What’s Worse For Your Brain—Drinking or Playing Football?
I woke up Sunday morning with a throbbing headache. I’d spent the previous night heavily sampling a selection of rare whiskeys with some friends.
That may have been fun, but now here I was, still in bed at 11 a.m., barely able to keep my eyes open, hardly able to think, certainly not wanting to turn on the day’s NFL games.
And I thought… this cannot be good for my brain.
The effect of NFL action on the brain is one of the hottest topics of the moment, with the movie Concussion opening this Christmas weekend.
In that film Will Smith portrays Bennet Omalu, the forensic pathologist who first brought to light the appearance of CTE (chronic traumatic encephalopathy) in American football players.
Thanks partially to Omalu’s work, nowadays when we watch the constant brutality on the football field, when we see players crashing their heads into each other down after down, when we notice aging players getting dementia (and worse) once retired, many of us have even started to wonder, “Can I ethically enjoy football any more?” Myself included.
At the same time, though, I often put my own brain in serious jeopardy too.
Yes, I am a professional drinks writer. Mid-day cocktail tastings. Evening scotch samplings. Beer festivals on the weekends. Trips to breweries, distilleries, and wineries. You should see how much free liquor gets delivered to my house on a daily basis!
People often tell me I must have one of the best jobs around. But they aren’t the ones that have had to drink literally every single day for… hell, who knows how many days in a row it has been now. They aren’t the ones that wake up many mornings with a hangover—just another occupational hazard.
So, with all this in mind, I decided to ask some football concussion doctors about the effects of my equally dangerous profession on my own precious brain. I wondered, how bad is my drinking compared to playing football?
Was a single whiskey shot equal to a QB sack?
A night of heavy beer drinking equal to a half of football?
Did my brutal Sunday morning hangover feel worse than it did on a Monday morning for a running back?
Neither Dr. Omalu—nor Will Smith—returned any of my calls, but luckily I had other accomplished doctors willing to answer my questions.
Dr. William Barr is the Director of Neuropsychology at NYU Langone Medical Center.
He is a clinical expert on epilepsy, forensic neuropsychology, and sports concussions. He has testified in numerous cases involving forensics and in civil cases involving MTBI (mild traumatic brain injury). More importantly, from the mid-1990s until 2004, Barr was a neuropsychological medical consultant for the NFL’s New York Jets.
He quickly understood the somewhat silly concept behind this piece, and even why a professional drinks writer had reason to be concerned.
“I used to think about boxers,” he told me, noting that this was before all this concussion talk was in the mainstream. “People used to say boxing was the only way for a kid to get out of the ghetto—but he had to put his brain at risk. How terrible it was that society forced them to do this! But I also thought about the typical Mad Men-era businessmen. They had to do the three-martini lunches for their work—they too were pickling their brains just to get ahead!”
Barr is a bit of a firebrand when it comes to talk about concussions. In fact, he believes concussions—whether from football or otherwise—actually have a fairly minimal impact on future cognitive functioning.
“When you look at the studies and what happens three months after a concussion—do you know what meta-analysis is?” he asks. I don’t. He explains that, “In science, rather than making conclusions based on a single study, you look at all the literature. Put it into a similar metric. What’s the overall effect based on many, many studies? So now, maybe, you’re looking at 300 people over 10 studies. What it shows is the overall effect (on your brain) of a concussion after 30 days is lower than the effects of intoxication.”
The study Barr is citing is Grant L. Iverson’s 2005 paper Outcome from Mild Traumatic Brain Injury.
Iverson didn’t study alcohol’s traumatic effect on the brain per se, but he did find chronic cannabis use to be worse on overall neuropsychological functioning than an MTBI (mild traumatic brain injury) was on a person just one to three months after the injury had occurred. Likewise, he found chronic cannabis use to be slightly worse on future memory functioning than an MTBI.
For Barr, that was enough for him to deduce for me that alcohol abuse would be probably likewise worse on the brain than head injuries from playing football. Uh oh.
Barr isn’t completely speculating, as he has co-authored his own significant studies. With a team of other doctors and PhDs he helped pen “Cumulative Effects Associated with Recurrent Concussion in Collegiate Football Players and Acute Effects and Recovery Time Following Concussion in Collegiate Football Players.”
“I’ve studied athletes more than the general population. With them we can get information before their injury and then after,” he tells me. “And what that shows is that 95 percent (of athletes who have a concussion) recover back to normal in 7 days or less.”
He tests alcoholics’ brains in a similar manner to how he tests concussed athletes. He interviews them and then gives them a series of tests, ones mainly based on memory functioning (they have to remember a certain story).
“So I might notice, this person has problems with attention and remembering things. In the past they’ve been a 10-drinks-a-day alcoholic and now it looks like they’ve pickled brain.”
Though well-honored and quite thorough, you can probably see how Barr is considered a bit of a contrarian for his thinking on concussions.
Barr was even dismissed from the NFL’s MTBI committee in 2004 by then-chairman Elliot Pellman, another former New York Jets team physician who is not without his own controversy.
I wanted another doctor’s opinion on my potentially pickling brain. Dr. James Paci, a professor and orthopedic surgeon, specializes in sports medicine at Stony Brook University Medicine. He’s also the football team’s doctor.
First, he clarified that he was neither a neurologist nor brain physician. Despite that, he was trained to deal with concussions on a day-in, day-out basis in his own role as team doctor.
“My expertise is how do we treat these athletes,” Paci told me. “What do we look out for? How do we prevent long term consequences?”
However, unlike Barr, Paci somewhat struggled with the comparisons I was hoping he would draw for me.
“Certainly there is some connection between alcoholism and Alzheimer’s, brain diseases. Drawing a parallel between drinking and football though? I don’t think anyone has made that correlation.” Though he does note, “The rock ‘n’ roll lifestyle and athlete lifestyle certainly do have some comparisons.”
A man like Paci believes that both football and drinking are inherently dangerous, but that’s OK, so long as we acknowledge the risk involved in both activities and, thus, let potential participants make informed decisions.
“I’ve had concussions before,” Paci tells me. “Anyone who plays sports has had one before.”
Paci is about my age, having played football at Yale University in the late-1990s, while the slightly-older Barr played during a time head injuries weren’t treated all that seriously.
“Back in the day when I played high school football,” Barr tells me, “you pretty much had to be in a coma before they did anything about it.”
So both men had played football at a fairly high level, had head injuries on the field, and were still able to become prestigious doctors. But did they drink?
“Not routinely, but I do,” Paci tells me. “Most doctors do. There are certainly benefits to some alcohol.”
(I’ve been saying that for years.)
“I do,” Barr also tells me. “Everything in moderation. A little bit of alcohol can be good for the heart. There’s good data for the red wines. Some scotch in moderation, a finger a day maybe.”
So you guys drink, but now knowing what you know, would you let your own children play football?
On that point Paci is fairly strict, believing young children simply don’t have the body control and should stick to flag football or two-hand touch.
“A parent can’t consent to giving their kids a cigarette or a beer—why can they consent to him playing tackle football?”
Barr has a six-month grandson he absolutely wants to play football some day.
“Should that boy play football or not? My take, from what we know right now: the chance of getting dementia, the prospect of a 13-year-old boy who starts football getting dementia one day is, let’s say, 1 to 2 percent. I’m being liberal,” Barr tells me. “But let’s say that boy is not allowed to play football. Instead ‘junior’ becomes fat and gets diabetes and high blood pressure. Now he has a 30 percent chance of dying of dementia.”
So to Barr inactivity in this country is a much bigger problem than helmet-to-helmet contact—interesting, because drinkers on the whole are statistically much more “active” than non-drinkers according to the Center for Advancing Health.
That paper’s lead author, Michael French, a professor of health economics at the University of Miami, found that alcohol users not only exercised more than teetotalers, but “the differential actually increased with more drinking.”
“I don’t fully understand the relationship,” Barr admits, though he has a speculation. “Maybe people feel like after visiting the gym, they deserve to do something ‘bad.’”
It’s true enough anecdotally for myself, though I’m a bit more of the reverse. I do something “bad” the night before, then feel the need to go jog five miles the next day.
I ask Barr point-blank, “It seems like you ultimately think it’s safer to play in the NFL than to drink heavily?”
“Yeah, you could say that,” he confirms.
This did not sound good for me. But what exactly did “heavily” mean? This week alone I sampled new whiskeys on Monday, drank wine with dinner on Tuesday, visited a hot new cocktail bar on Wednesday, went to a brewery opening on Thursday, and hit happy hour with friends on Friday.
Luckily, Barr relieved some of my concerns about any sort of future with dementia, simply telling me, “You would not be on the phone with me, or even able to write this story, if you were drinking too much.”
Regardless, I think I’ll start trying to be more cognizant of my intake. As Paci ultimately summed up for me: “The brain is an amazing thing. Your head hurts when you bang it. So you try not to bang your head again. With a hangover, there’s obviously something similar going on there.”