Your Health Checkup: Athletic Brain Injuries

Even mild traumatic brain injuries can lead to an increased incidence of many diseases, including heart disease, diabetes, and dementia.

Football player being tackled

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“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ books, Ari’s Spoon, a new novel, as well as Bear’s Promise and Damn the Naysayers, A Doctor’s Memoir. Check out his website at

When I was a youngster, my parents refused to let me play football past the little league age that ended with 6th grade. They were so bent on my becoming a surgeon, they didn’t want to take the chance of an injury to my hands. They couldn’t have known that preventing head trauma, not even on the radar screen at that time, was more important.

Today, concussive head injuries are a well-recognized risk in contact and collision sports and represent a global health problem, with an estimated incidence of around 70 million cases per year worldwide (2.8 million in the U.S.). However, such traumatic brain injuries (TBIs), a leading cause of morbidity and mortality, garnered scant attention years ago. New research comparing outcomes in more than 4,000 individuals with TBIs versus an equal number without TBIs has shown that the incidence of hypertension, coronary heart disease, diabetes, stroke, depression, and dementia increased after even mild TBIs and persisted for the ten years of follow up. Changes that could emerge several years after the TBIs were found especially in those younger than 40 years old, and even as young as 18. Individuals who developed multiple post-injury problems had higher mortality during the decade-long follow up.

The researchers concluded that TBIs of any severity — even mild TBIs — were associated with a higher risk of chronic cardiovascular, endocrine, and neurological comorbidities and higher mortality. Helmets and a new neck collar may help reduce injuries. However, the new data raise the question whether the relatively brief screening done following a TBI event is sufficient, compared with a longer term follow up to search for multisystem problems.

The reasons for the changes after TBIs are not known, and other organ injuries sustained in the trauma may contribute. Drugs may also play a role. Some athletes ingest multiple body-building supplements that contain substances at high doses such as testosterone, human growth hormone, amphetamines, diuretics, thyroid hormones, insulin, and anabolic-androgenic steroids, the latter often via injection. Many of these drugs have important psychiatric, physical, and medical risks such as increased risk for mania, depression, cognitive impairment, infertility, liver and kidney abnormalities, and cardiovascular morbidity and mortality.

I have emphasized multiple times that non-FDA approved dietary supplements can carry major risks. Just because something is labeled “natural” does not mean it is safe. A bee sting is “natural,” as is poison ivy. Hence my advice for those who ingest dietary supplements: Caveat emptor. Let the buyer beware.

And, today, we must also factor in changes following COVID infection. A study that compared brain scans before and after SARS-CoV-2 infection concluded that brain changes could be a lingering outcome of even mild COVID-19. The imaging found that infected individuals had loss of brain size and developed abnormalities mainly in areas associated with smell, compared with participants who hadn’t been infected with the virus. Whether athletes with post-COVID brain changes are at increased risk of TBIs needs to be explored.

Health is a precious commodity not to be taken for granted, nor to be found in a pill bottle. Many would rather swallow a pill than change behavior. Yet it is the latter that can most impact future health and is critical to be able to live life free from cancer, heart disease, and type 2 diabetes.

Health is like your bank account: what you put in and what you take out determine its balance. Use it judiciously.

Featured image: Shutterstock

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