Football in the news: The Super Bowl and CTE

Football has been in the news recently, and not just because of the Super Bowl. In the past few weeks, it has been reported that several former NFL players suffered from brain injury as a result of concussions sustained over years of playing. Some players have even retired early in their careers in an attempt to avoid such injury. Far from being an NFL problem, the issue of sports-related concussion is something that should concern young athletes who play football and other sports, as well as coaches and parents. This is the topic of my Health & Fitness column in the Aiken Standard this week.


Football, especially at the professional and college level, has long been known for violent collisions. An obvious concern is that players could sustain a career-ending injury and head injuries, including concussions, are particularly worrisome. In particular, repeated concussions can cause a degenerative brain disease called chronic traumatic encephalopathy, or CTE. The recent motion picture Concussion brought this issue to the attention of a wider audience, but many sports medicine professionals have been aware of this problem for years.
A concussion is caused by the brain moving forcibly inside the skull as the result of the head striking an object (another player or the ground) or simply the head moving violently without hitting anything. Because of this, concussions and sub-concussive injuries can occur even when an athlete doesn’t lose consciousness or appear to be injured. This can put athletes at increased risk for multiple injuries in a season—or even in a single game. This last part is critical, because much of the permanent damage comes from a second concussion sustained before the first has healed completely.
New rules banning helmet-to-helmet contact are part of an effort to reduce the risk of concussions. Off the field, players are subjected to special screening to detect concussions, assess recovery, and determine if it is safe to return to play. Improvements in equipment, including helmet technology that can monitor potentially concussive hits, may also help reduce the risks of serious injury.
Despite these efforts, some experts believe that football is simply too dangerous and have called for tackling to be banned. These concerns are more frequently expressed when it comes to youth football. The evidence that accumulated brain trauma sustained by young athletes can have immediate and lasting effects has lead some communities, schools, and even whole states to consider banning tackling in youth football.
This is complicated by the fact that other sports also have a high risk of concussion, including hockey and soccer. In fact, heading has been banned in some competitive youth soccer leagues. And there is the fact that all sports have some risk of injury, including concussions. Furthermore, youth sports, including football, provide a great many young people with opportunities to be active, promote growth and development, enhance academic achievement, and have fun. The effect of banning tackling in football or heading in soccer on the health, social, and educational opportunities for young athletes is unknown and should be considered.
Whether policies like these are practical or not remains to be seen. In the meantime, there are steps we can take to make all sports safer for young athletes. We should make sure that coaches are educating players how to compete as safely as possible instead of emphasizing winning at all costs. We should also advocate for having certified athletic trainers at all games and practices to teach players safe techniques, assess and treat injuries, and ensure appropriate return to play. Most of all, we should be mindful of the risks of playing sports while encouraging kids of all ages to be active, play, and have fun!

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Exercise is an effective, but underused, treatment for depression.

You probably know that exercise is good for your physical health. A lower risk of weight gain, diabetes, heart disease, and some cancers are among a long list of positive health effects of physical activity. Lesser known benefits include improved mental health, cognitive function, and greater feelings of wellbeing. In fact, research shows that exercise is an effective way to prevent and treat depression, which is the topic of my Health & Fitness column in the Aiken Standard this week.

Yoga class

Depression has been in the news recently following the release of new guidelines for the screening for depression in all adults, especially women during and after pregnancy. Considering that depression affects almost 15 million American adults and is a leading cause of disability, diagnosing and treating depression should be a priority. Unfortunately, the effectiveness of common depression treatments, including antidepressant medication, is questionable.

It turns out that exercise is an effective, if underused, strategy to treat depression. Exercise itself has been shown to be as effective as some medications for reducing depression symptoms. More commonly, exercise is used in addition to other treatment strategies, including antidepressant medication, increasing the effectiveness of those therapies. One study showed that exercise can reduce depression symptoms after just 10 days, even before many medications are effective.

It appears that both aerobic and resistance training are beneficial. It is also possible that social support experienced through group exercise is important, too. Additionally, where the exercise is conducted matters and exercise outdoors, especially in nature, can be particularly beneficial.

Indeed, activity outdoors leads to enhanced feelings of energy and diminished fatigue, anxiety, anger, and sadness compared to similar activity conducted indoors. In one study, people who walked in a quiet, tree-lined area had greater improvement in mood—they felt happier—than those who walked along a busy street in an urban area. The researchers also completed brain scans to determine that the difference in mood was related to changes in blood flow in the brain. Additionally, some research suggests that outdoor activity may improve attention in adults and children.

The good news is that almost any indoor exercise can be moved outdoors. While walking, running, and cycling are most obvious, resistance training exercises using body weight and many high-intensity interval training workouts can be modified for outdoors. Yoga and aerobics classes in the park are also great ways to promote both the physical and psychological benefits of exercise.

Much of the psychological benefit of outdoor exercise occurs in the first five minutes, so even short bouts of activity are meaningful. It also means that going for a short walk outside when you have a break at work or walking instead of driving short distances can have positive effects. At home, taking the dog for a walk, playing outside with the kids, or doing yard work are good ways to be active and reap the benefits of being outdoors.

Every little bit of activity you do outdoors will have both physical and psychological benefits to help you become and feel healthier. So, get outside and get active!

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Follow the new Dietary Guidelines for Americans? Would if I could.

The most recent update to the Dietary Guidelines for Americans was released earlier this month. This is the latest attempt to provide us with information about what we should eat—and not eat—to stay healthy. The new guidelines, and why they may be difficult for many people to follow, are the topic of my Health & Fitness column in the Aiken Standard this week.

Good food display

Like past updates, there is some debate about the recommendations in the current guidelines. Uncertainly about the role that specific foods and nutrients (saturated fat, for example) play in promoting health and political influence from segments of the food industry are causes for criticism of these guidelines.

Despite the controversy, the guidelines do provide some good advice for us to follow. For example, they recommend that we eat a variety of fruits and vegetables, something that almost everyone agrees is healthy. Refined and processed grains should be limited in favor of whole, unrefined grains. Furthermore, added sugars should be avoided. There is good support for these recommendations, and the distinction is a welcome one. The recommendations for fat are a bit less clear, but the guidelines steer us toward “healthier” fats from plants, including nuts and seeds.

No doubt, everyone could experience some health benefits from eating more fruits and vegetables, favoring whole grains over refined, and limiting the consumption of processed foods containing added sugars. In my mind, the problem isn’t the recommendations themselves (although I might make some changes), it’s the fact that following them is challenging, if not impossible, for many people.

First, access to fresh fruits and vegetables is limited for many people, either by availability or by cost. The well-meaning advice to shop the perimeter of the grocery store avoids many of the unhealthy processed foods that are found in the center aisles of most stores, but it also results in a cart filled with more expensive produce, dairy, and meat. Many people simply can’t afford or shop this way, so the prepackaged, processed foods and meals are practically a necessity.

Second, making smart decisions in the grocery store and in restaurants requires that you have some nutrition knowledge. At the very least, reading food labels is essential. Unfortunately, the “label language” used to make nutrition claims on the front of packages and the less-than-complete information on the Nutrition Facts panel makes this challenging. Claims like “fat free” and “no high-fructose corn syrup” may seem to indicate a healthier choice, when in reality these foods are often no better than the alternatives on the next shelf.

Even though interpreting and following the new Dietary Guidelines for Americans can be challenging, it is still important to try. Making real food, as opposed to processed, prepackaged “food,” your first choice whenever possible will go a long way toward making your diet healthier. This will certainly involve putting more thought into what you eat, and you may find yourself preparing more meals at home rather than eating out.

And try not to worry too much about the debate about which foods and nutrients are the healthiest. If you select food that is as close to its natural state as possible you are likely to make good choices. For example, choose plain beef, poultry, and fish as opposed to flavored, cured meats. The same is true for dairy products like yogurt—watch out for lots of added sugar!

Regardless of what the current and future Dietary Guidelines say, you should strive to follow advice of author Michael Pollan: Eat food, not too much.

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Is obesity all in your gut? A NYTimes video

This is an interesting video about how the bacteria that live in our gut may be linked to chronic health conditions, including obesity. In many ways, our gut bacteria may be the missing link between what we eat and our health. It’s certainly worth a few minutes of your time to watch!

Is there a hidden cause of obesity? A professor at Stanford thinks the answer might lie with the 100 trillion microbes living in our bodies.

Source: Is it All in Your Gut? – Video –

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When fat attacks! Use your muscle to fight back.

Everyone knows what fat is. It’s where the extra calories you eat end up and the reason your clothes fit too tightly. But beyond that, it doesn’t do much, right? While fat, or adipose tissue, is a place to store excess energy, research shows that it also plays an active role in health and disease. In fact, your fat may be keeping you fat! The good news is that weight loss and regular exercise can reverse the negative health effects of excess body fat. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Adipose tissue

Body fat is essential for storing extra energy, something that allowed our caveman ancestors to survive times when food was scarce. But fat cells have important biological functions beyond storing extra energy. It turns out that fat cells release chemical signals called adipokines that have effects on other organs and tissues.

For example, type 2 diabetes is strongly linked with obesity. Type 2 diabetes is a condition of high blood glucose caused, in large part, by cells not responding to the hormone insulin. Resistin, which is produced by fat cells, has the effect of causing insulin resistance in the liver and muscle, the two major places where excess glucose is stored. The result is high blood glucose, the hallmark characteristic of diabetes.

Fat cells also secrete adipokines such as leptin and TNF-alpha that promote inflammation and abnormal function of blood vessels. This is associated with atherosclerosis, the development of cholesterol-containing plaques that form in blood vessels. These plaques may be unstable and rupture, leading to clot formation that causes a heart attack. This is one reason why obesity is a major risk factor for cardiovascular disease.

The hormone leptin also plays an important role in regulating body fat stores. Leptin signals the brain about the amount of fat stored in the body. When body fat stores decrease, leptin stimulates appetite to increase energy intake and storage as fat; when body fat increases, appetite is reduced.

At least that is the way it is supposed to work. The effect of leptin on appetite is only a suggestion, and it is easy to eat despite it. The result is excess energy intake which leads to obesity. Worse, the brain develops a resistance to the high levels of leptin produced by the excess body fat and establishes a new “normal” level. When someone loses weight and leptin levels go down, the brain responds by increasing appetite. Is it any wonder why losing weight and keeping it off is so difficult?

The good news is that losing weight and body fat, no matter how difficult it can be, can reduce the negative effects of these adipokines. The even better news is that exercise can reverse some of this damage, even if you don’t lose weight. The reason is that, like adipose tissue, muscle produces chemical signals, too.

These myokines also have beneficial effects include improving insulin sensitivity and reducing inflammation. This is one way in which regular muscle activity (exercise) is thought to promote good health. Myokines can also counteract the negative effects of adipokines by creating a balance between the two opposing effects.

In fact, the myokines that are stimulated by exercise can have a greater effect than the adipokines. This helps explain why being obese but physically fit may actually be healthier than being a normal weight but unfit.

The bottom line is that excess fat is unhealthy and we are starting to understand the mechanisms that explain why. Losing weight is important for improving your health. And exercise may be even more important, so you should strive to be more active regardless of your body weight

If you want to learn more about the role of adipose tissue on health, these two articles are a good place to start (fair warning–they are high-sci):

George Ntaios, Nikolaos K. Gatselis, Konstantinos Makaritsis, George N. Dalekos. Adipokines as mediators of endothelial function and atherosclerosis. Atherosclerosis 2013;227(2): 216-221.

Coelho M, Oliveira T, Fernandes R. Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci. 2013;9(2):191-200.

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Friday video pick: Be carb smart.

Nutrition can be confusing! Depending on the day, individual nutrients and whole foods may be good for you…or really bad. This is especially true for fats and carbohydrates, the major sources of calories in our diets. I have written about carbohydrates previously, but this video can also help you become carb smart!

How do carbohydrates impact your health? | via YouTube

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How washing your hands, going for a walk, and getting enough sleep can make this a healthy New Year!

Now that the holiday season is behind us and 2016 is underway we can focus on our goals and resolutions for the new year. Staying healthy is essential for achieving these goals, whatever they may be. Unfortunately, the natural spread of cold and flu viruses at this time of year can interfere with your plans. The good news is, there is much you can do to reduce your risk of getting sick, which I explain in my Health & Fitness column in the Aiken Standard this week.


For starters, getting a flu vaccine is the most important thing you can do to prevent seasonal influenza (flu). And it’s not too late if you haven’t gotten your flu shot yet. You can also protect yourself by not touching your eyes, nose, or mouth and by washing your hands frequently with soap and water or using an alcohol-based hand sanitizer. You have probably been doing it wrong, so you may want to learn this song.

Exercise can have a positive effect on your immune system. People who exercise on a daily basis have fewer and less severe colds and have up to 50% fewer sick days than those who aren’t regularly active. Research in animals and humans shows that exercise increases the activity of certain immune cells called helper T cells. This makes the immune system response to viruses, like the cold and flu, more robust. The strongest evidence is seen when the exercise is moderate in intensity and duration, such as a 30–60 minute walk or jog each day.

More exercise isn’t always better, though. Very vigorous and prolonged exercise can have the opposite effect. Athletes who engage in long, intense training tend to be more susceptible to upper respiratory infections. Research shows that immune function is depressed in the weeks leading up to and after running a marathon, resulting in an increased risk of becoming sick. The bottom line is that while exercise improves your immune system, very vigorous exercise may not.

Regular exercise also enhances the immune system response to the influenza vaccine. This means that the flu vaccine can be more effective in people who exercise. If you don’t exercise already, you can still benefit: one study showed that a single 45 minute exercise session can improve the immune response to the flu vaccine. You can get this benefit by going for a brisk walk before your flu shot.

Good nutrition is also important for optimal immune system function. Deficiencies of certain nutrients can have a negative effect on immune function, so eating a balanced diet is essential. That said, there is no support for “boosting” the immune system by taking high doses of vitamins, minerals, or other supplements, despite the claims made by supplement companies. In fact, one supplement company paid $23 million to settle a class action lawsuit regarding false claims that it prevented colds.

You can get benefits from two more common-sense recommendations: getting adequate sleep and reducing stress. Poor sleep habits are associated with suppressed immunity and more frequent illness. Sleep deprivation can also reduce the positive immune response to a vaccine. Another study showed that sleep following a vaccination enhanced the effectiveness of that vaccine. High levels of stress increase susceptibility to colds and the flu and can lead to more sick days from work or school. Stress and poor sleep habits tend to occur together, creating a double negative effect on the immune system.

In order to have your best chance of staying healthy this year you should exercise every day, eat a healthy diet, manage your stress, and get enough sleep in addition to following the traditional advice to get a flu shot, wash your hands frequently, stay away from people who are sick, and stay home yourself if you are ill. As a bonus, many of these habits will also help you lose weight and reduce your risk of diabetes, heart disease, and some cancers along with keeping you healthy this cold and flu season.

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