Pursuing Health
An Unlikely Antidote to Anorexia with Becky Fox PH161

An Unlikely Antidote to Anorexia with Becky Fox PH161

September 15, 2020

“My journey to finding myself and my will to live began with finding CrossFit.
- Becky Fox

The stress of everything was just too much. If she could just lose weight, Becky believed, she would be okay. She drastically cut her calories, restricted food intake and began exercising incessantly. A sophomore in high school, she succeeded only in losing athletic opportunities, a sudden drop in academic performance, and seclusion in her social life.

As her eating disorder consumed her, Becky would constantly think about how many calories she had eaten and how many hours she would need to spend in the gym to work them off. Friends and family became alarmed by her obsession with food and her sudden outbursts, and Becky sought help from a therapist, but it wasn’t enough.

Becky’s health continued to decline, and her bloodwork showed it. Her heart was not able to keep up with her physical state. Doctors stripped exercise from her, forbidding even recreational walks. Soon, depression, suicidal thoughts and self-harm replaced the physical activity Becky had once loved.

Becky’s sister had been by her side throughout her ordeal, and she knew just how important athletics were to Becky. Her sister had heard there was a CrossFit affiliate in their hometown, and hoped it might be a place Becky could go to work out safely and rebuild her self-esteem. “It sounded crazy at the time, putting an anorexic girl who had an addiction to exercise into a gym setting again. Little did I know that a box is very different than the typical gym.”

Becky came to an agreement with her family that if she met her calorie intake goal for the day, she would be permitted to attend a class. “I was hesitant. It was higher calories than I had in about a year, but I wanted fitness back in my life.”

Her first class was terrifying. Becky had developed extreme social anxiety and felt uncomfortable anytime she was away from home. But soon, she found she had a new home. “I could be myself and not worry about what anyone thought. The coaches were patient, everyone was kind, and no one treated me differently even though they could see every vein in my body. It gave me a reason to be OK eating again, fueling my body so I could work out later.”

As time passed, Becky developed close friendships with other members at her box, conquered her fear of food, and returned to a healthy weight. But her battle with eating disorders wasn’t over yet.

“I was always told in recovery that another eating disorder could hit me at any time and it would be something I would have to fight my whole life. Being as stubborn and strong-willed as I am, I never thought that would be me.”

2 years after she started CrossFit, Becky found the pendulum swinging the other way, this time towards binge eating. During the worst of her anorexia, Becky would have a small snack in the middle of the night to help calm her hunger pains and allow sleep. Although her body had returned to a healthy weight, her brain still turned to this old habit as a stress and anxiety reliever.

Becky’s midnight snacks grew to out-of-control binges, sometimes exceeding 2,000 calories a night. She feared her weight gain would be noticeable so she started restricting during the day, which only fed the cycle. Her depression returned with a vengeance, she lacked the motivation to work out, and found it embarrassing to be around her friends from her box.

Once again, Becky’s sister was at her side to help. They moved in together so that her sister could help her control the nighttime binges, even locking food up when it became necessary to break the habit. It was a long road back to a healthy weight as Becky sought to move at a slow pace that would be sustainable for the long term and not mirror her old anorexic ways. Once again, her commitment to fitness and her community helped her overcome her demons.

These days, Becky remains very active with her box, and even married one of the owners!  She recently graduated and is helping others as a school counselor. She is a firm advocate for the physical, mental, and social benefits of CrossFit.

“I have had to learn so much about balance through this process and just how important it is in our lives. I have also learned a lot about how important finding self-worth is and not tying it to my body. My body, my weight, my looks do not determine how good of a friend I am or how academically smart I am or how good of an athlete I am. My body is not just to be seen but to be used. CrossFit gave me new goals, and PR's helped me to see my progress and make the journey to recovery worth it. I was getting better, getting stronger, and finding myself, my confidence, and my worth. I cannot thank CrossFit enough because it literally saved my life.”

I first heard Becky's story some time ago, and I think it will resonate with so many women (and men!) who find a new respect and admiration for their bodies when they focus on what it can do, rather than what it looks like. I was excited to have a chance to catch up with her to learn more about how CrossFit helped her overcome her eating disorders, how we can support others who are struggling, and how she's using her experiences to help others in her new role as a counselor.

In this episode we discuss:

  • The factors that played into Becky developing an eating disorder
  • How she realized her relationship with food was unhealthy
  • Becky’s advice on the best ways to approach a family or friend with an eating disorder
  • How she was able to safely reintroduce exercise into her routine
  • The importance of trying multiple nutritionists and counselors to find the right fit for you
  • How Becky’s calorie restriction turned into binge eating at night
  • Why community support was so important for helping Becky to heal from her eating disorder
  • Using intuitive eating to establish a healthy relationship with food
  • Using self care to overcome the self-hatred she experienced with her disorder
  • What Becky’s life looks like today
  • How her own experiences help her as a school counselor and a CrossFit coach
  • Characteristics of CrossFit that led Becky to feel like CrossFit saved her life
  • How Becky found the right balance for working out at an appropriate volume
  • Three things Becky does on a regular basis that have the biggest positive impact on her health
  • One thing she knows would have a positive impact on her health, but she struggles to implement
  • What a healthy life looks like to Becky

You can follow Becky on Instagram, and you can follow her affiliate, SouthWind CrossFit on Instagram and Facebook.

Related episodes:

Ep 85 - Back on Track with Carleen Mathews

Ep 71 - The Sugar Free Revolution with Karen Thomson

Ep 30 - Nadia Johnston on How CrossFit Helped Her to Overcome Eating Disorders and Depression

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 September 14, 2020.

Chandler Smith: Brotherhood, Heart, Attitude, Warrior PH160

Chandler Smith: Brotherhood, Heart, Attitude, Warrior PH160

September 8, 2020

I think if I just limited myself to being an athlete I’d be doing a disservice to the other demographics that I represent.  I’m a wrestler. I’m a former West Pointer. I’m an Army officer.  All these different intersectionalities that are composed within me, and everyone has their own group of intersectionalities that they represent. That’s how you - if you want to create understanding about something that you do that’s outside of the gym - the CrossFit box is a great space for it, because again, of what you said. It’s not a responsibility, but it’s an opportunity that I think should be recognized and capitalized upon.
- Chandler Smith

In 2012, Chandler Smith set a goal to qualify for the CrossFit Games by 2022.  In 2019, he smashed that goal when he placed 15th at his rookie CrossFit Games appearance, and now he's set his sights on climbing up the leaderboard.

The path to becoming an elite CrossFit athlete hasn't always been straight-forward. As a child, Chandler had aspirations of following in his father's footsteps and playing for the NFL. But as a smaller athlete, in high school he decided to focus on wrestling, a sport better suited for his stature.

A lifelong interest in the Army led Chandler to attend West Point, where he would continue to compete as a wrestler and received the Warrior Athlete of Excellence Award in recognition of his mental toughness, coachability, perseverance, and athletic skill.

Following graduation, Chandler was commissioned as an officer and began work as a tank platoon leader.  He had previously used CrossFit to help him train for wrestling, but now it became the primary focus for his athletic drive. In 2016, he made a splash onto the competitive scene when he qualified for the Atlantic Regional after finishing 7th in his region during his first complete CrossFit Open.

In 2017, an injury resulting in the loss of part of his ring finger cut his Open season short, and in 2018, a deployment to Bulgaria meant work took priority over training. When he returned to the States, Chandler resumed training with a single-minded focus, and a stellar performance at the 2019 Rogue Invitational earned him a ticket to the Games.

Today Chandler is a Captain in the United States Army as well as the officer in charge of the U.S. Army Warrior Fitness Team. In the lead up to the 2020 CrossFit Games, he's been training with athletes from all over the east coast in an effort to get out of his comfort zone and be as prepared as possible for whatever challenges lay in store.

When Chandler and I recently caught up, I was excited to hear what his 2020 training season has looked like, how his experiences in the Army have helped him grow as a competitor, and to hear his ideas on how CrossFit can improve it's diversity, equity, and inclusion.

In this episode we discuss:

  • What Chandler’s training has looked like leading into the 2020 CrossFit Games
  • His background and childhood, and how his parents and the Army have influenced him
  • Factors that influenced Chandler to attend West Point
  • How Chandler got into CrossFit
  • The power of writing down your goals
  • How Chandler’s success at the 2016 Regionals changed his approach to training
  • His experience at the 2019 CrossFit Games
  • Chandler’s role with the U.S. Army Warrior Fitness Team
  • How COVID has impacted his 2020
  • Chandler’s decision to sit out the 2020 CrossFit Games following Greg Glassman’s comments
  • His experience at the CrossFit Community Summit and first interactions with Eric Roza
  • Diversity, Equity and Inclusion within CrossFit
  • Chandler's experience with being in the racial minority of CrossFit athletes
  • The importance of being a good role model
  • His former political aspirations
  • #BHAW: Brotherhood, Heart, Attitude, Warrior
  • Three things Chandler does on a regular basis that have the biggest positive impact on his health
  • One thing he thinks could have a big impact on his health, but he has a hard time implementing
  • What a healthy life looks like to Chandler

You can follow Chandler on Instagram and Facebook.


Related episodes:

Ep 157 - Work Hard, Be Kind with Cole Sager

Ep 147 - Cancer, Racism, and Speaking Up with Deb Cordner Carson

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

Ep 52b - Tia-Clair Toomey on Realizing Her CrossFit and Olympic Dreams and Finding Confidence

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

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

This post was originally published on September 7, 2020.

Exercise + Why It’s So Good For Us PH159

Exercise + Why It’s So Good For Us PH159

September 1, 2020

In this edition of the Pursuing Health Pearls, we take a deep dive into one of the last big cornerstones of health - physical activity and exercise.

Generally physical activity refers to unplanned activity that you are doing throughout the day as part of your job or daily activities, while exercise is intentional, planned, or a structured form of physical activity, but you can expect us to use these terms interchangeably throught the rest of this post.

Here, we’ll look at current physical activity patterns in the US and the world, and break down the latest Physical Activity Guidelines for Americans which were created by the U.S. Department of Health and Human Services. Then we’ll provide an overview of the amazing benefits of physical activity, and dig into the mechanisms behind why it has such a positive impact on our physical and mental health. All of the information from this article comes directly from the guidelines unless otherwise noted.

This excerpt from the introduction of the guidelines sums up the health impacts of exercise well:

“Regular physical activity is one of the most important things people can do to improve their health. Moving more and sitting less have tremendous benefits for everyone, regardless of age, sex, race, ethnicity, OR current fitness level. Individuals with a chronic disease or a disability benefit from regular physical activity, as do women who are pregnant. The scientific evidence continues to build—physical activity is linked with even more positive health outcomes than we previously thought. And, even better, benefits can start accumulating with small amounts of, and immediately after doing, physical activity.”


Physical Activity Patterns in the US

Shockingly, only 26% of men, 19% of women, and 20% of adolescents report meeting current guidelines for physical activity (both aerobic and muscle strengthening).1  This means that close to 80% of Americans are not getting enough physical activity to support their health.

This physical inactivity is linked to $117 billion in annual health care costs and 10% of premature deaths. The therapeutic potential of exercise is far-reaching given that 7 of the 10 most common chronic diseases are improved by physical activity. So, along with nutrition, sleep, and stress management, physical activity is a crucial cornerstone for health.

This pattern of insufficient physical activity is also seen worldwide, although not to quite the same degree, where 1 in 5 people are insufficiently physically active according to a 2011 study of 300,000 individuals older than 15 years old form 76 different countries.2

Physical Activity Guidelines

Now that we know there is a lot of room for improvement, we’ll break down the latest Physical Activity Guidelines for Americans. This is the 2nd edition of these guidelines published by the Department of Health and Human Services, and it was published just two years ago in 2018.


We’ll begin with some definitions to give us context as we go through the guidelines:

Intensity of Physical Activity:

  • Light-intensity: Walking at slow/leisurely pace, cooking, light household chores
  • Moderate-intensity: Brisk walk, light biking, heavy house cleaning, mowing the lawn or raking the yard (can talk, but not sing)
  • Vigorous-intensity: Jogging, running, carrying heavy groceries upstairs, shoveling snow, fast biking, or a high-intensity fitness class (cannot say more than a few words)

Examples of different intensities of physical activity. Adapted from Harvard.edu.

Types of Physical Activity:

  • Aerobic: Endurance or “cardio” characterized by increased heart rate. eg) brisk walking, running, biking, jumping rope, swimming, or rowing.
  • Muscle-strengthening: Resistance training or weight lifting, exercises that cause the body’s muscles to work or hold against an applied force or weight. eg) external weights, resistance bands, or body weight exercises.
  • Bone-strengthening: Weight bearing or loading activity that puts a force on the bone to promotes bone growth and strength, commonly produced by impact with the ground. eg) jumping jacks, running, brisk walking, jump rope, weightlifting.
  • Balance: Improves our ability to resist forces outside the body that cause falls. eg) walking backward, standing on one leg, wobble board, or weightlifting with free weights.
  • Flexibility: Enhances the ability of a joint to move through full range of motion eg) stretching, yoga.

Next we’ll review the guidelines for children and adolescents, and adults, as well as some special considerations for older adults, those with chronic health conditions and disabilities, and pregnant and postpartum women.


Preschool Aged Children (3-5 years)

The previous version of the guidelines did not address children in this age group, but evidence for improved bone health and weight in children who are active between age 3-5 years has become clear. Our sedentary lifestyles are now affecting children and younger and younger ages, so that may be why it was important to specifically address this group.

The guidelines here are very general, basically saying that kids should be active throughout the day to enhance growth and development. They should be encouraged to engage in active play that includes a variety of activity types.


Children and Adolescents (6-17)

For children and adolescents, it’s important to provide opportunities and encouragement for movement that is age-appropriate, enjoyable, and offers variety. 60 minutes or more of moderate-vigorous physical activity daily is recommended, and this should include vigorous activity, muscle strengthening activity, and bone strengthening activity at least 3 days per week each.



General recommendations for adults include encouraging them to move more and sit less throughout the day, and these guidelines acknowledge that any amount of moderate-vigorous physical activity is beneficial. Previous guidelines had suggested activity had to come in at least 10 minute intervals, but the evidence is now clear that any amount of activity provides positive health benefits.

For substantial health benefits, adults should do at least 150-300 minutes of moderate-intensity, 75-150 minutes of vigorous-intensity (or some combination of the two) aerobic activity per week. Ideally, this should be spread throughout the week. To see what this would look like, that would be a minimum of 30 minutes of moderate activity (like brisk walking) or 15 minutes of vigorous activity (like biking or running) 5 days per week, or some combination of those. It’s important to note that additional health benefits have been associated with more than 300 minutes of moderate-intensity activity per week as well. In addition to this aerobic activity, muscle strengthening activities of moderate or greater intensity and that involve all major muscle groups are recommended two or more days per week.


Older Adults

The guidelines for older adults are the same as adults, but include a few extra points.

  • Part of weekly physical activity for older adults should include multicomponent activity that includes balance training as well as aerobic and muscle-strengthening activities.
  • The level of effort should be relative to their level of fitness.
  • When they can’t do 150 min of moderate intensity activity per week because of chronic conditions, they should do as much as they are able.

This sounds a lot like CrossFit, doesn’t it? Constantly varied, functional movements, done at intensity that is relative to the individual.


Pregnancy + Postpartum

For pregnant and postpartum women, at least 150 minutes of moderate-intensity aerobic activity per week spread throughout the week is recommended. If the woman engaged in vigorous intensity aerobic activity before pregnancy, she can safely continue during pregnancy and postpartum.

It is also important to note that the guidelines recommend pregnant and postpartum women should be under the care of a healthcare provider who can monitor the progress of the pregnancy, and they should consult their health care providers about whether or how to adjust physical activity during pregnancy and postpartum.


Adults with chronic health conditions and disabilities

The recommendations for this group are the same as adults, but if they are unable to meet those guidelines they should engage in regular physical activity according to their abilities and avoid inactivity. Basically, something is always better than nothing. Adults with chronic health conditions and disabilities should be under the care of a health care provider when engaging in exercise, and they should consult with a healthcare professional or physical activity specialist about the types and amounts of activity that are appropriate for their abilities and chronic conditions.

Physical Activity + Safety

One of the big deterrents for many considering starting an exercise program is a fear of injury or heart attack. The guidelines specifically address this issue, stating that studies in generally healthy people clearly show that there is low risk with moderate-intensity activity.

The risk of injury does increase with the total amount of physical activity, which makes sense. For example, someone who is running 40 miles per week has higher risk of injury than someone running 10 miles per week. Not surprisingly, there is also higher risk of injury in contact or collision sports such as soccer or football.

It is also important to note that those who are less fit are more likely to be injured than those who are more fit when doing the same activity. For example, cardiac events (heart attack or sudden death) are very rare during physical activity, but the risk does increase when a person suddenly becomes more active than they were previously. The greatest risk comes when an adult who is usually inactive engages in vigorous intensity activity (for example, shoveling heavy snow). People who are regularly physically active, however, have the lowest risk of cardiac events both during activity and overall. In order to minimize this risk, it’s important for someone who is deconditioned and starting to ramp up their activity to “start low and go slow.”

The bottom line is that the health benefits of physical activity far outweigh the risks of adverse events for almost everyone, and we also have to weigh the risks of being inactive, such as increased risk of chronic disease, decrepitude, and injury or heart attack when life does demand for us to suddenly exert ourselves.

Here are some ways that the guidelines suggest to minimize risk:

  • Choose types of physical activity that are appropriate for current fitness level and health goals
  • Increase physical activity gradually over time to meet key guidelines or health goals. “Start low and go slow” with lower intensity activities and gradually increase frequency, duration, and intensity over time. Consider one-on-one instruction when learning something new.
  • Use appropriate gear and sports equipment, choose safe environments, follow rules, and make sensible choices about when, where, and how to be active.
  • Consider air quality when planning to be active. Exposure to air pollution is associated with health problems including asthma attacks and cardiac events. If possible, modifying the location or timing of exercise outdoors to avoid heavy traffic and industrial sites especially during rush hour or high pollution times can improve safety. The Environmental Protection Agency Air Quality Index (AQI) provides information about when air conditions are unhealthy that can be accessed here.
  • And as a reminder, those who have a chronic health condition, symptoms, or are pregnant, should be under the care of a healthcare provider and consult with their health care provider or trainer about types and amounts of activity that are appropriate for them.


Physical Activity and Our Health 

Now that we know the guidelines and some parameters for implementing physical activity safely, we’ll review what we know about how physical activity impacts our health.

Most striking is the impact of physical activity on all-cause mortality, or death from any cause. To put some numbers to this, it’s estimated that people who are active 150 minutes/week have a 33% lower risk of death from all causes than those who are not physically active.

The graph below compares amount of physical activity per week and mortality. As you can see, the highest mortality (or risk of dying) is over on the top left, when someone is not physically active at all. From there, there is a pretty steep drop off - where going from no physical activity to just small amounts of physical activity results in a large reduction in risk of dying. Most of the benefit of physical activity on mortality risk is achieved by the time you get to 150-300 minutes/week, which is how the guidelines were derived. However, there does seem to be additional benefit and no increased risk of mortality even at very high levels of physical activity (3-5x the amount recommended in the guidelines).


Relationship of Moderate-to-Vigorous Physical Activity to All-Cause Mortality from the 2018 Physical Activity Guidelines for Americans.


Aside from decreased risk of death, regular physical activity has many other specific health benefits which are outlined in the table below:

Health Benefits of Regular Physical Activity from the 2018 Physical Activity Guidelines for Americans.



Cardiorespiratory + Metabolic Health


Cardiorespiratory and metabolic health are the areas that have been most heavily researched and where the benefits of regular physical activity are abundantly clear. Physical activity strongly reduces both the risk of developing and dying from cardiovascular disease including heart attack, stroke, and heart failure.

Exercise also reduces elevated blood pressure, an effect that can be observed immediately after just one bout of physical activity. Regular physical activity can also reduce the risk of developing high blood pressure in the future.

Regular physical activity also reduces the risk of developing type 2 diabetes. Insulin sensitivity can improve with just a single bout of physical activity. Physical activity also helps to control blood glucose in people who already have type 2 diabetes, and reduces the progression of the disease.

Lower triglycerides and higher HDL are also observed in those who exercise regularly. Physical activity can also help with weight gain, but it’s important to note that a lot of the benefits of exercise are independent of weight. So, even if someone is not losing weight while exercising, they are still experiencing a lot of health benefits.


Bone and Musculoskeletal Health

Exercise also plays a big role in the health of our muscles and bones. We know muscle strengthening exercises help to preserve or increase muscle mass, strength, and power and can also improve muscular strength in people with conditions where the musculature is affected such as stroke, MS, cerebral palsy, and spinal cord injury.

When it comes to bones, regular exercise helps us to build strong bones as we are growing up, and it also helps to reduce the decline in bone density that is often seen with aging. Improved symptoms of osteoarthritis and other bone conditions, pain management, function, and quality of life are also seen in those who are physically active. In particular, having arthritis can often be a deterrent to doing exercise, but regular physical activity is associated with decreased pain, improved physical function, and improved health-related quality of life in those with osteoarthritis, and being active does not seem to make the arthritis progress any more quickly than it would otherwise.


Functional Ability and Fall Prevention 

Physical activity is critical for functionality and the prevention of falls in older adults. Physical activity can prevent or delay the onset of functional limitations that necessitate the need for assisted living or 24/7 care in a nursing home.

Physical activity also reduces the risk of falling which can result in injuries that dramatically change one’s quality of life. Hip fractures are one example of this. An all-too-common story is an elder who falls and breaks their hip after which they never return to the same baseline, end up needing support for their activities of daily living, and continue to experience a decline in health until the end of life.

For those at risk for these kinds of injuries, multi-component physical activity programs including muscle strengthening, balance, gait and coordination, and moderate-intensity activities such as walking are most successful at reducing falls and injuries. This type of exercise is also beneficial for recovery of injuries such as hip fractures as well as neurological conditions such as Parkinson’s Disease and stroke.


Brain Health 

The positive benefits of physical activity are clear, and this is an exciting and continually emerging area of research.

Some of the benefits of exercise on the brain are immediate, after just one bout of exercise. These include: reduced anxiety, improved sleep, and improvements in some aspects of cognitive function such as performance on academic achievement tests, executive function, processing speed, and memory.

Regular physical activity over the course of days to weeks is also associated with the following improvements: long term anxiety, deep sleep, sleep quality, sleep efficiency, and daytime sleepiness, decreased use of medication to facilitate sleep, aspects of executive function such as the ability to plan and organize, monitor, inhibit or facilitate behaviors, initiate tasks, and control emotions, reduced risk of dementia, improved quality of life, and reduced depression.



Physically active adults have a significantly lower risk of developing several common types of cancer including:

  • Breast
  • Colon
  • lung
  • Bladder
  • Endometrial
  • Esophagus
  • Kidney
  • Stomach

Benefits are also seen in breast, colorectal, and prostate cancer cancer survivors with regard to quality of life, and the risk of dying from their cancer as well as all other causes.


Pregnancy + Postpartum

Finally, with regard to women during the pregnancy and postpartum periods, physical activity is generally safe and reduces risk of excessive weight gain and gestational diabetes during pregnancy. It increases cardiorespiratory fitness without increasing risk of negative birth outcomes such as low birth weight, preterm delivery, or early pregnancy loss. In the postpartum period, physical activity decreases symptoms of postpartum depression and can improve the return to pre-pregnancy weight.


Risks of Sedentary Behavior 

Now that we’ve reviewed all the wonderful positive impacts of exercise on our health, we’ll highlight the increased risk that comes from not being physically active, or from sedentary behavior.

We’ve all heard the phrase “sitting is the new smoking” by now, and it’s well deserved - sedentary behavior poses a tremendous health risk.

What does sedentary behavior actually mean? Sedentary behavior includes waking behavior with low energy expenditure, in a sitting, reclining or lying position, which may include TV or other screen time.

Relationship among moderate-to-vigorous physical activity, sitting time, and risk of all-cause mortality in adults from the 2018 Physical Activity Guidelines for Americans.


The National Health and Nutrition Examination Survey estimates that children and adults in the US spend 7.7 hours per day sedentary. According to the study, that’s more than half of the time they are awake! The prevalence of sedentary professions has increased by 20% in the United States between 1960 and 2008, with a simultaneous decline of more “physically active professions.”3 This may explain, in part, why we are now facing such an epidemic of sedentarism and chronic disease.

More time spent in sedentary behavior increases the risk of all-cause mortality, cardiovascular disease mortality, cardiovascular disease, type 2 diabetes, and cancer of the colon, endometrium, and lung.

A large 2016 meta-analysis study which pooled 16 studies looking at over 1 million people demonstrated that increased daily sitting time and decreased moderate-vigorous physical activity increased all-cause mortality risk.4 The heatmap above used data from this study to plot all-cause mortality risk based on both daily sitting time and the amount of moderate- to vigorous- physical activity.

From all of this data, it is clear that two different approaches are both necessary to decrease all-cause mortality risk: 1) increasing the amount of moderate- to vigorous- physical activity done per week and 2) reducing the time spent sitting (replace with light-intensity activity). Two ways we personally like to do the latter are using standing desks, and the Pomodoro Technique as a way to take regular breaks and move around.


Comparison of Exercise and Pharmaceuticals

Next, we’ll review the impact of exercise relative to pharmaceutical drug interventions we have for certain chronic diseases. When making such comparisons, it is important to note that exercise does not benefit just the specific condition the drug is treating and what is being studied. As we’ve reviewed above, exercise has a wide range of positive side effects from improved mood, to decreased cancer risk, to decreased frailty and fall risk. So even if exercise is equally or even slightly less effective than a pharmaceutical drug (that comes with its own unwanted side effects), many people may still opt to incorporate exercise if given the choice.

A 2015 study that looked at 16 meta-analyses including over 305 randomized controlled trials with over 300,000 participants found that physical activity was more effective than drug interventions among patients with stroke.5 The drug interventions they looked at included antiplatelet drugs such as aspirin or plavix and anticoagulants such as coumadin. Additionally, they found no difference in mortality outcomes between exercise and drug interventions for secondary prevention of heart disease  (i.e. trying to prevent cardiac death after already having been diagnosed with heart disease), or prediabetes.

Finally, a separate review of randomized controlled trials comparing exercise to antidepressants showed that exercise and antidepressants were equally effective for depression.6


The Mechanisms: How Physical Activity Impacts Our Health7

Here, we will review 3 main mechanisms by which exercise improves our health:

  1. Optimizing the stress response
  2. Reducing inflammation
  3. Enhancing brain health


A Review of the Stress Response

We’ve talked about the stress response in many previous episodes, but essentially it is composed of two different systems:

  • The Hypothalamic-Pituitary-Adrenal (HPA) Axis, which releases glucocorticoids including cortisol
  • The Autonomic Nervous System (ANS), which includes the sympathetic nervous system that releases chemicals like epinephrine (adrenaline) and norepinephrine

Activating these systems in response to an acute stressor (such as getting chased by a tiger, or slamming on your breaks at the last minute to nearly miss a car accident) then coordinates the response of other systems (cardiovascular, musculoskeletal, GI, immune, nervous) in a fight-or-flight response that includes mobilization of energy or glucose, increases in heart rate and blood pressure, enhanced cognitive processes such as alertness, arousal, vigilance, and attention, and a coordinated inflammatory response to prepare for potential injuries or infections.

However, chronic long-term activation of this fight or flight response results in persistent activation of these systems, which can lead to chronic systemic inflammation and a whole host of chronic health conditions.


Optimizing the Stress Response 

Acute exercise activates the stress response in a dose-dependent manner (that means higher intensity or longer duration exercise results in a more robust stress response). This may seem counterintuitive, however, over time this can be a good thing.

It turns out that although exercise acutely increases the stress response, repeated, intermittent exposures to exercise, with enough time to recover in between, can lead to physiological “stress training”, meaning we develop a more optimized response when we encounter exercise or other stressors in the future.

This is an example of the concept of hormesis, which is the notion that low levels of cellular stress (whether from exercise, toxins, temperature changes, or other factors) stimulate or upregulate existing cellular and molecular pathways that improve the ability of cells and organisms to withstand greater stresses.

An untrained person initially mounts a dramatic stress response to exercise, but after training, the stress response to the same physical stimulus is lower. Not only is the response to physical stress lower, but regular activity seems to provide protection against mental and/or psychological stressors as well. Regular physical activity results in greater control of the parasympathetic system (the “rest and digest” part of the ANS that counters the “fight or flight” effects of the sympathetic nervous system). This is why those who engage in regular activity are also found to have lower heart rate and blood pressure readings at rest. Additionally, higher physical fitness is also associated with a more optimized immune response.


Reducing Inflammation 

In addition to optimizing the stress response, exercise also plays a role in reducing the chronic systemic inflammation that is seen in states of metabolic dysfunction and chronic disease. For example, inflammatory biomarkers such as C-reactive protein (CRP) are lower in those who engage in regular physical activity compared to those who are inactive. Regular exercise has been shown to reduce brain inflammation in response to insults such as stroke or infection.

This reduction in inflammation could be at least in part due to a reduction in visceral fat mass, which we know releases many pro-inflammatory chemicals, but there also seems to be an anti-inflammatory effect separate from the reduction in fat mass that may come with regular activity.

Interestingly, we know that a specific chemical called IL-6, when released from contracting skeletal muscle promotes an anti-inflammatory environment. More IL-6 is released with increased intensity and duration of exercise. Although IL-6 has a proinflammatory effect when released from other tissues such as adipose tissue, when released from skeletal muscle it has been shown to have anti-inflammatory effects.


Enhancing Brain Health 

A final mechanism by which exercise improves our health is by enhancing brain health. Chronic stress with persistent cortisol exposure has detrimental effects on brain including: reduced volumes of certain brain regions such as the hippocampus and prefrontal cortex, decreased expression and signalling of neurotrophic factors (factors that improve cell growth, survival, and repair), reduced generation of new neurons and their supporting cells called glial cells, depression, and impaired cognitive function.

Regular exercise, on the other hand, has been shown to enhance positive mood, decrease depression and anxiety, and increase cognitive function. This occurs by two major mechanisms:

  • Structural: Regular exercise results in increased neurogenesis, synaptogenesis, gliogenesis, angiogenesis. This means increased production of brain cells, more connections between those cells, increased surrounding support cells, and more blood vessels to bring nutrients and take away waste from the brain cells as they do their job. Structural brain changes seen with regular exercise include: increased grey matter volume and white matter integrity (especially in the prefrontal cortex and hippocampus), and decreased age-related hippocampal volume loss.
  • Cellular and Molecular: Regular physical activity results in increased expression of growth factors and neurotransmitters, which results in improved function and communication between neurons.

Together both of these mechanisms help to enhance neuroplasticity, or the ability of the brain to learn and make new connections between neurons, and may be able to reduce or reverse some of the detrimental effects of chronic stress on the brain.

Brain-derived neurotrophic factor (BDNF) is one of the most important and widely studied growth factors when it comes to the impact of exercise. BDNF supports the survival of existing neurons and promotes the growth of new neurons and connections. Low levels of BDNF are found in many chronic disease states and metabolic conditions associated with insulin resistance including neurodegenerative diseases like Alzheimers, major depression, impaired cognitive function, cardiovascular disease, type 2 diabetes, and obesity. Enhanced BDNF levels are associated with improved metabolism and cardiovascular function, and decreased risk of Alzheimer’s. BDNF levels are downregulated by chronic stress and inflammation, but exercise has been shown to significantly increase BDNF production in the brain, which then circulates to the rest of the body.8


In summary, a great majority of our US population is not getting enough physical activity to substantially benefit their health. The ways that increasing physical activity and decreasing sedentary time can improve our health are numerous, and we reviewed the most recent guidelines for Americans to reap these benefits. Regular exercise can have similar effects to pharmaceutical drugs for some common conditions like stroke, heart disease, prediabetes, and depression. Exercise exerts its health benefits through three major mechanisms: optimizing the stress response, reducing inflammation, and enhancing brain health.

When it comes to helping a friend or family member get started with exercise, interventions that are based in behavior change theory are usually most successful. Some that we have found most useful are the stages of behavior change, motivational interviewing, and solution focused therapy. Generally, community or peer support is helpful for creating sustained change. Technology can provide feedback or remote coaching and guidance to someone starting a new program. Most importantly, we find that helping someone to tie their physical activity goals to their values and what’s most important to them in life is the key to finding long term success.

We also recognize that we have a lot of work to do to improve the ability of our population to be more active on a community level. Working with our communities to make doing physical activity a safe and easy choice is something we can all strive to do.


Related episodes:

Ep 132 - Healing Through Functional Movement with Dr. Amy West

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


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


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

This post was originally published on August 31, 2020.

Eric Roza: CrossFit’s new CEO on Health, Happiness, and Performance PH158

Eric Roza: CrossFit’s new CEO on Health, Happiness, and Performance PH158

August 25, 2020

So, you have this term sheet, and the term sheet is non-binding, either party can walk away.  The most important part of it is that you’re agreed on some basics for the transaction, and there’s what’s called a no-shop or exclusivity period. Usually lawyers write that, and that says that the seller can’t talk to anybody else. You can do a lot of work, spend a lot of time, spend a lot of money figuring out how this is going to happen.  So, instead of talking to any lawyers, I just said I’m going to write this myself right from the heart. So, I wrote - I basically said, “Greg, please don’t shop this deal or try to negotiate it in anyway. I’m not commodity money. I’m a passionate [person] who wants to spend the rest of his life building on your legacy.” And, it was my first version of this notion of being the world’s leading platform for health, happiness, and performance.
- Eric Roza

When CrossFit, Inc. announced that Eric Roza would be taking over as the new owner and CEO, the news was met with excitement and enthusiasm from the CrossFit community. As a longtime CrossFit athlete and affiliate owner, he has experienced first-hand the power of CrossFit to forge bonds and bring people together, as well as the challenges facing affiliate owners.

Eric brings much more than just a passion for CrossFit to the table.  He has a wealth of experience as an entrepreneur, business owner, executive, and consultant.

Eric studied Economics at the University of Michigan, and completed his Masters of Business Administration at Stanford University Graduate School of Business.  In 2007 he founded Datalogix and served as CEO until the company was acquired by Oracle in 2015.  From there he led Oracle's Data Cloud.  Most recently he's served as an executive in residence for a venture capital firm and taught entrepreneur leadership as an adjunct professor at the University of Colorado Boulder.

Eric is also an active board member for several organizations and supports charitable efforts focused on mental healthcare, education, and entrepreneurship.  In his downtime, he enjoys working out with friends, skiing, mountain biking, running, singing, and playing guitar with his band, The House Cats.

I first met Eric about a month ago, and we immediately connected over his vision to make CrossFit “The world’s leading platform for health, happiness, and performance." I was excited to catch up with him to learn more about the behind-the-scenes process for taking over as CrossFit CEO, the key elements that have played a role in the transition, and his vision for the future of CrossFit.

In this episode we discuss:

  • Eric’s fitness background and how he found CrossFit
  • How CrossFit has impacted his mental health
  • Eric's dream of owning CrossFit, and how that dream materialized
  • How he assessed what needed to be done to transition CrossFit to new leadership
  • The importance of identifying and communicating with stakeholders
  • The inception and evolution of the CrossFit Community Summit
  • The biggest priorities for CrossFit at the moment
  • CrossFit's new mission to become, "The world's leading platform for health, happiness and performance."
  • Why CrossFit for health and CrossFit for performance are not separate entities
  • The notion of thinking “in the box” vs “out of the box:” expanding the idea of what a CrossFit box is, and bringing CrossFit to different audiences
  • Who will be driving the decision-making process of CrossFit moving forward
  • Three things Eric does on a regular basis that have the biggest positive impact on his health
  • One thing he thinks could have a big impact on his health, but he has a hard time implementing
  • What a healthy life looks like to Eric

You can follow Eric on Instagram, Facebook and Twitter.


Related episodes:

Ep 58 - Nicole Carroll On the Early Days and Preserving the Culture of CrossFit

Ep 118 - The State of CrossFit with Coach Greg Glassman

Ep 131 - Dave Castro on Changes in Life and the CrossFit Games

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

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

This post was originally published on August 24, 2020.

Be Kind, Work Hard with Cole Sager PH157

Be Kind, Work Hard with Cole Sager PH157

August 18, 2020

When you think of the CrossFit community, you think of people who are going to the gym to challenge themselves, to be better than they were the day before, and that is such a cool part of the community, and it’s what I fell in love with.
- Cole Sager


6-time CrossFit Games athlete Cole Sager wants to be known as the kindest person you'll ever meet, and in doing so, he hopes to motivate others to be the kindest, hardest-working version of themselves.

Growing up in a small town in Washington, Cole played sports throughout his youth and aspired to be an NFL player.  In 2009 he joined the Washington University Huskies as an invited walk-on, and was one of only a handful of true freshmen to play.  At the end of his freshman year, he was awarded the Scout Special Teams Player of The Year award, an honor that would change the trajectory of his life.  The honor was awarded based on hard work, and receiving it ignited Cole's drive to always be the hardest worker on the field.

As Cole neared graduation, his goals shifted from playing professional football to becoming a professional CrossFit athlete. Within months of his first CrossFit workout he qualified for Regionals, and just one year after that he established himself a serious contender when he placed first at the 2014 North West Regional and 17th in his rookie appearance at the CrossFit Games.

Eventually, Cole took a leap of faith, resigned from his job as a loan originator, and began training full-time in his home garage gym.  With the support of his wife, Genasee, and his coach, Ben Bergeron, he has built a reputation as one of CrossFit's most consistent athletes.  Career highlights so far include placing 5th at the 2016 CrossFit Games, 2nd at the 2019 Fittest in Cape Town sanctional, and 3rd at the 2019 Rogue Invitational, but according to Cole, one of his biggest achievements was winning the Spirit of the Games award in 2017, an honor that recognized all the hard work he puts into developing his character.

I was excited to catch up with Cole to learn more about what drives the intensity behind his training, the qualities he values in himself and others, and why he believes developing character leads to athletic excellence.

In this episode we discuss:

  • How Cole is approaching the 2020 CrossFit Games
  • How he stays focused on his goals in the face of doubt
  • Cole’s collegiate football career
  • Letting go of NFL aspirations and falling in love with CrossFit
  • Cole’s experience of getting to his first CrossFit Games
  • How he started working with Ben Bergeron as a coach
  • The qualities of a good coach
  • How Cole has developed as a person over the course of his CrossFit career
  • How he stays driven to train even on days he doesn’t feel like it
  • The importance of accepting help from others to hold yourself accountable
  • How Cole’s wife, Genasee, is a vital part of his team
  • A typical day for Cole and Genasee
  • Three things Cole does on a regular basis that have the biggest positive impact on his health
  • One thing he thinks could have a big impact on his health, but he has a hard time implementing
  • What a healthy life looks like to Cole

You can follow Cole on his website and on Instagram, YouTube, Facebook and Twitter.


Related episodes:

Ep 54 - Neal Maddox: From Football to Forty

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

Ep 76 - Working Against Gravity with Adee Cazayoux

Ep 84 - Chasing Excellence with Ben Bergeron

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

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

This post was originally published on August 17, 2020.

Adapting to Muscular Dystrophy with Dano Lotz PH156

Adapting to Muscular Dystrophy with Dano Lotz PH156

August 11, 2020

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

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

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

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

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

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

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

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

In this episode we discuss:

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

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


Related episodes:

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

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

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

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

This post was originally published on August 10, 2020.

FACTS about Fertility with Dr. Marguerite Duane PH155

FACTS about Fertility with Dr. Marguerite Duane PH155

August 4, 2020

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


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

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

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

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

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

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

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


In this episode we discuss:

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

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


Related episodes:

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

Ep 126b - Nicole Christensen on Coaching Pregnant Athletes

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


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


This post was originally published on August 3, 2020.

Sleep Basics PH154

Sleep Basics PH154

July 28, 2020

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

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

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

State of Sleep in US

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

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

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

Sleep, Health, and Disease

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


Metabolic Health 

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

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

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

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

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

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

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

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

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

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

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


Alzheimer’s Disease

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

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

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


Immune System

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

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

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

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


Testosterone and Fertility

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

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


Psychiatric Conditions

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


Driving Accidents

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


Athletic Performance

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

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


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



How Sleep Works 

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


When We Sleep

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


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

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

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


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


Sleep Cycles

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


Non-Rapid Eye Movement (NREM) Sleep

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


Rapid Eye Movement (REM) Sleep

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

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

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


Sleep Cycles

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

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

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


Sleep as We Age

Several changes to sleep occur as we age:

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


How Much Sleep?

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

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

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

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

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


Improving Sleep

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


Give Yourself the Opportunity 

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


Maintain a good sleep environment

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



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

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



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

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

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



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


Make your bed a place for sleep only 

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


Avoid Substances that Interfere with Sleep 

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



Alcohol impacts sleep in two important ways:72

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

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

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

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



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


Daily Exercise

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

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


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


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


Related episodes:

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

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


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


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


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This post was originally published on July 27, 2020.

Mat Fraser + Sammy Moniz: Sweethearts on a Mission PH153

Mat Fraser + Sammy Moniz: Sweethearts on a Mission PH153

July 21, 2020

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


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


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


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


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


In this episode we discuss:

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

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


Related episodes:

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

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

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

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

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

This post was originally published on July 21, 2020.

Overcoming Grief & Losing 65 Pounds PH152

Overcoming Grief & Losing 65 Pounds PH152

July 14, 2020

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

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

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

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

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

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

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

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

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

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


In this episode we discuss:

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


Related episodes:

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

Ep 84 - Chasing Excellence with Ben Bergeron

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

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


This post was originally published on July 9, 2020.

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