Dick Butkus played football for the Chicago Bears from 1965 to 1973 and was regarded as one of the greatest, fiercest and most intimidating linebackers in professional football history. He played in eight Pro Bowls, was named a first-team All-Pro six times, and twice was the NFL’s Defensive Player of the Year. He was voted NFL 1960s All-Decade Team, NFL 1970s All-Decade Team, NFL 75th Anniversary All-Time Team and NFL 100th Anniversary All-Time Team. One reporter noted that at 6 feet 3 inches, this 245-pound powerhouse “terrorized opposing ball carriers and quarterbacks. His mauling style of tackling was worthy of a grizzly bear.” He retired from professional football at age 31 because of recurrent injuries, primarily a damaged knee.

In spite of his amazing physical conditioning, strength and speed, his heart arteries were blocked by plaques and in August 2001, 28 years after he retired from professional football, he had bypass surgery for the five major arteries carrying blood to his heart. Twenty-two years later, on October 5, 2023, he died in his sleep of an unreported cause. I have never seen his medical records or examined him, but the most likely cause of his death would be an irregular heartbeat and/or a clot released from inside his heart to his brain or lungs.

Destined for Greatness
He was born in 1942 in Chicago’s Far South Side, the youngest of nine children. At birth, he weighed a massive 13 pounds 6 ounces. His father and all four of his brothers were more than six feet tall and weighed over 200 pounds.

Butkus knew that he was going to be a professional football player by the time he was in fifth grade, because “society said you had to be fierce and I was fierce and tough.”  He was also gifted with amazing speed and could outrun most tight ends and running backs. He was the star of his Chicago Vocational High School and University of Illinois football teams, and he led his college team to the Big Ten Championship. The team was ranked third in the nation and beat Washington 17-7 in the Rose Bowl. He was a unanimous All-American in 1964 and the University of Illinois retired his number 50 jersey.

As a professional football player, he was known as a vicious tackler who was the greatest linebacker in football. Opponents said that every time he hit you, he tried to put you in the cemetery, not just the hospital. After retiring from football, he acted in more than 20 movies and was a football announcer on radio and TV.

Plaques are Formed from an Unhealthful Diet
While he was training, Butkus ate an unhealthful diet and smoked cigars. After he retired from playing football, he stayed overweight and continued his unhealthful diet and smoking, which put him at very high risk for a heart attack. Following his bypass surgery, he improved his lifestyle and he and his surgeons wrote a book, The OC Cure for Heart Disease, in an effort to teach people how to prevent heart attacks. A diet that is high in the pro-inflammatory foods (sweets, refined grains, sugared drinks, red meat, processed meats, fried foods, alcohol) is associated with increased risk for forming plaques (J Amer Coll Cardiol, July 2017;70(4)). A diet that is high in vegetables, fruits, whole grains, beans, seeds and nuts will reduce your chances of suffering a heart attack (J Am Coll Cardiol, Nov 10, 2020;76(19):2181-2193).
Exercise Does Not Prevent Plaques
Heart attacks are not caused by arteries narrowed by plaques. A heart attack is usually caused by a sudden immediate complete blockage of blood flow to the heart muscle itself. First a plaque breaks off from the inner lining of an artery leading to the heart. This is followed by bleeding and clotting. Then the clot extends to block all flow of blood through that artery to deprive the heart muscle completely of oxygen, so that part of the heart muscle dies.

Exercise can help to prevent heart attacks by stabilizing plaques so they are less likely to break off, bleed and block completely all blood flow to the heart to cause a heart attack.

An X-ray test called Coronary Artery Calcification Score or Calcium Artery Score (CAC) is used to measure the size of plaques in the arteries leading to the heart. That test can also tell whether the plaques are very stable, or are unstable and more likely to break off to cause a heart attack. A stable plaque is called “hard; ” it is not full of fat and has a thick calcium periphery to keep the plaque in place. An unstable plaque is called “soft;” it is full of fat and has irregular calcium borders that may not hold the plaque in place.

Why Athletes May Have Higher Calcium Scores
Competitive older athletes can have more plaques in their arteries than non-exercisers, and intense exercise may increase plaque formation However, athletes are likely to have the type of plaques that are far less likely to break off to cause heart attacks (Circulation, April 27, 2017;136:138-148; May 2, 2017;136:126-137). Plaques form in arteries from an unhealthful diet and faulty genes. Exercise does not prevent plaques from forming, and a pro-inflammatory diet increases plaque formation regardless of exercise. Exercise stabilizes plaques so that they are less likely to break off to cause heart attacks. Since exercise burns lots of extra calories, exercisers may eat more food, and if they choose to add more pro-inflammatory foods, they can expect to build up more plaques.

Having a Big Belly Increases Risk for a Heart Attack
After his bypass surgery, Butkus saw the light and changed many of the lifestyle factors that put him at high risk for a heart attack. However, he was still overweight and had a big belly, a major risk factor for heart attacks. People who have a big belly are at high risk for having excess fat in their liver, which prevents them from responding to insulin. Everyone’s blood sugar rises after they eat. To prevent blood sugar from rising too high, the pancreas releases insulin into the bloodstream to lower blood sugar by driving sugar from the bloodstream into the liver. However a liver full of fat does not accept the sugar and even releases sugar from its cells to drive blood sugar levels even higher. A high rise in blood sugar after meals can cause diabetes, plaques to form in arteries and plaques to break off to cause heart attacks. A high rise in blood sugar after meals can also damage the heart muscle to cause irregular heartbeats. One type of irregular heartbeat called atrial fibrillation causes clots to form and block blood flow through the body.

Lessons from the Story of Dick Butkus
Exercise helps to prevent heart attacks, but you should also do other things to help protect yourself from heart muscle damage, heart attacks, irregular heartbeats and forming clots:
• avoid being overweight
• exercise
• eat plenty of nuts, beans, seeds and vegetables and some fruits
• restrict sugared drinks, sugar-added foods, fried foods, refined carbohydrates and red and processed meat
• do not smoke
• avoid alcohol
• avoid recreational drugs and unnecessary prescription drugs
• get blood levels of hydroxy vitamin D above 30 ng/mL

Dick Butkus
December 9, 1942 – October 5, 2023