Grant Cohn: Heart issues a core problem facing NFL

Three hundred and thirty-five-pound San Francisco 49ers guard Thomas Herrion died at his locker after a preseason game on Aug. 20, 2005. He had heart disease. He was 23.

Eleven years before Herrion died, the National Institute of Occupational Safety and Health examined 7,000 football players and decided the life expectancy for linemen is just 52 years. According to the study, linemen also have a 52-percent greater chance of getting heart disease than other people.

Heart disease is a root problem for the NFL. The league can improve helmet technology and tackling techniques to limit concussions, but the league cannot make linemen smaller.

Teams want the biggest, strongest players. That won't change. 49ers general manager Trent Baalke recently made that clear when he laid out his team-building philosophy at a pre-draft press conference: 'When you look at the makeup of the team from a structural standpoint, we want to be big and we want to big physical,' he said.

Teams are getting bigger and bigger. Last season, the Niners had eleven players who weighed at least 280 pounds. In 1984, the Niners only had one — offensive tackle Bubba Paris. They listed his weight at 295.

Bill Walsh thought Paris was too big, so Walsh kept him on a diet. One year during training camp, Walsh made Paris stand on a scale every day to make sure he weighed no more than 325. For nine weeks in a row, the scale said Paris weighed 323. Walsh was pleased.

Next to the scale was a Coke machine and a stack of empty wooden Coke-bottle crates. Paris cleverly was leaning on the crates while he stood on the scale. He was displacing some of his weight. One day, he tried to lean on the crates, but he missed and almost fell over — a delivery man had moved the crates a foot. Paris got back on the scale, and he weighed 336.

Today, Paris wouldn't have to lean on a table and pretend he's lighter than he is. Today, he would fit right in. Every offensive linemen currently on the 49ers weighs more than 300 pounds.

Have linemen become too big for their own good?

Board Certified Cardiologist Dr. Stephen Sinatra believes that is not the case. Dr. Sinatra says there is nothing inherently unhealthy about being a 330-pound linemen, although he says they could be healthier. And just to be clear – during our interview, which lasted half an hour, Dr. Sinatra never said, 'I did it my way.'

Here's what he said: 'It's a good thing that these offensive linemen are very strong and agile and big. They're exercising. They're burning off sugar and they're getting sugar inside their cells. When they retire and get heavier and don't exercise, then they're in trouble from a cardiovascular point of view. The risk profile is much larger as they get older.'

What's the primary issue facing offensive linemen while they're playing?

'Heavy people contain a lot of inflammatory chemicals in the body,' said Dr. Sinatra. 'The popular name for those chemicals is 'cytokines.' These cytokines, or these inflammatory chemicals, they live in fat cells. If you feel your belly right now, your love handles, that's triglyceride. These triglycerides, these fat cells, they're the home of all these inflammatory cytokines.

'When we're fat, we're much more inflamed. When a man gets a waistline greater than 40, he becomes a little hypertensive and he develops higher blood pressure, higher blood lipids. And he develops metabolic syndrome, which is an inflammatory form of diabetes. And that causes heart disease.'

The Source of Inflammation, and the dark side of Gatorade

What can the NFL do to protect linemen from inflammation and heart disease?

'They need a Gatorade without sugar in it,' said Dr. Sinatra. 'They need a Gatorade that doesn't have artificial colorings or dyes. Whoever is making Gatorade needs to make a healthier Gatorade for these athletes.

A 28-ounce bottle of Gatorade 'G' series (the one that says 'Prime, perform, recover' on the label) contains 52.5 grams of sugar.

'Sugar brings nothing to the table,' Dr. Sinatra said. 'All it does is create an insulin response. It's very pro-inflammatory on the body. It's a perfect storm. These linemen not only are eating like crazy and pumping iron and putting on bulk, but now they're taking on sugar. And sugar over many years creates inflammation.'

Is coconut water a good substitute?

'Coconut water is very good,' said Dr. Sinatra. 'Why? It has much more potassium. It doesn't have the sugar. And it doesn't have the artificial ingredients. I'm a big fan.

'Gatorade has a dark side – there is no question. Just give the athletes a drink where they're protected as opposed to getting more inflamed. That's No.1.'

Reducing Inflammation

'No. 2, I think these linemen need a health coach,' said Dr. Sinatra.

'They're used to being coached, and they respect their coaches. Linemen need someone from the American College of Nutrition who has a CNS after his or her name – that means Certified Nutrition Specialist.

'You know what a health coach would do? It would protect the team's investment. That's what we're really talking about. These guys are worth millions and millions of dollars. If you give them the right ingredients and the right personnel – not just the trainer and the team doctor. I'm talking beyond that. I'm talking somebody who thinks out of the box, somebody who has more savvy in nutrition. I think you can protect the investment.

'I'm doing that with thoroughbred race horses. I've done a lot of studies on measuring inflammatory mediators in thoroughbreds. A thoroughbred is just like an NFL football player, but even more inflamed. One of the reasons we haven't had a Triple Crown winner since 1978 is that these thoroughbreds get so inflamed that they can't get that third leg in (the third leg being the Belmont Stakes — the third race in the Triple Crown). They need more rest.'

'Just like thoroughbreds, linemen are so inflamed that performance becomes an issue. Instead of giving them injections and whirlpools and ice and analgesics and drugs, you can do a lot by giving them proper nutrition and proper anti-inflammatories.

'Heat and cold will help alleviate inflammation. Sure. But, again, there are other things you can bring to the table in addition to the old-school management. In the Olympics, the East Germans and the Bulgarians gave their players Wobenzym – a natural digestive enzyme. The East Germans and the Bulgarians were winning Olympic gold medals because they were taking herbal anti-inflammatories.'

The German Olympic team still uses Wobenzym. It was one of their official sponsors during the 2012 Olympics in London. They won 11 gold medals.

Dr. Sinatra says other natural anti-inflammatories exist, like earth, as in grass, dirt or concrete. He wrote a book called, 'Earthing.' In it, he writes, 'If somebody is in direct contact with the Earth, the free electrons flow into the conductive circuitry of the body and snuff out inflammation.'

Since most of us wear shoes, we rarely come in contact with the earth's anti-inflammatory energy.

'If I was coaching an NFL team,' said Dr. Sinatra, 'I would have my players walk barefoot on the grass, provided they don't put insecticides or pesticides on it. I would have them go barefoot for an hour a day. Just going barefoot, they would take in the earth's energy and it would create an anti-inflammatory response. There is tremendous science and physiology and chemistry behind it. I actually published some studies on it myself.

'There are so many things you can do for these guys that aren't done in the NFL. It's all the old school. It's Gatorade, it's whirlpools — it's the stuff that I did when I went through college athletics.'

Staying healthy after retirement

Bubba Paris retired in 1991, and he turns 55 in October. He has outlived the National Institute of Occupational Safety and Health's expected lifespan of an offensive lineman.

He looks trimmer than he did when he played. It is not uncommon for former NFL linemen to lose 40 or 50 pounds soon after they retire.

'Some of these linemen put on 40 to 50 pounds of bulk just to play in the NFL,' said Dr. Sinatra. 'And when they retire, they probably say to themselves, 'I don't have to do this anymore.' So the hulk stuff comes off them, and they look trimmer.

'The problem is when the overweight lineman gets more overweight or he lets his life go and he keeps putting on weight. Then, he's in serious trouble. That's the one we've got to get to. When these linemen leave the NFL, we don't want to see them weighing 350, 400 pounds. We want to see them weighing 210, 220.'

'We want to empower them. A lot of these guys retire in their early 30s. They're still young adults. They can do an awful lot to improve their health. I am upbeat and positive that if they meet the right health coach or if they get the right information, they will do themselves a world of good.'

The NFL is stuck in the 1960s when it comes to treating linemen. If bigger is where they're going, then nutrition will be crucial. Not only to get players back in the game, but to ensure their health long after their last game is done.

Grant Cohn writes sports columns and the 'Inside the 49ers' blog for The Press Democrat's website. You can reach him at grantcohn@gmail.com.