life sciences industry, but had a boss that on the from the. He and I were both professional wrestling fan than a lunch conversation turned into, hey, you know, this job will always be here, but when you think about trying to become a professional wrestler, I was like, what do you know about that? It turned out he knew people in the business and makes a call and suddenly jj Dylan’s bring me down to the power plant and WCW and Mr. wonderful is beating me up. I’m trying to see if I had what it took to become a superstar. And a long story short, I enrolling killer kaslowski’s wrestling school, get on tough enough on a that to be an MTV. Did the reality show back in 2000. One was runner up and was eventually hired and was, uh, was on Monday night raw for over a year.

Chris Nowinski: 03:51 I came in and the real name the year with John and Randy Orton, brock Lesnar, unnecessarily called me Christopher Lewinsky, but everybody from the reality show, Joe remembered me as Chris Harvard and that was sort of my name because they based my character on my actual Harvard history and so as you can imagine, I was a bad guy, is just like been grown up in the midwest to the Harvard guy. You imagined a silver spoon. Guys had it all handed out. I got to play a a terrible person that traveled the country, making fun of people and then we’ll get beat up. The audience, have their satisfaction.

JJ Pinter: 04:27 Couple of questions really quickly here because it’s just so interesting as a. As someone who played football their entire life from elementary school on growing up and when you go to play football at Harvard, I’m just interested like when you’re doing the kind of mental calculus, I got to imagine when you’re. When you’re weighing kind of potential for a future in football versus outside of football. Like Harvard is not known to be a football powerhouse in college football, so were were you. Were you, did you have aspirations of playing at some kind of football powerhouse or was it like, Hey, I’m looking to the future here and like, you know, Harvard is probably like one of the best known schools in the world and that’s maybe a good place for me to land.

Chris Nowinski: 05:08 Uh, so I was really took pride in being a nerd most of my life. I was a science Olympian. I actually went into my middle school hall of fame for sports and I was like, I, it was a terrible athlete when I was here. I was assigned, I was a state champion Science Olympia. No. So when, when I was actually like, became a good athlete, I was a late bloomer and then first of all I think I might’ve picked the wrong sport based on my recent work, but I choose treat and football and basketball for college and have, you know, good interest in football. And I chose it just because I like to sing. I was a football player more than I ended up basketball player because of the way people responded. They thought they thought you were tougher when you were a football player, so, and I had like low level division one offers, you know, maybe could have gone to western Michigan or bullying. I actually wanted to be a scholarship for one player. That was the dream. I was lucky to have a coach you said done and all the Ivy League Harvard invites you to come, you do not turn them down. And, and sort of persuaded me to just pursue the Ivy League opportunities. You know, Harvard was a great choice because when you actually get there, you realize the football teams, like any other football team, you know, maybe most of the guys could have played, you know, at Ohio state. But, uh, it’s all the same people who just had a good sat scores.

JJ Pinter: 06:22 Yeah, it was, it was a great experience at the end. I want to talk about this in more detail, but my grandfather was born in the former Czechoslovakia, immigrated to the United States after World War Two and never really spoke great English, worked in Detroit and the auto factories his entire life. And He loved professional wrestling more than life itself and believed that it was real and we would, every time I went to his house, when I was a young young child, we would watch professional wrestling together and he would even sometimes like take us to these like local shows and like Michigan to Detroit to see like minor league professional wrestling or whatever, but I still to this day can name every professional wrestler of any substance from the eighties and probably their signature moves. So it’s like very close to my heart. And then I was always a big brutus the barber beefcake fan when I was, when I was a kid. Huge. And then fast forward to. I graduated from college in 2001 and he like Monday night raw and Thursday night’s smackdown were like super popular at the time. And so we would always go to like this like little little bar type thing and with our friends. And so I don’t know, like it’s just, it’s one of these things that I just grew up with and I don’t know, I just find it really interesting. So I definitely wanna ask you some questions about that at the end, but I just wanted to queue that up.

Chris Nowinski: 07:45 We can get lost in professional wrestling. Is this one of the most interesting thing was to have conversations about and uh, you know, I got into it late because my, I wasn’t allowed to watch it growing up. My mother would get very tight controls on the television and identity brothers to help back me up. And so, uh, I got, I got hooked late. I got hooked like watching summer 99 when the rock and stone hold. We’re just taking over the world and uh, I learned more in that, in that business and you know about life than anything else. It’s just a fascinating world to be involved and go from being a fan of some of the guys to actually being in the ring with them was a trip.

JJ Pinter: 08:21 It’s so funny to me that if he go back to the rock that you think the whole like Brahma bull thing in the ring and like what, what is he well known now for? He’s like the guy on marijuana in the movie. That’s all kids, that’s what they know him from. He’s he’s Maui in the movie Rwanda, so I can tell you have three kids, three kids, so I knew that. I didn’t mean to interject. I just thought that was really nice to finally get to the interesting stuff and the stuff that matters to your audience. So

Chris Nowinski: 08:50 I’m wrestling. We’ll jump into having a great time. You as still the youngest hardcore champion in the history of third of you because they essentially hired the belt, they realized with objects is a bad idea, but it wasn’t kicked in the head from bumper made deadly in June of 2003 that sent me on this new path. Problem was I just definitely concussed when I got the kick, but I didn’t really appreciate what a concussion was and so I just figured, oh, I blacked out and I sort of forgot what was happening. My head really hurts. No big deal. And wasn’t honest with anyone about how bad it was. The only enter five weeks of just fighting tooth and nail to stay active and in the ring and not lose my position. Uh, I developed a rem behavior disorder, are sleepwalking and hurt myself, and finally was honest about what happened when I woke up in the floor of a hotel room, having jumped through the nightstand according to my girlfriend who was crying because she couldn’t wake me up or stop.

Chris Nowinski: 09:46 So, uh, at that point, uh, I was like, well, I’m going to get checked out and what happened? And the problem was by that time I’d done so much initial damage that I just never got better. And frankly, I’m still not 100 percent. I’ll probably 95 percent, but even today with a rain clouds pouring through, I’ve got a headache that shouldn’t really be there, but something still wrong and beside my spill somewhere. And it was that pain that really kept me going forward because at the beginning I just was trying to get better and so going to all these doctors and nobody really had a good fit. The story as to why this one concussion quote unquote, that I, that I had so many problems because I’d never had one before. Then I met Dr Robert Cantu. I eventually cofounded passion legacy foundation with and he was the first guy to help me appreciate that.

Chris Nowinski: 10:34 I’d had the. Helped me understand what the definition of a concussion. Once he was like, well, how many times have you been hit in the head and you saw stars, you’re dizzy or forgot where you were, you confused or he saw flickering lights or stylish change colors, and I was like, not that. That’s all at the time and it helped me appreciate that. I’d probably have a lot of concussions that weren’t very many. I can remember specifically, but we don’t have to get a concussion stories and it was the accumulation concussions plus not taking care of them. That led me to this and I had this epiphany. I was like, why the hell does nobody know this? You know, why are we all out there? And I pulled the wrestlers I worked with, I pulled, hasn’t played football with. Nobody knew that when those things happened, what was happening inside our brain and that we needed to take time away from getting hit in the head again.

Chris Nowinski: 11:17 If you wanted to recover 100 percent. And so I had this idea that, you know, what, maybe I should tell other people and that can be my pendants for sort of taking my Harvard degree and taking it into a new direction and I can go back on with my life in some other way. But the more I dug into this, the more I realized there was a much bigger problem here. And I kept getting drawn back and it started with. I told the story to a book called Head Games, football pedestrian prices, six that didn’t, as you can imagine, a book written on neuroscience by pro wrestler did not fly off the shelves. But I learned so much along the way that I was like, well, I gotta give it a try. I’m going to give the old college try to putting this in action. And so, you know, first it was trying to get media stuff and realized, you know, I couldn’t get the media to talk about this concussions was a problem to talk about because it’s invisible.

Chris Nowinski: 12:06 We’ve all sort of had them, but we can’t see them on everybody. You know. The Tad one seems to get better or else you stopped seeing them because they’re so bad they don’t come out anymore, but cte, this disease, chronic traumatic encephalopathy had just been diagnosed in the first two nfl players. I thought this might be a way we can get people to care because it was a disease. You can see it was a disease that appeared to have really life changing symptoms that that correlated to it. Mike Webster being the first case who was homeless and you know, one of the all time great players who died at 50, so big life changing moment was November 2006 when I read about a guy grew up watching Andre waters of the same generation who remember, he was great strong safety for the Philadelphia Eagles and he held his life at the age of 46 for no, like sort of obvious reasons from the time sort of naive understanding of suicide.

Chris Nowinski: 13:00 You know, like he was a football coach and there was no discussion. 20 problems or family problems or life events. And you know, I was looking at the article and I noticed he was nicknamed dirty waters because they liked the lead head by decided just on a lark back in the good old days when you had to buy Google news article 99. I bought an old article where it mentioned the word passion is quoted saying I lost count at 15, but just grab smelling salts to keep playing. And I was like, I wonder if he would have been one of these guys, just CTV. And that led to me calling the medical examiner and trying to convince them to study his brain for Ct. And he refused, but I called it, you know, he, he didn’t believe that, you know, getting hit in the head can be related to the suicides in any way, shape or form.

Chris Nowinski: 13:44 They send them All these articles, uh, he fused to read them. And I just on a lark, I called them back two weeks later just because I wanted to win the argument. Waters had already been married, but I want to be like, you know, I’m not wrong here, right? Like the head injuries can lead to depression, can lead to issues that could lead to suicide, like it’s out of crazy theory and the evidence backs it up. Right? And he finally said, well, you know, maybe so, uh, so if, if you’re really serious about this, I’ll let you know. I did keep part of his brain and I will send it to a doctor of your choosing if you want to have a study. So that became like, wow, okay. So I called the doctor to the original studies and said, I sent you the brain.

Chris Nowinski: 14:23 And I said, sure. I said, great. Apparently we need the, the next of kIn’s permission, here’s his wife’s. Or here’s his mother’s phone number, who was in her eighties. Uh, I’m not going to follow her. I’m not comfortable making that phone call that I was stuck at this other sort of fork in the road of, do I have the guts, you know, no one else will make this call. Do I have the guts to call this poor breathing mother and say, hey, I don’t know if you know this, but not all of your sons brains with varied with them, study it, but I did it and his family amazing and started it and he had cte. And then I went down to that, convinced the doctor that we wouldn’t wait for this to go into the lay press of people committing suicide because of brain disorder.

Chris Nowinski: 15:02 We need to let the world know. And so, uh, convinced them to let me take the news of New York times and ended up writing a front page story about it for first after talking to me, they thought I was crazy to convince them. and then that sort of opened the door to this conversation. We’ve had it for 11 years about a cte in football and, and now now we’re finding in military veterans and every other contact activity. So that was sort of like the change. And then I was like, well, jeez, if we’re gonna if this is here, we’ve got to have an organization that gives. These brains can’t just be calling a. So we started the foundation with the goal of finding the best researchers to build a brain bank because of brain makes really how we, the best way to start foundationally understanding of disease in this disease had been neglected for so long.

Chris Nowinski: 15:50 They are only 45 cases in the world’s literature. Uh, and so I met the team of boston university and the va that’s lead by Dr. Mckee and we’re now 600 brains later and we’ve got this great partnership between the foundation bu in the va, started the boston university cte center and we, for the last 11 years I’ve been fighting this battle to understand this disease, but also then fighting the sports world, especially the football and hockey worlds who don’t want to believe it. So I guess that’s it. Go gone forever. But I’ll, I’ll, I’ll cut it off there and say that’s how we got to there. And while I’ve been starting the foundation, I went back to school and got a phd in behavioral science that I could make sure I could be making the right decisions. Luckily I got lucky when I was young and naive, but now I know a bit more about what we’re doing.

JJ Pinter: 16:39 That’s a really, really powerful story and I want to dive into some of this in a little bit deeper sense because there’s a lot here. This is really interesting and it’s really timely right now. So you’re the ceo and cofounder of the concussion legacy foundation. I want to maybe define terms a little bit just because if you’re not in this world, you hear a lot of things kind of in our world and the veterans world. You hear the term tbi, traumatic brain injury, you know, you hear concussion now people are starting to talk about cte. Can we maybe just start with some terms really quickly to vector everyone in so they know kind of what we’re talking about and when we talk about brain injuries, maybe like what the major categories might be or types.

Chris Nowinski: 17:22 That’s a great idea. So the, you know, the term we’re probably most familiar with is not tbi, a traumatic brain injury, so that’s a, that’s an injury to your brain that can be both functional and physical. And caused by direct impact to the head or rapid acceleration or deceleration of the head or a tremendous energy going and talking about contact on blast injury falls, so that’s a brain injury and the idea with the brain injury is the brain gets injured and then recovers and it may not get to 100 percent and the injury sort of evolves a little bit over time, but one of the major differences between tbi and cte is that tbi is not a degenerative brain disease, does not continue to aggressively progressively get worse in a in a systematic way, although it is related to an increased risk of some different pathologies and diseases down the road.

Chris Nowinski: 18:20 Concussion is another word for tbi and concussion tends to be used in the more mild injuries that don’t cause whether they would consider to be moderate or severe. BrAin damage would and It’s usually moderate or severe as defined by you know, really aggressive symptoms at the beginning of a long period of consciousness for a long period of asia are more often a injury that you can see on a standard scan, like an mri. A concussion by definition doesn’t show up on an mri. You start to see damage on mri or more moderate. Your brain injury are you taLking about bleeds, you talking about maybe large aspects of tissue damage and then cte than is degenerative brain disease that looks at the end of stage a lot like alzheimer’s disease where you have problems with cognition, you mIght have problems with behavior, problems with mood and it appears to be triggered by trauma and usually repetitive trauma. A sport like football retake thousands of hits and it starts a degenerative process. It’s very microscopic, the beginning metric, microscopic but can spread even in the absence of additional blows to the head in a sort of a known way through the frontal and temporal lobes and some other key barriers.

JJ Pinter: 19:35 How widespread are these? I know that probably part of the problem, I’m guessing is that his diagnosis and people not getting medical care and getting treatment for these, but I mean if you had a general sense of how widespread some of these different conditions are and I just think to my own experience, you know, playing sports my entire life, playing football, you know, I’ve played rugby and virtually everybody that I know that I ever played football with probably had got a concussion. It’s important in their life. I mean we, we were taught to lead with our helmet to knock the ball out when we were tackling right. And getting your bell rung as we called it at the time was almost like a badge of honor. So I’m just, I’m wondering, nobody knows but, or maybe somebody does. How widespread are these? Are these various conditions, do you think?

Chris Nowinski: 20:22 So we don’t know. We have insights from the data that we have. So as I mentioned earlier, this was barely studied and I always have some sort of braIns and shocking things are in some some groups we’ve seen almost all the people in that group habit, 100 tons of honor Lebanon, fl players we’ve studied that, tested positive for this disease, 48 out of 53 and played in college, but only three out of 14 of play just through high school and that plus some other data is showing us that there appears to be a dose response relationship and it’s been known for years in boxing and it’s not one year of boxing that with permission box 10 more than 10 years, your risk was actually quite high. So it’s really a demographics question. It’s, you knoW, how many people are out there that have played 10 or 20 years of contact sports and it’s luckily not that many.

Chris Nowinski: 21:14 So I’m very hopeful that. I mean I think we would, we would know more about this if, if this was everywhere and it’s not everywhere, but in certain populations that have certain exposures, we see it as that. And I would say that the, like the one piece of data I can say for sure is that over the 10 years we’ve had our brain bank, it’d be you, we’ve, we’ve started the brain of about 10 percent of nfl players who have died during that period and 99 percent of them had it. So if you’re thinking about just looking at nfl feel, a minimum is that two of them have it that are playing in the game you started watching next month. And it’s possible that, you know, potentially over 20 of them have it, although it’s not likely. but, so If you’re in that extreme category of nfl, which means you played at least 15 or 20 years, it’s not an insignificant number of people have it.

Chris Nowinski: 22:06 And then with our military, we published the first case series on, on people who served our country, dr ricky published in 2012. Um, so we have just a handful of cases and very few of them were not all, you know, a lot of people who serve played context for snare, younger. So only about fIve percent of our 600 brains are actually military service members who never played contact sports but served and so we don’t have a good appreciation to what military exposure, what that risk is. And again, we’re hoping it’s small but we know we definitely know what’s up.

JJ Pinter: 22:42 I feel like, and maybe your organization has had a huge part of this, but I have felt what to me, what feels like a big culture change around this topic in the last five to 10 years. I’m all around youth athletics a lot at this point in my life and the way with which youth sports address this and are super mindful of head injury the way abby. I just feels like there’s been a huge change. I mean I think, I forget who it was, maybe daniel cormier. There was a. There was a very high level ufc fighter. I’ve heard about a couple of ufc fighters who’ve just said that they don’t spar anymore and their training camps just because they want to be super conscious of this. I think I did dartmouth maybe or or some other colleges. They don’t. They don’t hit anymore in practice.

Chris Nowinski: 23:31 They’re recruited on the idea that you will never tackle your teammates know. Really. That’s great. Yeah.

JJ Pinter: 23:37 It feels to me like there’s been a big kind of cultural change around this recently. Maybe. Maybe not as fast as there should be, but I don’t know. What do you attribute it to?

Chris Nowinski: 23:49 No, you can read the chronicLes of this. You can watch league of denial. I mean a lot of that credit has given our team, you know, we were a voice in the wilderness at the beginning, but we were smart and strategic about how, you know, where we created change and so you know, for example, the no hitting and practice like that was literally our idea. I mean Dr. Cantu raise that as the best thing that the nfl players association could do for the players in the 2010 meeting leading up to their collective bargaining agreement, the negotiations. So they learned the players like that’s a great idea. Like we’ve never had to realize that you get rid of probably 60 percent of the exposure if you just changed and so that that’s trickled down. And other sports, we had a very public campaign, we called safer soccer to band, heading in soccer for children before we recommend you don’t hit your kid in the head until 14, but a saw us soccer medicine part way and there’s no heading the lab in the us before age 11, which is fantastic. We literally cutting out billions of head impacts for children for a technique that could help pickup in a week when they’re older and able to actually control their body in a way that makes it somewhat less risky. So we’ve been literally trying to make this a public discussion because it’s in the athlete population, it’s so easily preventable and most of the changes come down to changing how we deal with the millions of young kids playing sports.

JJ Pinter: 25:18 Yeah, because I guess dealing with the athlete is one thing, but really the coaching is where you have to make the inroads, right? Because if the coach is telling you that it’s not a big deal, you know, as a young athlete you’re going to try to please your coach. And just I guess educating at the coaching level is probably more important I imagine, than than the athletes because kids are fairly docile maybe. Yeah.

Chris Nowinski: 25:45 Good point. I’m going to bring you into another program that we do that I’m now that I know that you’re a big time coach and I need you to bring and I want to see video of you doing this. We launched a new program two years ago called team up speak up, so you now know that there’s laws in every state that every coach has to be trained on and most of them are also training their kids on compassion. Although what we’ve learned is that it’s really hard to teach a kid what a concussion is and it’s really hard to teach a kid who’s had a concussion to raise their hand and pull them out of the game. Like it’s a lot to ask of brain injured ten-year-old. The one group that we’ve never asked to help us is the teammates and so we created a program called team up speak up to literally require the coaches say to their team in a team meeting a, we’re a team and that means we look out for each other and a teammate with concussion is need your help.

Chris Nowinski: 26:37 I may not know they’re hurt and it’s your job to speak up to an adult coach and athletic trainer if you made suffered a concussion and make everybody promised to do that and help change that culture. And it was inspired by, you know, I never heard that speech when I played in almost no one did for 100 years, but it was actually founded in the 19 oh, five diary or harvard football coach who was 19. Oh, five was telling his players to call a timeout if we thought a teammate is a novel and we stopped doing it and now we’re bringing it back. So are you in.

JJ Pinter: 27:08 So this is really pertinent to me right now because you have some of the more traditional sports like you know, soccer that obviously in there they’re not heading the ball at all. My kids aren’t involved with football, but they’re very involved in wrestling, amateur wrestling, freestyle wrestling at. They’re very mindful of kids getting dumped on their heads. But baseball, it’s like still the outlier. These kids start new, they make the transition from machine pitch to coach pitch when they’re, you know, seven, eight years old, nine years old. And these kids are super wild. They can’t control the ball and kids are getting popped in the head every game, multiple kids and it’s just kind of like hey, you know, the crowd gasps and then they take their base and you know, you look to see if they’re crying or not. But there’s, there’s really no, they have helmets on obviously. But like there’s no intervention systematically at all that happens there. And so that’s probably a great place to start, you know, maybe talking to the first baseman to say, hey, why don’t you talk to this kid when he comes down here? Like the coaches should be doing this as well, but having not only be your teammates but other. It could be the other team as well. I think that’s maybe a great place to start.

Chris Nowinski: 28:22 Well, yeah, you know that. That’s a great point. I actually talked to some folks in major league baseball who want to help us out programs and that’s a. What you’re talking about is sort of standard care. Like we actually hopefully should be at a place where if a kid does get hit head and chose any, any sign or reports, any symptoms, they should be pulled and they should not be playing. And if you have a medical nurse and they’re good, have we evaluated for. If you don’t, don’t take the risk. Right? It’s, it’s a brain is too fragile, but we’re more thinking about like we have actual stories and actually we have a brain and the brain bank have a young lady named rowan. Rowan strayer and rowan was a rugby player, so 17 years old. Had a concussion in the game that she was pretty sure she had, but she didn’t report.

Chris Nowinski: 29:09 It didn’t go to medical person but told her friends about and we had a had a text exchange before her next game saying that I still don’t feel right. I’m not sure what to do. And they agreed over text, yeah, you probably shouldn’t be playing, but the team needs you. So tell everybody after the game, and then she went out and played and she got hit in the head and she died of second impact syndrome, which can happen. It’s not fun all the time, but it happens a handful of kids every year that you get, you get a hit after with an unrecovered concussion and for some reason your brain just swells and you die. And so that’s the kind of thing we’re trying to prevent. If your friend tells you they’re not right or if that kid says, my head hurts, like they’re out, they are out because that’s your kid. A kid can barely verbalize a problem. So they tell you anything about their head nephew.

JJ Pinter: 29:55 So we’ve talked about kids a lot. I want to move into talking about adults and stigma maybe. I’ve never been a professional football player so I can’t speak or a college football player, so I can’t speak about that, but I have been in the army and I know lots of athletes and there’s this disconnection. Maybe when. I’m sure there’s some psychological term that I’m not sure here, but you know when you’re talking about someone else versus taking care of yourself and the stigma around like letting your team down, so on and so forth. That causes people to do things that are really illogical. Right. So if, if this, if something happens to a to another member of a team, something that you would step up and say, hey man, like you need to go get some medical care, but you will ignore that in yourself because there’s some kind of stigma around being seen as weak or being seen as letting the team down and that seems to. Maybe it’s getting better, but that seems to still be there. That’s. I know it’s a super high, like a very broad platitude, but I’m interested in from your perspective, like if you see that as well and just what’s the way forward on that? Is it just education with, do we just have to wait this out? Do we have to educate kids and just kind of like, you know, this is a terrible question because it’s not formed very well, but I maybe. I think

Chris Nowinski: 31:17 you get what I’m saying. Yeah, I totally get what you’Re talking about. You’re talking about that self sacrifice, that instinct to do, to destroy your, your yourself for your team and for your cause and we all have it and it’s amazing like even mean this story that helped me appreciate how strong that is is, you know, I, I’ve, I’ve done that my whole career. It’s sort of embedded into the sports culture and military culture. You take one for the team, you don’t come out of the game if you can help the team. It’s not about personal interest. And so this was like six years ago. I’m playing, you know, my head’s finally feeling good playing pickup basketball with nine other guys and I get clocked in the head and it was a shot, like everyone sort of stopped because they know my history and I stand there for a second.

Chris Nowinski: 32:08 I sort of opened my eyes pretending like I don’t feel anything. I think I’m fine and I know how hard I was hit. I definitely should have just said, hey guys, we’re done. I’m done. But I said, you know, I’m going to keep going because I didn’t want the guys to play four on four because that was. So this basketball game in our mid thirties was so important. So I stayed in and I just started deteriorating and, and I made it worse. And then I look, I’m driving home and I’m starting like bri for no, like arguing with my wife about breakfast. I have a total meltdown by the time I got home and I knew better and I literally couldn’t pull myself out of a pickup basketball game. So you think about that’s how strong that pressure isn’t that culture is. And so I think the answer is, you’re right, we do have start training.

Chris Nowinski: 32:55 You have to start training and educating people from day one that, that, that self sacrifice makes sense at times. I think there’s that hurt. Are you injured, are you willing to pay through play through pain? And the question that we’ve always asked is, you know, can I make it worse or is this going to hurt you long term if you actually have someone to ask, and if it’s no, then you go back out there and we have to teach people that head injuries are one of those things. You can’t feel how bad it is, but it’s bad and you have to teach them that. You cannot sacrifice your, your brain for this. You’re no good to the team when you’re out there with a brain injury.

JJ Pinter: 33:28 There’s a guy you might even know him. Uh, I did a podcast with him a few years ago and we did, we can tell about the friendship actually in. His name’s Michael Rodriguez. He’s a, he’s a former green beret. Are you aware of his story?

Chris Nowinski: 33:40 Uh, no. I’m sorry, I’m not.

JJ Pinter: 33:41 He’s a fantastic guy and was one of the people that was painted by president bush in the book that he did recently, but his story is very similar and you know, because he’s kind of said this on the podcast, I feel comfortable sharing it. you know, essentially he’s on a special forces team, series of head injuries. He’s a medic actually, so he knows better and he is and he is actually sending people, his teammates, he’s sending them home to get treatment when they’re having head injuries, but he had a series of them over a few years and hit it, hit it, hit it, because he didn’t want to feel like he’s going to let the team down to the point that he started having seizures and he couldn’t hide it anymore. It was so bad and led to a really long hard recovery that I think he’s still fighting through, but just he’s like the most selfless person you’ll ever meet in your life. and it was just, you know, that’s just kind of the classic story where he just didn’t want to feel like he was letting the team down. But intuitively he knew the right thing to do because he was a medic and he was to other people, you know, he was, he was forcing them to get treatment.

Chris Nowinski: 34:48 That sounds familiar, although that’s, it’s unfortunate, but it’s even more powerful, I’m sure in that culture

JJ Pinter: 34:56 you’ve brought up the brain bank, uh, several times and I think I know what that is, but I’d like to talk about that a little bit and what it is and if you’re trying to grow it kind of what the goals are there. Would you mInd sharing that a little bit?

Chris Nowinski: 35:12 Sure, sure. Yeah. I had really never heard those two words put together until I got into this world. But a brain bank is basically a collection of brains for research. And one of the things you don’t always appreciate is that, you know, a lot of the foundational understandings of any brain disease or brain injury is actually done from looking at the brain post mortem because we can’t scan or image or x ray really the microscopic damage or the more interesting things that are happening within the brain that caused a problem. And so, you know, Dr. Mckee and our braIn bank, she runs multiple brain bank collections. Uh, she runs the va, als springbank, she runs the framingham heart study brain bank. She runs a brain bank of people who lived to 100 years old. And so we added this, this brain bank focused on people that have been exposed to head impacts about things and veterans.

Chris Nowinski: 36:06 And, and what we’ve learned is that it has been an enormous accelerator of research. So if you’re trying to jumpstart a research field, proved there’s a lot of cases at the beginning, you know, it was sort of like, okay, there were two, then there were three than there were four. And boy the first four were all positive. I wonder what’s going on here? And then suddenly, you know, I, I used to call like guy, I still get approval. There’s every morning on certain keywords that helped me track down who’s passed away overnight. And I used to spend like my mornings finding people and calling them. Luckily the awareness of the brain bank has changed so much that most families are calling us. And then we also started a program for getting athletes to pledge their brain and so that helps raise awareness and it makes it.

Chris Nowinski: 36:50 So I write all of that. So we’re up to almost 4,000 people pledge to donate their brain, which is great. So is this something that the listeners of this podcast, I mean, are you trying to actively recruit people to pledge to donate their brain? Yes. And in fact, you know, we just launched a new initiative, so you know, again, I mentioned earlier, you know, very few of our brains, our, our, our military veterans and that’s an area that was very under researched. so it’s the more research we get, the faster we can understand why pathways towards potential prevent, the faster we can understand how to diagnosis living people. How many people might actually have thiS. And so, you know, we, we, because of that relationship that we’ve built with hero foundation actually helped us give us the seed funding to start this new campaign. We’re calling project and list to get a, to raise awareness of this project into a encourage more veterans to sign up, to pledge their brain to this research to continue to create that awareness of, if one of us does, it’s not that I want someone to have pledges to sign up and then pass away with a really the game here is creating awareness in, in, in these networks, when you deal with community networks, it’s very awareness so that if you do unfortunately lose somebody that you might think about brain donation, um, while you’re dealing with the unfortunate things that come with losing during that terrible time of grieving.

Chris Nowinski: 38:13 And, and it’s been an effective strategy. We’ve actually, the last two years we’ve doubled the number was since we started asking for pledges, doubled the number of grains we’ve gotten 50 to 100 to 200 this year. So we just launched the campaIgn quisha part of the national hot rod association to make it, uh, to get more media interest in it. But we had a tremendous roster of veterans sign up right away. If you want. I get a gang at the list in front of me if you want to go. Yeah, go for it. But you know, gary lay these, you know, these are guys I’m getting to know very well and I’m sure are known for gary, Michael Wilson, former seals, jason redman, Alexander Oliver, morgan latrelle all signed on as sort of our first class of project list. And then we’re, we’re, we’re sort of partnering with these groups to do the same. By the way, I don’t know. I haven’t asked you yet, have you considered signing up?

JJ Pinter: 39:10 No, but I’d be completely, uh, I could be completely down with it. And that’s a perfect segway. So here’s a couple of things that’s actually a perfect segue to what I was going to ask next because a, I’m going to put the link to project enlist in the show notes. So if you’re listening to this and you want to find more information, just go to the show notes on this episode. But here’s the question. So I think I probably got when I was younger, playing football got banged in the head a little bit, but I think I don’t have, I believe any brain injury at this point in my life and in the past historically when you’ve heard about people donating their brains, it’s been trying to think of how I want to put this. It’s been people who are very symptomatic, right? I think maybe like kenny stabler is someone who comes to mind. So I guess is this something who’s for everybody? Like are you guys looking for people with certain backgrounds, certaIn demographics or the control is you know, in, in any kind of science that you do, the control is just as important as the group you’re trying to study. Is this just trying to cast as wide of a net as possible?

Chris Nowinski: 40:14 We are where we are. We want everybody to sign up and there’s multiple reasons why. One is we Actually do need more controls because the research has accelerated so much that we’ve actually had a good bank of controls to star that’s startIng to diminish and realize that we aren’t replaced him as passive studying them. So we want more controls. We want more awareness. So, so you know, I can’t promise that everybody who signs up will eventually have their brain studied because our criteria changes over time as research interest in funding, but we want everyone to, to, you know, make that pledge to sort of raise awareness of the program. But the other reason Is that this becomes our research registry on studies of living people. And so what I’ve learned is that if you’re willing to give your brain, you’re also willing to be part of the reason we use this list to do all those other important studies that we do to try to diagnose and treat this disease and living people.

Chris Nowinski: 41:08 And then also when you pledge, you also get on our list of all the information that we’re learning. We just, we is probably also be interesting for your listeners is that we’re putting out new cte resources for people that are concerned. They might have the disease every week with interviews with our doctors, were the interviews with people who might have it to try to show that it doesn’t, you know, we hear what the doom and gloom and we hear about people taking their lives who are diagnosed with it, but the message there is you can actually still live a very good life with this disease and we want you to help you live it as long as possible. Even if you’re concerned about it. We don’t want to get brains through suicide. What we want to do is help identify people who are in need and get them the support they need and help them push this disease in context. I mean, I think it’s based on what we’ve seen in the people who hit their head as much as I have. Like there’s a very, very good chance I have this, but I’m not living my life dwelling on, you know, is the shoe gonna drop next time I’m focused on can I use the, you know, basically I’m still enjoying my life, but can I use the time I have to help accelerate treatment whether it’s me or somebody else I care about. And so, uh, I turned that concern and forward progress.

JJ Pinter: 42:20 This might be a really silly question, but I’m already an organ donor and I just assumed the brain is an organ that if you do that, it’s your brain. I know that obviously we’re not doing brain transplants, but I assumed that it would be available for scientific study. Is that not the case?

Chris Nowinski: 42:37 It is not the case. So, and again, something I learned once we got into this organ donation is all about life saving. And because we can’t do brain transplants, it doesn’t qualify. SO all brain donation has to come through research, separate whole separate system. And so you have to activate your, your neck can actually make that decision. Final reforms. It’s not actually your choice. so if you do choose to pledge also made, we’ll send you the brochure and a brain donor card and they’ll say, make sure you tell the people you love that this is, these are what you’re wearing,

JJ Pinter: 43:09 I’m in. So send it to me and thank you. I’m happy to do it. Happy to help. One of the scariest things that has ever happened to me in my life happened about four months ago. One of my sons who’s a second grader at the time was playing kickball at school and we live in a fairly tight knit community. My wife’s a teacher so we know everyone at the school, you know, you know, you know the, the principal, these are, these are our friends and you know, you get the standard phone call sometimes from the school. It’s like, oh well your son likes grapes, you know, when you and let you know and like scraped his knee or something and he’s bleeding a little bit and I get the phone call in may and which they never called me. They called my wife in the school called and said your son was playing kickball.

JJ Pinter: 43:53 He hit another kid head on bad and yoU need to get in here now and that’s a scary phone call to get and did. They had both blacked out and he ended up having an having a concussion and we had to do like the low stimulation environment, all that kInd of stuff. It was terrifying. So he, you know, he basically had, he was playing little league at the time. He stopped playing sports for a couple of weeks and what was so tough about it is that, you know, he’s like, you know, got banged in the head as this huge, huge knot on his head and we’re trying to like get him to heal. And he’s saying, am I in trouble? Am I being punished? Like, you’re not letting me play baseball with my friends. Like I can’t watch. Like I can’t read. I can’t do all these things. Like, what did I do wrong? And you’re like, dude, I know that this doesn’t make sense to you right now. And I say you, but you just have to trust me on this. You’re not being punished and we’re just trying to make you as healthy as possible, but it was terrifying.

Chris Nowinski: 44:46 Yeah. I feel for you. That’s why we’re so focused on prevention. It’s just because, you know, luckily most kids recovering from concussions are fine, but sometimes they don’t. And yeah, I guess when you see it up close it does. And your kids become somebody else for awhile. Those scary. So he’s lucky educated parents who you know, dId that because we still have to educate parents that think the sports are more important than they really are.

JJ Pinter: 45:10 And he had, he had educators, the school nurse, the principal, they all acted super appropriately and so I have to commend them as well because they were great in the situation in, in like really taking action. So a couple more quick questions and then we’ll let you go here. But the hallmark of a good podcast is when I look at the clock and it’s like, oh man, where did the time go? So I’m gonna ask you a couple of, I guess maybe a little bit more difficult questions. One of the challenges that we see in the veteran community is that you come across people who you think you know, you, you look at them and you interact with them and you say something doesn’t feel right here, but that can be a really difficult conversation to have with someone to approach them and say, hey, I think you might have, you know, I think you met, we need to help you get treatment. You might potentially, you know, the, we think you might have tbi, whatever. Is there a way that you recommend talking to someone if you have someone in your life who you think might have suffered from some kind of brain injury but they are either unaware or ignoring it?

Chris Nowinski: 46:13 That’s a really hard question.

JJ Pinter: 46:16 It’s a hard sound. It’s a really hard conversation to have and this. That’s why I’m wondering if you have any suggestions.

Chris Nowinski: 46:22 That’s interesting because I, you know, I’m not a clinician, I’m just a research scientist so I don’t have to go into my daily life and the reality is my daily life, everyone’s always coming to me saying, I think I have a problem, right? There aren’t that many people around who who don’t think they do and I think, you know, so I, I literally had to tell you this isn’t necessarily medically approved advice, but I think you have to come at people for my book

JJ Pinter: 46:48 I just said to one of your football teammates, I guess is a way to say it and I know if you know now

Chris Nowinski: 46:53 or acute concussion or are we talking about somebody showing cte issue?

JJ Pinter: 46:57 You know, I don’t know because I guess maybe a lot of people wouldn’t know the difference, but you know, if you’re around someone who is off and you can tell they’re off, I’m like, how would you approach that? I guess

Chris Nowinski: 47:09 let’s choose everywhere. So I guess if you’re talking about, I can, if you know someone just recently got a hit to the head and they’re not their selves and this happens all the time in sports. I treat them like I treat someone who’s drunk and trying to get. You get the keys to drive home. Yeah. You just take the keys. You just forced them like you, you will have a brain injury, you have a year, you’re not yourself and I can’t let you put yourself or other people at risk. And I think that that’s how I deal with people when they’re, when they’re acute, that I. And I will, you know, I’ve nearly gotten into fights with people trying to prevent them from driving home or, or doIng something dangerous. I would say when you’re dealing with somebody who you’re worried about that they got hurt years ago and now they’re changing.

Chris Nowinski: 47:49 That’s a much more delicate question because a lot of times they don’t know if they know they’re changing as much easier if you can. If you can engage a conversation, we get them to acknowledge I don’t feel as good as they used to. I don’t feel like the same person. Then the answer’s very easy. You say, look, that’s okay, but you can if you actually, there’s people who could help you feel better and maybe get back to the person you were and. But that takes treatment and you have to be willing to go see a doctor and that’s often a very hard thing to get people that were willing to go see a doctor and then it’s hard sometimes to find a doctor who has that bedside manner and that that, that a skill set to get them better. So I would always encourage people to reach out to us a confession foundation.org if they need a referral to somebody who understand this sort of issue. The hardest group is those who are in denial or don’t realize that don’t want it, is not great advice other than, you know, over trying to open the door that conversation or working through loved ones who they trust to say, we’ve noticed some changes in you that we’re concerned about. We wanted to see if there’s ways we can help.

JJ Pinter: 48:51 Awesome. Yeah, that was her. I think a lot of times if people know that you care about them, you know, I think that goes a long ways and if you can just catch the conversation and saying, hey man, I care about you. I want to have this conversation because I want to. We’re doing it because I care about you and I think we need to, you know, generally can, can be helpful if. AnD now If this is too personal a question, please, please just tell me. But you know, you’re, you’re about to have your first child. I have three young kids and I think about this all the time. You know, there’s, I think that so many life skills come from playing sports, like learning how to be a good teammate and learning how to lose, learning, how to work hard, all of these things. But there’s downside to certain sports is we’re, we’ve been talking about today. Are there supports that you at this point that you wouldn’t let your kids play?

Chris Nowinski: 49:38 Well, that’s not personal. That’s so straight policy question. I’m very vocal. Do not enroll your child in a sport where they’re letting their kid get hit in the head over and over again. What? It’s entirely preventable. So that means, you know, you don’t. I mean, most of it’s been changed though. There’s no heading in ice hockey anymore. Sorry, don’t check in until you’re 13. Now. Probably even go higher because they’ve been buying that culture. That is not a skill you need to learn. Young soccer is the same way. Never I would argue with your own kid. Never throw a projectile in their head and ask them to hit it back to you until they’re at least in high school. Uh, and, and I would say never played tackle football until High school. It’s insane. I wouldn’t play tackle rugby. I wouldn’t, I wouldn’t do mixed martial arts.

Chris Nowinski: 50:22 These things are not appropriate for children. And if we can just get the world that will have a much safer place. I agree that sports are amazing, but we have to separate sports from hits to the head. The sports don’t have to have his head. This is our choice as belts. We’ve tried to shoehorn a lot of adult money sports into kids’ sports with the same rules and that’s insane, you know, we’re tackling and football for the entertainment value, so we would make billions of dollars. We don’t need the same thing. And so I feel very strongly about that. It’s not always a popular position, but my, it always falls back to do not hit your child in the head and do not let anybody else take your child in the head. The brain is developing, especially when they’re young. To me

JJ Pinter: 51:06 it’s interesting because been around youth sports a lot. Football is kind of getting a bad reputation now. This is purely anecdotal so I want to make sure that I’m 100 percent saying that. So like with, with the people I know that are involved in youth sports, football is getting a bit of a bad reputation and people are just saying like, the risk is not worth it for me. like I’m just not going to let my kid play no matter what. It’s like smoking in the seventies. Right? People did it before they knew how bad it was and people are just saying, well, well, we’re not going to start and just there’s lots of other options out there, so.

Chris Nowinski: 51:38 Well I will. I’ll just clarify that. I’ll say football, this isn’t an attack on the game. We were really trying to save it so it can go on and exist, but football’s got a bad rap because the nfl truly played the role of big tobacco to a t and denying this problem existed in funding research that was meant to be it. That was badly designed. So football is fighting an uphill battle because of bad leadership, but I know the people who are doing coaching it are doing it because I think it’s what’s best for the kids. And so we, we, we admire when people are willing to give their time to the kids, but this is one small change, you know, can transition kids from tackle to flag. That really is a great move and if you’re not convinced yet and reach out to us and we’ll show you the data.

JJ Pinter: 52:21 Awesome. Crystal, I want to ask you two more quick questions that I’m going to let you go and I want to end with a couple of things that are a little bit fun because I personally like this kind of stuff. I told you my favorite professional wrestler when I was a kid earlier produced the barber beefcake.

Chris Nowinski: 52:35 I want to know who yours was

JJ Pinter: 52:37 and I know you said you didn’t watch when younger guy who’s favorite old school wrestler.

Chris Nowinski: 52:42 No, I no longer answer that question because I don’t want to.

JJ Pinter: 52:45 Oh, you have coworkers so you see you to be careful.

Chris Nowinski: 52:49 One of my great joys is that like some of those, some of these legends who I worked with and even I didn’t work with an output, you just worked me into the show to give, given my guy that they’d given this guy frank died. And uh, so I, I appreciate and respect everybody for what they have accomplished. There are certainly icon fields trail, but I, I, I’m going to politely decline so I don’t offend any one of these guys who are. I’m trying to help.

JJ Pinter: 53:20 That’s probably a wise position. I didn’t think about that one when I asked it. You have a very position, you know, there’s a really interesting. You probably have seen this. There’s a video of a. It’s a yoga video, you know, diamond dallas page is the yoga of a. Have you seen this kind of video that went viral about five years ago of a veteran who couldn’t walk and kind of started on the ceo. Good journey with him and you know, is.

Chris Nowinski: 53:45 I think I have. Yeah. No. Has been terrific with that.

JJ Pinter: 53:49 Yeah. And anyways, it’s been a, it’s been a pretty cool story. So there’s kind of a cool connection to the military there. So. All right chris, well I’m going to let you give a huge thanks for your time. Anything we missed? Anything that you want people who are listening to this podcast, you want them to know, do hearsay

Chris Nowinski: 54:04 well, I want to thank everyone who served for their service and let them know that, you know, we’re, we’re out here trying to, to understand this young, what all these heads down in these blast injuries. You know, we’re here to be a resource for folks. We have a great deal of expertise and so we want it needs anything. Literally if you have questions you need to learn more and you dr girls, so that’s why we exist.

JJ Pinter: 54:33 Awesome. Well thanks so much for your time. Thanks for all you do and this has been a fantastic conversation. I know people are going to love it. So huge thanks. And we’ll, uh, we’ll see on the high ground. I appreciate it. Thanks for your brain.