Pursuing Health
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.

Understanding and Assessing Metabolic Health PH146

Understanding and Assessing Metabolic Health PH146

June 2, 2020

This edition of Pursuing Health Pearls will build on our last edition about COVID-19 and our Health. In that edition, we revealed that only 12.2% of our population is optimally metabolically healthy, and a lot of metabolic dysfunction goes undiagnosed.

Good metabolic health is a state of being in which the biochemical processes in the body that regulate blood sugar and lipids are operating normally. There are many definitions of metabolic dysfunction, but all involve abnormal regulation of blood sugar and lipids as well as systemic inflammation. If metabolic dysfunction is left unaddressed, it can ultimately lead to a range of common chronic diseases and causes of death such as hypertension, diabetes, heart disease, and stroke.

Here, we’ll review how metabolic dysfunction develops, what is actually happening in our bodies that sets the stage for chronic disease, and how to assess metabolic health so that this dysfunction can be detected and addressed early.


Overview of Metabolic Dysfunction


There are 3 different phases of metabolic dysfunction:

  1. The first phase is generally silent, and can go on for years without anyone knowing it is present.
  2. The second phase is characterized by one or more chronic diseases: hypertension, type 2 diabetes, hyperlipidemia, fatty liver, or others. Individuals in this phase may still feel generally well, but they may carry these diagnoses and take medications to keep them “under control.”
  3. The third phase is what we are all trying to avoid, which is significant impairment or death from the end-stage complications of metabolic dysfunction including stroke, heart attack, limb or vision loss, or kidney failure.

The phases of metabolic dysfunction all exist on a continuum and the earlier they are detected the easier it is to reverse the process. Unfortunately, our healthcare system is designed to identify metabolic dysfunction in phase 2, which is often years after it has started.

We should also note that the manifestation of metabolic dysfunction depends on the person and their unique genetic makeup and environmental exposures. The underlying process of abnormal glucose and lipid processing and inflammation is the same, but in one person this may lead to high blood pressure while in another it might be type 2 diabetes and in a third it could be polycystic ovarian syndrome. Other manifestations of metabolic dysfunction include: fatty liver, dyslipidemia, cardiovascular disease, arthritis, cancer, neurodegenerative diseases and even mental health conditions such as depression.


Diagnosing Metabolic Dysfunction

There is no single test for metabolic dysfunction, but there are many different signs and symptoms which we can assess to determine whether it is present. Some of these indicators have been grouped together to define a condition called metabolic syndrome. Metabolic syndrome is a grouping of five different risk factors that, when present, raise the risk of heart disease and other health problems, such as diabetes and stroke. Any one of these risk factors may be present by itself, but they tend to occur together. Having at least three of the five risk factors is consistent with a diagnosis of metabolic syndrome. The risk factors include:

  • A waist measurement of 35 inches or more for women or 40 inches or more for men
  • Triglycerides of 150 mg/dL or higher (or being on medicine to treat high triglycerides)
  • HDL cholesterol level of less than 50 mg/dL for women or  less than 40 mg/dL for men (or being on medicine to treat low HDL cholesterol)
  • Blood pressure of 130/85 mmHg or higher (or being on medicine to treat high blood pressure)
  • A fasting blood sugar level of 100 mg/dL or higher (or being on medicine to treat high blood sugar)

Metabolic syndrome has a prevalence of 24% in US adults and 43% in US adults older than 60 years. In other words, 24% of adults and 43% of adults over 60 in the US have at least 3 of the above five risk factors. The NHANES (National Health and Nutrition Examination Survey) from 2009-2016 showed that only 12.2% of American adults have zero of these five criteria. In other words only 12.2% of American adults are considered to have optimal metabolic health. In this study an even more stringent blood pressure criteria was used of <120/80, which is considered a “normal” blood pressure.

The risk factors listed above have discrete cutoffs, but of course our bodies behave on a continuum. It’s important to look at the big picture of what these numbers mean and their trends over time.


Development of Metabolic Syndrome

Now that we’ve defined metabolic syndrome, we’ll review how it develops. What causes the process of normal metabolism to become dysfunctional, and how does it progress?


Excess Carbohydrate Intake

In the simplest terms, the process starts with increased carbohydrate consumption. Increased carbohydrate consumption leads to increased sugar circulating in the bloodstream, and a storage hormone called insulin is released. Normally, insulin signals cells to take up the blood sugar and store it in muscles, fat cells, and the liver so that it can be used later when energy is needed.


Visceral Adiposity

When there is excess sugar circulating and the muscles are full, then the insulin directs the glucose to be stored in fat cells as fat. Over time, this can lead to increased body fat or obesity. In particular, increased fat cells in the abdomen around our organs (called visceral adiposity) is what contributes to increased abdominal circumference, one of the hallmarks of metabolic syndrome discussed above. This visceral fat contains fat tissue that is very metabolically active and releases more than 50 different molecules called adipocytokines. Secretion of these molecules leads to increased inflammation and also contributes to insulin resistance, which we’ll define shortly.


Insulin Resistance

It’s important to note that the level of sugar in our bloodstream is tightly regulated by insulin and other hormones, because very high or very low levels of sugar in the blood can be dangerous. So, if there is continued excess carbohydrate intake and elevated blood sugar, large amounts of insulin are required in order to keep storing blood sugar in the tissues. Eventually this can lead to a state of insulin resistance, which is where the cells don’t respond to the insulin as well. It takes more and more insulin to get the cells to receive the signal and take in sugar for storage. There are other factors that play a role in insulin resistance, too, and can make a person more or less susceptible to this state in the context of high carbohydrate intake. For example, a person’s genetics, sleep deprivation, inactivity, exposure to toxins, and stress can all contribute to increased blood sugar levels and/or insulin resistance.


Lipid Abnormalities 

Insulin resistance usually occurs first in the muscle, which then drives excess glucose to the liver. The liver then uses excess blood sugar for increased production of VLDL, (a type of lipid transport molecule), as well as elevated blood triglycerides and decreased blood HDL. This is why elevated triglycerides and low HDL are also hallmarks of metabolic syndrome. The fat cells then become insulin resistant too. Because they are not picking up the signal from insulin to store energy, they start behaving as if they are starving, and they start breaking down the stored fat. As a result, the fat cells release this stored fat into the bloodstream and deliver it to the liver, where the liver uses it to start making more glucose which further contributes to the problem.



In the end, all key insulin-responsive tissues (liver, skeletal muscle, fat tissue) become insulin resistant and the body has to use higher and higher levels of insulin in order to break through the resistance and get the sugar out of the blood and stored in these tissues. This means there is a high circulating level of insulin in the bloodstream which is a state called hyperinsulinemia. Hyperinsulinemia leads to increased production of inflammatory markers further leading to a state of systemic inflammation that characterizes metabolic syndrome.


Elevated Blood Sugar

Insulin is normally produced in a part of the pancreas called the beta cells. Eventually the pancreas gets so tired out from having to make so much insulin that these cells start to die off. Less insulin is then produced and blood sugar can’t be stored in the tissues as efficiently, so the concentration of sugar in the blood rises. The end result is a metabolic catastrophe known as diabetes. This is why elevated blood sugar is another hallmark of metabolic syndrome.

Please note that a lot has happened up until this point before the blood sugar even becomes elevated, which is usually the way prediabetes or diabetes is initially detected. For example, decline in beta cell function has been noted to begin as early as 12 years before the diagnosis of diabetes. This process of metabolic dysfunction can be taking place for many years before it may be apparent on a test of blood sugar.


Elevated Blood Pressure

High circulating levels of glucose and insulin coupled with inflammation also contribute to elevated blood pressure. Insulin resistance can lead to hypertension through increased oxidative stress, increased production of chemicals that cause the blood vessels to constrict and reduction in levels of chemicals that cause the blood vessels to relax. Hyperinsulinemia also activates a hormonal system called the Renin-Angiotensin-Aldosterone System which leads to salt retention and increased blood pressure. This is why elevated blood pressure is another hallmark of metabolic syndrome.


Vascular Damage

The dysregulated glucose and lipid metabolism in addition to systemic inflammation also eventually leads to damage of the large and small arteries. In the large arteries, this leads to what is called macrovascular damage, or increased inflammation and development of plaques in the artery walls. As the plaques grow they can restrict blood flow or rupture and cause blockages in arteries in places such as the heart or brain, leading to heart attacks or strokes. The same thing can happen in the legs leading to peripheral artery disease.

In addition, exposure of the small arteries to high levels of blood sugar, oxidative stress, and other inflammatory compounds leads to decreased blood flow to the eyes (leading to blindness), to the kidneys (leading to kidney failure and eventually dialysis), and to the nerves (leading to impotence and diabetic foot disorders which include severe infections leading to amputation). These are known as microvascular complications of metabolic syndrome.


Gut Microbiome

The gut microbiome is also emerging as an important player in the development of systemic inflammation and metabolic dysfunction, which is also strongly affected by the food we eat, stress, sleep, and exercise.

Physiology of Insulin Signaling in Metabolic Syndrome


Assessing Metabolic Health

Now that we’ve covered what metabolic dysfunction is and how it progresses from a silent process to life-threatening disease, we’ll review how to assess metabolic health. Below, we’ll review how to assess each of the five hallmarks of metabolic syndrome, as well as systemic inflammation.


Body Composition

Because lean muscle tissue and fat tissue act very differently from a metabolic and hormonal perspective it is important to assess the presence of each. There are many different ways to estimate body composition and the presence of fat mass, and each has strengths and limitations. We’ll cover some of the most commonly used methods below:

  • Body Mass Index (BMI): This a measurement of Weight (kg) / Height (m)^2. There are BMI calculators that can be used to easily perform this calculation if weight and height are known. The advantage of this measure is that extensive national reference data establishing the relationship between BMI, body fat, and risk of illness and early death exists. In adults, BMI levels above 25 are associated with an increased risk and are considered overweight. BMI levels above 30 indicate obesity and are associated with even higher risk. We do have to use caution with this measure though, because it does not distinguish between fat mass and muscle mass. This means that a well-muscled athlete may have a higher BMI but may not carry the same associated increased risk as someone with the same weight but more fat mass.
  • Abdominal Circumference: Abdominal or waist circumference of 35 inches or more for women or 40 inches or more for men provides one of the criteria for the definition of metabolic syndrome. Remember that fat deposited in the abdomen seems to be more inflammatory and more closely associated with the development of metabolic disease than fat deposited elsewhere, called subcutaneous fat (typically fat in arms, legs, hips, etc). This measurement is taken as the circumference around the abdomen at the level of the top of the hip bones, or what is called the iliac crest.
  • Waist to Hip Ratio: A ratio of the abdominal or waist circumference described above to the circumference at the hips is called the waist to hip ratio, which also provides an estimate of increased metabolic risk. Most men with a ratio greater than 1.0 and women with a ratio greater than 0.85 are at high risk for cardiovascular disease, diabetes, and cancers. Some argue that these abdominal measurements are better discriminators of cardiovascular risk factors than BMI. Again, this is probably due to the increased association of visceral or abdominal fat with metabolic disease than subcutaneous fat elsewhere in the body.

Table from IFM Cardiometabolic Advanced Practice Module. Source: Ford ES, et el 2002. 

  • Skinfold Measurements: Skinfold measurements with calipers are commonly used, but are not ideal because they predominantly measure subcutaneous fat rather than the visceral abdominal fat which carries the strongest association with increased metabolic risk.
  • Body Fat Percentage: All of the measurements discussed above have the advantage that they are easy to obtain: all you need is a measuring tape and maybe a scale. They are good crude ways to estimate total body and abdominal fat which is known to be associated with increased metabolic risk. But, in order to really assess total body fat there are more advanced imaging methods that can be used. The methods below are used to estimate the percentage of body weight composed of fat mass vs. lean mass (muscle and organs), and in some cases where that fat mass is distributed in the body (abdominal vs. subcutaneous). The 1999-2004 NHANES survey compared body fat percentage cutoffs to BMI cutoffs and identified body fat percentage cutoffs that were associated with increased metabolic risk. These differed by age, sex, and race so it’s difficult to generalize what body fat percentage is considered “normal” without knowing an individual’s background. On average for men, body fat percentages above 25% were associated with the same risk of a BMI of 25 or being overweight, and above 30% were associated with the same risk of a BMI of 30 or being obese. For women, body fat percentages above 38% were associated with the same risk as a BMI of 25 or being overweight, and body fat percentages over 42% were associated with the same risk of a BMI of 30 or obesity. The table below shows more specifics based on age, sex, and race:


Body fat percentage cutoffs in reference to BMI and cardiovascular risk

  • Below are some of the ways body fat percentage can be measured:

    • Bioimpedance Analysis (BIA): BIA measures bioelectrical impedance and estimates total body water, fat-free mass, and fat mass by measuring the resistance of the body as a conductor to a very small alternating electrical current. These are the devices used by standing on a scale and/or holding on to handles such as an InBody machine. Overall, these measurements give a good approximation of fat-free mass (muscles and organs), and fat mass.
    • Body Density: There are two ways to measure body density using either water or air:
      • Hydrodensitometry is commonly called “underwater weighing” and is an accurate way of measuring body fat percentage.
      • Air Displacement Plethysmography uses air displacement to measure the body’s density. This method which is used by devices such as the BodPod, is preferred to underwater methods by most people, but does result in higher mean % body fat than underwater weighing.
    • Dual Energy X-ray Absorptiometry (DEXA): DEXA is the most popular method for quantifying fat, lean, and bone tissues. It uses two separate low energy x-rays to assess total body fat and soft tissue and bone mineral density. This is a relatively cheap and convenient way to assess body composition and is what has been used to collect data in the National Health and Nutrition Examination Survey (NHANES). DEXA has long been thought of as a gold- standard, but a recent study comparing DEXA, air densitometry, and BIA showed that all three methods were comparable, although air densitometry and BIA underestimated percent body fat compared to DEXA.



Blood Pressure

Although a blood pressure >130/85 or being on medication to treat high blood pressure was a criteria for metabolic syndrome, remember that blood pressure exists on a continuum, and increased cardiovascular risks have been identified at even lower blood pressures than 135/85. Below are the stages of hypertension:

Definitions of elevated blood pressure

The risk for cardiovascular disease increases as average blood pressure readings increase. Notably, a 20 point increase in systolic blood pressure (top number) and 10 point increase in diastolic blood pressure (bottom number) are each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease. In those over age 30, higher blood pressures are associated with increased risk for cardiovascular disease, heart attacks, heart failure, stroke, peripheral artery disease, and aneurysms. It is important to follow the correct protocol when measuring blood pressure in order to obtain accurate readings.

Glucose and Insulin

There are several ways to test for elevated levels of blood sugar. These methods are described next, and cutoffs of each that define prediabetes and diabetes by the American Diabetes Association and World Health Organization are included in the table below.

    • Fasting Blood Sugar: This is a blood test for the level of sugar or glucose in the blood after an 8-12 hour fast.
    • Hemoglobin A1c: Red blood cells live for about three months, and as they float around in the bloodstream, sugar sticks to them. We can measure the amount of sugar stuck to these cells through a measurement called the hemoglobin A1c. This gives us an  estimate of the average blood sugar over the last 3 months.
    • 2-hr Glucose Tolerance Test: After fasting, a patient drinks 75g of glucose and their blood sugar is checked one and two hours later. This gives an indication of how good the body is at storing the sugar that was just consumed.

Definitions of Prediabetes and Diabetes

As we discussed earlier, a hallmark of type 2 diabetes is a decline in beta cell function, which begins as early as 12 years before diagnosis and continues throughout the disease process. Insulin resistance and hyperinsulinemia can be occurring for many years before the blood sugars or hemoglobin A1c start to look abnormal. One way to assess for hyperinsulinemia is by using an oral glucose tolerance test in which both insulin and glucose are measured fasting, and at 1 and 2 hour intervals after drinking 75g of glucose.



Elevated triglycerides > 150 mg/dL and low HDL <50 mg/dL for women and <40 mg/dL for men are also criteria for metabolic syndrome. These can be measured in a basic lipid panel, which is a blood test that also contains total cholesterol, and LDL.

The triglyceride/HDL ratio has also been proposed as a marker of insulin resistance. One study suggests a ratio of >2.75 in men and >1.65 in women to be highly predictive of metabolic syndrome (1, 2).

There are also more advanced lipid measurements which look at particle size and lipoproteins. In particular, apoB ≥ 130mg/dL and lp(a) > 50mg/dL are associated with increased cardiovascular risk and are considered cardiovascular disease risk enhancers.


Systemic Inflammation

Finally, we’ve talked about how metabolic syndrome is associated with chronic, low-grade systemic inflammation. Elevation in many different inflammatory markers has been observed, but as of yet very few are used clinically. High sensitivity CRP (hsCRP) is one marker that is used, and has been associated with increased risk for future cardiovascular illness and death independent of other cardiovascular risk factors. We also touched on this briefly in our Pursuing Health Pearls Episode 140 about cholesterol and statins, where hsCRP ≥ 2.0 mg/L was considered to be a cardiovascular risk enhancer.


Lifestyle Factors that Drive Metabolic Health

Reversing metabolic dysfunction is possible by implementing healthy lifestyle factors below:

  • Focusing on a nutrient-rich, whole-foods diet, low in carbohydrates and especially refined carbohydrates and sugar
  • Getting regular exercise, including bouts of high intensity exercise
  • Reducing and learning how to manage the physical impacts of stress
  • Getting enough good quality sleep

Weight loss is often a focus when it comes to metabolic syndrome, and a sustained weight loss greater than 10% has been shown to be enough to reverse glucose intolerance, high blood pressure, and several lipid abnormalities. However, we really don’t like to focus on weight, because we see weight as just another symptom of this metabolic dysfunction. Instead, we like to think about excess weight like high blood pressure or high cholesterol. Giving our bodies the ingredients necessary for optimal metabolic health listed above will often lead to weight loss as a result.


Wrapping it Up...

We’ve covered a lot of ground. We talked about the prevalence of metabolic dysfunction and how it is characterised by abnormal glucose and lipid metabolism and chronic systemic inflammation. We then talked about how metabolic dysfunction is diagnosed, and how it develops insidiously over many years.

There is no one test in order to assess metabolic dysfunction but looking at many different symptoms and biomarkers can identify early signs of metabolic dysfunction such as glucose and insulin regulation, body composition, blood pressure, lipids, and systemic inflammatory markers like hsCRP.

At the end of the day, the goal is to detect metabolic dysfunction early and then make adjustments to lifestyle factors (diet, exercise, sleep and stress) in order to reverse the process before it manifests as chronic diseases such as hypertension, dyslipidemia, and type 2 diabetes or life-altering complications such as kidney failure, blindness, and limb amputations or even death from stroke or heart attack.


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 May 30, 2020.

2019 Third Fittest Woman Jamie (Greene) Simmonds PH145

2019 Third Fittest Woman Jamie (Greene) Simmonds PH145

May 26, 2020

“I love competing and testing.  You know what you were like the last time you competed, or the last time you did this sort of training block… and I just like building on trying to get better.  So there’s that. I also like… I know growing up what my parents and my sisters put into me to try to help me build something like that, so it’s not just for me, I’m doing it for them. And also when I compete at different places they come see me. So I don't get to see my Mom, Dad, my sister Becky much, so they always travel over to the Games, or they’ve come to Madrid a few times and the motivation to train, to get them to watch me to compete is motivation in itself.
- Jamie Simmonds

Jamie Simmonds, formerly Jamie Greene, made a huge splash in the CrossFit arena when, as a relatively unknown athlete, when won the 2016 CrossFit Open.

Since then, she's gone on to compete at the CrossFit Games four times, and stood atop the podium twice: first as a member Team CrossFit Yas in 2016, and most recently, as an individual at the 2019 CrossFit Games.

Perhaps even more remarkably, Jamie didn’t even start CrossFit until 2013.  Her background as a gymnast and rugby player helped propel her from a novice athlete to a force to be reckoned with.

Jamie’s journey to becoming the third Fittest Woman hasn’t always been easy: along the way she’s been challenged by a ruptured Achilles tendon, a team disqualification, and a dislocated shoulder, but her commitment to constantly improving herself has shaped her into a formidable competitor.

Jamie is a native of New Zealand, but since 2014 has lived in Abu Dhabi where she coaches and trains at CrossFit Yas.  She and I recently caught up to chat about her experience at the 2019 CrossFit Games, what her 2020 training season has looked like so far, and how she stays motivated and committed to her training in the face of challenges.


In this episode we discuss:

  • What the COVID-19 pandemic experience has been like in Abu Dhabi
  • Jamie’s childhood in New Zealand
  • How her Mom introduced her to CrossFit
  • Jamie’s experience with rupturing her Achilles’ tendon
  • Her move to Abu Dhabi, and what prompted her to become a CrossFit competitor
  • Jamie’s training environment at CrossFit Yas
  • Why Jamie believes she excelled at CrossFit so quickly
  • The transition from team to individual competition
  • What Jamie does to train her mindset
  • Her approach to the 2020 CrossFit Games season
  • How she met her husband, Elliott
  • What Jamie does to stay motivated in the gym
  • The inspiration for her Feel Better Friday tips
  • How she’s grown as a person, athlete, and coach while at CrossFit Yas
  • Jamie’s plans for the future
  • Jamie’s approach to nutrition, and why she likes fasting
  • What her training looks like while self-isolating
  • Three things Jamie 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 Jamie

You can follow Jamie on Instagram


Related episodes:

Ep 104 Physical Therapist & CrossFit Games Athlete Amanda Barnhart

Ep 130 - Kristi O'Connell on Training for Joy and Balance

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 May 25, 2020.

What COVID-19 is Teaching Us About Our Health PH144

What COVID-19 is Teaching Us About Our Health PH144

May 19, 2020

Last time we talked about the coronavirus it was our very first Pursuing Health Pearls episode just one day before COVID-19 was declared a global pandemic by the WHO.

Over the past 2 months, we’ve experienced dramatic changes to our day-to-day lives from cancellations of large gatherings, to closures of schools and restaurants, and stay-at-home orders in order to “flatten the curve” and decrease the burden of this disease on our health care systems. We’ve seen the stock market crash and hospitals in places such as New York, Washington, and Detroit collapse under the burden of patients with severe disease due to coronavirus infection. There are now millions infected and hundreds of thousands of deaths across the globe.

Lately, a lot of talk about the coronavirus pandemic is focused on re-opening our local economies, the availability of widespread viral PCR and antibody testing, when we’ll have a vaccine, and investigating treatments that might be useful for those with severe illness.

These are all incredibly important topics and things that have to be worked through, but a lot of this talk in the general news media has shifted our attention away from a very important question: “Why are so many of us so vulnerable to this virus, and what can we as individuals do so that we don’t end up in a situation like this again?”

The answer to this question lies in large part on another pandemic that has been mounting over the preceding decades, and that's the pandemic of chronic metabolic disease.

We’re all about getting to the root cause, and from our standpoint it does seem that the prevalence of metabolic disease in our country and world is a big underlying cause for the mess we are currently in. We argue that if we didn’t have such high rates of metabolic disease, it’s likely our populations would not have been so severely affected by this virus, and we may not have been forced to shut down our economies and our lives in order to allow our health care systems time to prepare for the influx of severely ill patients.

Our health care systems were already overrun trying to keep up with the sequelae of chronic disease before COVID-19, and COVID-19 was the final straw, exposing our vulnerabilities and everything that is wrong with our approach to health and health care.


In this edition of Pursuing Health Pearls, we investigate this topic in detail including:

  • What we know about who is most susceptible to becoming severely ill from COVID-19
  • The current state of metabolic disease in our population
  • Major drivers of metabolic disease
  • How COVID-19 is thought to cause severe disease in metabolically unhealthy individuals
  • What this pandemic could be telling us on a large scale

Risk Factors for Severe Disease

As COVID-19 has swept the globe, it has become more and more apparent that those who are elderly, obese, or who have chronic metabolic disease are most likely to develop severe symptoms requiring hospitalization or succumb to death from the disease.

Below we’ll highlight some of the data we have now, noting that much of this is published ahead of print and has not been peer reviewed in order to make information publicly available more quickly.

In China, over 72,000 cases of COVID-19 were studied and it was found that older age (≥65 years) and the presence of comorbidities were associated with a more severe course of COVID-19. Among the comorbid conditions, the highest fatality rate was found for cardiovascular disease (10.5%), followed by diabetes (7.3%), chronic respiratory diseases (6.3%), hypertension, (6.0%) and cancer (5.6%).

A smaller study of 191 patients admitted to the hospital for symptoms of COVID-19 in Wuhan, China showed that the most common comorbidities in hospitalized patients with COVID-19 were hypertension (30%), diabetes (19%) and coronary heart disease (8%). Additionally, the odds of dying in the hospital were higher for those with older age.

We see similar findings in the studies that are now coming out of New York. One study of 4,103 patients with COVID-19 in New York City showed that the strongest risk factors for hospitalization were: age >75 (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2).

Another case series of 5700 Patients with COVID-19 in New York City revealed that the most common comorbidities among those hospitalized were hypertension (56.6%), obesity (41.7%), and diabetes (33.8%).

As seen in these two large studies from New York, obesity is emerging as an important risk factor for severe disease, and this seems to hold true even in those who are less than 60 years old.

An analysis looking at over 3000 symptomatic patients who tested positive for COVID-19 in New York City found that individuals under age 60 who were obese (BMI >30) were 2-3.6 times more likely to be admitted to the hospital and to require ICU care than those with BMI <30.

This trend between obesity and severe disease was seen in China, too. A study of 383 COVID-19 patients in Shenzhen, China showed those with obesity had a  2.42-fold higher odds of developing severe symptoms. Obese men in particular seemed to have the highest risk of 5.7 fold.

It has also been reported that those with diabetes and metabolic syndrome have up to ten times greater risk of death from COVID-19.

The risk of death does seem to be much higher in those with at least one underlying chronic disease. The CDC reports that overall, 94% of deaths from COVID-19 in the U.S. are in those with at least one underlying chronic disease.

Another recent study which pooled data from France, Italy, Netherlands, Sweden, Georgia, and New York City found that less than 3% of all COVID-19 deaths occured in people less than age 64 years old without underlying conditions. That means the other  97%+ of deaths from COVID-19 occured in people who are over the age of 65 or who have an underlying health condition (cardiovascular disease, hypertension, diabetes, chronic obstructive pulmonary disease and severe asthma, kidney failure, severe liver disease, immunodeficiency, and malignancy).

This is a lot of data, but taken together so far they are telling us that the risk of severe disease is relatively low in those who are young and metabolically healthy.


Prevalence of Metabolic Disease and Obesity

Knowing that COVID-19 tends to affect those with chronic disease and obesity more severely, let’s take a look at the prevalence of these conditions among the U.S. population:

Chronic Diseases

  • 6 in 10 adults have chronic diseases
  • 4 in 10 adults have 2+ chronic diseases
  • Chronic and mental health conditions account for 90% of the $3.5 trillion annual health care expenditures in the U.S.


  • 71% of US adults are overweight
  • More than 42% are obese

It’s important to note that a lot of metabolic disease goes underdiagnosed, and diabetes is a prime example of this:


  • >30 Million people in the U.S. have diabetes (about 10%), and 1 in 4 don’t know they have it
  • >84 Million adults in the U.S. (1 in 3) have prediabetes, and 90% of them don’t know they have it

It’s estimated that 20% of normal weight individuals are actually metabolically unhealthy, and also have increased risk of all-cause mortality and cardiovascular events.

A great analysis of NHANES (National Health and Nutrition Examination Survey) data from 2009-2016 showed that only 12.2% of American adults have optimal metabolic health. This is a staggering number, indicating that 88% of our population is metabolically unhealthy! Knowing this, it’s no surprise that we have been hit so hard by the coronavirus pandemic.


Drivers of Metabolic Disease

As discussed above, we know that almost 9 in 10 American adults is metabolically unhealthy and therefore at high risk of severe COVID-19. How did we get to this place?

The answer lies in the development of systemic chronic inflammation, which is driven largely by our modern lifestyle factors and environmental exposures.

Below are some of the causes of systemic chronic inflammation that lead to chronic disease:

  • Poor Diet: We know that processed, refined, and sugar-rich foods drive inflammation. In America, 60 percent of our calories come from ultra-processed foods, and it is estimated that our modern diet kills 11 million people globally each year, making it the single biggest cause of death.
  • Physical inactivity: It’s estimated that 50% of American adults are physically inactive, and physical activity is associated with decreased inflammatory markers.
  • Chronic stress: Chronic stress and isolation are major drivers of chronic systemic inflammation, a topic we discussed in detail with Dr. George Slavich in Ep 139 of the podcast.
  • Distrubed sleep: Sleep deprivation and lack of quality sleep contributes to chronic inflammation and immune system disruption.
  • Environmental toxins: Cigarette smoke and excessive alcohol use are some of the most well-known toxins that lead to chronic inflammation, but there are many other toxins we are exposed to in our day-to-day lives that have been shown to alter molecular signaling pathways that lead to inflammation. The Tox21 Program has tested more than 9000 such chemicals including phthalates, bisphenols, and flame retardants, many of which are suspected to play a role in the development of chronic conditions.
  • Chronic infections: While controversial, there are findings to suggest the role of chronic viral infections in the development of systemic inflammation and increased chronic disease risk.

Taken together, these various modern lifestyle behaviors and exposures can drive chronic systemic inflammation, manifesting in a variety of chronic diseases from metabolic syndrome, obesity, diabetes, and cardiovascular disease to cancer, mental health disorders, autoimmune disease, and neurodegenerative disease.


How Does COVID-19 Cause Severe Disease in Metabolically Unhealthy People

To our current understanding, there are 3 main factors that play a role in the development of severe disease or even death in those who are metabolically unhealthy:

  • Immune system dysfunction: Immune system dysfunction leads to increased susceptibility to infection as well as decreased vaccine efficacy.
  • Chronic low-grade inflammation: When chronic inflammation is already present, infection with a virus such as coronavirus can cause the immune system to go into overdrive. It is not the coronavirus itself, but the massive inflammatory response including cytokines that are released in a cytokine storm that causes severe disease. This can take the form of Acute Respiratory Distress Syndrome (ARDS) and can lead to multi-organ failure. There is also some evidence that coronavirus can have direct metabolic and endocrine impacts by binding to the ACE2 receptor in blood vessels (increasing blood pressure and vessel permeability) and the pancreas (decreasing insulin release).
  • Chronic organ system disease: Chronic disease of the heart, lung, kidneys or other organs means these organs are already not operating optimally and don’t have as much reserve in the face of an infection like the coronavirus. Those who are obese may also demonstrate impaired respiratory mechanics due to lower lung volumes, decreased respiratory muscle strength, and increased airway resistance, which can lead to decreased lung function and increased stress on the heart.

Image from: https://www.nature.com/articles/s41574-020-0364-6#Fig1


Lessons From COVID-19 + What We Can Do

Now that we’ve reviewed how our modern lifestyle has driven a pandemic of metabolic dysfunction in our population making us more vulnerable to COVID-19, let’s take a step back and look at the big picture.

What has the coronavirus pandemic been telling us on a deeper level, and are we going to listen?

We want to put a big disclaimer on what’s coming next, making the point that these are our opinions based on the information we have so far. We also want to make it clear that in no way are we trying to shame or blame anyone who may have a chronic disease or metabolic dysfunction. As we’ve outlined here, the majority of our population is affected by metabolic dysfunction and we believe this is largely driven by systemic issues within our healthcare system, our food system, and the way we live our lives. The COVID-19 pandemic has shed some light on some of these systemic issues and we hope this will drive positive change as we move forward.


The Healthcare System

One of the biggest opportunities we see for change comes in our healthcare system. Our healthcare systems were already buckling under the pandemic of chronic disease before the coronavirus came along. Chronic disease was already threatening to bankrupt our country and decreasing the productivity of our workforce and the quality of life of our people.

The coronavirus pandemic has exposed many of the vulnerabilities of our healthcare system. The way the system handles chronic disease is largely by using medications to make “the numbers” look good: blood sugar, blood pressure, cholesterol, etc. Medications might put these numbers in an acceptable range, but when the coronavirus came along it didn’t care - it only cared about the chronic systemic inflammation that was still smoldering underneath and allowed severe COVID-19 to take hold.

We believe that if we want to improve the health and safety of our population and build resilience against the next coronavirus that comes along, we have to abandon our tactic of putting band-aids on problems, and we have to start addressing their root cause.

In the case of coronavirus, a big root cause lies in the lifestyle we have been living that promotes this chronic systemic inflammation and chronic disease. If instead of only 12.2% of our population being metabolically healthy, only 12.2% were metabolically unhealthy, we would be looking at a very different world right now. COVID-19 would probably still be spreading quickly across the globe, but the number of people requiring attention from the healthcare system would be far fewer, and perhaps we wouldn’t have had to take such drastic social distancing measures.

We need to focus our efforts as a culture and as a healthcare system on truly creating health so that we have the reserve to fight against any threat that comes our way, whether it’s another coronavirus or anything else. The only way for us to do this is by addressing the root causes of systemic inflammation which means changing our diets and the way we live our lives.


The Food System

This pandemic has also exposed some of the problems with relying on “big food” for our nutrition. Not only does outsourcing our food make us vulnerable to problems in a supply chain, but this food is also less nourishing and more likely to contribute to chronic disease. A better solution would be to focus on local farms and regenerative agriculture.

We also have to work to change our toxic food environment. Foods that are designed to be hyperpalatable and addictive are all around us - there are fast food restaurants on every corner, vending machines and soda in every building, and processed food and sweets easily accessible in every workplace. There is no amount of willpower that would allow someone in this environment to avoid unhealthy foods 100% of the time.

One of the most discouraging things that we’ve observed during this pandemic is the donations of unhealthy food as a way to say “Thank You” to our healthcare workers. Our healthcare workers are doing amazing things in this challenging time, and we feel that saying “Thank You” with foods that are not nourishing, but are actually contributing to the metabolic dysfunction that increases their risk of becoming severely ill from the very disease they are fighting is wildly inappropriate. This highlights the fact that in our culture, sweets and sugar are frequently used as a way to celebrate or reward good behavior. Rarely is there a day that goes by that someone doesn’t bring cake, donuts, cupcakes, or cookies into the office to celebrate something, and this culture further perpetuates our toxic food environment and statistic that almost 9 of 10 of us is metabolically unhealthy.

We have an opportunity to change - whether it’s on a small level by finding other ways to celebrate birthdays or thank your co-workers, growing a garden in your backyard, buying your vegetables from a local farmer, “voting with your fork” by choosing not to purchase foods that are highly processed, or advocating for policy changes - we can all do our part to shift the food system in a direction that supports health.


Our Personal Lifestyle Habits

Not only has the pandemic put a spotlight on our healthcare and foods systems, but it’s also showing many of us ways to live a healthier life.

Canceling travel, events, and meetings has forced many of us to slow our pace of life. Suddenly we are confined to our homes and have more downtime, creating an opportunity to spend more quality time with loved ones, take more walks outside, incorporate movement into our daily lives, and even explore cooking at home.

These are all things that we could have been doing all along, but the fast pace of our day-to-day lives often made us feel like we were too busy or didn’t have enough time to spend on these activities that are crucial to our health and well-being.

We think this pandemic is teaching us that illness and disease stems from an imbalance in our relationship with ourselves (what we do and feel) and our relationship with our environment (what we expose ourselves to), and this is our chance to find balance again.

We hope that this difficult time has not been in vein, and that it has helped many of us re-evaluate what’s most important and how we want to continue to live our lives moving forward in a healthier and more sustainable way.

We hope that this is the trigger our healthcare system needed to make some dramatic changes and to shift the focus to creating true health rather than on putting band-aids on disease.

We’re optimistic about the future, and there is so much we can all do. It starts on a local level in each of our homes, continuing with some of the positive habits we’ve developed over the past two months and not allowing them to fall to the wayside as the pace of life picks back up again.

We’ve talked about how young, metabolically healthy people have relatively low risk of severe illness from COVID-19, and we don’t want to minimize the fact that a majority of our population is not in that category. The beautiful thing about this situation is that it is within all of our power to make some simple changes (note they are simple - but not necessarily easy) to our diet and the way we live our lives, to reverse metabolic dysfunction and chronic disease. We’ve seen it happen in a matter of weeks - and there’s no time like the present to get started.


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 May 18, 2020.

We Work Until It’s Done: Caity Henniger on Rogue Fitness and its Response to COVID-19 PH143

We Work Until It’s Done: Caity Henniger on Rogue Fitness and its Response to COVID-19 PH143

May 12, 2020

Everybody puts their boots on the same way.  And what that means is, it doesn’t matter your title here.  It could be the people on our leadership team, Bill and I, or it could be the person coming in their first day on the job on the assembly line...everyone is the same. And everyone is going to be treated the same. And it goes back to that first [value], we work until it’s done. If there are boxes that need to go out the door, or we need to make more barbells, you’re going to see the top leadership down going out and helping right now. We did get overrun before we could hire some people- we have everyone in our office right now, they’re doing shifts on our production floor. And that’s really what this is all about, and you see people getting experiences that you normally wouldn’t have. To go out and build a barbell, and maybe you’re in our IT department, a lot of places you wouldn’t have that opportunity, but we live by that standard. Everybody puts their boots on the same way.
- Caity Henniger

Caity Henniger has been a lifelong athlete.  In high school she led her basketball team to victory in 91 out of 102 games, was voted MVP of the 1998 Junior Olympic AAU circuit, and was a two-time state champion in both shot put and discus.  She went on to play collegiate ball at Ohio State where she averaged 15.4 points per game and set the school single-season record for three-pointers, with 106, earning her the Edward S. Steitz Award as the nation's best three-point shooter.  In 2005, Caity joined the WNBA as a player for the Charlotte Sting.

After multiple leg surgeries led Caity to retire from basketball, she was drawn to the competitive side of CrossFit.  In 2008,  with just a few months of CrossFit experience, she took first place at the 2008 CrossFit Games.  Caity would go on to become a fixture in the production side of the Games, working as an ESPN commentator and as a representative of Rogue Fitness.

Shortly after Caity's 2008 CrossFit Games victory, she began playing a huge role in helping Rogue Fitness grow from a small e-commerce site to a major powerhouse in the fitness equipment industry.  With a focus on manufacturing quality, American-made products from local sources, Rogue now employs over 900 people at their massive 600,000 square foot campus in Columbus, Ohio.

Recently, when Ohio issued a stay-at-home order in response to COVID-19, Rogue quickly pivoted their manufacturing processes to make Personal Protective Equipment for healthcare workers, a decision that is not only helping to keep healthcare workers safe, but is also helping to keep their local community employed.

I had to opportunity to sit down with Caity to learn more about the mission and values Rogue was founded on, and how those principles are driving their business during this time of uncertainty.  We chatted about her days as a competitor,  how she balances her role as an executive with her own personal health,  and we were even able to steal a few minutes from Rogue's Director of Product Development, Ahmik Jones, to learn more about the processes behind shifting gears from manufacturing fitness equipment to manufacturing PPE.


In this episode we discuss:

  • Caity’s athletic background
  • The history behind Rogue Fitness and their partnership with the CrossFit Games
  • What led Rogue to branch out into manufacturing equipment for other sports
  • Rogue's new facility and the Industrial Revolution 2.0
  • Rogue's three core values and how they implement them
  • The story behind Don’t Weaken
  • Rogue’s early response to COVID-19
  • How Rogue came to have a doctor as their Director of Product Development
  • How Rogue made the decision to manufacture PPE for healthcare workers, and what the development process has been like
  • Measures Rogue has taken encourage employees to embrace fitness and the positive impact they’ve seen as a result
  • How Caity manages her time to allow for her own workouts and downtime away from work
  • The mentors who helped Caity grow into a strong leader
  • What a typical day looks like for Caity
  • Stand-out moments where Caity has felt especially proud of the work Rogue is doing
  • Three things that Caity 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 Caity

You can follow Caity on Instagram and Twitter.

You can follow Rogue Fitness on Instagram, Facebook, Twitter, and YouTube.


Related episodes:

Ep 51 - Dick Costolo on Taking Risks and Finding Fitness

Ep 90 - CrossFit Games GM Justin Bergh: The Man Behind the Magic

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

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 May 11, 2020.

Pursuing Health Pearls: How We Organize Our Lives PH142

Pursuing Health Pearls: How We Organize Our Lives PH142

May 5, 2020

The most common question Julie has been asked over the years is, “How did you balance training for the CrossFit Games while you were in medical school?”

Julie feels fortunate for the circumstances that allowed her to pursue competing in the CrossFit Games and medical training simultaneously, and finds this a difficult question to answer. However, what we will do here is share a general framework with you for how we structure and organize our lives.

We’ll talk first about the big picture - how we’ve come to understand the importance of connecting with our mission, vision, values, and goals and a process we use to review these regularly. Then, we’ll get down to the nitty gritty of some tools and technology we’ve found to be most useful in our day-to-day. Finally, we’ll talk about how we implement these tools on a weekly and daily basis.

Please do keep in mind that this is ONE process. It’s a process that works for us and that has evolved over the past 10+ years of knowing each other and that will continue to evolve in the future. We hope that our process provides you with some insight or ideas that you can use to refine a process of your own.


Mission, Vision, Values, and Goals

We started this process shortly after getting married in 2015. Julie had learned the hard way the importance of identifying with her “why” while competing in the CrossFit Games, and it became clear that we wanted to define our “why” as a family.

For us, this process looked like lots of dedicated time in reflection and discussion of the values that were most important to us, and identifying what we felt was our calling - our reason for being on this earth.

Then we spent some time envisioning what we wanted our day-to-day lives to look like 10 or 20 years in the future. We’ve come to understand the importance of visualization in sport, but also in life, and this is a tool we use often.


Goal Setting

After creating a clear vision of our lives 10 or 20 years in the future, we start to break down goals. What needs to happen in order to make that vision a reality? We set 10, 5, 3, and 1-year goals in the following domains:

  • Home
  • Work
  • Financial
  • Spiritual
  • Health
  • Relationships

While we may leave the 10, 5, and 3 year goals more broad, we try to make the 1-year goals very detailed. For example, instead of just writing down a goal of “pass the board exam,” we break down every step that needs to happen in order to achieve that goal: register for the board exam, collect study materials, create a study plan, take a practice exam, etc.

Then, from these 1-year goals we identify those that we plan to accomplish in the next 90 days. We further refine these goals and set deadlines for each step within the next 90 days. We will then revisit these 90-day goals when we plan for each week to make sure we are staying focused and on track. Knowing that we have made a detailed plan with the end goal in mind gives us a lot of peace of mind. We know that if we stay focused on what we have planned for each day or each hour, we will be moving in the right direction.

Every 90 days, we sit down and review what we’ve accomplished during the previous quarter and adjust our 1-year goals as needed. We then create a new set of 90-day goals and the cycle repeats! We revisit our bigger mission, vision, values, and longer-term goals each year or when big life events occur.


Two Types of Goals

We distinguish between two types of goals - task oriented goals and habits. Task oriented goals are those that can be accomplished, checked off the list, and you’ll never think about again, or at least for a very long time (eg. “pass the board exam”). Habits, on the other hand, are actions that must be repeated on a regular basis in order to help you achieve your long-term vision. Many of our habits fall into the health domain, and we’ve found it helpful to identify those habits which are “non-negotiables” and others which are “ideal.”

“Non-negotiables” are habits we’ve found through trial and error to be necessary for us to function well. When these things don’t happen, we start to not feel like ourselves, we are on-edge, and the rest of the time in our day is often not used effectively. Our current personal “non-negotiables” include: some semblance of a morning routine, 8 hours of sleep, 3x/week workouts, 1x/week date night, and every other week counseling. Of course, when we are in an “ideal” situation we like to work out 5 or 6 days per week, get 8.5 hours of sleep, or do a more extensive morning routine. We try to make the “ideal” habits happen whenever possible, but we know each week we need to get our “non-negotiables” in at a minimum.


Our Favorite Tools + Tech

Now that we’ve talked about our big-picture process, here are some of the tools and technology we’ve found over the years that allow us to maintain productivity and successfully implement our goals into our day-to-day lives:



Asana is a project management platform, but we like to think of it as the most amazing to-do list ever! It has been a real game-changer for us when it comes to keeping track of goals, random to-dos, birthdays, upcoming events, or even those big bills that are due once or twice per year.

An example of our weekly to-do boards in Asana

We make projects for each of our goal domains (eg. home, work, financial, health, etc) and file away every task needed to achieve our 90-day goals here. The software is great for reminding you what you need to do exactly when you need to be reminded of it. Once we file something away into our Asana, we feel confident that we will be reminded at the appropriate time and we don’t need to keep juggling it with all of the other thoughts bouncing around in our heads - what a relief!

We each have a project which we use as a board to plan our weekly tasks. There is a column for each day of the week so that we can distribute tasks that need to be done that week appropriately. It’s also a nice place to check at the beginning and end of each day, and it’s easy to move tasks to a different day if you didn’t get them done for one reason or another. We also have columns for incoming tasks where we can drop a quick note about something we want to add to our to-dos later using the Asana app on our phones on the go, and columns for things we want to read, listen to, or watch later.

Asana has a free version which includes all of the functionality discussed here, but they also have premium versions for larger teams or businesses who want to access more advanced functionality.


Google Calendar

We’d be lost without our Google calendars! There are obviously many Calendar apps out there, but we’ve been using Google’s for well over a decade and have found it to work well for us. We use our calendars to organize when we’ll be allotting time to accomplish each of our Asana tasks for the week in the midst of work, sleep, and other events and obligations. We sync our calendars so we know when we can schedule things to do together if needed.

Image from https://edu.gcfglobal.org/en/google-tips/getting-started-with-google-calendar/1/


You Need A Budget - aka YNAB

You Need A Budget, otherwise known as YNAB, is a budgeting app. We have only been using it for a short time but we. are. in. love! In the past, we used another financial management software and Julie created a complicated Excel spreadsheet to keep track of our savings, making sure we’d have enough for those big intermittent expenses when they came along (travel, weddings, insurance bills, etc). Needless to say, it was painstaking and when we came across YNAB which automated Julie’s spreadsheet and then some, we were sold! What we love about YNAB is that it gives you a proactive look at your finances and helps you to give each dollar a job. It’s incredibly empowering to know where all of your money is going and allows you to seamlessly plan for big purchases or to cover large unexpected expenses when they come along. YNAB offers a 34-day free trial and then charges $11/month or $84/year.


Image from https://docs.youneedabudget.com/article/150-step-3-budget-your-money


The Pomodoro Technique

The Pomodoro Technique is one that comes in handy for us when we are facing a long day of studying or computer work. Essentially, it involves setting a timer for 25 minutes of work, followed by a 3-5 minute break. After four rounds of this, you take a longer 15-25 minute break. We’ve found it to be very similar to TABATA or interval-style training - knowing that you have a break coming up allows you to stay focused and keep the intensity high during those work intervals. We’re always looking for ways to improve focus and make the time we spend working count, so that we can enjoy time to relax, too. This is one way that has worked for us and gotten us through many long days of studying! There are plenty of apps out there you can use to set up these intervals; one we’ve used called BeFocused Pro is shown below:

BeFocused Pro app for implementing the Pomodoro Technique



Before we got married, we got great advice from a doctor couple ahead of us in their journey. “Get a cleaning service - even if it doesn’t seem like you can afford it now, it will save your relationship and so many headaches in the long run.” We followed their advice and are so glad we did! Since that time, we’ve looked for ways to continue to outsource tasks that we don’t enjoy so that we can spend more time working towards or goals and doing things we love. Some examples include landscaping services, Instacart, Thrive Market, Vital Choice, or ButcherBox for grocery delivery, and meal delivery services such as Sunbasket.



Now that you know about our big-picture process and our tools, let’s talk implementation! Here’s how we put this all together on a yearly, quarterly, weekly, and daily basis:



As already outlined above, each year we carve out a day or two (best if it’s after a little vacation or getaway to allow for some space and reflection!) to revisit and update our mission, vision, values and long-term goals.



Every quarter, we review and reflect on the previous quarter and create a new set of 90-day goals based on the 1-year goals we are working toward. We then enter each of these goals into our Asana and assign them to either one of us with an anticipated due date.



Every Sunday, we spend about an hour reflecting on the previous week and then looking at our progress toward our 90-day goals. We review our Asana and the tasks that are scheduled for the upcoming week and then distribute them by day of the week on our weekly to-do boards. Then we turn to our Google calendars. Here, it’s important that we schedule in our “non-negotiable” habits first, because otherwise it’s easy to make excuses and prioritize other tasks that seem more urgent. We have recurring calendar events for each of our “non-negotiables” so that they are already on our calendar for the week. Then we start to schedule in time for the other tasks around work, sleep, or other events and obligations. We’ve learned through experience that it’s best to be conservative with your schedule and what you expect to accomplish each day. If you end up with extra time, great! You can start chipping away on the tasks for the next day or take some time to do something you enjoy.



We start each day with our “morning huddle” - a time for the two of us to check in and review the day ahead. We usually do this over the phone while driving to work. We’ll take a few minutes to check in with our mission and core values, express gratitude, review our previous day and look for ways to improve, and then review what each person is up to that day according to our Google calendars and daily Asana tasks. We always end by setting a time for us to reconvene after work for dinner and what time we plan to go to bed.

At the end of each workday, we each review our Asana tasks and re-assign any tasks we were unable to accomplish to a different day. We finish each day by reviewing our “3 Wins” and saying a prayer before bed. We used to fall into the trap of talking about all the things we didn’t get done or all the things we wanted to accomplish the next day while getting ready for bed, which was counterproductive. Now by switching this conversation to our “3 Wins,” we end the day focused on all the positive things that happened or that we accomplished that day to get us closer to our goals.



We would be remiss not to credit some of the people and books who’ve inspired our own process over the years. We love reading about self-improvement and productivity, and here are some of our favorites:

So, we’ve reviewed our process for defining our mission, vision, values and goals, shared with you some of our favorite tools and technology for enhancing productivity, and taken you through how we implement all of this on a yearly, quarterly, weekly, and daily basis. We hope that sharing our own process for organizing our lives has given you some ideas for refining your own. Remember, that every person and every family is different so what works for us might not be best for you. This is also an iterative and constantly evolving process for all of us. We’d love to hear some of your own tips and tricks below in the comments!

Although we’ve mentioned and linked to many products and services in this post, we do not have formal relationships with them. The links above are not affiliate links and we do not receive money from any of these companies. We do provide discount codes to some products and services we trust and use ourselves for our subscribers, but we do not receive any compensation from the companies in return. Read more about the perks of subscribing to Pursuing Health here.


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 May 4, 2020.

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