Can We Prevent Traumatic Brain Injury & Concussion? w/ Gary "Smiler" Turner (SSOF Podcast Ep. #3)

Gary Turner0:24

But basically, back in the day when I were young, we would just get asked to do things, we'd go out and do it. It's fun. We'd pick up fights. I opened for Arnold Schwarzenegger. I fought for the Arnold Classic. For a week's notice: "Gary, we need you to fly out to Ohio for the Arnold Classic to fight Carter Williams, the USA K-1 champion. When can you fly?" "Wednesday." But it's only Monday. "Yeah, of course I can."

And we just zip off and do it. We fight. There's nothing protected. We just go out there and fight anybody. So my fight career is basically I'm tough and I'm determined, and I would just do what was necessary. So jack of all trades and master of a few. I'd actually say I'm a master of very few skills.

So I've always fought with applied psychology, and whatever the combat sport rules that you're fighting under, applied psychology is always going to give you the heads-up. But also, I do things that people don't expect. So one of my coaches said, "Gary, you just do things that you can't actually do." And then a friend corrects him and said, "No, what Gary does is he makes things work that shouldn't." That's basically it.

So I carried on fighting, and then 2009 I had a tooth implant, and I was 39 at the time, and had a little bone graft, and then the tooth went in. I was like nine months away from fighting. And at 39, I just wasn't getting the contracts that I was getting before, so I kind of retired by default.

And then, being a typical crazy idiot fighter, after that I just went off and started running to keep in shape, and I got a couple of huskies because I need somebody to get me up in the morning and get me exercising. And ended up doing ultramarathons. So did, oh my gosh, eight years, eight, nine years worth of ultramarathons. And now I just train and do what I need to do just to be fit and alive. So that's my sport background.

James de Lacey5:01

So you've essentially gone from one extreme to another extreme, and now you've kind of found the middle.

Gary Turner5:01

Well, interestingly—I know we're going to blend into the scholarly work—but part of, I've got a multi-discipline PhD I'm doing, but the combat sports, for example, so mental toughness, resilience, pain thresholds and such. Combat sport athletes sit top of the tree out of all sports for those attributes.

First off, combat sports attracts people who are naturally like that, but then it develops it and keeps it going as well. If you haven't got it, there's an attrition—you'll drop out of the combat sport. So combat sports are the toughest of all. And then beneath it, we've got combat sport, contact sports, rugby, AFL and such. And then beneath that, you've got more normal sports.

Interestingly, the only people who come close to the resilience, pain threshold, and mental toughness: ultramarathoners. So nine, ten years after I started doing ultramarathons, I now know that for me it was actually a natural transition.

James de Lacey6:04

It's funny because you mentioned the pain threshold and resilience. My wife, she was a six-times karate world champion back in her day. She competed in the CrossFit Games, she's a medalist in Olympic weightlifting at the Commonwealth Games. And it's funny because I always tell her she has the highest pain threshold out of anyone I know, and she's so resilient.

I mean, she's done four or five Commonwealth Games. It took her, I think, four Commonwealth Games that she won the medal—that's like 16 years of resilience. So it's funny how you mention those things, and it kind of ties up really well there.

But I want to go further into your PhD as well, because you're studying—you say it's multidisciplinary—but I mean, I know you're studying high trauma as well. Was there something that happened within, say, your fight career that got you down that road? Was it something, or was it just something you just fell into?

Gary Turner7:04

It was something I fell into. It was one of these chance meetings with extraordinary people. So I got tagged on an online forum, a sports forum, by a friend of mine we used to teach judo to back when he was younger and who's doing his degree. And this professor on the forum had said that in the UK, hitting kids in the head in combat sports is child abuse.

So I got called in. I get known as the Credible Hulk, not the Incredible Hulk, but the Credible Hulk, because I don't speak unless I can back it up, unless I've got the evidence to back it up. And I allow my opinion to change as new evidence comes out or I'm corrected. I prize being right far too great to hold on to things that are wrong. So something's new and that makes sense—oh yes, yet I better change my opinion.

But I got called on there to counter his views because I love my combat sports. So I went online and I found it's Professor Anderson, Eric Anderson—my professor. And I found him incredibly engaging, and he could talk to me on a highly technical level that I needed to understand the ins and outs far better, because this whole social, cultural, medico-legal environment—and he could talk to me on the level that I needed. But at the same time, he could put things damn bluntly for those who need it put damn blunt.

So I went away and I gave myself two weeks to prove him wrong. Came back two weeks later, and I basically had to tell everyone that not only is he right with what he's saying, he's actually understating the situation. He's very conservative with his views here. He's putting it gently to us.

Basically, in the UK, under CPSU guidance—the Child Protection Sport Unit—and all child safety welfare, it's actually illegal to hit a child in the head, even if a child hits another child in sports. It's not been granted legal exception. It's not tested, and it will be coming through. But I can't deny data.

So yeah, we—basically, it was child abuse, and the damage is quite intense. So I started studying, and Eric would send me the odd message and say, "Have you seen this, Gary? What do you think of this?" And at the time, so 2016, he and others in my scholarly team—or who became part of the, who were in the scholarly team that I've become part of, let's get it right—but if I say my scholarly, I'm the—I'm in...

The new kid on the block, yeah. But they were the ones who were challenging whether it was right to allow tackle rugby in schools, different to the community setting when you've got rugby-trained coaches training kids how to play it properly, tackle properly, and the rest of it. And it kicked off in the media and such like.

It was a lot of fun because I saw what happens when data meets passion and how sport looks to protect itself all the way through. So I had all these discussions taking place and I was reading books, I was devouring books, and then Eric started saying, "You ever thought about doing a PhD?" He'd start dropping the seed in.

And in the end he basically said, "Come on, Gary, you got to do it. You want to, you've got the time, you got the space, you've got the availability. You got to do it." So like, "Yeah, but I got my degree back in '96 in building surveying, architecture and stuff. I'm not sure if I'm cut out to go back to the scholarly world."

So he said, "Come and sit in on my lectures. I'm teaching sociology of sport the next semester." So I sat in on three months, three hours every Friday morning of sociology and sport. I loved it so much that I didn't know that I needed to know. It was brilliant.

And yeah, we carried on chatting. And yeah, I'm now doing this multidisciplinary PhD into the behavior effects of repetitive head impacts in combat sport athletes. And to say it covers a lot is an understatement.

James de Lacey11:26

I can imagine, yeah.

Gary Turner11:26

And it's quite interesting because it's not just the knowledge, it's not just the research that we're doing. We're looking to make it usable as well, and we're looking to help improve people's lives. Quite often people say, "Oh, Gary, you just want to ban the sports." I'm like, "I'm trying to save the sports. I'm trying to save you and the sports."

Because we all know what happens. Most of the viewers would have seen Will Smith's film Concussion where he plays the real-life person Bennet Omalu, who found chronic traumatic encephalopathy, CTE, in American football players. And it results in one heck of a lot of kickback from the sports. And basically, quite... I think it's something like over 4,000 now out-of-court settlements, multi-million figures for almost each one, for players.

And it's kicking off in rugby at the moment. I was privileged to chat with Alex Popham, an international rugby player who kind of heads up the players. And I've been chatting also... the first lockdown in the UK in 2020, I chatted with his lawyer as well about it, the legalities of it and the duty of care. And Stephen Schaller-Thorpe, legal scholar, he makes it quite blunt that if you haven't got all these levels of protection in place by the year 2012, if you've not got them, you're now failing in your duty of care and you're open to litigation.

Combat sports are low-hanging fruit. We're dinosaurs. I mean, some of the practices in combat sports are absolutely horrific. And considering that... so my latest thesis chapter is the epidemiology of traumatic brain injury in combat sport athletes. So epidemiology, it's how many traumatic brain injuries we get, how many of us actually receive that.

And the combat sports I'm looking at: boxing, mixed martial arts, kickboxing, and Thai boxing, full-contact striking arts. We got MMA has got the grappling in the mix. But interestingly, boxing and MMA have just about the most head impacts out of everything. MMA just more than boxing, which surprised me because you got element...

James de Lacey13:39

Because a lot of people say, "Yeah, that's the reason then, that MMA has that."

Gary Turner13:39

Okay, okay. Yeah, we just get far more battered on the ground than boxers. We actually get more hits to the head.

James de Lacey14:13

And it's smaller gloves as well. What do you say to the people that say that because of the training... So boxing training, you obviously only throw punches to the head and body, whereas MMA training, you have days maybe where you're just grappling. Does that make a difference, or is this just within the fights?

Gary Turner14:13

It seems that we still get more overall, which is the really worrying part. We literally... we've got sports here where we lead with our heads. If you take boxing and MMA, MMA just slightly highest, and then boxing, then kickboxing, and then Thai boxing very slightly lower. Maybe because of the grappling and things, but the elbows tend to create more acute injuries.

So basically, any full-contact art where we strike to the head, we'll give ourselves a good twatting in the head. It's not good for us. It's highest out of all combat sports, and considerably so.

So in this chapter I looked at, first off, what's the threshold that our brains we've got before we suffer traumatic brain injury? And it's minuscule. We're talking heading a football six times, just lobbed underarm, is enough force for using testing to see the adverse effects of traumatic brain injury. Even fast cuts and turns on a football field, if they're done repeatedly, those head movements are violent enough to show the effects of it.

And looking at the biomechanics of traumatic brain injury, basically every single direct hit that we get causes traumatic brain injury. If we've got glancing blows or even light contact, they're likely to create brain damage, which is the structural injuries and things that happen that will very quickly accumulate to injury, which is then dysfunction. So think of it this way: every time we get hit, that's actually a traumatic brain injury event. We're damaging ourselves.

And then it's also the individual events, but also accumulates as one overall injury. It compounds over time, making it worse and worse. So much so that the Professional Fighters Brain Health Study in Nevada is studying a load of mixed martial artists and professional boxers at professional level. And they're doing yearly brain scans, cognitive testing, and such like. And even over the course of a year, brains are shrinking, cognitive abilities shrinking, even over the course of the year. It's this longitudinal study, taking people, seeing what happens to them. It's scary.

So basically, we get an astronomical amount of traumatic brain injury events. Each round of sparring, we're getting on average between 4 and 18 hits to the head, up to even 42 or more hits to the head, each of which have enough force to create traumatic brain injury. And every single one of us gets traumatic brain injury. The only difference is how much the effects are on us as an individual and when those effects hit in. It's a scary proposition. Yeah, literally, we're not doing ourselves any favors, unfortunately.

James de Lacey17:34

Man, I've got so many questions from that. I'm going to try to remember them all, but I'm going to go where this logically, I guess, moves next. You talked about traumatic brain injury. What's the difference between a traumatic brain injury and a concussion? Are they the same thing? If I get a concussion, do I have traumatic brain injury?

If I don't get a concussion or don't get knocked out... You've obviously mentioned that some movements cause traumatic brain injury anyway. So is getting knocked out, having a concussion, a worse traumatic brain injury than just a knock to the head? Or are they kind of on the same level? One just ends up being lights out.

Gary Turner18:01

Yeah, this gets... I've got some props. I'll explain what actually happens in a moment. But with the traumatic brain injury and concussion, they're not the same thing. So traumatic brain injury is the injury taking place. A concussion is particular signs and symptoms that are associated with and developed from a traumatic brain injury. You can have traumatic brain injury without a concussion, and there's lots of other injury effects.

But so if I see a paper that says concussion is a traumatic brain injury, I facepalm because it's not the same thing. They're related, but they're not the same. So concussion's signs and symptoms, they don't tell you what the actual damage is, they don't tell you how it's being caused, they don't tell you the disease pathways.

Someone... I can't remember the citation now... they said a traumatic brain injury is the most complex set of diseases, plural, in the most complicated organ in the human body. So it's not just one disease. So concussion is just a syndrome, a collection of behaviors that's come from a neurological event, which is traumatic brain injury. They're not the same thing.

And concussion, there's no actual agreed definition of what concussion is that is uniform. There's six different consensus statements as to what a concussion is defined as. And sports tends to use concussion as, "Oh, I've got a concussion." That doesn't sound so bad as, "I've got a traumatic brain injury." It's always like a euphemism.

So it's a sport... sport kind of has created concussion as like a lesser term for traumatic brain injury. It's less scary. If you say, "There's people... oh, if you take up combat sports, you might get a concussion," compared to, "You take up combat sports and you're going to get numerous traumatic brain injuries. In fact, an astronomical amount of them that will have an effect across your lifetime and you'll never recover from it." That's the difference between using traumatic brain injury and concussion. Concussion is like one tiny area of this whole spectrum of traumatic brain injuries.

Perhaps it's easiest if I get my little props out and show you.

James de Lacey20:18

Yeah, go.

Gary Turner20:49

When Will Smith was researching Bennet Omalu in his work for the film Concussion, Omalu needed to describe to Will Smith and show him exactly what's going on in people's brains for Will Smith to get the idea. I think they used like an avocado or something in a jar in the film, but I've recreated what Bennet Omalu did with Will Smith.

So what I've got in here is just like a glass jar, and in there's a water balloon which can kind of like wobble around and move around a little bit. To get rid of the friction, I've got a tiny little bit of fluid in there, like cerebrospinal fluid. This represents a head, yet this is only part of a head. There's a couple of important layers missing.

James de Lacey21:20

So on the outside of the skull we've got our skin. In fact, if you Google Gary Turner Wikipedia, is it Gary the fighter or is it Gary stretchy skin man?

Gary Turner21:20

I am not the stretchy skin Gary Turner.

James de Lacey21:20

Wikipedia, Gary Turner fighter?

Gary Turner21:20

Thank you. But yes, we've got skin on the outside. So when we get hit, the skin, the scalp, the hair, that will actually dissipate some of the force.

Beneath that, then we've got the skull, the various parts of the bone structure that become fused together and the jaw that opens and closes and stays a little bit loose. Now the purpose of that is actually to protect the brain. So when we get an impact, the purpose of the skull is to dissipate and spread a lot of the energy around the outside of the brain so it doesn't get on the inside.

And in fact, if the force is strong enough, we get like an indent, we get literally a skull fracture. So at the point of impact, goes down and like sort of pressure ridges, they rise around the outside. We get the fracture around the outside of it, and the skull fracture actually saves the brain from taking a fair amount of trauma. So the skull's protective of the brain.

So we got skin around the outside, then we've got the brain on the inside. We've got a set of tissues known as meninges. My one of my supervisors, my PhD, Adam, he hates that word. So Adam, meninges, yes, squirm. But got all the different layers, and that's where you've got various like vascularity going through, sort of blood vessels that pass through from the skin to the brain.

So that if we get something called a subdural hematoma, it's the blood vessels between the meninges and the brain which have perforated. And as they bleed out, it creates swelling that puts pressure on the brain. A subdural hematoma, the most common brain injury in boxers, kickboxers, Thai boxers, mixed martial artists that causes death.

So we've got the skin, scalp, hair, et cetera. We've got the skull, then we've got the meninges, and the brain sits inside the meninges. The brain doesn't bounce off the skull itself. So when we hit, we have something called linear movement. I hit from on the outside, see the brain move?

So the strain, the force, some of it goes around the outside of the skull, and some of it gets, stretch goes into the brain, which then moves. So we've got stretch point at this end and then a compression point at this end, and then it reverses as it bounces. So we get that bouncing. That's linear motion. The brain that moves about one millimeter plus or minus each way. Doesn't sound like a lot, but it's able to cause a lot of damage like that.

Also at the same time, we get rotational movement where the brain will then rotate inside the meninges, inside the skull, inside the skin, and that will move by plus or minus four or five millimeter. And that will develop a lot of strain down to the real center of the brain.

So when we get hit, basically the skull, the brain moves. We can't get away from that. Through normal life, we've got a system of getting a knock, repair, repeat. It's just that we're not giving a chance to repair, and we're of a magnitude so much it doesn't get the opportunity to—I don't know whether this will come out, it did with the last one before the balloon burst, but I'll get my cushion.

James de Lacey24:50

That's my husky.

Gary Turner24:50

Here we go, on my seat cushion. Harley, Max, Husky. And I put that there and hit it. Can you see that the brain actually moves? And if you do it in a lab for the same impact each time, you've got movement when you hit. But when you put a cushion against it, the brain actually moves more.

So there's something called compliance. Compliance is the rate of force transfer between the strike hitting and it's how quickly that force transfers to the target. If it's a fast impact, a high compliance, and the force when a punch goes straight through, then it tends to create acute injuries local to that point of impact. The brain still moves, but you're more likely to get acute, the subdural hematomas and such like, the vascularity. It's all that force gets concentrated in one area, but it saves the rest of the brain. But one area basically is screwed.

But if you put padding in front of it, more of the force, it's a slower rate of force transfer, and more the force goes into the brain, created a more spread out diffuse injury. So it's less concentrated and more spread out. So instead of a catastrophic small injury, we just basically mess the whole brain up instead, a catastrophic big injury.

James de Lacey25:57

Instead, you got it.

Gary Turner25:57

So we're wearing head gear, for example, when we're sparring and such like, we're actually increasing the brain injuries that we're getting. It's quite worrying. There's no way around it. You can't literally protect the brain. If we get hit, it's going to cause the damage. We can wear big gloves, but the bigger gloves—oh, big gloves and head gear, that's what I used to do. I used to wear 18, 20-ounce gloves so I didn't hurt my training partners. Little did I know back then I was actually increasing the amount of force that's going to the brain.

James de Lacey26:29

Oh, yeah.

Gary Turner26:29

So that's the brain bouncing around. A little hit, we may not actually experience it for that. I've got a little tidy up to do after this podcast because this always goes everywhere.

So what I've got here is spaghetti, right? And imagine this spaghetti is little bundle of spaghetti, there's a load of networks in the brain, loads of connections in the brain. And if we get a little hit—boom—it gets a little bit of strain. Little hits, a little bit of strain. Now it doesn't actually snap with a little bit of strain, but what's happening is it's weakening. There's damage taking place. It's starting to weaken. So every time, even those little light hits, it's weakening.

Then over time, oh, now they're starting to snap and those connections are starting to go. Or if we get, say, the overhand right that Tank Abbott got me with, it goes straight away. So the communication between these is damaged. But when these break or indeed as they start to perforate, as they twist, think of it like big garden hose.

James de Lacey27:53

I've got all the props, say. Where you pulling these from?

Gary Turner27:53

You know me—bomb, look, another one rabbit out of a hat. But it's like garden hose. If you start putting too much strain in it, will start to perforate and bits of the water that's on the inside will start pouring out into the brain or spitting out. That's what's happening inside our brains with all the connective tissues.

So there's blood that comes out and all the metabolites in the blood as the blood starts to, the vessels start to tear and perforate. The same with our axons and dendrites, the connections between the neurons. It starts to perforate and all that muck spilling out. And when it's actually snapped, obviously we're generally screwed.

So the first thing that happens is there's an immediate effect. There's an immediate effect on our behavior. So imagine that these three bits of spaghetti are bridges over a river. My fingers, the river, okay? And we want to go from point A to point B. With the brain intact, it's quite straightforward. We just go over the first bridge.

Now we get light impact like an earthquake. The bridges may remain, but what we're not seeing is the weakened structures. Now as a result of that, another earthquake, aftershock, there we go, bit of a Kiwi aftershock going on there. And maybe there's a few like water mains now going on the inside, but we still can't see that. We still go from point A to point B.

But then catastrophic one, and the bridge breaks. Now we can't go from point A to point B directly. What we can do is reroute when we go down to the next bridge along and up. So think of a boxer, and suddenly the legs go. That's this happening. But then they regain the legs. The brain is literally using more connections and it's going to the next bridge, going along and going up.

So it regains function, but it's got to go further. It's a little bit slower. Everything starts to slow from the brain's operation through to a resultant action. Every hit actually slows the way that we respond.

Another earthquake—bang. Next one goes, hey, it's okay, we'll reroute. Now we'll go the bottom one, go along and go up, which is now even longer still and even slower at responding. Think about sparring. This is what's happening in sparring. You think you're improving your fight ability when sparring, you're actually taking three steps forward and then two to four steps back every time you get hit. Then eventually we run out of bridges. Now we can't get across the bridge.

Point A to point B and we've lost that function. So in the immediate and the acute time, so the minutes to hours afterwards, we've got the effects of the primary injury, the basic structures going wrong. But then we've got the secondary injury, which is known as the neurometabolic cascade, which gets really complicated. When we go into, so I prefer to describe it as a battle of good versus evil.

So that neurometabolic cascade, we've got all these broken connections and everything pouring out of it. It's all going into the brain. It's like, no, it's messing this up. We get these really excitable new ones that start going, yeah, start jumping up and down, and then they use too much energy so they die, like explode. Like if you got like a 5-year-old at Christmas, they always explode Christmas. That's what your brain cells are like, but they pop. They actually pop.

But things is popping and then he gets some like, you're taking all my energy. I'm like dying. They can't operate. So you've got neurons getting excited and dying or being starved of energy and dying.

So at the same time you've got this reparative adaptive processes taking place, doing its best to repair everything, to reroute, to get rid of all the crap that's been spilling out into the brains. Yet it never actually clears everything up. So for example, if that was an axon, a connection between two brain cells, and it's snapped or it's perforated, things like phosphorylated tau protein, good old tau protein, and something called beta-amyloid start basically spewing out into the brain.

Now they accumulate in sort of the crevices of the brain at the bottom, and they start creating adverse functioning, brain atrophy, brain death at the bottom. That's CTE. That's what happens with CTE. CTE is related to but not quite the same as Alzheimer's. So with CTE, tau proteins accumulate in the bottom crevices, but with Alzheimer's they're generally on the top surfaces. Slight, slightly different nuance, but they are related.

So then what happens is we've got this reparatory process taking place and we've got this death and destruction taking place. This battle going on. And that's why sometimes we feel sleepy because our brain's shutting down like, come on man, give me a chance, give me a chance. And that's why for the first 24 to 48 hours after receiving hits to the head, if you have rest, i.e. nothing cognitive, looking at screens, listening and watching podcasts and such like, no TV, no screens, turn your little phones off and stuff, your smartphones, and don't do the physical activity, it gives your brain a chance to do what it needs to do, that adaptive process. And then you've need a gradual return to play as we go.

So the secondary injury, that's when we will generally get the signs and symptoms of concussion. When we get, oh, bit bright, aversion to light. Oh, bit sharp on the ears, the aversion to sound. Photophobia and phonophobia. We'll get the headaches. We might get the sickness and nausea. We might just feel drowsy. That's when we get those kind of symptoms.

But concussion is just a set of small symptoms and signs. Signs are things you can see. Symptoms are experienced by the person. For example, I can't see if you got a headache. That would be a symptom. You subjectively experience it and you got to voice it to me you've got a headache. Your legs go, that's a sign. I can now see that. Signs and symptoms not the same thing.

So in the acute and the subacute, so got the injury and straight away, our ability to think, act, and behave changes. Straight away we're literally slower at responding. So every hit means you're more likely to get another hit and more likely to lose.

And then we've got the situation where the secondary injury starts to unfold. We start getting drowsiness. We start getting signs and symptoms. Even in the absence of those, we're still cognitively, our ability to learn, our ability to retain information, our memory, all becomes depressed.

And then what then happens is over the chronic time, so we're talking months to quite a few years, we start developing mood disorders. Because the areas of the brain that we're damaging are associated with mood and emotion and such like. So the classic things are more aggressive tendencies. It's kind of like, whereas before, so we lose impulse control, for example. It's like driving your car.

It's like, whoa, we're driving, great time to stop. Oh damn it, we can't because we've gone over a rock and it's cut a brake line. That's what our aggression is like. It's like, hey, what are you doing? And then normally we'd stop because we're kind of bit reserved. I said, what are you doing? And now we can't stop. The brakes are off.

James de Lacey36:05

Yeah, that reminds me of those old news stories. I think it was like old WWE wrestler or something that ended up killing his whole family and committing suicide. And they put it on CTE or something or some kind of brain problem.

Gary Turner36:31

Now, we're, we're a lot in combat sports. One of the things that we've actually got is self-control, as it turns out. We're actually less aggressive than other contact sports, which is just the nature, the fact we're aggressive in our day jobs. Like we don't want to take our work home, do we? It's like, these are the tools of our job. It's like, you wouldn't get your laptop and lob it over your shoulder. We look after our bodies because, you, what you want to fight? No, no, I get paid millions for that, thanks. Well, I wish I could.

Does that make sense? We're less likely to actually engage in those behaviors. But we do suffer things like, so combat sports, just the nature of the impacts, we suffer more memory issues which affects everything that we do. And it will also get more motor control issues, which is why parkinsonism is part of the issue.

We get mood disorders that then take place over a period of years, but we also get the earlier onset and more rapid development of neurodegenerative diseases. For those we're talking Alzheimer's disease, various dementias, parkinsonism, amyotrophic lateral sclerosis, ALS, the old ice bucket challenge stuff, the multiple sclerosis and such like of the neurodegeneration world, chronic traumatic encephalopathy, CTE. That's only one tiny part of these neurodegenerative diseases that take place.

Everyone goes on about CTE and I'm like, but that's just the tip of the iceberg. Why, why you just talking about CTE? What about dementia, Alzheimer's, Parkinson's and such like, the motor neuron diseases? It's all caught in the mix. Basically, getting hit in the head, we never fully recover from being hit in the head. Housekeeping at night can only do so much. The little cells that run around with the little brooms and sweeps and, oh, dustpan and brush, get rid of that. There's only so much of that that we can actually repair.

Normal human day-to-day life, the little things we do, lock our head on the wall, that kind of thing, that's what that's designed for. It's not designed for getting between 8 and 48 hits per round of sparring every week. It's not designed, although a lesser, so headers, those six headers of a football, lobbed underarm, they're creating brain accelerations of around 8.6 through to around 15 G.

A right hook, we're talking about 80 to 90 G. Yeah. And then, which is the force of basically two American footballers with all their size and weight, full pelt, running at speed and colliding. It's like being hit on the head by a vehicle, a medium-sized car going at 30 to 40 miles an hour. That's what a right hook is doing. But then if you want to take it up a level, a round kick, we can double that.

James de Lacey39:03

Wow.

Gary Turner39:42

So if you're thinking six headers of a football is all that's required, are those tiny little head movements is all that's required for testing to show the brain damage and the traumatic brain injury that's unfolding, enough to affect someone's behavior. Imagine what we're doing to ourselves. It's like crazy.

So with my research, for example, we're actually looking at performance deficits through getting hit in the head. Because we're thinking, how do we get through to fighters? I mean, we're thick as two short planks anyway. And we're making a living and doing a sport where we hit each other in the head. Whoever thought that was a good idea? It's damn good fun though, isn't it?

Here's the thought, right? If we limit what we do to competition, then we're reducing the hits that we have to the head. And then people say, well, what about training? And then you think, well, why do we spar? We spar to get the appropriate response to stimuli in competition. You don't need to spar to do that. You can create, so for strength, for example, you want to improve strength, do mental rehearsal, mental training.

Strength is motor neuron, main part of it is how much motor neuron, how much motor units you can recruit in your muscles. It's neurological. So that's why you got the 5 by 5 with 5-minute break in between. We're training those muscles to maximumly lift. We're trying to get all that recruitment and then firing and wiring. Let it wire in the background mentally. Mental rehearsal, you can actually increase your strength. You can increase technique.

Who in combat sports, apart from me because I'm a hypnotist, does mental rehearsal and train their people with mental rehearsal? It's a massive part. If a combat sport athlete is not doing appropriate mental training, mental rehearsal, they're never going to hit their full potential. So imagine what the good ones who aren't doing it are going to be like when they do.

Sparring is, if we get hit in the head, it's slowing our ability to respond and act. We're more likely to get injuries of any kind as a result because we're literally lowering the control of our body. So who thinks it's a good idea to get hit in the head in training, lowering our ability to respond and act? How's that a good idea for competition?

So it's time to start thinking about new ways of training. My guys, I play around a lot with slow motion training, and I find it highly successful for many reasons. I do various protocols of it, but basically what you're doing is now stimuli, they're starting to throw a shot, you start to see every first movement, reading how that shot's moving, how it's going. You're now thinking what's the appropriate move in this context, and then you're executing it, yet with control because it's slow motion.

We do various speeds of, one person might be going full speed but non-contact, the other person going super slow, and we start doing various mixes and matches on it. We're having a great success with that. So we're getting the appropriate response to stimuli but without being hit in the head. Oh, how much better is that.

So my aim for combat sports: stop hitting kids in the head, because under 18 is the legal definition of a child, and in the UK at least, every piece of child welfare legislation says you can't do that. And the criminal legal position is that no child can consent to harm. We now know that getting hit in the head causes harm, and no adult can consent on their behalf. So we can't use the excuse of "but he likes to do it, I'll let him do it." Can't use that anymore.

And the case law for that was actually tattoos, where some kids went and got tattoos and the parents sued the tattooist, and that's where it starts coming from. But, you know, I want informed consent. I want fighters, I want combat sport athletes to understand what we're doing when we're twatting each other in the head.

So if we know what we're doing and actually we're fully informed, then we get the opportunity to make an informed decision to practice. Also, we then get the ability to think about what we're doing and find safer ways of doing it. We don't, back in my days, oh, I remember fighting Matt Skeleton, and oh, my brain was shot. I was slurred speech. I blew my nose, had a little mini fracture in my eye socket, blew up, and oh man, my eyes were pointing in opposite directions.

I was that crazy guy from Happy Gilmore, is it Happy Gilmore, his eyes? I was like that. I was out of it. Two days later, I'm sparring again. Crazy. In knowing what I know now, because I'm actually at risk of death at that point in time, because if you don't let the brain recover to the best of its ability, that damage can actually shut down parts of your brain, can shut down your life support system.

It's something called second impact syndrome. I think the research states that yes, it does happen in adults, but some research states that it doesn't, only happens in kids and developing kids. There's a classic rugby case with a poor lad, Ben, who received a concussion on a rugby pitch. They allowed him to play on. He had another hit and unfortunately it was enough to finish it. It's horrific.

The lack of duty of care, even at that time with what we knew back then, was horrific. And I hate to mention it because it makes me sad because it could have been prevented. So this is what we're putting ourselves at risk. So I want informed consent. I want no head contact for under 18s.

People will say, "but then they won't be able to compete as an adult." Look at the literature. Actually, they will be able to. Within one year of having head contact, they'll be the same as someone who's had head contact their entire life, but they won't have the 10, 12, 14 years of getting repetitive injuries.

I also want to make the whole practices, the whole medical care and such, far better. I want appropriate medical attention at shows. I want correct protocols in place and such. I just want to make it safer while preserving it. That's the important thing.

James de Lacey46:15

So that's a lot of information for you. I've got like a billion questions, so I'm going to try to remember them all and kind of run back. But your idea of that slow motion sparring as well, I love that idea.

One of my strength and conditioning mentors, Vern Gambetta, always talks about rhythm, right? Sport is rhythm. And he'll get his guys in warmup, so whatever warmup drills are doing, he'll give them a rhythm, like you have to do this like it's a slow motion movie, or you have to do it backwards like you would do it forwards, and things like that.

As you mentioned, one person going slow, one person going fast, or switching up, you're playing with the rhythm of essentially the sport. And if you can play different rhythms, break rhythms, et cetera, it's going to give you a huge advantage. I mean, you see, I think it's CSA Gym MMA, they're very against hard sparring all the time. They often do very light sparring. There's some really good videos on YouTube of people doing like flow sparring and stuff like that. You get the same stimulus just without the head contact.

But I mean, I'm going to jump into one of my millions of questions. One of them, you mentioned how, I guess like the bridges, right? You snap the bridges. For example, you watch some, if anyone watched the fight over the weekend, that was scary stuff with, got getting head kicked out of the ring, and he was out for, yeah, he was gone.

So he got dropped first, I think the round before. So I guess you could say that's a couple of the bridges gone, and then finally that last bridge gone. Are those bridges, are those bridges then, say within the fight, but then is it fight to fight as well, those bridges are gone forever? So the next fight then, you're starting at a deficit again, and then next fight you're...

Gary Turner47:50

So it's a gross generalization. And we know it used to be said that once you lose the brain cells, you've lost them. But we do know that there is neurogenesis in the human brain. We do get new brain cells. It's actually incredibly limited, and there's only so much repair that can go on.

So whereas we may recover, we're talking like a little knock on the head, maybe head the football once a week, this is just a gross generalization, we'll probably repair from that quite nicely. It's part of the normal, won't affect us adversely. We won't notice it. It won't, we're living longer, so we're all basically going to wear out soon.

I've got an artificial hip at the moment. I was kicking head height. I was in Body Pump classes eight days after a total hip replacement. I was kicking head height again six weeks later. Clear to fire and do everything again and run again after 12. So it doesn't slow you back, doesn't slow you at all. But we're going to run out. There's so much replacing that we can do.

So the normal life knocks that we get will generally not affect us. We're just stacking the odds against us. So with Conor, it was Conor, wasn't it? His spaghetti, it was like an Italian chef having a right wobble and snapping it everywhere. That's what his brain's like.

When I saw the video the next day, he was going, "Yeah, I'm okay," and his face is all bent and broken. And you can see the damage, the amount of hits he's had, and the impact, the soft tissue damage, the hematoma on the outside of the face. To receive that many hits that created that much soft tissue damage on the outside, God knows the bruising, the damage, the hematomas, the connections that are gone, how much gunk has sort of pissed out of the broken connections.

He's not done himself any favors in his career. And had a discussion online actually, because I've got this thing that, and it's coming out in the literature and I'm not alone for saying this, people within the sport of boxing are saying it as well, that we should stop a fight at the first signs of concussion.

James de Lacey49:39

I was going to ask you that, if that's something you would change, because you see people get dropped. You got this, I mean people love the comeback story, right? The guy was almost out and then he wins by knockout. It happens every now and then, but you watch the guys, this guy can barely stand, but because he's standing...

Gary Turner50:05

So there's a study, the Professional Fighters Brain Health Study. They looked at 30 UFC fights and 30 professional boxing matches in Nevada. And they had a look to see through video review when the first signs of concussion happened. And I think one poor side had 12 concussions in one fight. Oh my Lord, because you recover, but it's just that re-routing taking place and he's gone again. It's like, heck, those bridges have gone now.

But basically, the first person to show any signs of concussion invariably goes on to lose. The one who gets more concussion events goes on to lose. So even there, they're suggesting the first sign of concussion, stop the fight. But the problem is, and...

This is one of my supervisors, John Baton, came back with and said, "What makes a classic fight?" Because a classic study looking at the number of hits for classic fights compared to ones that have caused death, and there's no difference in the number of hits. And it's like, what makes a classic fight? What does everyone love about the classic fight?

And it comes down to the sport culture. We love the underdog, we love the war, we love the battle.

So I posted—so high level, these guys are boxing sort of pundits and journalists and boxers themselves and trainers and coaches—when was the first signs of concussion in that fight? And they said, "Well, simple, round one." So then I said, "If I had my way and stopped it at that first sign of concussion, that would ruin a classic fight, wouldn't it?" And they're like, "Yep, and probably kill the sport too," because no one's going to tune in to watch it.

So it's like you're kind of stuck against it. But then everyone says, "Oh, it's a tragedy when a boxer dies," and I'm like, "No, it's by design, essentially a fight to the death." You know, the days of fighting to the death and gladiator times have now passed. Where do we draw a line to protect the individual?

And then you've got some referees letting fights go on, other referees stopping fights early.

So I think I've got a paper that I'm submitting at the moment on a fair and objective way of referee stoppage, which is at the first line of concussion, because at least that it's uniform and everyone knows what they're playing to. It also might make it more interactive and it might make defenses better. So it might actually make it more the way that boxing was portrayed legally in the UK so it wouldn't get deemed illegal, which is it's a sporting endeavor and it's as much about the defense as it is about the offense.

And it might put it back towards the offense. Unlike me, I took 10 to give 11. I didn't have a good career like that. I led with my face. That's why I've got the good face for radio.

James de Lacey53:00

This is on audio, is it?

Gary Turner53:00

Yeah. What do you mean? You're seeing me, your food.

So it's the case of, we're like, you know, do we ruin—

How do we get it right for people? There's cries of like a box match a couple of weeks ago when a guy clearly won, he clearly won, but they awarded it against him. We need some objectivity within the sport of boxing, otherwise it's going to collapse anyway because there's so many wobblies being thrown everywhere.

We need to uniform like, "No, this is how it is, this is what it is. No, your legs went, fight over." That kind of thing. "No, you're fine, carry on." And it's like a clear set of rules. I mean, referees don't even get trained in traumatic brain injury.

James de Lacey53:53

Yeah, it's horrendous.

Gary Turner53:53

So the classic fights, we might end up with less classic fights and we would change the nature of it. And that's what happened with amateur boxing when they took the head guards away. For the first two years, injury rates went up and then dropped, especially concussions

dropped, because the sport changed. Suddenly it became more professional head movement rather than more upright. So that, you know, it will change the nature of the sport, but at the same time we're preserving health while keeping the sport before it gets deemed illegal.

James de Lacey54:27

Nice. All right, I'm going to jump into some practical things for the people listening as well. And I've got some other questions too that we can circle back to as well. I've still got a bunch.

But in terms of

the practical side, so you mentioned about sparring as well, something that people can do if they're in a striking sport to essentially lengthen their career. Would it be trying to minimize hard sparring then between fights and maybe only keep—I mean it depends on the gym they're in too, right? They're going to, it's going to be dictated by where they train as well. So would it be then maybe hard sparring only once or twice say in the build up to a fight, just so—I mean people

are going to do it anyway—to minimize that hit?

Gary Turner55:20

I would change that because I wouldn't say any hard sparring. No hard sparring.

James de Lacey55:20

All, that's what you would recommend then?

Gary Turner55:20

I wouldn't have any head contact.

James de Lacey55:20

Gotcha. And what about headgear as well then? Because I know I guess a lot of gyms will require headgear and large gloves with sparring, then you'd be like, "Okay, best case scenario ideal would be no hard sparring, no need for headgear."

Gary Turner55:47

No headgear actually makes the brain injury worse anyway. What headgear will do for a fighter, benefit for a fighter, is maybe prevent some cuts and whatever. That's about it with soft tissue injuries, that kind of thing. It's going to stop that, but doesn't stop the brain injury at all.

In fact, it makes the brain injury worse. It allows more force to transfer to the brain. And then we've got risk homeostasis and risk compensation theories.

"I'm wearing it, so we can go a little bit harder," and it starts to escalate. But I would suggest that head impacts are not required in sparring. At the highest level, you don't get hit to train to take a hit. You get hit to test your ability to take a hit.

Let the competition take care of itself. Ultramarathoners, for example—the world's best ultramarathoners don't run that far. They actually run to practice their technique and form. The races take care of the long

stuff. The head contact, get rid of it from training. The competition delivers the head contact.

So yeah, look to lower it. Even back in the '90s, I spent three days in Amsterdam every two weeks. So I used to go out there, Lucien Carbin from Fighting Factory Carbin was my coach for a while. So I go out there and train with them. I love doggies as well, your dogs in background.

James de Lacey56:52

I just muted the mic.

Gary Turner57:22

Dogs are cool, man. Life's not life without a dog. You know, start each day with a waggin' tail.

So Fighting Factory Carbin, for example, we're talking Alistair Overeem, Tyrone Spong, people like that, as my training partners. Valentine Overeem was a beast as well.

Thursday night they've called it black hell. They called it black hell to me. It's a gym full of Surinamese, and they're all black apart from me, the lone white guy, basically. There's an English guy they called Lonsdale that was working in Amsterdam as well there. They called it—

so Rodney Glunder would call it black hell. And it was, we do carousel sparring. So like me, Tyrone, Valentine, Alistair, Remy Bonjasky would come over as well. It's like—this, some legends there, plus me. And like seven or eight people, one minute carousels, going 100% flat out. And it had to be 100% flat out to the body, touch contact to the head,

which then allows for light contact with movement. So you aim for touch contact with the head, anything you light to the body. And that was—so even then, back in the early '00s and mid '00s, Fighting Factory Carbin, they were watching how many hits to the head you were going to get. They realized it's not doing you any favors.

I went to Vos gym and I was—what was it—Kops? Vos gym? Peter Arts, or Peter Aerts.

I was training with him and had five, six rounds with Pete, and I was doing all right. I got some lovely shots of me kicking his legs and stuff, and it's going really good. And then he let loose. The thing he was working on, this right hand from hell, I saw it coming. The glove was just getting bigger as it came. We're like, "Oh my God." And it just stopped it on my head, and then we

just carried on sparring. And we're having a drink afterward, I went, "Pete, why didn't you let it go?" And he went, "Just, you're a great sparring partner. You were enjoying it, I was enjoying it. Why injure a sparring partner? You knew it hit, I knew it hit. We didn't need to actually hit it." So that was good.

Then if you go to Mike's gym, they just kill each other. So—

James de Lacey59:18

That's awesome to hear. So if

someone was going to spar then, that's how you'd recommend they should spar if they were going to? 100% body, just touch contact to the head?

Gary Turner59:45

You can still go, touch contact to the head. Yep, with good coaching, check the form.

James de Lacey59:45

That's the thing too, you got to have the coach on board.

Gary Turner59:45

Yeah, it's not "Where's my guard, my head up here?" They need the coach to point out the technique. And of course, there's the supplementary

training, elemental rehearsal, slow motion stuff, the various drills and such to get the right response to stimuli that sparring would provide. Get that separate to the sparring and concentrate on body boxing. Lucien, for example, body box, body box, body box. It was great, which body box. City, you get in there, glove up and start body boxing, and that was the start of the class. Soon as your gloves are on, away you go.

So I'd prefer to see that coming.

James de Lacey1:00:37

That's a really good way to look at it too, that's a really good way. And I wanted to touch on as well the idea of strengthening the neck. So there's some pretty good research on, I guess, isometric neck training reducing that peak linear acceleration of the head, like for example hitting a soccer ball. Have you just seen the study that was released in the BJSM a couple of weeks back?

Gary Turner1:00:37

Might have done. Hey, I haven't.

James de Lacey1:00:37

They're saying the same thing. Okay, so break it down for me. Is there essentially an intervention that can help us, for example, reduce the severity?

Gary Turner1:01:02

Nothing. Can't do anything. No. So you've got, there's a couple of ways of looking at. Firstly, the research is a rugby scholar that I've got friends with on Twitter. She broke it down, it's her field, and she broke it down really well that neck strength on its own won't do anything. And she looks at it from the fact of the imbalance in the neck and how that sits amongst the rest of the framework, the structure, the biotensegrity of, say, a rugby player on it.

So that on its own won't help, and you might be putting injuries to other places as well. But also, you have a strong neck, and if you don't apply it at the right time, there's also a rate of force development concept too. How quickly can you turn that force on, or that braking force on?

James de Lacey1:01:37

You got it.

Gary Turner1:01:37

But then if you think that this car, it's coming at 30 miles an hour to my head. Okay, so if my neck isn't strong, my head's might move that way more—boom—so my head accelerates. So the force hits my head, creating the movement, and the force is still going through the brain. The brain's giving it a wobble as it moves away.

Or I resist that force, so the kinematics change. So the same force is being hit, but now my head's not moving and I'm tense. Where's that strain going to go? Straight through, straight through to the brain. It becomes almost like a blast wave, a shock wave, traumatic brain injury that the military get.

So you get this, if you move with it, are you actually dissipating some of the force by the movement? If we're resisting it going in, we might actually be allowing more the force to go through the brain. In other words, on the balance of what the evidence shows at the moment, neck strengthening doesn't work. Even application of neck strength doesn't work. All it does is again change the nature of the injury.

So MMA gloves, nice and light, four to six ounces depending on what rule set you've got: acute injury, localized. Big 20-ounce boxing gloves, hits the head, spreads it out more. Same, well, not the same grade injury—it's different. It's same extent of effect and damage, just focused in different ways. Does that make sense?

So, neck strength, no, unfortunately. And what makes it worse is some of the press, and we're not fans of the latest study that was in the British Journal of Sports Medicine for quite a few reasons. I've actually got complained to him with the BJSM.

James de Lacey1:03:57

I need to read that, actually. I still need to read that.

Gary Turner1:03:57

Oh, to cut a long story short, you've got the Concussion Sport Group, which was headed up by Paul McCrory, an Australian scientist who was for seven years the editor of the British Journal of Sports Medicine. Turns out he's been committing plagiarism in his articles. Nice. He admitted to one to start with, but by the time two days had passed, about two days, there's a guy called Nick Brown—I think I'm going to have a look at his articles—he'd found 10 that he plagiarized. Damn.

And then the 11th one came up where, let's just say, the data was very questionable. So he's disgraced, and he's attended his resignation, which was accepted, from the Concussion Sport Group. The Concussion Sport Group has huge corporate entanglement with World Rugby, the NFL, the International Olympic Committee and such. Okay.

And we've always been complaining. There's a paper, Casper and Alan Pierce and lots of people of names in between, I've just put a paper out recently: Towards a Fair and Objective Consensus Statement for Brain Injury in Sport. Because the CISG downplays CTE, they ignore all the research that shows CTE is a serious issue. They use 'concussion,' they keep saying concussion is a transient injury until it's not. To some people, it never goes away. How can that be transient?

And it's always downplaying, downplaying, downplaying, always privileging sport. So at the heart of the BJSM, you've got people like Paul McCrory, and you've got the head of science for the IOC, for example, as part of the BJSM editorial team as well. And they're all appearing to privilege sport, which really raises some questions there.

My first name on the paper was calling out a rugby trial for lack of ethics. So we wrote an editorial, which had a tiny little role, and I was like the middle author in the long line. The big wigs at the other end, the tiny little G in the middle. But it was enough for me to know exactly what was going on, and their ethics were out—their ethics were wrong. And we called them out on it's editorial.

So just before our editorial was published in the BJSM, the BJSM allowed World Rugby authors to make over 100 changes to an already published article, including changing the research question. Oh, wow. In an attempt to counter the points that we made. And it's all published, it's all public knowledge. I've got a complaint in about that at the moment because I think it's corporate entanglement.

There's a few emails that flew around. There's an email that I was copied in on that I shouldn't that says I'm completely right to make my complaint. So there's this huge fallout, and it's like, what do we do so far by way of looking after brain injury sports, looking to protect sport? Unfortunately, McCrory being dishonest has unfortunately really hurt sport because litigation is now open. Sport's looking, it's clear to look to support sport.

James de Lacey1:07:11

Not good, not good.

Gary Turner1:07:11

So it's no surprise that the BJSM, with 3,500 articles—I think it's 350 articles published a year—they get 3,500 submitted a year. So which ones are they putting out there? They're putting out there the ones like from a couple of weeks ago that show that isometry neck strength actually is a benefit in concussion, or are they then stopping five or six that say it doesn't work?

So are we getting a skewed data set through this? So I've asked the question. I've got no skin in the game. I'm not going to have, I'm not looking for a career in academia. I'm no longer a professional athlete. I've got no business interest apart from a few bits of personal training in sport. I've got no skin in the game. What are they going to do to me?

James de Lacey1:08:14

Exactly. And for anyone asking the questions, for anyone listening in the academic world, if you plagiarize in your publication, that's like career suicide. That's like the worst thing you can do. So for anyone listening, that's just some perspective as well.

Man, I had a whole bunch of questions I forgot some of them, but I'm going to roll on to some more that I had anyway. Is there anything that someone can do to help reduce the impact of TBI other than not get hit in the head? Supplements, anything, or was it just, okay, just stop getting hit in the damn head, and that's all you can do?

Gary Turner1:08:40

So there's two things here. There's primary injury, which is what happens when we get the neural trauma. There's absolutely nothing we can do to stop the primary trauma. Okay. The brain cannot take the strain, so the only way of getting rid of the primary trauma, the primary injury, is not to be hit in the first place. If you get hit, you're screwed.

And then we've got the secondary injury, and that's what everyone's looking at. What can we do, how we can work? So for example, there's various things that will help. So a lot of the effects, for example, a lot of the testing that's highly sensitive and highly specific to traumatic brain injury looks at the effects on the eyes, the way that we can't track anymore. Smooth track and smooth pursuit, the way that we jump about, it all changes. Even the focus—called, eyes going in different directions again—it affects the eyes.

So they're looking at testing for that. So if the eyes are going funny, there's various ocular trainings that you can do. But that's not getting rid of the original injury, that's helping you redirect and reconnect. Physiotherapy, if you have balance and gait issues, for example, the musculoskeletal control on the body, again, there's various physiotherapy approaches. It's showing some degree of efficacy in helping you recover from the movement disorders. But again, that's a rewiring, it's not correction of the original damage.

So we're kind of left with, there's little things that we can do to kind of get rid of the signs and symptoms, but it's not actually correcting the injury. The underlying thing is still there.

James de Lacey1:10:06

You got it.

Gary Turner1:10:06

Now, pharmacologically, there's not a single pharmaceutical intervention so far that's shown to have any efficacy with human TBI. Mice is a different matter, but we're not mice. For example, let's pick on creatine, because I get really annoyed because it's like, so creatine, for example, you've got the ISSN. They claim in a lot of their articles that creatine is neuroprotective. Creatine increasing the...

And until you actually look at it, and you find out that it doesn't. They still don't even know whether the exogenous creatine that we eat, for example, actually passes the blood-brain barrier and gets to the brain in the first place, at least any more than normal homeostatic levels. In rats it does, in mice it does, but unfortunately it doesn't in humans.

And let's just say that you've got to go some with creatine for it to have adverse effects on your body. You'll have pre-existing kidney issues or take it a long time and have hyperfiltration issues for creatine to cause you some trouble. However, if it starts going up to the brain and you get too much up there, the brain gets rid of the waste. So excess has a cost. So if it is passing the blood-brain barrier, you put the brain on strain to get rid of the waste, the excess that you don't actually need.

Not only that, if it does what they say it does, you'll be doing things like reducing inflammation. But inflammation is part of the reparatory process. So you're actually stopping the brain adapting and healing if you're doing that. Also, it gives energy to the brain, to those cells that are lacking energy. Hold on, that's part of the hibernatus state that we're going into to allow us to recover. So at least in the acute and subacute phase, creatine can actually be neurodegenerative rather than neuroprotective, if it does what they say it does.

But let's look at human studies. So with neurodegenerative diseases in rodents, there are a few studies that show a lot of promise. These studies with humans were stopped halfway through the trials because they had absolutely no effect. It's a bit of a—yeah, so there's no human translation from studies.

So when we look at TBI, there's only one piece of research that's looked at creatine with humans: Selis et al. And they've produced three papers, one of which has disappeared and I believe to be retracted. What they looked at was about 30 kids with severe TBI, hospitalized, and the TBI was so bad that three of them during the course of the study died from their injuries. So it's got no cross-reference to the normal brain injuries from sports. We're talking catastrophic brain injuries here.

And it did show that there was some result on these kids. Now, kids have got developing brains. Kids' metabolism is slightly different to the more mature brains. So does it have translation over to humans? It was a pilot study as well. It could be by chance that these couple of kids improved a few days earlier than others. So you've got this tiny pilot study in humans, and of course those sponsored by supplement companies seem to say, "Yeah, it works, it works." It doesn't. We haven't got the evidence there yet.

James de Lacey1:14:12

Oh, that's good to know. I need to go update a few of my articles now based on all the stuff you've told me.

Gary Turner1:14:12

That's good. That's good for anyone as well who's thinking of creatine anyway—take your damn creatine for the performance benefits.

James de Lacey1:14:12

Would not say not to take creatine, that's right. But I also wanted to touch on the idea—someone commented about this in the group and I'll rephrase it. What is it then, for example, someone who maybe gets knocked out or whatever in the ring, cage, whatever it is—some people seem to suffer more than others. So for example, someone might go through their fight career, not show any symptoms of the problem, but they could have underlying issues, whereas someone else could maybe get knocked out once and then have lifelong issues after that. What is it that has that difference? Is it just genetic luck, how they got hit?

Gary Turner1:15:11

I'd love to show you the chapter, but my laptop's sitting on the book. It's got about 60, 70 pages, which says—and the chapter's called "Why Outcomes Vary"—and there's a whole series of issues.

So firstly, suffering. I'm smiling because it just got cut from a thesis chapter. I'm like, "Damn! Damn, I like it. I know where to put it now." But if we're doing life stories, ethnographies—and I'm doing auto-ethnography of my experience with TBI—I've never suffered from TBI. I've never suffered from it. However, I've probably had more TBI than anyone put together, but I've never actually suffered from it.

So suffering is a subjective experience. So for us combat sport athletes, because we've got the mental toughness, we're resilient, we've got the pain thresholds, we just put up and shut up. For us, it's another day at the office. So firstly, combat sport athletes generally don't suffer.

There's a brilliant auto-ethnography from a surfer, and my God does he suffer from his concussion. Football, hockey—the ethnography is there. They suffer from their traumatic brain injuries. I'm reading it thinking, "That was just Tuesday." Combat sport—so firstly, you've got the culture, the whole psychology of it. It's a biopsychosocial cultural all in the mix for how we actually experience something and the valence—is it good or bad—that we put on things.

Like in combat sports, we seem to prize classic fights. "Yeah, man! See that hit that I took?" You're proud of it. We prize it. But then we've got a whole lot of things, so it's got heterogeneity. It's got—everyone's individual. Your head is a different shape to mine. Mine's kind of spherical and pointy and—you know, it's like Sputnik, as they said in that film.

But I've got this resilience, and I don't know where it comes from. It's got to be genetics and the way my body's put together. I've had probably more hits than anyone. I'm doing a PhD. Shouldn't I be mush? But then it's like it's compared to what, and what age will my neurodegeneration start to take place compared to what it would have done without the head impacts? Studies show can be from anywhere from 8 to 20 years early from a single concussion.

James de Lacey1:17:21

Wow. Okay. Yeah, that's a long delay.

Gary Turner1:17:21

Yeah, yeah, yeah. Imagine what it's like for people like me. But then there are genetic risk factors as well that are being proposed, that's emerging as well. And it's likely, I would suggest, that I don't have the genetic markers that would predispose me for suffering. I probably genetically got one heck of a lot of bits of spaghetti in my brain—lots and lots and lots of connections—which means that the damage is having less overall effect. The damage is still there, but it's having less overall effect. I've got enough bridges.

James de Lacey1:17:47

It could be, yeah.

Gary Turner1:17:47

It could just be chance. You can't account for it.

James de Lacey1:17:47

It's interesting.

Gary Turner1:17:47

Yeah, I might spar next Monday, body boxing, and it might ping off my glove and get me, and that might be the one that—

James de Lacey1:18:19

Like a final bit, that's interesting. That some people were just, I guess, more susceptible from the beginning. Like some people might just have harder heads.

Gary Turner1:18:19

Yeah, thick as two short planks, you know. I've got—in fact, I used to have a regular MRI scan to get my fight licenses in Sweden, some of the American states. So I'd fly to Amsterdam and go to the Amsterdam MRI center to get it, because for the cost of an MRI in the UK, I could fly out to Amsterdam, have more training out there, have the MRI, and basically have another two or three trips. It's just so expensive over here compared to Amsterdam.

So I'd fly over there, so I got to know the guys. So I landed in Stockholm for my fight and I gave my CD—the CD—with the brain scans on it. Showing my age now—CD.

James de Lacey1:18:54

Still good CDs for scans, though. Well, they do here at least.

Gary Turner1:19:24

Oh, what? Should be a drive. Should be a link now.

James de Lacey1:19:24

But they called me in—"Nothing to worry about. We found an anomaly that you might want to have a look at."

Gary Turner1:19:24

And basically, got the millimeter slices through my brain. They're calling up the images, calling up the images, calling up the images, and it calls up an X-ray of Homer Simpson's head with a peanut stuck in a scan—a cartoon amongst all of my sort of official scans. Crazy. That's kind of what my brain's like.

James de Lacey1:19:52

You need to have a brain to damage it, I guess.

Gary Turner1:19:52

Oh, you're underselling yourself there.

James de Lacey1:19:52

I have a couple more questions as well. One of them—if you have kids. Oh, actually, no, let me start here. Grappling now, obviously other than being thrown on your head, is being choked out, put to sleep, is this going to be similar to a traumatic brain injury? Even though there's—

Gary Turner1:20:17

Yes, it is. Yeah, the hypoxic state that it creates—it's not the same, but it creates similar style effects. So yeah, getting choked out. So if you're doing BJJ, tap early. It's training. You're there to learn. Tapping out should be prized in training because you're being smart, egos to the side. We're here to learn.

So yeah, unlike my judo days when my mate Ron and I—I'd get strangled, managed to work it on, and then I'd tap, and that tells him, "Okay, I now relax." He gets it on good and proper, and I hold it off as long as I can. And sometimes you're floating around without a body experience. You know, that's crazy. That's doing my brain no good.

So yeah, so in judo, getting repeatedly thrown onto the mat, that's the same as heading the football. So you need to limit the heavy impacts to the mat more. Uchi komi, it's own practice, without actually the impacts on the ground. So combat sports that strike—

They're the highest TBIs. Wrestling and Judo that throw, go to the ground, then they're lower but they still got their TBI level. BJJ where, you know, sort of not point—not 1% is takedowns—sorry, BJJ and the rest of it's on the ground because you concentrate on the ground more, the TBI risk is actually quite low. It normally happens if you catch an elbow or a knee as you're passing guard. But practice that one time that you do a break, do a fall, get thrown—how'd you break fall? This is new to me.

Yeah, basically in BJJ you don't get that many TBI. It's actually very very safe by way of the brain. Small tissue injuries, perhaps a little bit different. But then yeah, as long as you tap early on chokes and don't hold off, the hypoxic state doesn't do you any favors.

James de Lacey1:22:17

Are there long-term effects then if if that happens too often?

Gary Turner1:22:43

Pretty similar to TBI.

James de Lacey1:22:43

Oh wow. Okay, I didn't know that. All right, I'm tapping early.

Gary Turner1:22:43

Lot of research. I'm tapping early today when I go to class. Always tap early. Who, if someone's got a heel hook on, who holds it off? I'm tapping early. I like the rest of my life being able to walk.

James de Lacey1:22:43

Yeah, exactly. I want my—

Gary Turner1:22:43

So if you if you tap out early on a heel hook, just think you can live without your heel. You can't live without your brain. So tap early on a strangle as well.

So again, it's like one thing—I'm Judo background, you know, second dan Judo black belt, British School Judo team. I was an international Judo player. So for me, a choke is on the windpipe, you're choking, and a strangle is when you're on the carotid artery. One cuts off the blood, one cuts off the air. You know, BJJ kind of get it kind of like, 'It's a strangle, that's a choke, it's a choke, no it's a strangle.' But yeah, so anything that cuts off the blood, tap early.

James de Lacey1:23:39

Okay, that's good to know. And I have one last question for you regarding, for people, maybe they have kids, maybe they want to put their kids in combat sports and stuff like that. Is there I guess a safe way for them to do it? Maybe put them into grappling versus striking? Is it maybe trying to find a gym that I guess is more up to date with things and the way they train their kids? Is there something that parents can do maybe to for their kids to be safer?

Gary Turner1:24:06

Yeah, so first thing is that sport—the sporting ideals, teamwork and all the good stuff that sport gives you, confidence and all the rest of it—sport doesn't. The research is quite clear. It doesn't. So physically, physical activity, movement, is what gives you the health benefit.

If you do regular structured physical activity, exercise—because you can get repetition injuries—it actually is less good than unstructured normal physical activity. So physical activity, yeah. Exercise, a little bit less, though exercise played for fun, games—because a little bit of fun competition gets in there—the injuries stack up a little bit. So it's less healthy still. Then sports, when you're playing to win, generally, it's a little bit less healthy. So even physically, it's physical activity that's key. So definitely prize physical activity.

Now sport, just a quick one—sport, for example, 'sport for all,' it's the most exclusive activity ever. If you're crap, you're on the bench, you're excluded. We haven't, the best guys yet, it's like, 'Oh come on, man.' So it's not even inclusionary. So if you're getting psychological benefits from sport, it turns out not to be sport. It turns out to be damn good coaches.

So I'm lucky that I've had masses of exceptional coaches that taught me how to coach and now I'm mentoring other people and have coaches passing on what's been taught to me. Coaching is where it's at. So a coach who develops—so if you get anything that's beneficial from sports, it's coming from the coach, not the sport. It's the coach.

So seek good coaches who are—it's all subjective, isn't it?—who's in alignment with your life, morals, and outcomes and such. You know, I would like if someone, a Sunday morning football, for example, having a kick around—soccer, they're having a kick around, for the Americans, Canadians around—you know, Canadians from Canadian land, soccer, Sunday morning soccer. Someone makes a mistake and trips over and falls over the ball. The team goes spacky at them like, 'What are you doing, you Muppet, you idiot.' I want to be with the coaches who encourage the team—'Come on, you Muppet, up you come, let's put this right.'

Yeah, the ones who help and encourage and engender teamwork, who lift people up, give benefits, who recognize that, you know, you're really crap at that, but you're my crap at that—come on, let's go. The ones that get inclusions, does that make sense?

James de Lacey1:26:28

Yep. No, that makes a lot of sense.

Gary Turner1:26:28

Smile takes the pressure off, lets them know that deliberate practice is what gets results, but hey, let's have a bit of a laugh while we do it. The ones who don't bully, the ones who actually meet their duty of care. So, and it's going to be a subjective and objective call for that individual.

The parents do need to wise up. If a if a combat sports club is allowing hits to their head, yeah, that's a big no-no red flag. That would be a red flag because they may not see the harm in doing it. But if they're not seeing the harm in doing it, what else are they not seeing the harm in doing? What kind of—

James de Lacey1:27:28

I was going to say, what kind of—because obviously the kids, they have the developing brain, taking hits to the head. Is it a different effect than an adult? Like a far worse effect, then, is it?

Gary Turner1:27:56

Yeah, yeah. So we get rapid periods of development every few years in the brain. It's like when, before lockdown, there's some kids that I taught and they're about so high. After lockdown, they're that high, looking down—'What, you grow?' It's like I caught up with one—Mike and Courtney came last night, and Courtney was a kid. It was really funny because she had one hell of a chopping leg kick and she really used to take it out on her dad. If she wasn't allowed out one night, she'd chop at that.

She just come back as a woman, you know what I mean. But the brain's like that. It develops really, really quickly. It has these rapid periods of development. If you get hit at that point in time, some areas of the brain may not actually come online. So it's quite serious. In developing brain, the impacts can be literally—impacts can literally be quite, with the pun there, can literally be really significant.

And the brain continues to mature until the age around 24, 25, although most of it is under the ages of of 18, 19. So under the age of 18, 19, if you're taking hits to the head, you might be throwing the entire developmental pathway of your brain off on some different tangent. It's quite worrying. I've got a book on the developmental brain and acquired brain injury.

So you can have, like, biological—you can have hypoxic, lack of oxygen—you have viral insults—I love it, 'insults of the brain'—you have traumatic, boom, insults of the brain. You know, reading that book scared me. Yeah, it really scared me. So even if the kid doesn't display any overt signs of behavioral effects from it, you're still lowering and reducing where they could have been, which is the worrying thing.

So yeah, kids—it's a tricky one. And I love my combat sports. Say that I got so scared. After just, you know, bear in mind, three years in now—so back in just around 2016 when I first did this online thing about going counter to Erik Anderson with, 'Getting hit in the head is child abuse'—you know, the moment I realized that, it took me a few weeks for it all to sink in. I'm like, 'I've got to, I've got to, I've got to.' And I stopped all head contact in my training for those under 16.

A few weeks later, under 18. A couple of months after that, no head contact in my classes. My class numbers actually went up, and I had no loss in ability. In fact, in some areas I had an increase in ability as well.

James de Lacey1:30:29

That's very interesting. It's doable. People just need to—people just need to, yeah.

Gary Turner1:30:29

It's—I mean, all sports have it, right? They all have the old, some kind of old school traditional mentality through it.

James de Lacey1:30:29

I mean, you mentioned rugby a lot. I mean, rugby is where I worked most of my career, and there's still a lot of stuff that goes on in rugby that's just, you know, you sit there going, 'What? Why?' You know? And obviously, all sports have it. All sports have it, and some are becoming slowly more, I guess, advanced or advancing through as more people coming and new ideas coming.

But I mean, that's the whole idea of this podcast as well. I'm pulling in people from not just combat sports—I'm going to pull people in from other sports, other areas of research and things like that that can offer insight into how they do things that can be applied. Because it's not just within combat sports.

Gary Turner1:31:22

Yeah, so in in combat sports, though, Yuki Price, who I passed my class to—I didn't go back to teaching after lockdown. I go back and enjoy it myself now. So I passed it to Yuki.

A really skilled coach. He's done a sports coach and sports science degree and he had the same sort of mentality as me of learn development and put the clients first. It's perfect because he's kept the same atmosphere, the same feeling in the class. Now I can just go and have some fun, like getting swept by one of the youngsters last week. So funny. Have a look on YouTube. It's gone viral on Instagram at the moment as well. It's had like 30,000 people have seen me swept there by a kid. It's really fun.

But he is dancing as well and he's been telling me some of the things that he's been getting from dance, like foot placement and such. Combat Sports can really wake up to different people. There's a ballerina and celebrity in the UK called Darcy Buel and I was lucky enough to get to chat with her on a social level.

We were talking about the similarities between dance and kickboxing. The focus is different. One is to look good and in time with the music, so to speak. Others for it to be applied. But there's a real big crossover between the two.

James de Lacey1:32:40

That's right. You got it on the rhythm.

Gary Turner1:32:40

Interesting on that, I would never fight to the rhythm. The Dutch flow is based on melody rather than the rhythm. If you're going, now you're readable. It's predictable there. So they do half beat shots, quarter beat shots, pause beats, slur beats and such, and get like a melody going on there. That's nice.

James de Lacey1:33:17

It's a way to break that rhythm down, right? You're playing with the rhythm there again. So it's that concept throughout. It's really interesting. I think most people learn from that. Most people miss that in all sports. It's about being able to play with rhythm and it comes down to not just sitting there doing strength conditioning on its own and then I'm just going to do skills on the pads and whatever else. You need to have that stimulus back so you can play with the rhythms and break them.

Gary Turner1:33:42

A different tangent, but well, on a tangent to offer you something for rugby: one of the things that Combat Sports can teach rugby is ground force reaction. Because it's the push into the ground that drives that initial drive through for the punches. That's what creates the power and acceleration, everything. So the ground force reaction that depends on the foot placement.

So I went to work with a semi-professional rugby team and one of the players was like the flash. It was so fast, it was unreal. And I said to him, "You realize you can be quicker?" He says, "What you mean?" I said, "On that turn, you took five paces, five steps. If you make these little adjustments, you could do it in three. You can be sharper and faster on your turns, more efficient, less energy, quicker overall." "Hey, how'd you do that?" I started to show about how to place the feet. They became quicker as a result.

So for example, from Combat Sports, we can offer rugby foot placement. And grappling, I use a lot of stuff wrestling.

James de Lacey1:34:35

Oh, do you do breathing?

Gary Turner1:34:35

Not much. I mean, depends how much time you've got. So here's a thought. You ever wondered why athletics tracks you run counterclockwise where everything else goes clockwise?

James de Lacey1:34:35

No, I have not.

Gary Turner1:35:10

Breathe out on your dominant side. So if I'm right sided, that's my right side. As I push on the right side, so it's leftist, yeah? This end, the left is coming around, but you can power around the turn because you're pushing more with the right leg and you breathe out the right leg. So I would know someone's going to hit me three shots beforehand by watching their breathing. Just the breathing.

So with rugby, for example, just on their breaths: if you want to tackle someone and win them, you want them breathing out. If you initiate the tackle and they're breathing in, so breathing out, they have to breathe in again to react to the tackle. So if you time it so just after they've driven off on their dominant side, for example a right-handed player off their right leg, and then you tackle, they're not going to be able to react. You're also going to be slowly up off the ground. There's lots of crossovers.

James de Lacey1:36:10

Interesting. Well, we've taken up a good 90 minutes of your time here, Gary. But thank you for coming on. This has been a learning experience for me too, and I'm sure everyone else listening has learned a ton as well. But where can anyone, I guess, keep up with your work or find you somewhere to get in touch?

Gary Turner1:36:10

You can find me on Facebook. You can find me on Twitter, SM Turner. Oh, I'll find you on Twitter too. I can't remember what I'm called on Instagram. That's terrible. I'm not great. I've got no skin in the game. I'm just me. I'm not looking to build an Insta following and stuff, wearing bikinis and pushing me cleavage up. If that was the case, but yeah.

So I'm on Instagram, I'm on Twitter, I'm on Facebook. I'm on obviously the performance page, conditioning page. Come on, come on. Find me, give me a little hunt. And yeah, any questions, fire it out. And the thing I always say on these things is come at this podcast and what I say as from the cognitive bias position that everything I've said tonight is completely and utterly wrong and look to prove me wrong. Because it might be that somewhere I am actually wrong, in which case I'll get it more right in the future.

James de Lacey1:36:59

Now, thank you for coming on. I really appreciate it. We might have to do a round two at some point and talk more concussion stuff as more of your research comes out too.

Gary Turner1:37:29

Shoot us up. Definitely keep that.

James de Lacey1:37:29

Perfect. Thank you, Gary. Appreciate it.