15 Actions to Lower Your CTE Risk After Contact Sports
Hi, I’m Dr. Mark—a concussion recovery specialist with over five years of experience working with athletes, parents, and weekend warriors. Whether you’ve hung up your skates, cleats, or gloves or are still in the game, you might be asking: How can I protect my brain after years of contact sports?
The good news? Many of the risks associated with Chronic Traumatic Encephalopathy (CTE) overlap with modifiable factors. Today, we’ll dive into:
What CTE is and why diagnosing it is so complicated.
The difference between CTE and TES.
Most importantly, 15 actionable steps you can take today to protect your brain health.
This blog isn’t about fear; it’s about empowerment. Let’s start with some context.
What Is CTE, and Why Is It So Complex?
Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative condition associated with repetitive head impacts, particularly in contact sports. It is defined by hallmark features found in the brain postmortem, including perivascular tau deposition, neurofibrillary tangles (NFTs), and neurodegeneration concentrated in cortical sulci. These tau protein deposits are thought to impair brain function and may contribute to behavioral, mood, and cognitive symptoms.
PMID: 32712946
But here’s (a brief look at) why CTE is so difficult to understand:
Diagnosed After Death: CTE can only be confirmed postmortem, meaning we can’t currently track or diagnose it in living individuals.
Selection Bias in Research: Most studies rely on brain donations from symptomatic individuals, skewing findings toward more severe cases.
Symptom Overlap: Many CTE-like symptoms, such as mood swings, memory problems, and behavioral changes, are also seen in treatable conditions like depression, PTSD, and sleep apnea.
Lack of Control Groups: Studies often lack non-athlete controls, making it difficult to determine if observed changes are unique to repetitive head impacts or part of normal aging.
What Does This Mean for You?
While CTE is real, much of the research is murky. The overlap with treatable conditions means there’s a lot you can control today to protect your brain health. Let’s explore how.
15 Modifiable Factors to Protect Your Brain Health
CTE research is complex, but one thing is clear: several comorbid conditions and confounding variables consistently show up in the studies. The good news? Most of these factors are independently treatable and may positively influence your brain health.
To make it actionable, we’ve grouped these factors into seven categories. Here’s what we’ll cover:
Foundational Health Conditions
Sleep and Recovery
Chronic Pain and Stress
Hormonal and Biochemical Imbalances
Substance Use and Misuse
Nutrition and Physical Activity
Mental Health and Social Connections
These categories provide a roadmap for improving your long-term brain health, starting today. Let’s dive in.
1. Foundational Health Conditions
Building a strong foundation for brain health starts with overall physical health.
Address Obesity
Excess adipose tissue alters the body’s inflammatory pathways (the inflammasome), potentially contributing to worse outcomes in traumatic brain injury (TBI). Reducing body fat through balanced nutrition and regular exercise can support brain health.Control Blood Sugar
Dysregulated blood sugar may accelerate tau buildup and vascular damage. Exercise and diet can improve glycemic control and reduce this risk.Monitor Blood Pressure
High blood pressure can damage brain blood vessels, contributing to cognitive decline. Lifestyle changes, such as regular physical activity and a balanced diet, may help.
Takeaway: Managing weight, blood sugar, and blood pressure creates a solid foundation for better outcomes in brain health.
Eagle, S. R., Basantani, M. K., Preszler, J., Sherry, N., McIntyre, P., Kershaw, E. E., ... & Okonkwo, D. O. (2024). Interaction of obesity and proteins associated with the NLRP3 inflammasome following mild traumatic brain injury. Scientific reports, 14(1), 10178.
2. Sleep and Recovery
Sleep is when your brain clears waste and repairs itself. Poor sleep has been linked to worse cognitive outcomes.
Address Sleep Apnea
Untreated sleep apnea disrupts oxygen flow and increases inflammation, which may impair cognitive recovery. Interventions like CPAP therapy or weight loss can reduce risk.Prioritize Sleep Hygiene
During sleep, the glymphatic system clears waste products like tau. Strategies like consistent sleep schedules, limiting screens before bed, and creating a cool, dark sleep environment can improve sleep quality.
Takeaway: Sleep is critical for brain repair and should be a top priority.
Kureshi, S., Stowe, C., Francis, J., & Djalilian, H. (2023). Circadian therapy interventions for glymphatic dysfunction in concussions injuries: A narrative review. Science progress, 106(3), 00368504231189536.
3. Chronic Pain and Stress
Persistent pain and stress may silently erode brain health over time.
Manage Chronic Pain
Chronic pain may increase neuroinflammation and affect emotional regulation. Tools like physical therapy, mindfulness, and targeted rehabilitation can help break the cycle.Reduce Chronic Stress
Prolonged stress elevates cortisol, which may impair memory and mood. Practices like yoga, meditation, or biofeedback can improve resilience and stress regulation.
Takeaway: Addressing pain and stress protects both your brain and emotional well-being.
4. Hormonal and Biochemical Imbalances
Internal imbalances may amplify your risk if left unchecked.
Monitor Testosterone Levels
Low testosterone may be linked to fatigue, mood changes, and reduced cognitive function. Addressing deficiencies under medical guidance can help. The study below found that former professional football players with low testosterone were more likely to report symptoms of neurobehavioral dysregulation, such as explosiveness, rage, and mood swings.Target Inflammation
Chronic inflammation may accelerate neurodegeneration. People can adopt an anti-inflammatory diet (e.g., Mediterranean Diet) to support brain health and consider supplements like omega-3 fatty acids or turmeric.
Takeaway: Reducing inflammation and optimizing hormonal health supports long-term resilience.
5. Substance Use and Misuse
Lifestyle choices can either support or harm your brain.
Limit Alcohol Consumption
Excessive drinking may increase brain inflammation and impair cognitive recovery. Reducing intake may lower your risk. Want more incentives? The table below demonstrates that even moderate alcohol consumption can negatively impact brain health. For a 50-year-old, having just one or two alcoholic drinks per day is associated with the equivalent of nearly two years of brain aging.Avoid Opioid Misuse
Opioids can disrupt sleep, leading to sleep-disordered breathing and potentially fatal complications. They also carry a risk of cardiovascular issues, including a 28% increased risk of myocardial infarction with current use. The long-term use of opioids can lead to cognitive and psychomotor impairments, such as decrements in working memory, reduced cognitive flexibility, and increased impulsivity. Explore non-opioid strategies for managing pain when possible.
Takeaway: Moderation and alternative treatments are key for protecting brain health.
Daviet, R., Aydogan, G., Jagannathan, K., Spilka, N., Koellinger, P. D., Kranzler, H. R., ... & Wetherill, R. R. (2022). Associations between alcohol consumption and gray and white matter volumes in the UK Biobank. Nature communications, 13(1), 1175.
6. Nutrition and Physical Activity
What you eat and how you move can profoundly influence your brain health.
Adopt a Mediterranean Diet
The Mediterranean diet—rich in fruits, vegetables, fish, and healthy fats—has been linked to better cognitive outcomes and lower inflammation. Its versatility makes it one of the easiest evidence-based diets to follow.Stay Active
Regular physical activity supports neuroplasticity, improves brain blood flow, and reduces cognitive decline. Even in the presence of high tau levels, medium and high physical activity are associated with a 58% and 41% slower rate of cognitive decline, respectively (see table below). Aim for 150 minutes of moderate exercise per week.
Takeaway: A balanced diet and regular exercise are essential for brain health.
Desai, P., Evans, D., Dhana, K., Aggarwal, N. T., Wilson, R. S., McAninch, E., & Rajan, K. B. (2021). Longitudinal association of total tau concentrations and physical activity with cognitive decline in a population sample. JAMA Network Open, 4(8), e2120398-e2120398.
7. Mental Health and Social Connections
Your mental and emotional health matters just as much as your physical health.
Address Anxiety, Depression, or PTSD
Mental health conditions such as depression, anxiety, and sleep problems strongly influence the endorsement of Traumatic Encephalopathy Syndrome (TES) symptoms, with or without a history of head impacts. Research shows that individuals with these mental health issues are significantly more likely to meet TES criteria compared to those with repetitive head impacts alone. This suggests that mental health plays a more significant role in TES-like symptoms than previously thought, challenging the belief that head trauma is the primary cause. (PMID: 38687442, 38204178)Build Strong Social Networks
Loneliness and social connection significantly influence cognitive health and overall mortality. Loneliness has been identified as a risk factor for dementia, cognitive decline, and early death, while social connection serves as a protective factor against these outcomes. Studies suggest that the effects of loneliness may partially overlap with the progression of dementia, highlighting the importance of addressing both psychological and social factors in mitigating risks associated with aging and neurodegeneration
Takeaway: Strong emotional and social support systems bolster brain health.
I bet you didn’t see this covered by the NY Times. Terry, D. P., Bishay, A. E., Rigney, G. H., Williams, K., Davis, P., Jo, J., & Zuckerman, S. L. (2024). Symptoms of traumatic encephalopathy syndrome are common in community-dwelling adults. Sports medicine, 1-13.
Final Thoughts: Your Brain Is Worth It
CTE and its related symptoms are complex and often misunderstood. But here’s the key takeaway: many factors thought to contribute to poor brain outcomes are treatable and modifiable. Addressing foundational health, sleep, stress, inflammation, and lifestyle habits can make a meaningful difference.
If you’re a contact athlete or someone concerned about long-term brain health, take control today. Small, consistent actions—like adopting a Mediterranean diet, improving sleep, and staying active—can create a resilient brain for years to come.
Take the First Step
At my clinic, we take a comprehensive, evidence-based approach to brain health. Whether you’re looking to recover from a concussion, optimize your performance, or reduce your long-term risk, we can help.
Let’s work together to protect and improve your brain health.