Pursuing Health
Adapting to Muscular Dystrophy with Dano Lotz PH156

Adapting to Muscular Dystrophy with Dano Lotz PH156

August 11, 2020

“When I was 12, I played my last season of parks and rec basketball in braces, and after that, everyone was basically like, 'Hey, no sports.  Try to limit activity, we don't need you to get hurt because you could seriously injure yourself.'  So, it basically turned into video games and reading.  I think it was in the best interest to keep me safe, but in my mind I was like, 'So, I don't get to play with my friends unless I'm inside?'
- Dano Lotz

Imagine being an active kid who loves playing baseball, basketball, soccer- basically anything outdoors.  You notice you’re a little slower than your classmates, but you chalk it up to minor differences, and go on playing sports for the love of the game.  Then, at age 12, you’re put in leg braces and told you need to stop being active in order to prevent injury.  Suddenly your world shrinks to afternoons on the couch, reading and playing video games.

This was the case for Daniel ‘Dano’ Lotz, who was born with a genetic condition called Charcot-Marie-Tooth (CMT) disease.  CMT is a form of muscular dystrophy that affects sensory and motor nerves in the extremities, causing nerve degeneration and resulting in muscle weakness.  In Dano’s case, his CMT affects his lower legs, including his calves and ankles.

Dano wasn’t about to let his condition hold him back.  At 16 he started weight training with the football team at his high school, and he found a new passion.  Working out helped him regain muscle mass and motor control, and it gave him the satisfaction of being part of a team.  It also ignited a fire to one day become a trainer himself.

As Dano continued to improve and build strength, his mentality changed.  Rather than letting his limitations hold him back, he became more and more active- but ended up breaking several pairs of braces, an expensive habit.  He decided to stop wearing the braces and continued with his active lifestyle.  After several years of working out at traditional gyms and practicing to become a personal trainer, some friends invited him to join them for his first CrossFit workout- Fight Gone Bad.

Dano finished the workout, collapsed to the floor, and fell in love.  He would go on to get his Level 1, and then his Level 2 Certificate, and has had the opportunity to compete as an adaptive athlete and to coach at multiple affiliates across the United States.  Dano’s tenacity and determination give him a unique perspective as a trainer.  As he himself learned what movements he could do, and how to modify the movements he struggled with, he laid the groundwork to be able to empathize with others.

Now, as a full-time trainer, Dano says, “The best thing is that I now get to teach and train others to become the best versions of themselves.”

I first heard Dano’s story several years ago- not too long after he started CrossFit.  I was excited to catch up with him and hear how his story has grown and evolved, and how he's using his passion for fitness to inspire others.

In this episode we discuss:

  • CMT muscular dystrophy: what it is and what it has looked like in Dano's life
  • How Dano’s childhood and activity was impacted by his condition
  • Reflecting on how becoming active as a teenager improved his mood and motor function
  • How Dano became interested in personal training and exercise science
  • How Dano got into CrossFit
  • The changes he noticed in his health and physical abilities once he started CrossFit
  • How he decided to become a CrossFit coach and what that journey has looked like
  • How his experiences as an adaptive athlete help him as a coach
  • Making the most of his downtime from coaching during the COVID pandemic
  • Three things Dano does on a regular basis that have the biggest positive impact on his health
  • One thing he knows would have a positive impact on his health, but he struggles to implement
  • What a healthy life looks like to Dano

You can follow Dano on Instagram and Twitter, and you can follow the Adapting to Life podcast on Instagram and YouTube.


Related episodes:

Ep 107 - Play the Hand You're Dealt: Choosing to Thrive with a Rare Genetic Condition and Congenital Heart Defect with Stephen Douglas

Ep 124 - Breaking Barriers with an Adaptive Athlete and Coach Kevin Ogar

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.

This post was originally published on August 10, 2020.

FACTS about Fertility with Dr. Marguerite Duane PH155

FACTS about Fertility with Dr. Marguerite Duane PH155

August 4, 2020

“When women learn to chart these observable external signs or symptoms that help them understand what’s happening internally with their hormones, it is so empowering, and we really should be about empowering our patients with this information. I mean, that’s why we encourage our patients to track with they’re their eating, or patients with diabetes to monitor their blood sugar so that they can use that information to to make healthier choices to better improve their overall health and well-being.  Fertility awareness based methods are such an incredibly effective tool to educate and empower women, and honestly, engage men back in the conversation of family planning.”
- Dr. Marguerite Duane


Dr. Marguerite Duane is a board-certified family physician and co-founder and Executive Director of FACTS, the Fertility Appreciation Collaborative to Teach the Science.  She serves as an Adjunct Associate Professor at Georgetown University, where she directs an introductory course on natural or fertility awareness based methods of family planning.

She is a practicing direct primary care physician and she has served on the board of the American Academy of Family Physicians (AAFP) and the Family Medicine Education Consortium (FMEC).

After receiving a Bachelor of Science with Honors and a Master of Health Administration from Cornell University, she earned her medical degree from the State University of New York at Stony Brook and completed her family medicine residency at Lancaster General Hospital.

During her residency, she was surprised to hear her senior resident explain to a postpartum patient that there is a way women can learn to manage their fertility without any medical side effects, such as those that occur from hormonal birth control.  She wondered how it was possible this topic hadn't been covered in her medical training.

This insight planted the seed that changed the trajectory of her career. Dr. Duane began to focus on learning more about these methods, for her own personal health as well as that of her patients.  She went on to complete training in the Creighton Model of natural family planning and has since made it her passion to educate other healthcare providers and patients.

After recently completing the FACTS course for medical students and residents myself, I was excited to have the opportunity to chat more with Dr. Duane about the basics of the female cycle, the efficacy of natural family planning, and the science behind fertility awareness based methods.

*Dr. Duane's bio adapted from the FACTS website.


In this episode we discuss:

  • How Dr. Duane became interested in fertility awareness based methods
  • How FACTS came to be
  • The need to educate doctors about FABMs
  • The benefits of being in tune with your cycle
  • The efficacy of this method and the best way to get started
  • The basics of the female cycle, and what women can observe throughout their cycle
  • How following your cycle can give insights to your health
  • How FABMs can help explain underlying reasons for infertility
  • Where to look for a practitioner and how to get started
  • Factors to consider when choosing the right method for yourself
  • Preferred apps and what to look for when selecting an app to use
  • The value of using FABMs to help with underlying medical conditions
  • Dr. Duane's experience with Teen STAR and the benefits of learning these methods from an early age
  • Three things that Dr. Duane does on a regular basis that have the biggest positive impact on her health
  • One thing she struggles to implement that could have a big impact on her health
  • What a healthy life looks like to Dr. Duane

You can follow the Fertility Awareness Collaborative to Teach the Science (FACTS) on InstagramFacebook and Twitter.


Related episodes:

Ep 83 - Pelvic Floor Health for Athletes with Julie Wiebe, PT

Ep 126b - Nicole Christensen on Coaching Pregnant Athletes

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.


Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


This post was originally published on August 3, 2020.

Sleep Basics PH154

Sleep Basics PH154

July 28, 2020

We continue the saga of exploring the foundations of health in this edition of Pursuing Health Pearls as we take a deep dive into the topic of sleep.

We’ll start with a basic overview of the state of sleep in the US and the world. Then we’ll dig deep into how lack of sleep is implicated in disease and shed some light on the crucial role sleep plays in our health and safety. We’ll spend some time briefly outlining the important components of what signals us to sleep and what happens when we do, and then we’ll wrap up by summarizing some of the most important and simple tools at our fingertips for improving sleep quality and quantity.

Please do keep in mind that this is an enormous topic, and as the title states, we are only dipping our toe in the basics of sleep and why it’s important here. Future posts may further explore maximizing sleep while doing shift work or traveling across time zones, sleep tracking, and specific sleep disorders such as insomnia or sleep apnea, so stay tuned for those!

State of Sleep in US

Let’s start with what we know about the state of sleep in the US and across the world. In the US, ⅓ of adults report sleeping less than 7 hours per night,1 which is the recommended minimum for adults by the Centers for Disease Control2 and National Sleep Foundation.3

Lack of sleep duration also highlights racial and socioeconomic disparities in the US.4 Minorities report less sleep than non-minorities, as do those who are unable to work or those who are unemployed. Furthermore, sleep duration is highest among those with higher education and those who were married. These disparities are seen worldwide as well, where lower education, not living in partnership, and lower quality of life are associated with higher prevalence of sleep problems.5

The World Health Organization (WHO) has even declared sleep loss an epidemic with roughly ⅔ of adults sleeping less than 8 hours per night.6

Sleep, Health, and Disease

The science is becoming increasingly clear that this lack of adequate sleep is a threat to our health and safety. Insufficient sleep is linked to 7 of the 15 leading causes of death in the US including cardiovascular disease, hypertension, diabetes, accidents, and cancer.7,8,9


Metabolic Health 

As we discussed in Episode 146 about Metabolic Health, hallmarks of metabolic dysfunction are excess carbohydrate consumption and impaired blood sugar regulation. As it turns out, inadequate sleep results in both.

First, we know that inadequate sleep results in increased food consumption, and particularly sugar. Sleep loss results in a decrease in the satiety hormone Leptin - which signals our brains that we are full,10 and also increases a hunger hormone called ghrelin, which motivates us to eat more. Together, these changes in hormone levels signal that we are both hungry and that we are not full. It’s been shown that those who are sleep deprived have increased hunger and appetite.11,12  Sleep loss has also been shown to result in increased calorie consumption by about 250 cal/day when compared to conditions of normal sleep duration.13  Additionally, those who are sleep deprived have increased preference for calorie-dense, high carbohydrate foods that are especially damaging to our metabolic health.14  This preference for hyperpalatable foods and carbohydrates may be due to changes observed in brain activity in sleep loss states in the areas of cognitive control and reward in the brain.15

Not only are we primed to consume more calories and more energy-dense carbohydrates when sleep deprived, but sleep deprivation also makes our bodies less insulin sensitive,16 meaning we are not able to handle those carbohydrates as well either. Sleep restriction to 4 hours for 1 night17 or 5 hours per night for just one week resulted in significant reductions in insulin sensitivity.18

Together this increased intake paired with impaired glucose regulation (insulin resistance) leads to weight gain19 and metabolic dysfunction. Additionally, even if restricting calories, the fraction of weight loss from fat while sleep deprived is much less, while weight loss from lean body mass is increased.20,21

Sleep loss also increases the activity of the sympathetic nervous system, the chronic effects of which we discussed in our episode on metabolic health and in Episode 139 with Dr. George Slavich on stress. Some effects of chronic sympathetic activation include increased heart rate and blood pressure, increased stress hormones such as cortisol, increased brain activation which may contribute to anxiety or insomnia, and increased low-grade inflammation. Years of inadequate sleep can contribute to the body chronically being stuck in this fight-or-flight state, which can then lead to a host of health problems. Deep sleep combats this sympathetic state by allowing a decrease in heart rate and blood pressure. Inadequate time in a deep sleep state prevents the cardiovascular system from achieving adequate time for rest, repair, and recovery.

Inadequate sleep also contributes to metabolic dysfunction through its epigenetic effects. Each of us is born with DNA which does not change and provides the instructions for our cells, but epigenetics is the description of how those genes are used - which genes are turned on and turned off - and that is mainly controlled by our lifestyle factors and exposures, sleep being an important one. A study restricting men and women to 6 hours of sleep per night for one week compared their gene expression to when they had 8.5 hours of sleep.22 Researchers found a change in the epigenetics, or expression of 711 different genes among these two states. When the researchers looked closer at the genes in the sleep deprived state, they found that the expression of genes linked to chronic inflammation, cell stress, and cardiovascular disease were increased, while those that maintain optimal metabolism and immune function were decreased.

As we’ve discussed previously, the ultimate deadly outcome of metabolic dysfunction as the high blood pressure, inflammation, and sympathetic state continue to spiral out of control is cardiovascular disease culminating in strokes and heart attacks, and sleep deprivation has been associated with greater risk of both.23

Interestingly, even small changes in sleep may impact heart attack risk. For example, one study done at the University of Michigan found a 24% increase in patients presenting with heart attacks to the hospital the Monday after “spring forward” daylight savings time, when they lost an hour of sleep over the weekend.24  After the “fall back” daylight savings time when patients gained an hour of sleep, they observed a 21% drop in heart attacks.

To summarize the effects of chronic sleep loss on metabolism, we know that it:

  • Increases appetite and hunger
  • Decreases impulse control in the brain
  • Increases caloric intake, particularly carbohydrates
  • Decreases insulin sensitivity (the ability to control blood sugar)
  • Increases sympathetic tone or the “fight-or-flight” state
  • Has epigenetic effects, altering the expression of genes toward metabolic dysfunction

Ultimately, this contributes to a metabolically dysfunctional state in which it is more difficult to lose fat even while restricting calories, and ultimately, over the long-term can accelerate progression toward fatal cardiovascular disease.


Alzheimer’s Disease

Our discussion of sleep and Alzheimer’s Disease is an extension of metabolic health, as Alzheimer’s Disease is sometimes referred to as “Type 3 Diabetes.”

We are still just beginning to understand the mechanisms that underlie Alzheimer’s disease, but there does seem to be a relationship between Alzheimer’s disease and poor sleep.25 For example, sleep disturbance affects up to 40% of patients with mild-moderate dementia, sleep changes seem to precede cognitive decline, and the intensity of the sleep disturbance correlates with the severity of dementia symptoms.26

Alzheimer’s is characterized by a buildup of toxic proteins called beta-amyloid in plaques within the brain which impair connections between neurons. Increased buildup of these plaques has been noted even after just one night of sleep deprivation.27 Initial research suggests that deposition of these plaques in areas of the brain involved in sleep result in disrupted deep sleep.28 Because deep sleep is important for memory, this disruption in deep sleep may represent one contributor to memory impairment in those with Alzheimers. It’s a two-way street: without adequate sleep, more amyloid plaques build up in the brain, and the amyloid plaques in certain areas of the brain may lead to less deep sleep. So, getting adequate deep sleep in midlife to prevent amyloid plaque buildup (and to allow for any buildup that does occur to be removed) may be important for the prevention of Alzheimer’s disease.


Immune System

Sleep is also incredibly important for a properly functioning immune system.29 We’ll review a few of examples of this here:

The first is an example of how sleep affects our susceptibility to infection.30 In this experiment, the sleep of 164 healthy men and women was monitored for one week. Each of them was then given nasal drops containing rhinovirus, a cause of the common cold, and they were observed to see who would develop cold symptoms. The researchers found that those sleeping less than 6 hours per night on average had an increased likelihood of developing cold symptoms compared to those sleeping 7 hours or more per night. About 45% of those getting less than 5 hours of sleep per night developed cold symptoms, while just 18% of those sleeping 7 hours or more per night developed colds. This is especially interesting to think about in the era of COVID-19, when getting enough quality sleep could potentially decrease our risk of infection even if we do get exposed.

The next example discusses our ability to mount an immune response to the flu vaccine.31,32 A study in JAMA in 2002 demonstrated that adequate sleep is important for mounting a response to the flu vaccine. Normally, the flu vaccine works by stimulating the body’s immune system to create antibodies against the flu virus, so that if you do become infected with the flu virus later on, your immune system will be able to fight it off without you getting sick. In this study of young healthy adults, half were allowed to sleep 7.5-8.5 hours while the other half were restricted to 4 hours per night for 6 nights in a row. At the end of this period they were all given a flu shot. The researchers then measured the antibodies in the blood of the two groups in the days following. Those who got the most sleep showed signs of a healthy immune system generating a powerful antibody response. In contrast, those whose sleep was restricted produced less than 50 percent of the antibody response.

Immune function is also important for the prevention of cancer and the natural killer cells of the immune system are particularly important for fighting cancer. Studies have found that even a single night of short sleep (4 hours) results in a 70% reduction in natural killer cells relative to a full night of sleep.33 Observational studies have also shown an increased risk of dying from cancer in those who have shorter sleep duration less than 6 hours.34 Disruptions to circadian rhythms is also at play, and the International Agency for Research on Cancer (IARC) has even classified nighttime shift work as a “probable carcinogen.”35


Testosterone and Fertility

Sleep also has a tremendous impact on testosterone levels and fertility in both males and females. In a study performed on young healthy men who were restricted to 5 hours of sleep per night for 1 week, a 10-15% drop in testosterone was observed compared to their rested state.36 To put this into context, normal aging results in a 1-2% decrease in testosterone per year, so this one week of sleep loss was effectively equivalent to aging 5-15 years. The poor quality and quantity of sleep in men who with obstructive sleep apnea, a common sleep disorder, has also been shown to lead to decreased testosterone levels.37 Finally, short sleep and late bedtimes are also associated with imparied sperm health in men.38

Reproductive function in women is also affected by sleep,39  and levels of Follicle Stimulating Hormone (FSH), an important reproductive hormone in women that stimulates egg growth in the ovaries, was found to be 20% lower in women with chronic sleep deprivation.40


Psychiatric Conditions

Sleep disruption is also implicated in most major psychiatric conditions, including depression, anxiety, PTSD, bipolar disorder,41  and schizophrenia.42,43 The mechanisms of this are still being worked out, and it is likely not a one way street in which sleep disturbance causes these conditions, but rather sleep may be one of many factors that contribute. Said another way, sleep affects psychiatric conditions and psychiatric conditions affect sleep. Sleep disturbance is also recognized as a universal risk factor for relapse in addictive substance use.44


Driving Accidents

Another way that inadequate sleep poses a threat to our health and safety is through the impact of sleep loss on car accidents. There is known to be an increased risk of car accidents with increasing sleep deprivation.45 When questioned, 1 in 25 adult drivers report having fallen asleep while driving in the previous 30 days.46,47 It is estimated that up to 6,000 fatal crashes each year in the US may be caused by drowsy drivers.48,49,50 After being awake for nineteen hours, people who were sleep-deprived were as cognitively impaired as those who were legally drunk.51


Athletic Performance

We’ve spent a lot of time talking about the damaging effects of inadequate sleep on our cognitive function and physical health, but sleep can also be used as a powerful tool to enhance our performance. The International Olympic Committee consensus statement on youth athletic development recognizes the importance of sleep in athletic development as well as the potential consequences of inadequate sleep, and they recommend interventions to support adequate sleep in youth athletes.52 Obtaining adequate sleep has been associated with increased athletic performance in a variety of different domains from aerobic output to vertical jump height, peak and sustained muscle strength.53 Additionally, chronic lack of sleep is associated with a higher risk of injury among athletes.54

Chance of injury decreases with increasing hours of average sleep.55


Performance enhancements seen in an NBA player achieving more than 8 hours of sleep56



How Sleep Works 

Now that we’ve reviewed many implications of poor sleep on health, we’ll provide a brief overview of how sleep works.57


When We Sleep

There are two main factors that determine when we sleep: 1. Circadian Rhythms, and 2. Sleep Pressure.


  1. The first factor that determines when we sleep is our Circadian Rhythm. You can think of this as the biologically built-in rhythm that allows our bodies to function on a 24 hour clock. The length of each person’s circadian rhythm is unique and usually just slightly longer than 24 hours. On average, the adult human’s circadian clock runs around twenty-four hours and fifteen minutes in length.58 An area of the brain called the suprachiasmatic nucleus uses light to reset the circadian rhythm each day, which allows us to stay in tune with a 24-hour cycle and prevents drift over time.The circadian clock is set not just by light but also by food, exercise, temperature fluctuations, and even regularly timed social interaction. The determination of an individual's preferred sleep and wake times, (whether you are a morning or evening person) differs between people as well and is strongly determined by genetics.The hormone melatonin also plays a role. It is released from the pineal gland and helps to signal darkness and the onset of sleep. Melatonin rises a few hours after dusk, peaks around 4am, then drops quickly. Light signals the pineal gland to stop releasing melatonin, and it is undetectable by mid morning.
  2. The second factor that determines when we sleep is Sleep Pressure. A chemical called adenosine gradually builds up in the brain while you are awake. The longer you are awake the more adenosine builds up. The more adenosine you have circulating in your system, the greater the pressure to sleep. Then when you go to sleep, adenosine is cleared and sleep pressure decreases throughout the night. In the morning the process starts all over again. Interestingly, caffeine works by blocking adenosine receptors. So even though there is increasing adenosine and sleep pressure as the day goes on, while caffeine is in your system you can’t sense this sleep drive.

Together, the circadian rhythm and the sleep-pressure signal of adenosine both work to coordinate sleep and wake times on a 24 hour cycle as seen in the figure below:

The larger the distance between the two lines, the greater the sleep desire. Figure from Walker, M. Why We Sleep.


It’s important to note that humans also have a genetically hardwired dip in alertness that occurs in the midafternoon hours. Not adhering to this drive for biphasic sleep, or nighttime sleep followed by a short nap in the mid afternoon, seems to lead to increased cardiovascular risk and mortality. Biphasic sleep is still observed in several siesta cultures throughout the world, including regions of South America and Mediterranean Europe. After one of these cultures in Greece transitioned away from a siesta practice, those that abandoned siestas went on to suffer a 37% increased risk of death from heart disease over the following 6 years.59 It may not be a coincidence that in other areas of Greece where siestas still remain commonplace, there are still the highest concentrations of Centenarians. One example is the Greek island Ikaria, with their famous tagline  “where people forget to die.”


Sleep Cycles

There are two major stages of sleep, and we alternate between them in approximately 90 minute cycles over the course of the night.


Non-Rapid Eye Movement (NREM) Sleep

Non-rapid eye movement, or NREM, sleep is more predominant earlier in the night. A key function of NREM sleep is storing and strengthening new information while weeding out and removing unnecessary neural connections and waste products. The glymphatic system, which is much like the lymphatic system in the rest of the body, drains waste products from the brain’s tissues and is especially active during deep NREM sleep. The glymphatic system is composed of cells called glia which are distributed throughout the brain. During deep NREM sleep, the glial cells shrink significantly, allowing the cerebral spinal fluid that bathes neurons to clean out toxic waste products that have built up and allows them to drain away. One example of such toxic waste products is the amyloid plaques we discussed above, whose buildup is associated with Alzheimer’s disease.


Rapid Eye Movement (REM) Sleep

Rapid eye movement, or REM sleep, is more predominant later in the night. REM sleep plays a role in integrating new information - this includes integrating new facts and memories with previous experiences, creativity, language learning, and social and emotional learning. REM sleep is also where dreaming takes place. You lose muscle tone during REM sleep, which prevents you from acting out your dreams.

To summarize, you can think of states of wake and sleep like this:

  • The waking state is for information perception and gathering
  • NREM sleep stores that information and weeds out unnecessary waste and connections
  • REM sleep integrates new information together with past experiences allowing you to develop complex functions such as problem solving, language, social interactions, and creativity.


Sleep Cycles

Sleep cycles take place every 90 minutes, and the ratio of NREM sleep to REM sleep within each 90-minute cycle changes dramatically across the night. There is a predominance of NREM sleep in the beginning of the night, and more REM sleep in the second half of the night. Because both cycles are important, and REM is especially important for integrating new information and creativity, missing out on the later sleep cycles by short sleeping can be especially detrimental.

REM sleep is especially important for development of neural connections in the developing brain. In utero, a fetus is almost exclusively in REM sleep, while infants may have closer to 50/50 split between NREM and REM sleep, and by the late teen and adult years most settle into an 80/20 NREM/REM sleep split.

Change in time spent in NREM vs. REM sleep in sleep cycles throughout the night. Figure from  Walker, M. Why We Sleep.


Sleep as We Age

Several changes to sleep occur as we age:

  • First is a decreased ability to generate deep sleep as we age. This is because areas of the brain responsible for generating deep sleep are some of the same areas that degenerate first with aging.
  • Next is reduced sleep efficiency. Teenagers have a sleep efficiency - or the percentage of time that they actually spend asleep while in bed - of about 95 percent. However, sleep efficiency usually drops below 70- 80 percent by the 8th decade of life. This is likely due to increased fragmentation of sleep as we age, often due to medications, diseases, or a weakened bladder.
  • Finally, the circadian rhythm shifts throughout different stages of life and there is a change in sleep timing as we age. In teenagers, the circadian rhythm is shifted forward, meaning they naturally fall asleep later and wake up later. This is why forcing teenagers to go to bed early, or asking them to wake up for an early school start time is especially problematic. In contrast, the circadian rhythm shifts backward in older adults resulting in earlier bedtimes and earlier awakenings. Additionally, the overall strength of the circadian rhythm and the amount of nighttime melatonin released also decrease the older we get. Interestingly, melatonin has been shown to help boost the circadian rhythm in the elderly, in contrast to middle-aged adults where it is most helpful only with jet lag.60


How Much Sleep?

Now that we’ve addressed the changes that occur to sleep as we age, let’s try to answer everyone’s favorite question - how much sleep do we really need? 

Both the Centers for Disease Control61  and National Sleep Foundation62 recommend 7-9 hours of sleep per night. Years of research indicates that 8 hours is optimal for most adults.63 After 16 consecutive hours of being awake, the brain begins to slow down significantly. A series of experiments showed that ten consecutive days of just seven hours of sleep resulted in the same level of brain dysfunction as pulling one “all nighter” or going without sleep for 24 hours.

Another important distinction to make is that it is almost impossible to “make up” for lost sleep. Performance still suffers even after several full nights of sleep following a night of sleep loss.

Finally, we as humans have a very hard time determining how sleep deprived we actually are, which is what can make inadequate sleep behaviors dangerous especially when it comes to things like driving.

There are very few people (<1% of the population) who truly only need a few hours of sleep per night and do not experience any negative cognitive or other health effects from doing so. This is largely programmed by genetics, which seems to lie in a variant of a gene called BHLHE41, or DEC2.64


Improving Sleep

Finally, we’ll address some of the ways we can maximize our chances of getting optimal sleep each night.


Give Yourself the Opportunity 

The first step in getting enough quality and quantity sleep is to give yourself the opportunity to do so. So often we are going to bed late, knowing that we have to be up early in the morning for work or other obligations. So plan ahead, and try to establish a consistent bedtime and wake time that works for both weekdays and weekends. Alarms can be particularly detrimental because of their propensity to induce a sympathetic fight or flight state immediately upon waking. Even worse is a snoozed alarm inducing that state multiple times in one morning.65 Ideally, when your body is getting enough sleep you should wake up on your own without an alarm.


Maintain a good sleep environment

After allowing adequate opportunity to sleep, it’s important to make sure to have a good sleep environment.



The first aspect of a good sleep environment is the appropriate use of light. Since the advent of artificial, and in particular blue LED lights, the usual changes in natural light throughout the day that helped to train our circadian rhythms and signal the release of melatonin are being overridden. A survey conducted of American adults revealed that 90% of people regularly used some type of electronics within 1 hour of their bedtime.66 When comparing reading an electronic book to a regular paper book before bedtime, those who read the electronic book had less sleepiness in the evening, took longer to fall asleep, reduced melatonin secretion, later timing of their circadian clock, and reduced alertness the following morning.67 There are a few ways to mitigate the damaging effects of constant blue light exposure:

  • Avoid bright lights in the evening hours. Dim the lights or use orange-tinted glasses to help filter out the blue light that suppresses melatonin release.
  • Programs that can be used on your computer or phone such as F.lux which automatically filter out the blue light as the evening hours approach.
  • An eye mask or blackout curtains in the bedroom can also help to maintain complete darkness throughout the night.
  • Outdoor sunlight exposure in the morning can also help to train your circadian rhythm appropriately. One easy way to do this is to drink your coffee outside or go for a short walk in the morning.



The next factor to address when it comes to a good sleep environment is temperature.68 Many people think it is mainly the darkness that signals our bodies that it’s time to go to sleep, but a drop in temperature is also very important. In order to successfully initiate sleep, core body temperature needs to drop by about 2-3 degrees F. A bedroom temperature of around 65 degrees F is ideal for sleep of most people, but for those having difficulty falling asleep, dropping their current room temp by 3-5 degrees might be a good strategy. An 18-25% reduction in the time to fall asleep has been reported in adults after dropping their core body temperature.69

In addition to just lowering the thermostat, taking a hot bath can also help to reduce core body temperature. This may seem counterintuitive, but the hot water helps to dilate blood vessels close to the surface of the skin, so that when you get out, heat quickly dissipates from the body resulting in a reduced core temperature. Hot baths prior to bed can also induce 10 to 15 percent more deep NREM sleep in healthy adults.70,71

There are other devices designed to reduce core body temperature to improve sleep onset such as the Chili Pad or 8 Sleep Mattress.



Noise elimination is also important for a good sleep environment. If there is ambient noise, wearing ear plugs or using a white noise or other soothing sound machine can be helpful.


Make your bed a place for sleep only 

If you cannot sleep, lying in bed awake looking at the clock can only make things worse. Going into another room and doing something relaxing until feeling sleepy again can help to train your body to recognize your bed as a place for sleep only.


Avoid Substances that Interfere with Sleep 

The two most widely used substances that have a substantial impact on sleep are alcohol and caffeine.



Alcohol impacts sleep in two important ways:72

  • First, alcohol fragments sleep, meaning it results in numerous brief awakenings which result in poor quality and non restorative sleep.
  • Second, alcohol is a powerful suppressor of REM sleep, which we know is incredibly valuable for making new connections and creativity. Aldehydes and ketones are produced when alcohol is metabolized by the body and these block the brain’s ability to generate REM sleep.

Because of its disruption of sleep which is so important for storing and solidifying new memories, alcohol has also been shown to reduce the amount learned in a day by 50%, and drinking 3 days after taking in information still reduces the amount learned by 40%.

Alcohol also has important effects on the sleep of infants when consumed by pregnant and breastfeeding women:

  • Alcohol, even in relatively small amounts, reduces the amount of time that the fetus spends in REM sleep and the intensity of REM sleep, which we know is incredibly important for their development.73
  • Additionally, infants of breastfeeding mothers who have had alcohol (the equivalent of a drink or two) have more fragmented sleep, spend more time awake, and suffer a 20 to 30 percent suppression of REM sleep.74,75



It’s probably not surprising to hear that caffeine is another substance that can significantly impact our sleep.76,77  As discussed above, caffeine blocks adenosine receptors, which inhibits the brain’s ability to sense sleep pressure. Caffeine levels usually peak approximately 30 min after consumption, and it has an average half-life of about 5-7 hrs. This means that if you finish drinking coffee at 2pm, by 9pm half of the amount of caffeine could still be in your system. Additionally, one cup of decaf coffee usually contains 15 to 30 percent of the caffeine in a regular cup of coffee, so there is still some caffeine there and this can build up if someone is drinking several cups of decaf, or even a cup of decaf later in the day.


Daily Exercise

Regular exercise can help improve the ability to fall asleep and quality of sleep, but ideally should be done earlier in the day, as exercise done immediately before bedtime can make it more difficult to fall asleep.78

If individuals are still having difficulty sleeping despite these measures, it’s important to work with an experienced physician to determine if there are any underlying sleep disorders that need to be addressed such as sleep apnea, insomnia, circadian rhythm sleep disorders, or others.


In summary, sleep loss is an enormous problem facing our world today that has far-ranging implications on our health from metabolic health to Alzheimer’s disease, immune system function, fertility, psychiatric conditions and car accidents. We have evolved complex biological systems that determine when we sleep, stages and cycles of sleep that play specific roles. However, our modern lifestyle often undermines these natural signals for healthy sleep. We reviewed strategies above that can be used to give ourselves the best opportunity to maximize sleep quantity and quality including sleep opportunity, an optimal sleep environment with regard to light exposure, temperature, and noise, avoiding substances such as alcohol and caffeine that significantly interfere with our sleep, and getting regular exercise.


We also wanted to give a huge shout out to Dr. Matthew Walker, Professor of Neuroscience and Psychology at the University of California, Berkeley, and author of the book, Why We Sleep which helped to direct much of our research and discussion here. If you are interested in learning more about these topics, we highly recommend checking out his book!


Related episodes:

Ep 105 - Sleep, Stress, and Brain Health with Dr. Nate Bergman

Ep 139 - Stress: The Elephant in the Room with Dr. George Slavich


If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.


Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


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38 Liu MM, Liu L, Chen L, et al. Sleep Deprivation and Late Bedtime Impair Sperm Health Through Increasing Antisperm Antibody Production: A Prospective Study of 981 Healthy Men. Med Sci Monit. 2017;23:1842-1848. Published 2017 Apr 16. doi:10.12659/msm.900101

39 Kloss JD, Perlis ML, Zamzow JA, Culnan EJ, Gracia CR. Sleep, sleep disturbance, and fertility in women. Sleep Med Rev. 2015;22:78-87.

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43 M. F. Profitt, S. Deurveilher, G. S. Robertson, B. Rusak, and K. Semba, “Disruptions of sleep/wake patterns in the stable tubule only polypeptide (STOP) null mouse model of schizophrenia,” Schizophrenia Bulletin 42, no. 5 (2016): 1207–15.

44 K. J. Brower and B. E. Perron, “Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances,” Medical Hypotheses 74, no. 5 (2010): 928–33;

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59 Walker, Matthew. Why We Sleep: Unlocking the Power of Sleep and Dreams.

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This post was originally published on July 27, 2020.

Mat Fraser + Sammy Moniz: Sweethearts on a Mission PH153

Mat Fraser + Sammy Moniz: Sweethearts on a Mission PH153

July 21, 2020

If you're wrapping up your identity in the results… there’s a lot of things that go on that you have no control over that can sway the results big time. So, if you’re basing your identity off those results… it might go right, but… There’s only two options when you sign up for a competition, either you’re going to win or you’re going to lose. I try to base my identity off of the effort that I put in. I hope that if the results aren’t what I was looking for, I hope that I’m still able to hold my head high and be proud knowing that I did everything I could.
- Mat Fraser


Four-time Fittest Man on Earth  Mat Fraser is arguably the most dominant competitor the sport has ever seen and has stood on the podium at the CrossFit Games every year he has been in attendance.  He earned silver in 2014 and 2015, and for the last four years he's earned gold, typically with a huge margin of victory.


Mat is the son of two Olympic athletes and growing up he was an Olympic hopeful himself, but the road to becoming the Fittest on Earth hasn't been without challenges. As a teenager he struggled with alcoholism and made the choice to become sober at 17.  At 19 he suffered a fractured back, an injury which sidelined his Olympic weightlifting career, but would ultimately lead him to try CrossFit. Since graduating from the University of Vermont with degrees in Mechanical Engineering and Business, Mat has become a full-time athlete and trains in Cookeville, Tennessee alongside some of the best CrossFit athletes in the world.


Mat's fiancé, Sammy Moniz, holds an impressive resume in her own right.  A former Reebok affiliate manager, she is now the brains behind Feeding the Frasers.  What started as a Instagram account documenting her love of cooking has grown into a website, e-book and upcoming cookbo0k, all a testament to Sammy's desire to make the people in her life feel loved and cared for.


Mat and Sammy are a powerhouse couple who need virtually no introduction in the CrossFit space, and I was excited to catch up with them in their home in Tennessee.  We shared lots of laughs as we talked about how they met, what inspires them to give their best in all their endeavors, their take on the recent changes in CrossFit, and where they see themselves in the next 5 to 1o years.


In this episode we discuss:

  • Mat & Sammy's day-to-day lives
  • Some of the experiences and challenges from their lives that they've learned from and have contributed to their successes today
  • The lessons Mat learned from breaking his back
  • How Sammy became interested in food and cooking
  • How Mat’s diet has changed since meeting Sammy, and the changes he’s noticed since improving his nutrition
  • How Mat’s parents' Olympic career impacted his mindset
  • Why Mat decided to pursue engineering in college
  • Sammy's college experience and how she ended up at Reebok
  • How Mat and Sammy started dating
  • Mat’s experience with alcoholism and sobriety
  • What it’s like for Sammy to watch Mat compete
  • Mat and Sammy's plans for the future
  • The story of the hype music in the tunnel at the CrossFit Games
  • How COVID has affected Mat’s training and their lives
  • Mat's first impression of Eric Rosa and what he hopes to see for the future of CrossFit
  • What motivates Sammy & Mat every day
  • Why it's important not to concern yourself with what other people think
  • What's next for Feeding the Fraser's
  • Three things Mat and Sammy do on a regular basis that have the biggest positive impact on their health
  • One thing they think could have a big impact on their health, but they have a hard time implementing
  • What a healthy life looks like to Mat and Sammy

You can follow Mat on Instagram, Facebook and Twitter.  You can follow Sammy on her personal Instagram, on the Feeding the Fraser's website and on Instagram and Facebook.


Related episodes:

Ep 57 - Annie Thorisdottir + Fred Aegidius on Team Work and Individual Performance

Ep 56 – Katrín Davíðsdóttir and Ben Bergeron on the Process of Creating a Champion

Ep 52a + 52b - Tia-Clair Toomey on Realizing her CrossFit and Olympic Dreams and Finding Confidence

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.

This post was originally published on July 21, 2020.

Overcoming Grief & Losing 65 Pounds PH152

Overcoming Grief & Losing 65 Pounds PH152

July 14, 2020

“We have life changing events, and at the time, they feel as if they are life-ending but they really mold us into somebody who we are meant to be.
- Marti Giambruno

“My first memory of waking up in the recovery room was the consent beep of the monitor. A feeling of impending doom consumed me as my doctor leaned over the stretcher and said, ‘Everything went well. We got it all, and the biopsy came back benign. Marti, 80% of your problem is what you put in your mouth and the stress you carry.’”

Another 9 months would pass, and Marti’s weight would top out at 198 pounds before she was ready to act. It was one year after her husband, John, lost his battle with lung cancer, and on his birthday Marti had the first of many epiphanies. She was tired of the pain, fatigue, and the shame of being overweight, and unhealthy.

She wanted to change, but had no idea where to begin. She realized she just needed to make just one small step to start. So, she rose one morning, laced up her shoes and walked. Each day Marti added a few more steps. Within a couple of weeks, she was walking 1.5 miles around her lake. “I felt something I hadn't since before my husband was diagnosed: control.”

Next, Marti made adjustments to her diet. She added new forms of exercise. Before she knew it, she had lost 65 pounds and was sleeping and feeling better than she had in years. Says Marti, “I felt like I was winning. Imagine feeling like a success while mourning the loss of your husband.”

In January 2015, Marti found the courage to walk into CrossFit Hyperperformance and was warmly greeted. She couldn’t wait to return the next day, and she became a regular member for six months, until she needed to move to return to the workforce.

“The next year was profoundly revealing. My position as a cardiovascular technologist in Interventional Cardiac Medicine demanded far too much of my time, and there weren't enough hours in the day to make it to the gym. I gained weight, was tired, and achy. My family needed me.” Realizing she needed to heal physically, mentally, and spiritually, Marti stepped back from her new position and sought to resume her new-found healthier lifestyle.

She joined CrossFit Palm Beach, where her coaches share the idea of fitness being a process of the mind, body and spirit. “The paradigm shift directing me to whole health has taken hold. At 56, I have more energy, and strength, focus, courage, faith, and desire, which enables me to live young, beautiful and strong in mind, body, and spirit.”

Marti is now making the shift to Integrative Medicine to focus on lifestyle changes that improve patient outcomes. She hopes to reach out to those in situations similar to hers to share the message that health, wellness, and fitness must co-exist to produce the changes needed to “Heal Thy Self.”

Says Marti, “The day John proposed to me, he declared his faith, which empowered me 3 years ago, and still does today. ‘Marti,’ he said, ‘I have faith and peace knowing that if either one of us passes, the survivor will not only pick up the pieces and move forward but become stronger because of it.’” To this day, Marti strives to uphold his vision and share her gratitude with those who've provided the means for her to get where she is, and where she is going.


In this episode we discuss:

  • Her background and the evolution of her health
  • What prompted Marti to start making changes to improve her health and how she got started
  • How CrossFit and exercise helped Marti through her grieving process
  • Recognizing the importance of balancing her caring for own health with a stressful job
  • Her advice to others who are unhappy with their health and want to make a change
  • Three things Marti does on a regular basis that have the biggest positive impact on her health
  • One thing she thinks could have a big impact on her health, but she has a hard time implementing
  • What a healthy life looks like to Marti


Related episodes:

Ep 48 - Jen Widerstrom: Health, Habits, and Why You Are Enough

Ep 84 - Chasing Excellence with Ben Bergeron

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


This post was originally published on July 9, 2020.

Mentally Tough: Kristin Holte, Second Fittest Woman on Earth PH151

Mentally Tough: Kristin Holte, Second Fittest Woman on Earth PH151

July 7, 2020

“I can say with probably 99% [certainty], I would never be at the Games if it weren’t for my mental coach.  I think I would be good but I would’ve gotten fourth place instead of third place at the 2014 Regionals, and who knows what would’ve happened after that, but I think that was the edge that I had in my training.  I was not better physically than any of the other girls there, I just performed when I had to and when the pressure was at its highest. And I think that’s what kept me in the game for all these years, too. I perform at Regionals every single year.  If you looked on paper, my stats are not super good compared to a lot of the other athletes, but I am able to PR.  I’ve PR’d my snatch in every single Regional since I started. I am able to perform when it really, really matters. And that’s the difference, that’s where the mental training comes in.
- Kristin Holte


Over the last 8 years, Kristin Holte has been quietly climbing her way to the top of the CrossFit Games leaderboard.

A native of Oslo, Norway, Kristin grew up in an active household and competed in a variety of sports, including gymnastics, track and field, soccer, triathlons and cross country skiing.  The work capacity and discipline she developed in her youth would help lay the groundwork for her success as a CrossFit Games athlete, where she is known to excel at endurance events and gymnastics movements.

Kristin has competed at last 6 CrossFit Games, never placing outside the top 20.  After spending two years in 7th place, Kristin knew she wanted to go from good to great.  She doubled down, surrounded herself with a team of coaches, and addressed as many nuances in her training, nutrition, and recovery as possible.  The attention to detail paid off with a second place podium finish at the 2019 CrossFit Games in Madison.  Her third place finish in the 2020 CrossFit Games Open earned her an invitation to this year's Games, and Kristin is excited to return to the Ranch to continue to put her training to the test.

Since qualifying for her first Regional, Kristin has also put a tremendous amount of focus into training her mind and credits her competitive edge to her mental game.  With the help of a mental coach, she has improved her confidence and her ability to perform at her best under pressure by using a variety of exercises including an intensive training camps, visualization, mantras, and more.

Kristin and I first competed alongside each other at the 2014 CrossFit Games, where as a rookie she took an event win in Triple 3.  I was excited to catch up with her to learn more about her mental training game, how she continues to improve as a competitor year after year, and why she believes that when it comes to training volume and intensity, sometimes less is more.


In this episode we discuss:

  • How Kristin’s training and day-to-day life has been impacted by coronavirus
  • Her thoughts on the CrossFit Games being hosted at the Ranch, and how she’s preparing for the Rogue Invitational
  • What it was like growing up in Norway
  • How Kristin found CrossFit
  • The importance of using a mental coach for her training
  • Exercises Kristin does with her coach to improve her mental game
  • Overcoming a lung injury and realizing the impact of her mental training
  • Her experience making the podium at the Games
  • Her mindset after placing second at the 2019 CrossFit Games
  • Where Kristin is at in her recovery process from a wrist surgery for Carpal Tunnel Syndrome
  • The factors that have played into her ability to improve every year
  • The key people on Kristin’s team
  • Why she uses a nutritionist even though she’s a nutritionist herself
  • How she’s preserving her longevity in the sport
  • Her proudest CrossFit accomplishments
  • What Kristin enjoys when she’s not training
  • Her outlook for her career and future
  • Three things Kristin does on a regular basis that have the biggest positive impact on her health
  • One thing she thinks could have a big impact on her health, but she has a hard time implementing
  • What a healthy life looks like to Kristin

You can follow Kristin on Instagram and Facebook.


Related episodes:

Ep 08 - Chris Hinshaw on Regaining Functionality and Endurance Coaching and Programming for the CrossFit Community

Ep 79 - Sam Briggs on Going Back to Basics and Training for Longevity

Ep 101 - Building a Champion Mindset with Dr. Joe Janesz

Ep 91 - Mind Over Matter: Improving Performance in Athletics and Beyond with Sports Psychiatrist Dr. MaryEllen Eller

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


This post was originally published on June 27, 2020.

Our Approach to Nutrition PH150

Our Approach to Nutrition PH150

June 30, 2020

In the last few editions of Pursuing Health Pearls we’ve been talking about the importance of metabolic health. In the coming months, we’ll explore some of the most important tools we have for improving metabolic health. We’ll begin in this edition with nutrition, which many would argue provides the cornerstone of metabolic health.

Before diving in, we also want to make it clear that we are very sensitive to the fact that not everyone has access to affordable healthy food, and we are actively working on exploring this issue as well as other social determinants of health on upcoming editions of the podcast.

This edition is in answer to the many questions we receive about nutrition, and provides an overview of the general framework we use. We attempt to break this complex and controversial topic down into simple pieces, some of which - such as mindful eating and food timing - don’t cost anything and are available to everyone.

Our intent is not to induce overwhelm, but rather to empower readers with information so that they can make more informed choices and implement small changes in a stepwise fashion. Although nutrition is incredibly personal, there are some general principles from which the vast majority of people benefit, and those are what we focus on here. Once these general principles are in place, a nutrition plan can be refined to meet individual needs with the help of an experienced clinician.


There are 3 different factors that we consider when it comes to nutrition:


  • Quality
  • Quantity
  • Timing

We find that for most people, working on them in this order leads to success, but every person is different and it’s always best to start in a place that feels right for the individual. We’ll review each of these 3 factors in detail here.



Refining food quality is a great place to start for many people. In this section, we’ll talk about:

  • The difference between real and processed food
  • The state of processed food consumption in the US
  • Why we like to start with food quality first
  • The role of eliminating processed foods and sugar for a period of time
  • How to easily distinguish between real and processed foods
  • Pesticides, GMOs, and processed meats and seafood


Real vs. Processed Food

When talking about food quality, it is important to first make the distinction between highly processed and real food. Processed food can be identified using a classification system called NOVA, which sorts foods based on the extent of processing. “Ultra-processed” foods are the most highly processed in this classification and are: “energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption.” Essentially, these are foods engineered by food companies to get you to purchase and eat more of them without regard for their nutritional value or impact on your health.

Real food, on the other hand, is food in its natural form, coming from the ground, a tree, or an animal. This is the food that has fueled our ancestors for hundreds of centuries.

You may be asking, “What’s the big difference between processed and real food? If they both provide calories, don’t they both give me the energy I need?”

This is a great question, but this is exactly where we’ve been led astray. At the end of the day we do need fuel in the form of calories, but in order for our bodies to function properly we need more than just calories, we need nutrients. Real food is different from processed food in that it is nutrient dense - it is packed full of the nutrients our bodies need to thrive. Remember that food does not exist just to make us feel full when we are hungry, it provides the building blocks for every cell in our bodies. It provides fuel for our microbiome to maintain a healthy gastrointestinal tract, and it provides information for our DNA, turning on genes that are important for our health. Without these nutrients, we are lacking very important ingredients needed for optimal metabolic health.

Examples of the most nutrient dense foods include [1, 2, 3]:

  • Organ meats
  • Herbs and Spices
  • Nuts and Seeds
  • Cacao
  • Fish and Seafood
  • Red Meat
  • Vegetables
  • Eggs
  • Poultry
  • Legumes
  • Fruits

Notice that you didn’t see refined grains, potatoes, or any type of processed or packaged food on that list, because the nutrient density of those foods is much lower. Not only do processed foods lack the nutrients that our bodies need to function optimally, but because they are engineered to be hyperpalatable, they hijack our metabolism and influence us to eat more than we need.


The State of Processed Food Consumption in the US

Ultra-processed foods contribute to about 60% of total energy intake, and about 90% of energy intake from added sugars in the US. Additionally, ¾ of the population has an eating pattern that is low in vegetables and fruits, and most Americans have exceeded the recommendations for added sugars. From 2001-2004 Americans consumed 22.2 teaspoons of added sugar per day (that’s 355 calories per day just from added sugar!). This exceeds the WHO's 2015 recommendations for added sugar of no more than 5% of daily calories or about 6 tsp of added sugar per day, as well as the AHA’s 2009 guidelines recommending less than 6 tsp of added sugar for women, 3-6 tsp for children, and 9 tsp for men per day.

It’s important to note that added sugar has zero nutritional value, but is included in a majority of processed foods to make them hyper-palatable and addictive. What makes consuming so much added sugar so dangerous is that there is a significant association between added sugar consumption and increased cardiovascular disease mortality. Although the sugar industry tried to cover up this link for many years and shift the blame to fat instead, confusing the public, the link is now very clear.

Dietary Intakes of US Population, 2007-2010 NHANES

So, if processed foods and added sugar are so bad for us, why is our consumption of these foods so high? In large part, our toxic food environment is to blame. The fact that these ultra-processed foods that have been engineered to be hyperpalatable are so freely available and constantly surrounding us make them nearly impossible to avoid.

Part of the reason these foods are so impossible to avoid is their addictive nature. In fact, one study demonstrated that the taste of sugar was more addictive than cocaine in rats, which are a well-established model for addiction research. Most mammals have evolved in environments where sugar was very rare, so we have an innate hypersensitivity to sweet taste. It is only recently in human history that we have had such abundant access to sugar and sweetness. Because we have such a hypersensitivity to sweet taste, the stimulation of our sweet receptors by sugar-rich diets which are now widely available sends a very intense reward signal to the brain with the potential to override self-control mechanisms and lead to addiction.


An Argument for Starting with Food Quality 

It is the addictive nature of ultra-processed foods and sugar that makes focusing on food quality such a great place to start. While consuming foods that are highly addictive and engineered to keep you eating more, in our experience it can be much more difficult to control food quantity or adjust food timing than while eating foods that are nutrient dense and satiating.

This is also a reason why so many diets are ineffective. Initially will power prevails, but no amount of will power can withstand the engineering that allows these foods to hijack our hormones and biochemistry to keep us eating more.


The role of eliminating processed foods and sugar for a period

We believe the addictive nature of these foods should be taken seriously, in much the same way as addiction to any other substance. We personally believe anyone can benefit from removing all processed foods and sugar for a period of time, if they are willing. Thirty days is a good time frame, but as little as 10 days can also have the desired effect. Much like detox from alcohol or a drug, it’s difficult to think clearly and understand the impact the substance has on you until you have some distance. Symptoms including headaches, intense cravings, and irritability are common when initially coming off these substances, but after the first week or so most people are amazed to see how great they feel.

Once afforded some distance from processed foods and sugar, it is much easier to make decisions about how to incorporate them back into a diet long-term. Some people are able to eat these foods infrequently for certain occasions, acknowledging that although they don’t have much nutritional value they may have value in enjoyment or participating in social situations. Most of the time after eating these foods again we don’t feel so great and this can act as a gentle reminder that focusing on nutrient-dense foods makes us feel at our best. For others, even a small amount of these foods can be a slippery slope, and they opt to keep them out of their diets permanently. Again, this is an individual decision and one to experiment with over time.

Eliminating processed foods and sugar from the diet can also be a great opportunity to experiment with an elimination diet. Because proteins from certain foods such as gluten and dairy are commonly associated with intolerance resulting in symptoms that range from nasal congestion to gastrointestinal upset to joint pain, eliminating these food groups and re-introducing them to assess for the recurrence of symptoms can help to determine which foods each individual’s body tolerates best.


Distinguishing between real and processed foods

It can be easy to get carried away in the details, but it’s actually very simple to distinguish between real and processed foods. Here are some of the guidelines we use:

  • Is it on the list of most nutrient-dense foods? If it’s on the list below, it’s probably a real food.

    • Organ meats
    • Herbs and Spices
    • Nuts and Seeds
    • Cacao
    • Fish and Seafood
    • Red Meat
    • Vegetables
    • Eggs
    • Poultry
    • Legumes
    • Fruits
  • Is it in a package? If yes, it’s less likely to be a real food. Check the ingredient list: If there are > 5 ingredients, sugar as one of the first 3 ingredients, or there are ingredients you can’t understand, then it’s probably not real food.
  • Is it found along the perimeter of the grocery store? If yes, it’s probably a real food. Most grocery stores will have produce, meat and seafood, and eggs around the perimeter. The aisles contain processed and packaged foods - steer away!
  • Does it pass the Michael Pollan quote test? Michael Pollan is an author who has written extensively about food in books such as Omnivores’ Dilemma, In Defense of Food, and Cooked. Here are some of his rules for determining whether what you’re eating is real food:
    • Food is something that comes from nature, was fed from nature, and will eventually rot
    • Don’t eat anything your great-great grandmother wouldn’t recognize as food
    • If it came from a plant, eat it. If it was made it a plant, don’t.


Pesticides, GMOs, and Processed Meats and Seafood

We’ve spent a lot of time distinguishing real from processed food, but there is another layer of complexity when it comes to quality. Unfortunately even when we choose foods in the categories of most nutrient-dense foods listed above  - meats, seafood, vegetables, nuts and seeds, etc - they may still not have been cultivated in their natural environment which can affect their impact on health.

Much of the produce sold today has been grown in another climate halfway across the world, sprayed with pesticides, and then stored and shipped to your local grocery store. Several pesticides have been linked to cancer. Perhaps the most talked about recently is glyphosate, the active ingredient in RoundUp. Monsanto, the maker of RoundUp is facing tens of thousands of lawsuits and has already paid hundreds of millions of dollars in damages after glyphosate, the ingredient in it’s weed killer RoundUp, was linked to non-hodgkins lymphoma.

Many crops have also been genetically modified in order to withstand being sprayed with these pesticides. We don’t fully understand the long-term implications of genetically modified organisms or GMOs on our health yet.

Additionally, the longer produce is stored before it’s sold and consumed, the lower the nutrient content. One study showed that broccoli purchased in the supermarket in the fall when it is in season has twice as much vitamin C as when purchased in the spring after it had been shipped from elsewhere.

Here are two ways to combat these problems with produce:

  • Buy organic when possible. Fruits and vegetables labeled organic have not been sprayed with artificial substances such as fertilizers or pesticides. Organic produce has been shown to have higher antioxidant content and lower pesticide residue than non-organic crops. Depending on the crop, it may be more or less likely to be affected by pesticides. Every year the Environmental Working Group puts out lists of the produce items that have the lowest and highest pesticide residues, called the Clean 15 and Dirty Dozen. The Clean 15 are the 15 produce items that have the lowest pesticide residues, and are safer to eat non-organic. The Dirty Dozen, on the other hand, are the 12 items that have the highest pesticide residue, and are best purchased organic when possible. We do have to keep in mind that organic items are typically more expensive than their non-organic counterparts and as we mentioned before this is all on a spectrum. Starting by eating real food first will derive a majority of the health benefits, but purchasing items on the Dirty Dozen list organic if possible may provide additional benefit. 
  • Buy Local. As mentioned previously, even better than buying organic is purchasing local, in-season produce which ensures it has not been stored and shipped for long periods and is more likely to have higher nutrient content. Shopping at local farmers markets, subscribing to a CSA, or even growing the items you eat most often in your own garden are great ways to eat local.

The Environmental Working Group’s Dirty 12 and Clean 15

Meat and seafood fall prey to similar issues with the way they’ve been raised. The topic of the role of meat in a healthy diet is a huge one in and of itself that we’ll save for another time, but for now we’ll suffice to say that meat is one of the most nutrient dense foods out there and an important source of complete protein. While it is possible to get enough protein and micronutrients from a diet without meat, it requires a lot of planning and attention to detail.

Just as with produce, there is a big difference between meat that is grass-fed and raised in its natural environment and meat that is processed or raised in factory farms and fed corn, soy growth hormones, and antibiotics. We think of meat that is raised in factory farms as another form of processing. Consuming meat that is raised in as close to its natural environment, if possible, is another way to increase nutrient density and real food consumption:

  • Red meat: Grass fed and finished
  • Poultry: Free-range
  • Pork: Heritage breed
  • Seafood:  Wild caught and screened for levels of heavy metals such as mercury

We covered a lot of ground here talking about food quality, and we believe fueling our bodies with the nutrients they need is one of the most important things we can do to support health and healing. This approach also allows us to focus on increasing nutrients rather than restricting calories.



The next factor we can consider when it comes to nutrition is food quantity. There are various ways to approach this with increasing levels of precision and we’ll review several of them here.

We find that by focusing on food quality first, many people tend to regulate their appetite quite well without having to worry about food quantity because real food is so much more satiating and they’ve gotten rid of the hyperpalatable and addictive foods that influenced them overeat. However, if someone wants to take their nutrition to the next level, thinking about food quantity can be a good next step.

There are two aspects to food quantity:

  • Total amount of food eaten each day
  • Ratios of macronutrients

We’ll start with the simplest ways to think about food quantity and then we’ll add more precision as we go.


Building Your Plate

A very easy and simple way to take food quality into consideration is by building a plate that is balanced in macronutrients. As a general guideline, a plate filled with the proportions below can provide a generally balanced macronutrient intake:

  • ¼ meat or protein (about a palm size portion)
  • ¼ healthy fats or starches (avocado, nuts and seeds, sweet potato)
  • ½ vegetables and fruits. We generally  favor vegetables over fruits because they have less impact on blood sugar.

A general guideline for designing a healthy plate

Eating 3 meals per day using this as a general outline in addition to a couple of real food snacks (think: nuts or nut butter, fruit or vegetables, hard boiled eggs, hummus, or guacamole) can be a great start.


Mindful Eating

We also find that mindful eating can be very helpful for preventing overeating. Personally, we found that initially after making changes to the quality of our food choices we felt much better and more satiated. However, eventually there came a point where we would still overeat, even on these healthy foods. Usually this is due to boredom, stress, emotional eating, or just plain being distracted while eating. Mindful eating is the concept of focusing on the present moment and being in tune with thoughts, feelings, and sensations while eating. Mindful eating can be approached in the following ways:

  • Avoiding distractions. Focus on eating when you are eating and put the phones, TVs, computers, and tablets away.
  • Starting with a small portion. After you eat it, stop to check in and see if you are still hungry before getting another serving.
  • Appreciating and expressing gratitude for your food and everything that it took to get it onto your table.
  • Using your senses. Appreciate the sounds, smells, and textures of the food as you prepare and eat it.
  • Taking small bites and chewing thoroughly. Most food should be chewed 20-40 times which most of us rarely do. We challenge you to give it a shot!


Adding Precision: Weighing and Measuring

Before we dive into weighing and measuring, we want to clearly state that there are some people for whom this approach might not be best for, particularly those who have a tendency toward disordered eating. Weighing and measuring can trigger patterns of disordered eating and for those individuals at risk it may be best to stick to general guidelines and following hunger cues.

For those who do not fall into that category and want to add some precision to their eating patterns, weighing and measuring is a way to do so. We would also like to note that weighing and measuring doesn’t have to be a long-term practice. Many people find that after measuring for a month or so they have a better understanding of portion sizes and how much food they truly need, and are able to “eyeball” portions moving forward. Measuring food quantity periodically from then on can be a good way to “recalibrate” your eye.

As we mentioned before, there are two measurements we’d like to focus on here:

  • Overall food quantity, or overall caloric needs
  • Ratio of macronutrients: protein, fat, and carbs


Overall Caloric Needs

Overall caloric needs can be estimated roughly or in a more precise way. Health.gov has a table with general guidelines for daily caloric intake depending on age, sex, and activity level:

  • For adult females, the daily caloric need typically falls between 1600-2400 calories/day depending on age and activity level.
  • For adult males it ranges between 2000-3200 cal/day depending on age and activity level.

There are also plenty of websites and apps out there which allow individuals to enter their weight, age, activity level and desired outcome and output an estimated daily caloric need.

This can also be made more personalized to the individual if their basal metabolic rate and activity level are known. Basal metabolic rate can be obtained by many of the body composition measurements we discussed in Ep 146 about metabolic health. These numbers can be plugged into an equation such as the Harris-Benedict equation which multiplies basal metabolic rate by an activity factor to determine caloric needs.

Overall, the method used is much less important than finding a starting place. Once tracking is started, caloric needs can be adjusted up or down to find the sweet spot based on how the individual's body responds and their goals.


Macronutrient Percentages

The first step in defining macronutrient percentages is to determine daily protein needs. Daily protein needs again depend on the individual’s goals and activity level and can range anywhere from 1.2-2.7 g/kg of body weight per day (see table below). Examine.com provides an evidence-based protein intake calculator which some people may find helpful.

Source: Examine.com 

It’s important to note that the US Recommended Daily Allowance (RDA) for protein is 0.8 g/kg. This number represents a minimum intake to prevent malnutrition, and is not an ideal intake. Subsequent analyses of the same data used to develop the RDA showed a minimum protein intake of 1.2 g/kg/day to be more appropriate. Additionally, major organizations such as the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine recommend protein intake of 1.2-2g/kg of body weight per day to optimize recovery from training and promote growth and maintenance of lean mass.

Adequate protein is especially important in older adults. 40% of men and 55% of women over age 50 have sarcopenia, or impairment of physical function combined with a loss of muscle mass. This can lead to frailty, falls, fractures, and dependence on others ultimately potentially leading to the need to live in a nursing home. Older adults need to take in more protein at each meal in order to stimulate muscle synthesis than younger adults. It’s recommended that adults > 65 consume 1.0-1.2 g of protein per kilogram of body weight per day, and it is acknowledged that they may need up to 1.5 g/kg/day if they have acute or chronic diseases with the exception of kidney disease.

For many people, just determining and tracking total daily caloric needs or total protein needs may be enough precision. For those who want to refine their food quantity even more, the percentage of total calories comprised of the other two micronutrients, carbohydrates and fat, can also be monitored. After establishing total daily caloric needs and protein needs, all that is left is carbohydrates and fat. As a general guideline, a healthy, active person may choose to split the rest of the calories by percentage in half. For example, if protein intake composed 30% of total calories, carbohydrates and fat would then each make up 35% of total calories per day for a total of 100%.

This is a good general starting place for those who are generally healthy and active, but is something that should be experimented with on a personal basis to determine what ratio works best. If an individual is less active, aiming for fat loss, or has signs of metabolic dysfunction, they may benefit from decreasing the percentage of carbohydrate and increasing the percentage of fat. On the other hand, someone who is much more active may do better with a higher percentage of carbohydrates. Working with a personal dietitian or physician is recommended to determine the right macronutrient percentages based on an individual’s health conditions and goals.

The extreme version of a low carbohydrate/high fat diet would be a ketogenic diet, in which carbohydrates contribute less than 5-10% of total daily calories. The goal of a ketogenic diet is to achieve nutritional ketosis, which is characterized by a certain level of ketones circulating in the blood that then provide energy for the body. This diet is currently being explored in a number of conditions such as epilepsy, diabetes, metabolic syndrome, cancer and neurodegenerative diseases such as Alzheimer’s. Implementing a ketogenic diet would be an example of adjusting macronutrient ratios for a therapeutic effect. It’s important to note that changing one’s diet for a therapeutic effect like this should be done under the supervision of an experienced physician or dietitian. We’ve talked about ketogenic diets in previous episodes of the podcast, for example with Dr. Dom D’Agostino in Ep 120.



The third and final factor that can be refined when talking about nutrition is timing. Depending on the person, timing may be a more accessible place to start because it is relatively simple and doesn’t involve a lot of planning or big changes to food choices, shopping, or cooking, but can still have a big impact.

Again there are two different factors we will discuss when it comes to timing:

  • Nutrient Timing: The timing of when certain macronutrients are eaten relative to time of day and activity
  • Fasting: The window during a 24-hour cycle during which no food is consumed


Nutrient Timing

Of the 3 macronutrients, carbohydrates are the most hormonally active and sensitivity to carbohydrates changes based on the time of day and activity.

All of our bodily functions operate on a 24-hour circadian clock, which is largely set by the light and darkness our eyes are exposed to and when we eat or don’t eat. In the simplest terms, when our bodies know we are awake based on external signals such as light, food intake, and activity, certain genes are upregulated in order to support metabolism. As a result, glucose tolerance, or the ability to regulate blood sugar after consuming carbohydrates is higher in the morning than the evening. For this reason, focusing on taking in more carbohydrate-heavy meals in the morning and less in the evening may be beneficial.

Carbohydrate intake can also be timed relative to activity. It is known that glucose tolerance increases during and after exercise. During exercise while muscles are contracting, they can take up 50 times more sugar from the blood without the need for insulin. Muscle tissue is also more sensitive to insulin after exercise. Because of these effects, some advocate consuming the majority of carbohydrates for the day within a 3 hour window after exercise. For endurance exercise events more than 2 hours in duration, consuming carbohydrates prior to exercise has been found to be beneficial to performance. Finally, consuming carbohydrates solely or in combination with protein during resistance exercise sessions has also been shown to improve adaptations.

Protein intake can also be timed relative to activity. While it’s true that consuming protein within 2 hours after a workout increases muscle growth, it seems to be more important to get enough protein throughout that day. In fact, muscles remain sensitized to protein for at least 24 hours following a resistance training session. Consuming 20–40g of protein every 3-4 hours improves muscle growth rates when compared to other ways of eating and is associated with improved body composition and performance. Additionally, consuming 30-40g of casein within 30 min of sleep may also improve strength and muscle growth.



Fasting is a very popular topic these days, and there is good reason why. There are many different ways to approach fasting and to use it strategically for a therapeutic effect or to promote health. This is another area that should be used with caution in certain populations, including those who have a history of disordered eating, children, and pregnant women. 

First we’ll review what is known about why periods of fasting can have a positive impact on our metabolic function. As discussed above, our bodies operate on a 24-hour circadian clock which coordinates changes in many different areas of our bodies so that we can metabolize the food we are taking in during the day. One of the signals that helps to set this circadian rhythm is food intake. However, during periods of prolonged fasting >8 hours, our metabolism adjusts to minimize processes that have to do with growth, and instead favors processes that involve maintenance and repair, enhancing our resistance to stress, recycling damaged molecules, improving glucose regulation, and suppressing inflammation. One can imagine that without periods of prolonged fasting, our bodies are not given adequate opportunity to do maintenance and repair, recycle damaged molecules, and enhance resistance to stress that is necessary for optimal metabolic function and health. One study found that more than half of adults eat > 15 hours per day, which limits the time spent in a fasted state during which this maintenance and repair can take place.

Fasting has been studied in humans and found to improve a variety of different conditions including obesity, insulin resistance, lipid abnormalities, high blood pressure, and inflammation. [1, 2, 3, 4, 5] These are essentially all of the factors we talked about in our last Pearls episode that are associated with metabolic syndrome. Fasting has also been shown to enhance parasympathetic tone and increase heart rate variability, and intermittent fasting is also thought to repair metabolism in cancer cells inhibiting their growth and making them more susceptible to treatments.

Effects of intermittent fasting on humans

There are several ways to incorporate periods of fasting, which can be seen in the table below:

Definitions of different types of fasting eating patterns

A fasting-mimicking diet, characterized by reduced calorie intake for 5 days monthly for 3 months has also been shown to provide many of the benefits of fasting for general health and a variety of health conditions. We discussed this diet in detail in Ep 112 of the podcast with Dr. Valter Longo.


In summary, we’ve reviewed our general approach to nutrition covering the factors of quality, quantity, and timing. We attempted to make this complex and controversial topic as simple as possible. Although most people can benefit from simple changes to nutrition such as eating real food, avoiding overeating, and incorporating regular periods of fasting, nutrition is highly personal and changes through different phases of life. Working one-on-one with a dietitian is a great way to personalize a nutrition plan to meet individual needs.


Related episodes:

Ep 95 - Optimizing Your Nutrition with EC Synkowski

Ep 123 - Zoe Harcombe on Dissecting Nutrition Research and Dietary Guidelines

Ep 146 - Pursuing Health Pearls: Assessing and Understanding Metabolic Health

Ep 144 - Pursuing Health Pearls: What COVID-19 is Teaching Us About Our Health


If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.


Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


This post was originally published on June 22, 2020.

The Science of Spontaneous Healing with Dr. Jeffrey Rediger PH149

The Science of Spontaneous Healing with Dr. Jeffrey Rediger PH149

June 23, 2020

I think spontaneous healing is a lot more common than we realize. I’ve asked a room of doctors before, 'How many of you have seen a case of unexplained recovery that you didn’t think was possible and it happened?' Well, lots of doctors raise their hands. And I asked how many had reported it.  No one had reported it.  And I was loathe to report things myself, because, first of all, how are you going to get it published if you do all that work, and if you do get it published how are your colleagues going to view it? - Jeffrey Rediger, MD, MDiv

Jeffrey Rediger, MD, MDiv,  has spent over 15 years studying spontaneous healing and pioneering the use of scientific tools to investigate recoveries from incurable illnesses.

He is on the faculty of Harvard Medical School, is the Medical Director of McLean SE Adult Psychiatry and Community Affairs at McLean Hospital, and is the Chief of Behavioral Medicine at Good Samaritan Medical Center.  Dr. Rediger is a a licensed physician and board-certified psychiatrist, and he also holds a Master of Divinity from Princeton Theological Seminary.

Dr. Rediger’s research has taken him from America’s top hospitals to healing centers around the worldand along the way he’s uncovered insights into why some people beat the odds.

I recently had the opportunity to chat with Dr. Rediger, and I was excited to learn more about how he became involved in studying a somewhat controversial field.  We talked how he objectively collects data,  the factors the play into spontaneous healing, and the lessons he's learned from his patients that have impacted his own life.

*Dr. Rediger's bio adapted from his website.

In this episode we discuss:

  • How Dr. Rediger became interested in studying spontaneous healing
  • The three criteria he uses to objectively collect data
  • The factors that play into spontaneous healing and help to build a strong immune system
  • Themes Dr. Rediger has identified in nutrition as it relates to spontaneous healing
  • The importance of building the parasympathetic response and stimulating the vagus nerve
  • How our identity contributes to healing
  • Dr. Rediger’s childhood and how his time in seminary shaped his path in medicine
  • The implications of quantum physics on our mind, body, and medicine
  • What Dr. Rediger has learned from his patients that has impacted his own life
  • Why stories of healing can inspire others in their own healing
  • The Four Pillars of Healing
  • Three things Dr. Rediger does on a regular basis that have the biggest positive impact on his health
  • One thing he struggles to implement that could have a big impact on his health
  • What a healthy life looks like to Dr. Rediger

You can follow Dr. Rediger on his website, Instagram, Facebook, and Twitter.


Related episodes:

Ep 97 - Challenging Conventional Cancer Care with Dr. Thomas Seyfried

Ep 116 - How Healing Works with Dr. Wayne Jonas

Ep 135 - Immune System Strength with Dr. Leonard Calabrese

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


This post was originally published on June 2, 2020.

Fighting Back Against Fibromyalgia PH148

Fighting Back Against Fibromyalgia PH148

June 16, 2020

“‘Olivia, you're healthy.’ I held it in in the moment, but when I left the [doctor’s] office that day I cried. I had never had a doctor tell me I was healthy.”
- Olivia Vollmar

Diagnosed with fibromyalgia in July 2016, Olivia Vollmar started CrossFit four months later, despite her doctor’s reservations.  “He loved that I was moving, but he thought it was too much. He has friends that are avid CrossFitters and just couldn't see how someone with fibro could manage to do it.  Like any good patient, I completely ignored him and continued on in what I was doing.”  Olivia decided she would continue with CrossFit for three months, and if the negatives outweighed the positives, she would stop.

One month passed, and Olivia found herself feeling better than ever.  Within two months, she was sleeping more regularly, feeling less fatigued, and her joint pain had decreased.  She no longer needed to see a psychiatrist from her anxiety and depression.  “CrossFit saved your life,” her therapist told her.  Within three months, she was completely symptom free, and living a normal life.

Along with her new exercise routine, Olivia made dietary changes, following the general advice to eat meat and vegetables, nuts and seeds, some fruit, little starch and no sugar.  When she returned to her doctor 10 months after her initial fibromyalgia diagnosis and just six months after starting CrossFit, he barely recognized her.  She had lost 100 pounds!

Olivia discussed her rheumatologist’s treatment plan with her doctor,  and he ran through a series of questions checking on her pain, sleep, mental health and quality of life.  Olivia was stunned when, for the first time in her life, he pronounced her healthy.

“When I was first diagnosed I had so many doctors tell me there was no hope in this disease. I would always suffer and always feel awful. I would never be free from medication and I would never live a normal life. One of my doctors told me to not pursue a career in medicine because it wouldn't be possible.”

“Now, I'm completely normal and doing exactly what I want to do.  I can confidently say that it [CrossFit] has saved my life. Not only in the physical sense, but also in the emotional sense. Before joining my box, I had suicidal thoughts and was completely ready to end my life. Now I've found health, healing and purpose.”

Olivia's road to maintaining her health has not been without bumps and detours.  As she continued her new lifestyle, Olivia felt pressure to please others and anxiety that she might let her coaches down.  She realized that her eating had become disordered, and instead of approaching her workouts as an opportunity to be better than she was the day before, she was constantly comparing herself  and competing against others at her affiliate.  Her "healthy" lifestyle began to take negative toll on her health.

Recognizing that she needed balance, Olivia shifted her focus to make sure she's eating with less restriction and with a greater focus on consuming plenty of nutritious food.   She has also recently left her affiliate and started working out solo with guidance from a powerlifting coach.  These days, she's finding happiness and confidence in celebrating her own accomplishments without seeking the approval of others.

As she graduates from college this spring, Olivia has big goals on the horizon: she's pursuing her Master's Degree in Nutrition and is excited to use her education and her experiences to help others as she continues her own health journey with a focus on the long-term.  Says Olivia, "I am nearly 100% symptom free.  I have found freedom from a disease through diet and exercise.”

Olivia shared her story with me many years ago and I was so inspired to hear how she's overcome so many challenges by focusing on what is within her control to change.  I was excited to catch up with her recently and hear how her journey has evolved, how she found the courage to get started in the first place, and the advice she gives to help others get started on their own health journey.


In this episode we discuss:

  • Olivia's childhood and how the passing of her mother impacted her health and her weight
  • How her father’s health condition and her fibromyalgia diagnosis prompted her to being changing her diet and lifestyle
  • Starting CrossFit with her roommate and how she overcame the intimidation of attending her first class
  • Her struggle with suicidal thoughts
  • How Olivia’s relationship with food changed when she started CrossFit
  • What led Olivia to leave her local affiliate
  • How she’s working to find balance in her nutrition and her fitness
  • What’s she’s most proud of from her journey
  • Advice she would give to others who are struggling with health and are scared to get started
  • How to help others who you recognize are struggling
  • What’s next for Olivia
  • Three things Olivia does on a regular basis that have the biggest positive impact on her health
  • One thing she thinks could have a big impact on her health, but she has a hard time implementing
  • What a healthy life looks like to Olivia

You can follow Olivia on Instagram and Twitter.


Related episodes:

Ep 45 - Dan Baily on Moving West, Training for 2017, and Danny Broflex

Ep 69 - From "Obese to Beast" with John Glaude 

Ep 19 - Michelle Mitchell on her Experience with Exercise and CrossFit for Fibromyalgia Syndrome

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


This post was originally published on June 15, 2020.

Cancer, Racism, and Speaking Up with Deb Cordner Carson PH147

Cancer, Racism, and Speaking Up with Deb Cordner Carson PH147

June 9, 2020

The thing about it, she said, ‘Why are they destroying our city?’  And I said, ‘What if you were trying to get mommy and daddy’s attention and we weren’t paying attention to you? What would you do?’  She was like, ‘Well, I would talk louder.’  I’m like, ‘What if we still didn’t listen to you?’  She was like, ‘I would scream!’  And I was like, ‘What if we STILL didn’t listen?’  She was like, ‘I would be really sad. I would start crying.’  And I was like, ‘I know! And what if we STILL didn’t listen?  What if it went on all day long and we just didn’t listen to you?'  She was like, ‘I would be so upset. I would… I don’t know.’  And I was like, ‘Would you throw a fit? A tantrum?’  And she was like, ‘Yeah, I probably would. I’d probably throw my toys at you.’  And I was like ‘That’s kind of what happened, and then we would notice you because you would be making a mess, and we’d say ‘Sydney, Sydney, what’s wrong?’  And we would stand with you and try to calm you down and listen to you.’  So I said, ‘That’s kind of what happened with black people around the city.’  Definitely the first night. And people I think have realized what was going on, finally, and what black lives matters means and they were like, ‘Alright. You’re right.  We stand with you.’
- Deborah Cordner Carson


The CrossFit community may best recognize and remember Deborah Cordner Carson as the gutsy athlete who gave an inspirational performance at the 2012 CrossFit Games, overcoming a fear of open water swimming in the triathlon event and going on to win the 2012 Spirit of the Games award.  Deb could also be distinguished by the compression sleeve she wears on her left leg, and by the color of her skin.  Deb is one of the few black competitors in the sport of CrossFit.

Growing up, Deborah was inspired by great athletes in her family.  Her father came to America from Trinidad and Tobago on a track and field scholarship and her grandfather was the heavy weight lifting champion of the British Empire.  As a young girl she competed in gymnastics, and as a teenager she excelled in track and field, eventually earning a full scholarship to the University of Northern Iowa as a 400-meter sprinter.

When Deb developed lymphedema, a condition where fluid is retained in certain parts of the body and can cause dangerous swelling, she was forced to retire from her track and field career, but in time, she discovered ways to manage her condition- including that recognizable compression sleeve- while still being active.  She took up CrossFit and quickly rose to elite status in the sport, placing as high as 5th in the 2013 CrossFit Open and 13th at the 2012 CrossFit Games.

Since retiring, Deborah continues to do CrossFit for health, but she has also struggled with the heartbreak of multiple miscarriages, and most recently, a diagnosis of gestational trophoblastic disease, a type of pregnancy-related cancer.

Throughout her life, Deborah has been aware that the color of her skin means she's had to work harder for opportunities than others.  As a mother to two mixed-race little girls and a resident of the Minneapolis area, she also has a unique perspective on the recent events that have highlighted the ongoing systemic racism in our society.

I am grateful to Deb for taking a moment to share her perspective amidst all the other challenges she is currently taking on.  These conversations can be uncomfortable, but they're also important as we all strive to stand together and learn from each other.  In this episode, we chat about her experiences as a minority CrossFit Games athlete, the mentality she's using to fight her cancer diagnosis, the lessons she strives to teach her daughters, and how we should all speak up to overcome injustice and racial bias.


In this episode we discuss:

  • Deborah’s struggles with multiple miscarriages
  • How she is coping with the diagnosis of gestational trophoblastic disease, a type of pregnancy-related cancer
  • How Deborah’s experience competing in CrossFit helps her focus on the task at hand when it comes to tackling challenges
  • Her initial reactions to hearing about George Floyd’s death and the outrage in Minneapolis
  • Explaining the looting and rioting to her daughter
  • Deborah’s personal experiences with systemic racism and unconscious racism
  • How Deborah needed to be the best of the best to have the same opportunities as her white classmates
  • Deborah’s thoughts on why there’s a disconnect in people understanding the additional challenges a black person has to overcome
  • The lack of sponsorship opportunities available for a black CrossFit athlete
  • Her disappointment with CrossFit HQ’s silence
  • What it’s like to be a black athlete in the predominantly white sport of CrossFit
  • Ways that Deb approaches the topic of racism with her children
  • The importance of speaking up and making an effort to understand other cultures
  • Three things Deborah does on a regular basis that have the biggest positive impact on her health
  • One thing she thinks could have a big impact on her health, but she has a hard time implementing
  • What a healthy life looks like to Deborah

You can follow Deborah on Instagram


Related episodes:

Ep 10 - Jenny LaBaw on Running 500 Miles for Epilepsy Research and Education

Ep 15 - Lewis Howes on Chasing Greatness

Ep 70 - USA Track & Field Heptathlete Tiffeny Parker on Beating the Odds

Ep 137 - Rich & Hillary Froning on Putting Family First

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.

This post was originally published on June 8, 2020.

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