Endo Block and the Obesity Epidemic

- 65 Comments

We’ve spent the last two  weeks of medical school in our Endocrinology Block.  Returning from a much-needed and  very restful break for the holidays, I was excited to be learning about a new system and expected the coming days  to be filled with discussion of those elusive glands and hormones I’d heard of, but never really knew exactly what  purpose they served.  While we did spend plenty of time learning about things like T3 and T4, Chromaffin cells,  and the difference between the anterior and posterior pituitary, to my surprise (and perhaps also to my  fascination) a significant portion of the past two weeks revolved around obesity.

We have learned about the genetics of obesity, how hormones and neural networks control how much you eat and  how much energy you expend, and all the hormonal factors that our fat cells release contributing to insulin  resistance.   We talked about a number of endocrine diseases that lead to uncontrollable weight gain or loss, but what resonated with me most was this figure that seemed to kick-off every other seminar I participated in, highlighting America’s  “Obesity Epidemic:”

The Obesity Epidemic – http://www.cdc.gov/obesity/

With all this buzz about obesity, I was fascinated by how quickly the word “exercise” passed in and out of  conversation – as if it were some sort of fictional idea, a figment of the imagination that only worked in fairy tales  and highly-controlled research studies.  Instead, after rapidly dissuading the eager medical students’ suggestions of  “lifestyle changes,” clinicians quickly turned the focus toward pharmacology and novel molecular targets for  treating this epidemic.  Did I miss something here?  At first I was quite perplexed – if we know that exercise  affords  us countless health benefits and is likely to prevent diseases from diabetes to cancer, why are we searching so  hard for the “magic bullet” drug to treat obesity and leaving this thoroughly tested and proven antidote to the  wayside?

What strikes me the most about many of our seminar discussions with highly-esteemed clinicians is their sheer  lack of faith in the ability of any patient to adhere to an exercise regimen.  But then I stop to think – can I blame  them?  Though I’ve only been immersed in the field of medicine for half a year now, I’ve become accustomed to  the standard “diet and exercise” talk.  Patients in need of serious lifestyle change are sent off for an appointment  with the nutritionist and told to “exercise.”  Now talk about an elusive idea – if I had been living an increasingly  sedentary lifestyle for much of my adult life and was given these instructions, I would have no idea what to do  either. Heck, I had no idea what to do or how to exercise the minute I was set free from my high school sports  programs, and exercise had been part of my everyday life for years!  The plethora of weight loss and fitness advice  we are constantly bombarded with  doesn’t help one bit – with so many options, many of them contradictory, and  different people asking for your money, it’s nearly impossible not to become overwhelmed and discouraged before  finding a program that works.  So, why is it that doctors frequently leave it up to their patients to figure out?  Sure,  they might suggest Weight Watchers or purchasing a gym membership, but ultimately this choice is left up to the  patient.  Do we leave other choices of this magnitude up to our patients?  If I came in to see my physician with  strep throat, would he make a few suggestions of what medication I should take and the dosage and leave it up to  me to decide? Absolutely not!  If I needed to rehabilitate a torn ACL would my doctor point me to a few  online resources and send me on my way? Not at all!  Next thing I know I would be standing in a physical therapy  clinic receiving step-by-step instructions from a doctor who had helped countless others through ACL rehab, and I  would be returning several times a week to ensure my therapy was completed fully and properly.  So why is it that  exercise, perhaps the most important and life-saving treatment of all, is so improperly “prescribed” by our  physicians?  The problems are many-fold, and as far as I can see they stem not from the doctors themselves but rather the health care system in which these doctors work. However, at least in my mind, the complexity of these problems doesn’t preclude working toward a solution.

After these past two weeks, the disconnect between medicine and fitness has never been so apparent to me. While I always knew it existed, there is just quite nothing like experiencing first-hand the Grand-Canyon-sized gaping hole between experts in sickness and wellness, and experts in fitness.  My favorite of CrossFit’s models of fitness is by far the “Sickness-Wellness-Fitness” continuum, yet in the context of medical care, this continuum is not quite as smooth as we might hope.  Instead of individuals oscillating freely along from wellness to fitness, fitness to wellness, and occasionally (God forbid) inching over to sickness, we have a serious traffic jam on the Sickness-Wellness side of the spectrum.  People are stockpiled on the cliff we call “Wellness,” peering over the edge   and looking down at the polluted waters of “Fitness.”   That’s a scary jump to take – and who knows where you will end up once you do?  A $10-per-month gym membership?  $100 for a video that promises to give you a six pack?  What we need is something to bridge this gap – someone who can take patients by the hand and lead them toward the right side of this continuum, and it’s clear to me that CrossFit may just help us find that someone we need.

“Your doctor is a lifeguard, not a swim coach” – Coach Greg Glassman.

  • nick strazar

    Good post Julie. Love the sketches!

  • Jacob Egbert

    I couldn’t have said it better myself. I am a new physician (7 months in practice) and I am a crossfit trainer (for the love of seeing wellness to fitness transitions). I have lamented these points for years and have yet to find an effective realistic solution. I appreciate your frustration with the system and feel sorry for the future frustration that you will surely find. The medical field is not designed to bring people to even wellness let alone fitness. We are trained to keep people hovering above death and just beyond sickness. There isn’t an healthcare money in wellness. And especially not fitness. You will not have the time to explain to your patients about diet and exercise. And they will be very reluctant to darken the doors of a crossfit gym. There actually needs to be an inbetween. A pre-crossfit program. One that takes a multi disciplinary team including psychologists, “real” dieticians, movement therapists, and medical monitorinig or evaluation at least. I am working on this currently, trying to find a program I can implement within the “system”. If you have ideas or come across anything that works I would love to hear about it.
    Every patient that I have referred to Crossfit and has actually gone has had tremendous success. But those are few.

    • http://megankaden.wordpress.com megankaden

      Hi Jacob,
      I am a psychologist and a CrossFitter in California working on this very notion, as well. I’d love to chat more with you. Send me an email when you get a chance. mkaden@gmail.com
      http://www.drmegankaden.com

    • Tony

      Hey Jacob,

      Great comment here and I applaud you for being in the profession you are and planning on doing something to improve it, rather than “just go with it” like most of the rest.

      You are correct that CrossFit itself is a bit intimidating to those who are failing in regards to their health and wellness… which is likely to be the vast majority of patients walking through your door.

      I actually got into chiropractic because it is so congruent and aligned with true wellness care (well, at it’s core it is… many DCs have gone allopathic too), and currently run a large wellness practice in Chicagoland doing exactly what you are talking about… “bridging the gap” for these folks and building a path and program for them to one day reach true wellness (and thus CrossFit – which I’ve been doing for 2 years and has taken me personally from a B+ to an A+!).

      Recently we became part of a program called 8 Weeks to Wellness which does just what you are looking for… it begins with the most comprehensive and FUNCTIONAL exam out there, allowing us to use our education and clinical expertise to know EXACTLY what is going on with a patient’s neurophysiology… so that our recommendations can then be fully based off what it takes to get them functionally well, instead of traditional care which simply trades drugs for symptoms.

      The exam is comprehensive and functional, and lends right into a comprehensive program of adjustments, personal training (functional fitness style), massage, diet and nutrition, and meditation/stress reduction. After 8 weeks, some may be ready for CrossFit and full wellness on their own… but most won’t. We then continue to build layer after layer of that bridge until they are.

      A true wellness doctor, which can and should be MDs, DCs, DOs, alike… begins by determining exactly where a patient is functionally, and then puts a program in place to get them where they need to be. In my experience, nothing does that like 8WW (www.8ww.com).

      I applaud you and Julie for looking into and going after functional and lifestyle-based medicine, as it is where we must head… and I can’t wait to have a true physician like one of you on staff one day at my place!

  • http://survivethejourney.blogspot.com Robin

    You forgot the part about testing to see if those patients really do have a medical problem causing the obesity. I’m part of a large support group for Cushing’s patients (most diagnosed and treated mainly with surgery), and we have heard the mantra “Diet and exercise” from so many doctors and endocrinologists that we laugh at the phrase now, sadly.

    With Cushing’s Disease/Syndrome comes other hormone disfunctions, especially of the pituitary-controlled variety, and hypothyroidism is common with us, also. Since Cushing’s causes extreme muscle wasting, exercise is a mis-diagnosis of the utmost extreme.

    I had Cushing’s for over 25 years. Part of the latter years was spent finally testing and receiving a diagnosis/pituitary surgery which did not cure my Cushing’s Disease. I eventually had a bilateral adrenalectomy 18 months ago to treat the high cortisol. Only in the past 6 months or so have I been able to successfully exercise without injury. I have not dieted at all beyond the normal diet I had prior to diagnosis when I put on all those pounds eating sensibly. However, I’ve been able to lose, since my BLA, almost 100 pounds. I’m still losing, slowly.

    Be careful with the “diet and exercise”. Save it until you really know for sure there isn’t an endocrine or other problem. One test will not show that. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978784/

  • Debra

    First, cheers to you for being interested in the endocrinology section. I truly think that endocrinology practiced well is one of the most intellectually challenging areas of medicine and we need many, many more endocrinologists. The one I see takes no insurance, has an office on the other coast, charges about $500 and has a very healthy part time practice that allows him to do research and volunteer work.

    I would like to give you a different perspective– as someone who is an endocrine train wreck. And to define that I mean two autoimmune thyroid disorders, severe growth hormone deficiency and cushings disease.

    First, don’t underestimate the value of he patient community in this field. Persistence and the help of other patients has very literally saved my life. There are a goodly number of fellow patients who know the medical literature in far more detail and depth than doctors who I saw in major research institutions. The Internet is a serious leveler in terms of information.

    Second, do not underestimate the effect hormones have on the weight equation. We have had people working out hours a day, with a trainer, we have had regular marathoners gain huge amount if weight and suddenly lose their muscles. Most of us have had extensive delays in treatment and we have seen people die because of those delays—allbecause doctors can’t get beyond the calories in calories out mantra that science is showing is a gross oversimplification. And I am saying this as someone who had complete gastoparesis and nonetheless managed to gain twenty pounds in three months.

    Third, endocrine disorders are much more common than you think. Start looking around at the grocery store for fat people with facial flushing, a buffalo hump, facial hair, acne, skinny limbs and who look pregnant but aren’t. You’ll soon conclude that cushings isn’t one in a million. Learn the symptoms of hypothyriod– the half eyebrows are a dead give away, and it’s clear that alot of people aren’t getting treatment that need it.

    And last, please, please consider being a kind endo. It’s something we really need.

  • Danielle

    A lot of obesity IS endocrine related. Hypothyroidism causes obesity. PCOS causes obesity. Cushing’s disease causes obesity. There are more, I’m sure, but these realitively common and underdiagnosed and under treated diseases can all cause people to gain weight, no matter how well you eat or how much you excercise. Please keep this in mind while learning about endocrinology and treating obese patients. Not all of us ate lazy over eaters.

    • http://juliefoucher.wordpress.com juliefoucher

      Danielle, Debra, and Robin:

      Thank you so much for your comments – I apologize for not being more clear in my post that I am talking about the abundance of diseases for which exercise and diet DO work and my frustrations with the disconnect between physicians who make the diagnoses and fitness experts who can help to implement the solutions in these cases. I thank you for sharing your stories and I am so sorry to hear about your own struggles and frustrations with the health care system.

      Best,
      Julie

      • Debra

        No offense taken. Just understand that the endocrine society estimates that 25% of people who are obese have an endocrine disorder as a cause. Per european research, between 5 and 10% of people with diabetes have at least mild cushings and 5-10% of people with hypertension have at least mild cushings. Can you imagine the savings in health care costs and improvement in quality of life if people had access to treatment? But there are only a handful of doctors in this country who can diagnose this. Exercise and diet work well in preventing weight gain in normal people, but researchers are finding that weight gain causes biologic changes that make it very difficult to sustain a loss. Thus the high long term failure rate with diet and exercise programs for weight loss. The consensus guidelines actually support gastric bypass as having a better success rate. Again, no offense taken, just wanted to provide a differing viewpoint. You clearly have a passion for health. Your profs aren’t as off base as you think.

    • Tony

      In counter… what causes hypothyroidism, Cushing’s, PCOS, etc.???

  • Jeff

    Very well written on a very real and serious issue.
    Just to add to the discussion that you did kind of mention. Please understand and NOT showing lack of empathy to anyone, but true genetic disorders only account for about 1-3% of all diseases out there with the rest being lifestyle related. so the idea of setting up a true wellness lifestyle program for the masses would not only be great but it would literally save our species as we are getting sicker and sicker every year. If all drugs and surgery were free and unlimited the trend of sickness would not get better. This is the first generation that has a life expectancy less than their parents. Diseases are showing at younger ages, and our genes have not changed in 200,000 years. The problem is poor lifestyle choices (which is creating adaptive/improper gene expression – or disease) and a lack of proper lifestyle education for the masses. People eat fruits, vegetables, meat, grains, and dairy and think they are eating a balanced and healthy diet because that is what the myplate or food pyramid or whatever says, when in reality half of that plate is adding to the problem. Lifestyle involvies how you exercise, eat, and manage stress with neither being more important than the other. Crossfit does a great job with the exercise and is very close on the nutrition, and I would even say close on stress reduction with the tribal- like community atmosphere that is created and the benefits of stress reduction that exercise creates.
    So great work on the article, but I would say as you continue with your journey for a solution dont forget about nutrition and stress management to go along with the exercise.

    • http://juliefoucher.wordpress.com juliefoucher

      Jeff- thanks for your comment. I absolutely agree about the importance of nutrition and stress management, and poor nutrition will absolutely prohibit many of the beneficial effects of exercise. If only there was some consensus and clear information out there for people…do you mind if I ask what parts of nutrition you think CrossFit gets wrong?

      • Jeff

        CrossFit promotes paleo. I’m sure you know paleo consists of eating fruits, veggies, meat, nuts and seeds and drinking water. Dairy and grains (you know 2 of the main food groups) are virtually eliminated. This it is very scary and surprising to a lot of people. So I do not think it is wise to tell someone to just quit eating dairy and grains straight up as most people will not. There are other strategies to do this.
        I do not think CrossFit is doing anything wrong with promoting paleo I just think paleo itself is leaving out a few very essential nutrients that unfortunately we cannot get in our diets today do to our current food industry practices. These nutrients are Omega 3 FA, vit D, and probiotics. Everything else should and can come from wholefood sources. I have lots of info on why these three nutrients need to be added to the diet in supplement form if you are interested.
        Just a quick note on endocrinology and probiotics. I’m sure you have learned that the Endocrine system and the Immune system are virtually intertwined. So if you or anyone has ever taken an antibiotic then most likely the healthy microflora in your digestive system (which houses 80% of the Immune system) is basically destroyed affecting the function of your Immune system which in turn will effect the function of your Endocrine system and can lead to a whole host of problems. So it is extremely important to regulate that as well.

    • Rod

      Jeff- Don’t take this personal but you stated another misconception about CF. The CF diet is not Paleo. As Level 1 certificate holder and I have studied the CF model and below is the nutrition model CF promotes. “In plain language, base your diet on garden vegetables, especially greens, lean meats, nuts and seeds, little starch, and no sugar”. Dairy and grains are included in the nutrition model taught at the level 1 certs.

      Now there are quite a few affiliates that support the Paleo/Caveman model but that is up to the specific owners/coaches to decide. Nowhere in all of the CF material does it say to give up dairy and grains. Again it is advocated by affiliates but Paleo is not part of the CF nutritional model.

      Just my $.02. Not trying to start a pissing contest but when I hear things stated about CF that are not so I feel the need to educate those reading this that may stray away because of false information.

      • Jeff

        Rod, I have heard both Zone and Paleo mentioned in CrossFit circles. Thank you for clarifying.

      • GM

        The disconnect you try to define is actually defined by the general population’s lack of brain power to think for themselves. In this google age it is not very hard to find crossfit or paleo or perfect health diet or ray peat or organic farm delivery websites, the list goes on. In fact it is easier than ever (think about how hard it would have been in 1979). So the fact is there is absolutely NO disconnect here. The #1 law in markets is supply and demand. The modern american wants pharmaceuticals, to not cook at home 20 meals per week, to not clean up, and to have that magic pill. Why would modern medicine waste its time with detailed exercise programs that can easilly be found googling skilled practicioners or following them on fb to guage what the practicioners M.O. is when thats not what millions of americans want? The demand is not there! Building supply when demand is not there is a surefire way to fail. Modern americans want magic pills. The demand is dictating the behavior of the supply market as it always will. If everyone was like me and my family or some of the practicioners i work with, big pharma would be bankrupt. But theyre not and big pharma is a multi billion dollar market. So the real question is why are modern americans so disconnected with themselves and with nature?

  • http://www.facebook.com/benweger Ben Weger

    At the risk of sounding insensitive, endocrine disorders predispose one to obesity, but do not cause it. As with many disorders, there are many factors playing into it. Roughly 5% of the population has hypothyroidism which is correctable through very inexpensive medicine. The incidence of cushings disease is 5 to 25 cases per million people per year. While nobody wants to have either diagnosis, please realize the staggering number of people without genetic endocrine disease that have obesity. PCOS frequently has a hyperinsulinism etiology. This is often due to poor diet. Hormones play a part and yes, there is more to the equation than calories in and calories out, but diet and exercise will make a difference regardless. If you are an adult that is metabolically normal, there isn’t any excuse.

    With regard to medical evaluations, the standard of care includes a thorough history, a physical exam, and basic tests to rule out an endocrine etiology. If the doctor doing the evaluation skips any of the three, they are not doing their job. Physicians and patients are partners in health. If your doctor isn’t doing their job, fire them. Conversely, if you are not holding up your part of your own health, you can’t expect the doctor to fix everything.

  • http://lifewithcushings.blogspot.com Danielle

    I do agree that EVERYONE needs diet and exercise but gaining over 100 lbs in less than a year without changing my already healthy diet and exercise routine isn’t normal. I gained more over my 10 year journey and now after 2 pituitary surgeries, a bilateral adrenalectomy and near total hormone replacement, I am down 70 lbs without much change to my diet and exercise as referred to above. Cushing’s did not put me at a greater risk of gaining weight, it just put the weight on me. Cushing’s is also not genetic most of the time unless the patient has MEN1.

    I appreciate the discussion about this issue, as it is a serious issue with our society, but I just wanted to provide another viewpoint as a patient who has spent most of my adolescent and 20’s in a hospital being misdiagnosed.

  • Kate

    Just want to chime in here as another Cushing’s Disease patient to remind y’all that Cushing’s is rarely genetic unless it is part of the constellation of Multiple Endocrine Disorder 1. Cushing’s is caused by a TUMOR, usually in the pituitary but sometimes in one or both of the adrenal glands (and less common, in an ectopic source, usually in men and often a small oat cell lung cancer). I’ve had my entire pituitary removed, both adrenal glands removed and gamma knife radiation to my recurrent tumor, which persists despite total hypophysectomy. Cushing’s is not rare, it is rarely diagnosed because few endos are willing to test beyond one normal test. Hormones fluctuate constantly. What saved me was doing midnight salivary cortisols and going to the hospital lab at midnight and having serum cortisol and ATCH tests done. I would also like to point out that during the 11 days I was having an open bilateral adrenalectomy (because the neurosurgeon could not get all of the tumor cells), I gained 28 lbs without eating any food until the last day. That was because they had me on 200 mgs hydrocortisone. When I weaned down to a normal dose of 20, that “steroid weight” dropped off without a change of diet and without much exercise (I had an 18″ chevron incision with 45 staples, so it was hard to move around for a month). Please hear what we have taken the time to come here to say. How often do you have passionate patients eager to share their experiences with you so that you can learn from our experiences? Most endos shrug off Cushing’s as too rare – or they forget that it can present in a cyclical/episodic fashion (which greatly impacts testing). If you take anything from this, please just understand that there are many of us out there who went years or even decades without a correct diagnoses…which would not have happened if we had doctors who believed us that we did not eat ourselves into a Cushing’s shape or weight. Look for that hump, the hard pregnant-looking belly, all of the signs of PCOS including androgynous hair growth and ammenorrhea are present. But also: major fatigue in the morning, intractable insomnia, opportunistic infections, huge stretch marks (which may be pale if cyclical and in a low), a red face with moon facies, weakness standing from a squat, even broken bones and soft teeth because of the cortisol-overproduction. Thank you for reading this and remembering these words. If you are interested, type “Cushings obesity” into Youtube Seach terms, and a 6 minute interview my endo and I did for National Geographic will come up as the first or second video. You can see with your own eyes what undiagnosed Cushing’s looks like, and a post-op picture after my 1st pit surgery (during a brief period of remission). please contact me via Youtube if you need more information.

    Thank you, Kate

    • Dave

      Hey Kate thanks for posting. Im uneducated about this issue and am sympathetic toward your disease. I hope you don’t take any offense to the questions I would like to ask cause I am not intending anything by them but to just get your perspective.

      If Cushings is caused by a tumor and is rarely genetic.. what environmental or physiological things have been shown to contribute to getting cushings?

      Cause and Affect?

      No doubt about the physiological changes that make dealing with Cushings a nightmare to hear words like exercise and eating right when the disease has already developed and you need surgery and medication to deal with the problem but previous to onset do you believe that starting a proper diet and exercise at a young age can prevent Cushings?

      When did you learn about CrossFit?

  • http://www.facebook.com/profile.php?id=1051873257 Catherine Thornton Cochran

    Julie,
    You will be a wonderful physician because you understand that when a doctor “prescribes” diet and exercise, there needs to be an explanation of what the heck that means! Love this article! No where in the article does it say that CrossFit (or exercise) will cure everything. But everyone can benefit from a healthy lifestyle including exercise. I am a type 1 diabetic (juvenile diabetes). CrossFit hasn’t cured my disease but it has sure helped by improving the efficiency of how my body processes the insulin that I have to inject daily. And even though I have met with nutritionists throughout my life, I really didn’t understand nutrition until I got involved with CrossFit a few years ago.

    Also, to correct another comment here, to my knowledge CrossFit doesn’t endorse Paleo diet. CrossFit endorces Zone diet, which I LOVE. With Zone diet, I always know how much insulin to take because I’m always eating about the same amount of carbs, balanced with protein and fat. When I took the level 1 cert years ago, they talked about Zone, and when I took the written exam last year, I had to know Zone, not Paleo.

    Thanks for writing this article!

  • Brent

    Julie, not sure how this turned into a discussion on Cushings and such but coming from a medical background (although now all I do is is preventative health care through diet and exercise) I totally get what you are saying here. Keep on doing what you are doing. Great post!

  • Debra

    No. Diet and exercise will not prevent Cushings. We have even had a Navy Seal be incapacitated. Kate used to be an avid runner before she got Cushings. http://www.youtube.com/watch?v=vxSAhLyKVqw&feature=youtube_gdata_player

    As to what might cause an endocrine related obesity, which is not preventable with diet and exercise, this is a really good presentation: http://www.endo-society.org/media/writers/upload/Lustig-ED-Final.pdf. Note, this isn’t off the wall nutroceutical thing, Its the Endocrine Society, which is very stodgy and conservative. Look at the slide on cortisol -cortinsone conversion.

    The reason why some Cushing’s folks have popped in here is because we are committed to replacing the pop-culture belief that everything obesity related is simply a calories in, calories out calculation. Because that misconception has nearly killed many of us and it’s just not supported by current science,– so we look for opportunities to provide education and get folks to think out of the pop-culture box. That isn’t to say that exercise isn’t a good thing or that a good diet isn’t a good thing. It’s just that its overly simplistic to say that its the only thing. The premise of this blog is that the profs were really missing the most important point in talking about medical causes of obesity and that the real answer is something like Crossfit. The truth is that for a very substantial portion of people with weight issues, endocrine issues are a substantial contributor. Treating those issues, not repeating “diet and exercise” like a robot, would go a long ways towards improving quality of life, health and decreasing health care costs.

    Consider this. Most of the banned substances in sports tweak the endocrine system. And, its pretty obvious that they are effective. That’s why they are banned. If those hormones can promote “super” fitness, why is it so hard to believe that they would make it hard to be fit if someone is deficient in them?

    • http://juliefoucher.wordpress.com juliefoucher

      Hi Debra – just want to clarify again that my premise was NOT that my professors were missing the point in talking about medical causes of obesity. We spent plenty of time talking about Cushing’s and other endocrine diseases and how to treat these. My frustration and premise for writing this was in our discussions of diseases such as type 2 diabetes in which exercise is a proven treatment yet is quickly dismissed because of the frequent failure of its successful implementation.

    • Dave

      Thanks Debra. Not sure if we are seeing that presentation through the same lenses. In that presentation they suggest many environmental factors that contribute to hormonal changes. They even suggest the plastic from baby bottles contribute to an inbalance of hormones. I’m not sure how you come to the conclusion that diet can’t influence physiology and then conclude with talking about banned substances because they can influence hormone levels. I disagree with your conclusions. But I do sympathize with the nature of the disease you have developed and should be treated for and know that if you are misdiagnosed or underdiagnosed you deserve better, I don’t believe anyone disputes that.

      It has been my experience that food can influence hormones and despite our societies belief in dieticians they don’t have things all mapped out. By this time she could have already progressed in her disease where it wouldn’t have matter as well. And I know its not as simple as just saying diet and exercise, those words are empty because the are just platitudes if they do not have meaning behind them, but is their a difference between buying Organic foods and pairing them correctly in your diet that could help influence hormone levels? More of a rhetorical question but I think the answer is yes but its only anecdotal in nature for me.

      Just because someone is actively running doesn’t mean they are healthy or eating a proper diet for them when they say they are eating a proper diet. I don’t have any journal or citations but I have seen studies that suggest excess endurance exercise can lead to excess Cortisol levels. Did Kate know that? Did the doctors know this. Did she lift weights? Now I really don’t believe people should withhold treating an issue such as Cushing because they believe diet and exercise is the treatment that is Naive but I believe it is also Naive and counter to even the study that you post that the environment and way we live our lives can’t make an impact on how diseases manifest themselves in our lives. Its not an either/or causal relationship from my experience.

      Thanks for the video and presentation.

  • Diane D.

    I acknowledge that some folks have a diagnosed/undiagnosed disease that causes obesity. For the purpose of these comments, I speak from personal experience and my observations of my family, friends, neighbors and others who do not have disease-related obesity. Instead, we have what I call “obesity creep”. We are over 50 years of age, we lead productive but non-athletic lives and, for the most part, we enjoy eating. Consequently, every year we put on a few pounds. A quick review of the photo album provides clear documentation of this phenomenon! In our thirties, we looked good in our clothes (despite the fact that they were “‘80’s” clothes!) and could unashamedly sport a bathing suit. As the pages of the album turn, our thighs get thicker, the paunch becomes more evident, and the next thing we know, we have a weight problem. And although many of the obesity-creep crowd can admit that their weight-gain is caused by their lifestyle and are capable of going from sickness to wellness through a pill or two or three, almost NONE know how to go from wellness to fitness! Julie’s graphic is a perfect description of this problem.

    I am fortunate enough to have found CrossFit just as my obesity-creep became a burden. Four years later, my husband and I are both CrossFitters. Unfortunately, we are the ONLY people in our circle (outside of our CF friends) who exercise regularly, let alone with the intensity of CrossFit! So, as I consider the Sickness-Wellness-Fitness continuum along with a recently published article in our local paper (the Pittsburgh Post Gazette), I find our situation to be instructive:

    The University of Pittsburgh School of Medicine studied 1,933 people in Allegheny County aged 45 to 75. Of those 1,933 studied, only one person had heart health meeting all seven factors the American Heart Association lists for “ideal cardiovascular health.” Those factors include four behaviors and three that are measured medically: Being a non-smoker, having a BMI below 25, having goal-level physical activity, eating a healthy diet, having cholesterol levels below 200 mg/dL, having blood pressure below 120/80 and, finally, having a fasting blood-sugar level below 100 mg/dL. The study’s senior investigator, Dr. Steven Reis, said that only one person of the nearly 2,000 studied achieved these results without medication.

    So while it may be anecdotal, it is not coincidental that of the two over-50 CrossFitters living in my household in Allegheny County, we BOTH meet the standards for ideal cardiovascular health without medication! On the other hand, our weight-gaining, pill-taking peers continue to live in denial while their doctors keep writing prescriptions and mouthing the words “exercise more”. We hope that soon, they too, will find the bridge from wellness to fitness. I know that I will be there, along with the entire Pittsburgh CrossFit community, to help them find their way.

  • JeffS.

    Thank you Julie for what you are bringing more into the light with regard to wellness, fitness, nutrition and where CrossFit can play a role in all of it. Before beginning CrossFit in March of 2011, I had been “battling” very high triglyceride levels and poor cholesterol scores for several years. To keep a long story short, after years of different medications, photo copied handouts of different “diets” and eating plans, I finally took hold of my own health and found some paths that worked for me to both lose weight, become fit and stop taking a triglyceride medication. This journey started (along with my wife) through Weight Watchers to drop some of the initial pounds, then continued with CrossFit. The immersion into CrossFit was the catalyst to get me where I am today with my fitness level, diet and overall wellness. The problem I can see with all of it though, is it’s a VERY big commitment to make these changes. They are hard, and unfortunately, society as a whole seems inherently lazy. There is no doctor in the world that can MAKE someone perform the daily things that lead to better health and fitness. Little things like staying up to watch David Letterman and being too tired to get up for a CrossFit WOD before work. Or planning your meals so poor decisions aren’t made when it comes time to eat. All of that takes time, dedication and EFFORT. The data is available on what works, the information is there. Guess what, smoking is bad for you. Guess what, eating shitty makes your health shitty. Eating too much makes too much of YOU. So much of it is not rocket science and I’m sure that physicians are sick of the majority of their at-risk patients not taking any advice to heart, so the effort probably wanes. From the perspective of the medical community, it seems like a daunting task to try to create some small amount of change in people’s thinking and actions when the yearly stats show the exact opposite. I just wish everyone could visit a CrossFit box for a taste of the environment and how they COULD feel with a bit of effort and change in priorities. Thanks again Julie. Very interesting topic and article. Now go kill it at the games! :)

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  • oneworldalex

    Aas a nurse in the intensive care unit for over 8 years and a trainer at OneWorld for 3, I have seen this disconnect you speak of, and the only glimmer of hope comes from Robb Wolf who is working on changing curriculums in Medical School, but the reality is that our healthcare is based on tertiary care. We are focused on waiting until the patient’s sickness is in a chronic state before we intervene. The true solution comes in education, and true preventive medicine that occurs at the earliest school age, as history has shown, to change we must be willing to invest in changing our children and breaking the pattern of horrible decision making there.
    Our GDP is projected to hit over 40% on healthcare alone in the coming years, which would put a huge strain on our society, but we are convinced as a medical community that our health care system is superior. I wrote of this disconnect that you are feeling in our blog a while back and appreciate the position you are in, http://crossfitoneworld.typepad.com/crossfit_one_world/2011/07/alex-has-words-for-you.html,
    I see cardiologists and other doctors and nurses who are as obese as the patient’s they are caring for, still convinced that low fat low calorie diets are the way to better health while neglecting true exercise. In the end, we know, our way of living has worked for us and countless of others, but in the eyes of the so called leaders of our medical community, we are based on correlation and causation, lacking empirical data to change their minds. I can rant for hours, so I won’t, just wanted to thank you for writing this and for speaking your mind. This feeling will get worse as you start clinicals, but remember that you have the ability when you are done to change things. Good Luck.

  • http://mjpendlebury.wordpress.com Molly Pendlebury

    Fantastic post!! Thank you so much! I’ve tweeted, shared on my fb page as well as our Crossfit’s fb page. Well done!!!

  • Ross

    Great job Julie! Similarly to yourself and some of the other contributors here I am a CrossFitter and recent graduate from med-school. As you will continue to see as you progress through your career, physicians are often taught that one of the first suggestions (as well as best possible answer on board exams) made for many diseases will be lifestyle modification. Whether it be hypertension, diabetes, hyperlipidemia, or some other acquired chronic illness, diet and exercise ( and smoking cessation) are the first lines of defense in preventing as well as curing these ailments. However, as you have so eloquently mentioned, the system is broken and the disconnect between “prescribing” diet and exercise and the fulfillment of that recommendation is broad. Hopefully with continued education for our patients as well as physicians in conjunction with people such as yourself and other medical/fitness advocates, changes can be made, even if on the small scale. Keep up the good work.

    “One of the first duties of the physician is to educate the masses NOT to take medicine.” – Sir William Osler.

  • http://www.willowparkfamilymedicine.com Matthew Stine

    Julie….first I would like to thank you for taking the time to write this blog in the midst of a very busy time in your life. Medical school is full of many different and unique challenges mixed within the context of adult life that to take the time to share your experiences is something you will really find the most rewarding later in your career. I hope that you continue to write during internship and residency as well. I also would very strongly encourage you to enter into Family Medicine as I can tell already that your personality would fit perfectly in that type of practice.

    As a Family Physician, finding avenues to get my patients to improve their lifestyle is by far the biggest challenge that primary care physicians face in their practice. I agree completely with Ben Weger that if you do not have a physician who is willing to take the time to take an adequate history, do a comprehensive physical exam and screen for disease states with labwork at appropriate intervals, you need to find a new physician. The effort from the standpoint of a physician is really minimal, and if you do not have a physician willing to provide that basic of a service for you, they are likely to miss something problematic later on in life.

    With respect to hormonal disorders, they are out there indeed. The perspective I have is that most people come into my office believing they have one, when in reality, very few actually do. I personally am not aware of ever missing a case of hypothyroidism or Cushing’s because I screen appropriately based entirely on history and physical exam. I think the majority of primary care physicians fall into this boat, but surely there are some physicians out there who gloss over details that may lead them to miss that type of diagnosis. Are there people who have unique features of common disease states that make it more difficult and nebulous to diagnose? Absolutely, and I think that many of the people who have taken the time to comment here about their specific courses of disease may fall into that category, but generally are not the norm.

    I have spent a considerable time thinking about the epidemic of obesity in our country, although my perspective is certainly limited by the fact that my patient population is unfortunately relatively homogenous. After years of thought, my conclusion is that obesity in America is much more of a cultural and sociologic problem than it is necessarily a medical problem. Obesity is not more common in America in 2012 because of a novel virus, or new type of bacteria, for example.

    In my own opinion, worsening obesity rates in America have more to do with what I call “The Culture of Easy” that exists in America. As our society has evolved over the past 30 years, it has done so with an obvious emphasis on ease and convenience. “The Culture of Easy” has trickled down to affect our lives in innumerable ways. We now all have a world of information at our figertips on our desktops, in our pockets through our smartphones and with the proliferation of television technology. As a society, we have also become very dependent upon restaurants where a family can sit and eat a meal quickly and relatively inexpensively without the hassle of grocery shopping, cooking, or clean-up. Neighborhood corners are occupied by “convenience stores” that stock soda, snacks, hot dogs, and beer. Our lives have become so chaotic with busy work schedules, children who are involved in countless activities, etc that the “my way, right away” options that are now available to us are so attractive. We are now surrounded by fast food restaurants and nightmare restaurants like Chilis and On the Border where calories and dangerously processed foods are the norm and nutrition is sacrificed. Healthy, nutritious food is admittedly more expensive and takes effort to prepare. Food costs have spiraled out of control, mostly because we have abandoned our own agriculture in favor of cheaper imported food products. This makes the good food of the earth grown in this country much more expensive and unfortunately, completely unrealistic for our country. Obesity is the consequence of that. Incomes are shrinking, gym memberships are expensive and civic programs emphasizing fitness and exercise have been slashed due to constrained budgets. Obesity is the consequence of that.

    As a physician, I am fortunate that I can provide my own example of the dangers of that type of lifestyle and the benefits of a healthier lifestyle. When I graduated college, I was in the habit of working out 5 days a week and eating relatively healthy because I lived with fitness competitors. I weighed 175 pounds when I graduated college. Upon graduation, I first worked a 60 hour a week job that often had me working late into the evenings. I ate what was easy and convenient, and because I was paid very little, I also ate what was cheap. That food was garbage, even though it tasted good to me! By the time I enrolled in medical school a year later, I had already gained 15 pounds and had not worked out once in that year. Once in medical school, the time spent in class, in anatomy lab and studying for exams left little time to cook and the habit I started the year before continued. I at least managed to get to the gym 4 days a week during those first 2 years, and only gained 10 pounds. From 3rd year of medical school until I graduated from an extremely challenging 3 year residency, I gained another 30 pounds and exercised about once for each pound I gained. 4 months into my practice which included hospital and ICU care, I had decided for myself that I had resuscitated enough obese, metabolic wrecks that I could see myself in them. I finally decided to change.

    It started with diet, curtailing my caloric intake and staying below a threshold of calories. As a young male, this was an easy way for me to lose weight. I lost 40 pounds in 4 months, and never regained the weight because I had finally enstilled the habit of discipline with eating and have been able to carry that forward. It was difficult. I spent a lot of my time hungry, admittedly. But despite the weight loss, I still felt very stale. I had little to no energy to get through my busy days. I relied on caffeine from diet sodas to get through. My fasting blood glucose was elevated at 95 and my total and LDL cholesterol levels were frighteningly high.

    I was blessed to grow up with Chris Spealler. We have known each other since I was 4 years old. He was a groomsman in my wedding. I knew of his exploits with CrossFit and saw how he became the most famous person I know. Finally a patient came into my office with a neck injury from doing pullups at our local CrossFit box, which I did not know existed until she came in. I signed up that day, 9 months ago, and have never looked back. I have lost 10 additional pounds. My glucose has normalized and I have lowered my cholesterol by 50 points, all thanks to 3-4 days a week in the box. I am now able to serve as a real life example for my patients of how fitness and nutrition can change lives.

    The challenge still remains for the physician as to how to motivate their patients to live the same type of healthy lifestyle. I try to be as specific as possible when making recommendations for exercise. Today, I suggested Yoga for a patient who had some chronic lower back pain and would benefit from the meditation and breathing exercises. Metabolism naturally slows as a normal process of aging because our body naturally slowly changes its composition from predominantly lean to one with more adipose tissue which is metabolically less active. Adipose tissue also has hormonal influences which only make the problem worse. As we age, our body composition ultimately dictates that meaningful weight loss cannot happen with diet alone. I have dozens of middle-aged men and women who fall into this group. They come to see me incredibly frustrated that “they dont eat anything” (never true) but they cannot lose weight. Exercise that results in changing of body composition back to one with more lean muscle mass in combination with diet will lead to weight loss and often leads to resolution of many metabolic medical problems.

    We all know this.

    Ultimately though, the responsibility lies with the individual patient and only them. They have to open the door to the gym, or the yoga studio, or their CrossFit box. I cannot hold their hand and lead them in. Physicians can encourage and implore patients to make lifestyle changes, but the responsibility lies with the person being told they need to change. I think the best service a physician can provide their patient is to try and uniquely motivate each individual. If I had to model a practice in a way that best optimizes the role of fitness and nutrition, it would be modeled after the Cooper Clinic in Dallas where fitness is an integral part of each doctor’s visit. Unfortunately, that model is usually reserved for the privileged and obesity is a disease which disproportionately afflicts the underprivileged. Our focus should be to make this model the norm in medicine and available to all. Unfortunately, we will have to undergo a huge change in culture to make this happen. Even medicine has fallen victim to the “Culture of Easy” with proliferation of urgent care clinics and fewer and fewer family physicians available to care for the population.

    The best answer is the one which is the most difficult. This is probably why there are so many people spending millions of dollars trying to identify the “magic bullet” that will cure obesity with a once-a-day dose. If that day were to ever come, which it wont, you can all rest assured that the pharmaceutical company will charge patients a hefty premium to try it out. And it will also cause Nausea, dizziness, delayed backache (what is that?), Fever, AIDS, blindness, obesity and sudden and unexplained death.

    Of course, none of this is intended to be medical advice, and you should consult your physician to be sure that you are healthy enough for diet and exercise.

    Hug somebody today. You may change their life.

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  • Noelani

    Great post, Julie. As a physician and a crossfitter, I agree with your sentiments. I am passionate about fitness, diet, and health and I try to convey that to my patients, but they don’t seem interested in the answers to their problems. I wish that I could write “Diet and Exercise” on their prescription and have them follow my advice daily. If we had a pill that patients could take once a day that accomplished the same results- my patients would be compliant. I can tell them that I have the answer to their problem- I have the solution to many of their health problems – but they don’t seem to follow my advice! It’s frustrating.

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  • Tony

    Truly amazing post, it was sent to me by a friend and fellow CrossFitter as she knows I practice with the exact same philosophy (the good side)! Thank you for this.

    You would really find the study of “epigenetics” interesting, if you haven’t already come across it. Search for Dr. Bruce Lipton, used to teach biology at Stanford and Wisconsin med schools before pioneering research in epigenetics. Basically what we are taught in our standard curriculums is ancient and outdated… DNA does not control our health… environment controls our DNA first.

    We simply need to eat well, move well, think well… and physicians should be the leaders of that! You will have tremendous success in medicine because the most important thing a teacher (doctor) can do is role model.

    Thanks again for this, loved it!

  • Lloyd

    great read, very interesting!

  • Dr. Erika

    Julie, I applaud you for choosing medicine as a profession. I also appreciate that with your entry into medicine that you are so quickly utlizing your passion as a CrossFit athlete to improve the well-being of others. It is important that we in medicine all work together to increase public awareness that for the majority of those who suffer from obesity that there is a solution right in front of them….HEALTHY DIET and EXERCISE!

    I am a physician, an Interventional Radiologist, in practice since 2000. I treat patients everyday with minimally invasive, image-guided techniques who are self-made victims of their bad habits, namely smoking, bad diet, and lack of activity. As a crossfitter, I make a point of being a good example to my patients and staff. I encourage all to make better choices and live healthier. I tell them to cut out sugar and move their bodies. I demonstrate air squats, sit-ups and push-ups to get people started.

    Way back in 1992, as part of my Master’s thesis in Kinesiology at UCLA, I published an article in the American Journal of Cardiology titled “The role of diet and exercise in the management of hyperinsulinemia and associated atherosclerotic risk factors”. (Volume 69, Issue 5, 15 February 1992, 440-444). My point in bringing this up is that hyperinsulinemia and its effect on obesity is not something we have just learned. Neither is the impact of diet and exercise on reducing obesity and its associated ill effects. Unfortunately, over the course of the many years since the publication of this article and many like it, there has been a very slow acceptance of this information by the general public. Part of the problem is that physicians unfortunately in their training generally do not receive adequate education as to what is a good diet, what is exercise, and how to educate their patients on how to live a healthy lifestyle. The other part of the problem is that many obese patients have an underlying unwillingness to accept that they are the root cause of their own illness, and that they will have to put some effort into making themselves healthy.

    So Julie, keep up what you are doing in medicine as well as CrossFit! We obviously have a ways to go, and we need more people like yourself to get people to be healthy. May we all who practice medicine and CrossFit go forth in continuing to spread the gospel of the benefits of exercise and eating right.

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  • http://digitalmustardkaren.blogspot.com/ Karen

    Great Read!!

  • http://www.facebook.com/cheryl.boatman Cheryl Boatman

    This is such a great article and great comments!

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  • YouAreNotAFitPerson

    Reblogged this on Markvaughan2009's Blog and commented:
    Julie Foucher TOTALLY Gets it! Read this entry from her and it should be clear to you as well. There is a HUGE gap for all of us.
    What does ‘Exercise and Eat Well’ mean to you? Not in general terms either, but in exact terms? If you can’t answer this question you are not alone. The problem isn’t the advice, ‘eat well and exercise’, the problem is knowing what eating well is, and what exercise is, and then having a blueprint to fit them into your life! You would be shocked at how few people actually know what eating well is and what exercise is. If you answer to the latter is ‘gym 3x a week’, you are probably wrong.
    I love Crossfit. If you can stick it out, it is the best workout on earth. There is nothing that can match it, but you have to be ready to work hard. I had to start down the road to fitness myself first before I would have ever been ready for Crossfit.
    It is remarkable how many diets and fitness regimes give you bizarre prescriptions for food to eat or give you a specific gym workout. These are terrible ways to get fit. Pick up ‘You Are Not A Fit Person’ or get the Couch 2 5K program and get started. Running 5k in 30 minutes is the base standard of fitness. If you are considerably overweight, have had injuries or are older, consider a walking program first. As always check with your doctor before taking up a program, and get his or her advice as to what you fitness level is.

  • GM

    The disconnect you try to define is actually defined by the general population’s lack of brain power to think for themselves. In this google age it is not very hard to find crossfit or paleo or perfect health diet or ray peat or organic farm delivery websites, the list goes on. In fact it is easier than ever (think about how hard it would have been in 1979). So the fact is there is absolutely NO disconnect here. The #1 law in markets is supply and demand. The modern american wants pharmaceuticals, to not cook at home 20 meals per week, to not clean up, and to have that magic pill. Why would modern medicine waste its time with detailed exercise programs that can easilly be found googling skilled practicioners or following them on fb to guage what the practicioners M.O. is when thats not what millions of americans want? The demand is not there! Building supply when demand is not there is a surefire way to fail. Modern americans want magic pills. The demand is dictating the behavior of the supply market as it always will. If everyone was like me and my family or some of the practicioners i work with, big pharma would be bankrupt. But theyre not and big pharma is a multi billion dollar market. So the real question is why are modern americans so disconnected with themselves and with nature?

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  • http://www.runwiththebiggirls.com Julie Shreve

    Definitely going to pass this on. Great post.

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  • Tim Flanagan

    Julie,

    Great article. I think the biggest reason that doctors try to find “a pill for every ill,” is due to the unfortunate issue that our medical industry is heavily funded and controlled by pharmaceutical companies. And the problem is that you can’t force anyone to exercise. I’m a firm believer that the only way to solve the obesity issue is a fundamental in the way we view health and fitness as a society. Programs like CrossFit need to be put into schools. The competitive nature of it is great for kids! I’m a huge supporter of Steve’s Club and think that’s a start, but we have a long way to go! Thanks for writing this!

  • http://twitter.com/neeltank Neel Tank (@neeltank)

    Great Blog Julie. I stumbled upon it randomly while browsing through some crossfit websites. I’ve been crossfitting for 6 months now and am starting medical school in the fall so I’m hoping I’ll be able to handle both like you did. Keep up the great posts!

  • http://Matthewcrouchmd.bloodspot.com Matthew Crouch

    Julie, I’m a child psychiatrist and fellow crossfitter. I had the same experience in medical school and felt woefully underprepared for the real patients I would encounter in my practice with obesity. Through my participation in crossfit and exposure to subject matter experts like Loren Cordain, Barry Sears and Gary Taubes, I’ve learned a lot more practical advice than I ever did in med school. I’ve also leaned that the doctor sitting down with the patient and making a dietary prescription works a lot better than anything. You will have an amazing power to change peoples lives for the better. A simple instruction such as “don’t drink any calories”, “change your breakfast to primarily protein” has led to significant weight loss in children I see. In your spare time you may want to check out Kenneth Bock’s book: Healing the new childhood epidemics. It contains a great deal of overlapping evidence for gluten free, dairy free, whole foods diet and relates these to autistic disorders, ADHD, asthma, and allergies. Whatever specialty you enter you will soon realize that everything comes back to the foods people are eating and the behaviors they exhibit. Also, let me give a little plug to child psychiatry- it’s really fun and rewarding, and I never anticipated I would be interested in it when I was at your point on school. Good luck!

  • Dave

    I just came across this blog, Julie, and I think it’s fantastic. I’m fairly new to the CrossFit world and love it. In working with a nutritional company and couldn’t agree more with the importance of diet and exercise. Looking through this thread, however, I haven’t seen any mention of the third component that I believe is critical in health maintenance and disease prevention, namely, pharmaceutical grade vitamin supplementation (I have not read every post, so I could have missed it).

    Diet alone will not provide the spectrum of antioxidants and the various nutrients needed to maintain optimal health. It is simply unrealistic to get the necessary vitamins through our food. JAMA (and other publications) have stated recently that it is necessary to supplement our diets with vitamins. I won’t list the top ten nutritionals out there, but it’s important to find pharmaceutical grade vitamins from manufacturers who follow Good Manufacturing Practices (GMPs). Don’t under-estimate the importance of these two criteria. The standard multi-vitamin off the shelf is for the most part ineffective with no gaurantee that what is on the label is actually in the vitamin. Of the top supplements, I only know of one that offers a one million dollar athlete guarantee for purity, potency and completeness. I’ll stop here as far as how to determine the good from the bad, but don’t under-estimate the importance of this process. The one that receives the highest rating by independent research that compares over 1600 multi-vitamins is found in the Physicians Desk Reference (PDR). I won’t give the name here since i’m not sure if I should.

    I know a number of medical doctors who after ten or fifteen years in their clinical practice came across the medical literature that emphasizes nutritional medicince and cellular nutrition. It changed their practice and opened a door to help people combat disease and prevent disease… which is the reason they became doctors in the first place. I’m basing these statements off their comments since I’m not a doctor. They claim doctors are trained to diagnose and treat disease and are not really trained that much, if at all, to prevent disease. These particular doctors also say that medical literature shows that most of the diseases plaguing our society and killing us are preventable.

    According to the literature, Oxidative Stress (excessive amounts of free radicals) is the root cause of diseases like heart disease, cancer, stroke, diabetes, alzheimer’s, parkinson’s, lupus, MS, fibromyalgia, and many more. Hereditary genes, stress, environment, toxins, exercise, etc all contribute to the free radicals that cause oxidative stress. The best way to combat the oxidative stress is to feed the cells the right balance and amounts of antioxidants. The most effective way to do this is with the best vitamin supplements in addition to a good diet and exercise. Diet alone will not provide this in our world today.

    I hope and pray that more doctors will add this third critical component to diet and exercise. It’s a powerful triad.

  • http://www.cf304.com Sharon Moskowitz

    Julie, Congrats on your tremendous success in Columbus! Watching you there provided such great inspiriation and ideas to bring back to my box. Your blog is refreshingly honest and right in line with so many “crazy and often nonsensical ideas that float around in my head” throughout my days as a police officer and CFer.

    I’m sure you’re quickly back to studying after missing a week, but I wanted to send encouraging thoughts and words your way as you study for school and prep for the games. How exciting!

    Best,
    Sharon
    (West Virginia – CF 304)

  • Michael

    I struggled with my weight for over 10 years. I’m 5ft 7 and my weight peaked at 260 pounds. Doctors had no idea what to do with me. They prescribed me various drugs, put me on ALLI fat loss pills and all sorts. I was told to do more exercise and to eat better portions of food, more potatoes and vegetables etc.

    Of course I had no idea what I was doing. As Julie says, you’re left to find the information yourself. And it’s impossible. 10 professionals will offer you 10 different solutions, and we’ve not even touched on the snake oil salesmen who offer products they know won’t work.

    So you try and find advice from somewhere because the doctors you speak to have nothing beyond ‘try harder’, Then they suggest if you were to add just a little more weight you’d be able to get a gastric bypass on the NHS (I’m in the UK). So one doctor almost encouraged me to put on more weight!

    I was lucky, I found Mark Sisson, turned Paleo and then found Crossfit about a year later. I don’t know how much I weigh as I threw the scales out some time ago but it’s probably around 170 pounds but more importantly I hit a PB snatch today of 80 kilos!

    My life is great now, no worries about what I eat, no breathlessness walking up stairs, my only stress comes from watching the guys at the Crossfit regionals and wondering how on earth someone can be that superhuman :)

    In all seriousness, if my doctor had prescribed me Crossfit or anything similar I would not have wasted 10 years of my life.

    But here’s the problem. The reason why doctors (in the UK at least) can’t give advice on this? Because they have no idea what they are talking about. I recently had a check up for insurance and was told I am unhealthy and need to change my diet and do more exercise. Apparently my BMI is too high and I’m obese (I have a six pack, alright, a four pack but I’m on the internet, no one will know!)

    Apparently bacon is bad for you so is eating red meat 4 times a week and where is all my fiber if I don’t eat potatoes? And the heavy lifting is doing my back no good at all.

    This is the same Doctor that told me to take fat loss pills!

    I laugh now but it’s scary. People supposed to be looking after us and offering health advice don’t have the basics of either nutrition or exercise. Sure they don’t need to be olympic lifting instructors but surely advising people to do a little functional fitness can’t be that difficult?

    If you ask me medicine today is not about helping people find the best solution for their problem but about getting finding quickfire solutions that are easy to administer. Not feeling well? Here’s some Aspirin. Muscle strain? Here, take some NSAIDs. Whatever happened to spending time with a patient and figuring out the root cause of the problem?

    My son had Asthma, not severe but the doctor put him on a Ventolin. Almost the moment we started him on his ‘dinosaur’ diet :) he stopped needing the Ventolin. We fed him dried fruit as sweet snacks and took away all the sugar and candy etc, and he’s fit as a fiddle now (touch wood). As no point did the doctor ask what his diet was or anything about his lifestyle. He simply said he had asthma and medicated for it.

    I really wish there were more doctors that had the knowledge and perhaps time to tackle the issues that need addressing but alas I’m not sure it’s possible in today’s world of medicine. Either doctors don’t have the time or patience or they know as little about nutrition and exercise as the obese patient.

  • http://twitter.com/2FitToQuit Rach Hartges (@2FitToQuit)

    Julie,

    Great job at CF Central East Regionals! You are an inspiration. Be sure to check out the Exercise is Medicine initiative to bridge the gap between fitness professionals and Health Care Providers. http://exerciseismedicine.org/

    In Health,

    Rach Hartges

  • Gabriel Huidor

    Julie, I just have to tell you that you are my role model. I mean you are a world class athlete and SUPER smart. Every time I feel like giving up, I ask my self, what would Julie do? Well the obvious answer is keep pushing and that is what I do. You are a huge insperation to me and have inspired me to start crossfit along side my basketball activities. Thanks for everything.

  • Megan

    Julie, love this post! I have been on the sickness to wellness continuum myself, and have found myself right at that gaping hole leading to fitness. I joined a gym, found I hadn’t the slightest idea what to do there (elliptical? how long? how often? and why are so many fat people doing hours on those and not changing?). I started training with a personal trainer about a month and a half ago, and it has made a real world of difference in how I feel. I think if I had tried to go it alone, I would have ended up frustrated and thrown in the towel, as I have before…

    You are an inspiration, indeed!

  • Bob

    Related Article:
    Lack of exercise kills roughly as many as smoking, study says
    http://latimesblogs.latimes.com/world_now/2012/07/lack-of-exercise-kills-roughly-as-many-as-smoking-study-says.html

    Keep posting! Love the insight, Julie.

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  • Esther

    Amazing post and great perspective!

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  • gina

    This is fantastic. I am a nurse anesthetic and obesity makes me SO angry! It complicates my job on a daily basis, not just putting patients to sleep for gastric bypasses but for simple procedures like colonscopy, cholecystectomy, and appendectomy. People make excuses ALL the time for their weight. We do not make excuses to not brush our teeth or change our underwear…why do we keep making excuses for exercise (and proper diet)? Patients do not have to do crossfit but find a love (tennis, swimming, yoga, running, hiking, weight lifting etc) and stick with it. Only 30 days…and you can change your life forever!