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MMA Guidance from a Black Belt Physician
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Hartford HealthCare’s Steve Coates talks to Dr. Bharat Narapareddy, a neuropsychiatrist at the Institute of Living, part of the Hartford HealthCare Behavioral Health Network. He’s also a black belt in Brazilian Jiu-Jitsu.
Dr. Narapareddy is part of a collaborative research team who recently published a study on brain changes in professional fighters based on weight class. He helps us better understand the effect repeated blows to the head have on brain structure and function over time.
But if you're taking a substantial amount of damage in a fight and there's no chance of winning, you know, expecting your fighter to kind of come from behind and landing that last blow could be the difference between a very minimal injury or a significant deficit down the road.
SPEAKER_02Welcome to more life. In this episode, Hartford Healthcare's Steve Coates talks to Dr. Bareth Nera Peretti, a neuropsychiatrist at the Institute of Living, part of the Hartford Healthcare Behavioral Health Network. He's also a black belt in Brazilian Jiu-Jitsu. Dr. Nera Peretti is part of a collaborative research team who recently published a study on brain changes in professional fighters based on weight class. He helps us better understand the effect repeated blows to the head have on brain structure and function over time. Here's Steve Coates.
SPEAKER_01As a physician and someone who has performed at a high level in martial arts and who has trained mixed martial arts fighters, you bring a really interesting perspective into this. Tell us a little bit about the study.
SPEAKER_00Yeah, absolutely. So, you know, we uh focused on weight class, and so we really looked at lightweight fighters, middleweight fighters, heavyweight fighters, and what we found was that in our heavyweight fighters, we had greater yearly reductions in brain volume uh and functional performance. Okay. Um, so really, you know, we have controlled for the number of years fighting, the number of professional fights. Um, and so what this kind of uh tells us, and what we what we think is going on, is that it's not the sheer volume of punches that's occurring, but it's the brute force of the punches uh, you know, which uh they're throwing. So it's the that force of the strike itself. Um and that's that's what we are we've kind of seen from this study in terms of the heavyweight fighters uh themselves. The lightweight fighters, uh much different kind of picture. So we did see volumetric changes, so reductions on a per fight basis. And so when we kind of thought about it, we were thinking about well, what's pretty significantly different between heavyweights and lightweights, aside from just the weight differences. And one of the common practices that occurs in lighterweight fighters is something called weight cutting. Okay, and just to explain a little bit and give a little bit of background, weight cutting is something that is done to kind of uh give the fighter an advantage. So, you know, they walk around at say 185 pounds, but then they cut a significant amount of weight to maybe make the 155-pound weight class. Okay, so the idea is that they would be losing water weight quite a significant amount the weeks leading up to the fight or even the week leading up to the fight. Uh, and then they would essentially, uh after weigh-ins, after they make the weight, they would refeed and then rehydrate and then gain that weight back to have a size advantage at the time of the fight. Um, so you know, this severe dehydration, we think, you know, may also contribute to uh the severity of an injury that maybe you know, a TBI that may be sustained during the fight itself.
SPEAKER_01So I'm guessing this could be dangerous as well to the lighter fighter they're competing against. They might be 150 pounds when they're fighting, but really they're getting hit by someone who might outweigh them by 20 or 25 pounds.
SPEAKER_00Yeah, yeah. They're they're going for uh a size and strength advantage. Certainly, you know, the amount of blow that you're gonna deliver is going to be more forceful if you're having more weight than your opponent on the night of the fight. But there are other things to certainly consider, which is, you know, previous studies out there have kind of shown that even though you rehydrate, you're still pretty significantly dehydrated because of the sheer amount of uh weight that you're cutting and the water weight uh that's being depleted. Um so you know, you you really have to ask yourself, is this a true advantage?
SPEAKER_01The hope then from this study is to have the governing bodies do something to prevent this weight cutting.
SPEAKER_00Yeah, I think it would dramatically increase safety. And it's one of my big concerns, not just as a physician, as a former competitor, and as an active mixed martial arts coach, you know, one of the big things that you know you worry about is your fighter cutting so much weight. And we've seen some horror stories where people are passing out on the treadmill trying to cut weight, passing on the sauna trying to cut weight. They're literally unable to stand on the scale during weigh-ins, right? These are all things you really worry about. So importantly is you know, to how to cut weight safely, doing it over a period of time and really making sure that you're not pushing your body past its limits, right? And cutting excessive amounts of weight where then you'd require going to an emergency room and needing fluids and uh other interventions.
SPEAKER_01And then the thought is the long-term impact on the brain from this continuous dehydration, correct?
SPEAKER_00Yeah, it's kind of a cumulative effect, right? So you've got a you've got a fighter who's been training, they're cutting weight, they're trying to make their weight, and then they're severely dehydrated, they're now rehydrating and now going into a fight and gonna take repetitive head impacts. And you have to wonder the role that severe dehydration is playing in any sustained TBI these fighters may experience.
SPEAKER_01Physicians and and other scientists involved in studies aren't usually as intimately involved with the subject matter. Your background uh is quite interesting. Tell us a little bit about that.
SPEAKER_00Yeah, absolutely. Uh so you know I I've been in martial arts my whole life. Uh, I started competing uh uh in my teens and then did some uh smaller mixed martial arts events and then transitioned to Brazilian Jiu-Jitsu in 2006, and I've been training and competing since that time pretty actively. I last competed in 2019 um and actually earned my Brazilian Jiu-Jitsu black belt uh in 2019 as well. So, you know, over the last couple of years I've put a lot of focus and dedication into coaching and training, and so I actively still coach mixed martial arts fighters, professional, and amateur in Baltimore, where my primary academy is.
SPEAKER_01So it's gotta be a tough internal battle for you as a physician. The sport can be brutal. We've seen the knockouts sometimes on loops on social media. So for you, it's really about making the sport as safe as possible, and it appears that you are finding ways.
SPEAKER_00Absolutely. And it it's not uncommon to, you know, have an athlete uh sustain a blow to the head and have have the essentially post-concussive symptoms, headache, dizziness, right, um, nausea and all those things. And you you see this in your gym, you see it happen frequently, and certainly you're in favor of always as a coach, you want your fighter to be able to compete at 100% and be in the best shape possible. The physician side of me kind of thinks about well, what are some ways that we can make this really safe in terms of the practice habits leading up to the fight, um mitigating some of these uh blows to the head so that, you know, people can go into the fight uh as close to 100% as possible. That's always the goal. I think there are always ways that we can make it safer, you know. And I think um just to answer the question, you know, I think that mixed martial arts, you know, when it kind of came together um so many years ago with of course the Gracies and Brazilian Jiu-Jitsu kind of uh evolving so rapidly and the sport coming together, it's a it's a beautiful sport that kind of combines all of mixed of martial arts together, you know? And so I think nowadays, especially kind of with what we've seen with football and kind of the focus on head injury, you know, it's starting to translate into other sports. How can we start to make these sports safer? And I think that it really does start with knowledge for the fighter and really knowing, you know, what to expect down the road, but also the the trainers. And I think this is a big kind of hole in the sport. And, you know, I think that what we oftentimes see is that you know, fighters are in a fight, they're down multiple rounds, they have no chance of winning, but yet there's this mentality where you have to push through, just keep keep going. And the fighter is never going to quit, very rarely. So oftentimes it falls on the trainer to either, you know, say, you've taken too much, let's let's go on to fight another day, throw the towel in, protecting their fighter. And so that's what I want to advocate more for. It's not so much looking at it as quitting, but if you're taking substantial amount of damage in a fight and there's no chance of winning, you know, expecting your fighter to kind of come from behind and landing that last blow could be the difference between a very minimal injury or a significant deficit down the road.
SPEAKER_01So you mentioned football over the past ye couple of years, we've had a lot of progress, it seems, made in terms of at least bringing um awareness to the need for more safety. It seems like MMA is also moving in that direction.
SPEAKER_00I think the progress is being made slowly uh but surely, and I think that awareness, as awareness continues to grow, as we continue to do more studies, as we continue to ask more important questions, things can change. I certainly think that there are always ways that we can improve the sport. And I think a large focus that um needs to be placed moving forward is certainly on practice habits. We focus so much on the fight itself, but there's so much that occurs uh during a training camp, which is often two or three months long, right? If you're training for a title fight or any kind of big fight. And during that time, you would have sparred several times over the course of a week, not just in striking, but in grappling as well if you're a mixed martial arts fighter. And so this has serious implications moving forward. You know, what's the culture of your gym? You know, how hard are you sparring? Are you sparring 100% where you're taking a significant amount of blows? Does that lower your threshold then for a knockout or to uh to sustain a significant blow during the fight? Does it, you know, kind of uh put you at higher risk for injury because you've taken so many blows in sparring itself before you even made it to the actual fight? So, you know, kind of making practice safer, I think we can go a long way.
SPEAKER_01I'm sure you've heard this a million times, but as far as brain injuries go, what about using headgear?
SPEAKER_00Yeah, that's a that's a fantastic question. You know, in terms of brain injury itself, right? You know, headgear protects you from superficial injuries, cuts, those kinds of things. But in terms of the rotational force of the brain inside the skull, the whiplash type injuries, what we call a coup counter coup type injury, headgear will not protect you from those uh kinds of injuries, right? Uh the other thing I can tell you from a fighting standpoint and a coaching standpoint is that headgear oftentimes can block peripheral vision. So certain punches are really difficult to see, such as those wide loopy punches like hooks, you know, and those kind of things. It also gives you a false sense of protection. So just anecdotally, one of the things I've noticed in my fighters and also myself when I spar is that, you know, sometimes you're not as reliant on footwork and head movement when you have big padded gloves and big headgear that's on. So there's this false sense of security. So actually, you know, I think what I've seen, and you know, this needs certainly more data, more studies need to be done. But when you have smaller gloves on and you tend to have, you know, maybe no headgear, you focus more on defense, you focus more on movement, footwork, um, and throwing punches with precision rather than just pure power. So that could have some safety outcomes moving forward.
SPEAKER_01So your love of the sport and your choice of a career, are they related?
SPEAKER_00Yeah, I think certainly having a background in the sport uh is certainly a motivating factor for me. And really, you know, spending so much time in so many different gyms for so many years, 20 years at least now of my life, you really grow close with your teammates. You start to see people develop symptoms, not just post-concussive symptoms, but neuropsychiatric symptoms, anxiety, depression, those kind of things. And you really want to do your best to help them. That that was my driving force of going into neuropsychiatry and why I pursued the fellowship in that area and then decided to branch off and do research uh kind of solely in this area.
SPEAKER_01And on a personal level, what continues to draw you to the sport after, you know, more than 20 years participating, whether it's competing or coaching?
SPEAKER_00To to the sport itself, you know, I think it's it's one of the most therapeutic things that I've ever done in my life. You know, I think when you when you get on the mats and and you train, it's probably the hardest workout that uh I've ever done. And, you know, I played three sports in high school, and uh, this was by far the hardest thing that I've ever done. You test yourself every time. Um, it's one of those sports where you literally have to check your ego at the door and you learn something every time you step on the mats. There's always going to be someone that's better than you. Um, so you're constantly testing yourself. I think that as I uh came up in my training, I started to see how this was kind of TPI was and traumatic brain injury was kind of starting to blow up in terms of the NFL and football. And I really wanted to see how this translated to mixed martial arts specifically and not just MMA, but also Brazilian jujitsu and the grappling arts, right? So there are lots of important questions that need to be asked about the effects of even repetitive chokes on a daily basis. You're training these chokes every day, submission grappling tournaments, how how what kind of effects did those have long term? So, you know, there are lots of questions that need to be answered.
SPEAKER_01Doctor, thanks for your time today and good luck, best of luck to you in your continuing quest to make MMA a safer sport.
SPEAKER_02Thank you for having me. Thank you, Steve Coates and Dr. Nara Peretti. To learn more about Dr. Nara Paretti, the study, and Hartford Healthcare's Institute of Living, check the links in this episode's notes. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to more life.
SPEAKER_03I'm ready for my clothes up. All the faces that light up. You know, I love this meal. I got more life than I like. We can go anywhere we want to go.