Does Being 'Too Healthy' Cause Health Problems?

This year I've hit some awesome highs with health and wellness, feeling what it's like to operate close to (or perhaps at?) optimal, and it rocks.

But not so quick.

Can't get cocky about it. 

Recently I had some hiccups in the progress, and a lot of time for more self-introspection, which also made me think more deeply about what I'll talk about in this post.

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First, the latest with me.

I'm still on this rollercoaster solving gastrointestinal (GI) disorders and building a healthy gut that was pretty wrecked. This is something I've mentioned but not written about in as much detail yet. In brief: I've diagnosed and successfully killed off (some) candida, an H. Pylori infection, etc, and generally I am not walking around like a bloated gassy balloon wretched in lower abdominal pain on the daily. It's not all done though. We are working on the rest including testing more specifically for Small Intestinal Bacterial Overgrowth (SIBO), and more investigation regarding the candida, which is a fungal infection, and whether its worked its way deeper into my tissues--we think this based on some symptoms. Furthermore we'll be entering the rebuilding phase to create a strong, robust GI tract. Meanwhile, additional diet tweaks and the right kind of eating for my situation have been integral to relief and recovery. However, ironically, often certain diet tweaks aren't optimal for hormonal health (for example, intermittent fasting = good for the GI tract, bad for hormonal status). It's quite the paradox.

Speaking of hormones. Starting in 2014, during my quest to regain health, I earned back a regular period and stellar hormonal status that I maintained even through marathon training, a BQ, and after. I regained this all naturally with damn hard work, a lot of love and TLC and holistic-style supplementation--coming off years of depletion, amenorrhea and poor interventions such as ongoing bouts with birth control before wising up and using the functional model.

But after so much progress my period packed up and left after this August. I know why. Looking back there was a shift. Not just the GI issues and diet, although, that was related. I allowed more stress back in my life, increased the training, and overall was not managing myself as well--getting too cocky that I was bulletproof--and slipping back to old ways like operating too much in a sympathetic state (aka flight or fight mode).

Had a "self-intervention," chilled out, (oh and got the flu = forced recovery) and, guess what, this December my period came back. All it took was some rest, recovery, and diet-wise increasing variety of carbs and even more nourishing fats. Carbs: things like white rice, long-fermented sourdough, and GF oatmeal. Fats: daily bone broth, and more of everything else.

But let me stop right there, save the back report for another post, and instead get to the point of this one:

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Why does someone who's so healthy have health problems?  

Of the many health experts and professionals out there, especially those in the functional health space, you'll see that a vast number of them became experts after and/or while having their own health problems and solving them (or perhaps still working on them). These folks probably had an natural attraction to health to begin with, and their problems were either 1) their own fault, 2) out of their control, or 3) both. In the process of learning, educating themselves, playing detective, fixing issues (instead of treating symptoms), and getting real results, these folks realized what it's like to actually feel great.

Many of us run around thinking we feel great, but in reality we're operating sub-optimally--our definition of "great" is very skewed. We could be better. The health experts realized this in their own journeys and have dedicated their life to helping others feel great.

Tim Noakes for example. Mark Sisson. Or functional health practitioner Brie Wieselman, with whom I recently started collaborating--she too struggled with health which you can read about here. Or Dr. Michael Ruscio (my new man crush) who contracted an amoeba--as did Chris Kresser--both these guys fixed themselves with the functional approach. And there's Chris Kelly, Jimmy Moore, the list goes on. Sometimes the professional is already a well-respected expert but is still on the path to healing and solving his/her own issues such as Stephanie Ruper of the Paleo Women podcast who says she was amenorrheic for four years while writing her book, "Sexy By Nature." Stephanie had already established herself as a leading lady for women's health in the Paleosphere, giving women's health advice on her website, etc. She fixed herself using probably a lot of the same tools she learned and recommends to others. Does it matter that she was still partially broken while working as an expert on this stuff? Not in the least, probably made her a better expert i'd argue.

Bottom line, all these folks operate in the health space after having crashed themselves for whatever reason and so they really understand healing from the bottom up. Most importantly they know that healthy living--the way some would consider extreme--is key to feeling great and avoiding setbacks. If you know what it's like to have a disorder-ridden, dysfunctioning, shitty-feeling body and mind, you don't want a setback...

I am no different than this.

I was operating sub-optimally for years--actually doing quite well in that state, all things considered. Why was I sub-optimal? Certainly a lot of it was my own fault. From an eating disorder, to triathlon madness, to generally just carrying a lot of stress, I'm sure I created a good chunk of my health issues. I recognized it. I owned it. If you've been following me and this blog for a period of time you know that my dedication to health now is to overcome the "damage" done in my teens and 20s. I also won't rule out potential genetic components as well. Nature, nurture; it is what it is. I can't wake up with a clean slate and start over. That's ok! I accept that my hormones are sensitive and it's on me to promote an environment in which I can thrive--not only me but for my future family.

Speaking to what it's like to go from sub-optimal to optimal: my GI disorders for example. For nearly 10 years I was running around with these gut issues not understanding fully that they were severe problems and could be fixed! I can't even tell you how many times I've been plagued with embarrassing, painful gas; bloating to the point where I seriously wondered if I might be pregnant; and poop issues. Not to mention how the gut issues affected my mind. They often made me feel fat--when I wasn't at all--and irritable to the point of straight up bitchiness. I just thought all this was normal. Boy, was I wrong. You get some relief and you're, like "Holy shit! This is awesome! I want to feel like this always." And while it may seem like I'm still having all these problems, the reality is that it's just a long road to recovery given the long history, complete with hiccups and setbacks along the way. But the healthier and more in-tune I have become, the more I understand, the better I get, and the greater I feel. Why would I want anything else?

And don't get me wrong, I don't have unrealistic expectations that I need to feel the best ever every day for the rest of my life, eat perfectly every single day, or freak out if something is off. Nor am I turning this into another type of unhealthy obsession over achieving some level of unrealistic health. It's actually pure intentions for once. No eating disorder, no mental hangups--just the desire to learn and implement what that takes to feel great then turn it into a story and an education for others on how to do the same! Yup, part of the current journey is the growing passion toward this field of functional health and wellness. I the past couple years I've empowered myself with knowledge on how to heal from the inside out, who knows you may see a new angle for my career and scope of practice budding.

Bottom line: Being healthy is a no-brainer when you consider the alternative--feeling like shit. 

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Does being too healthy cause health problems? 

Ohhh this is a good question.

Inherently, no. But hell yes, it can!

If the person's definition of health is skewed and not doing him or her any good, this could worsen and/or create problems, i.e. a vegan who's severely deficient in key nutrients and dysfunctioning; the obsessed runner who's scary thin and battling stress fractures left and right; the endurance athlete who goes too low carb while also doing crossfit style workouts on the side and HPA axis crashes. "But, vegan is clean!" "But, exercise is healthy." No, not in this context.

Or, too healthy can cause health problems if during the quest to be healthy one gets overly neurotic about every. little. thing. The stress state one can create over this quest for health is undeniably counterproductive and could worsen, prolong or create health problems--even the cleanest diet won't fix a person who's freaking out over every morsel of food, every germ, every sensation, every decision. When the quest to be healthy destroys your relationships and social life, when it keeps you up at night in worry, when you panic over food, anxiety over your condition(s); when you stop having fun, when you stop smiling, when there's no act of "playing" in your life, etc.... Dr. Ruscico talks about this a lot in how he treats patients--we need to care about health but not go off the deep end, so to speak. And I talked about this in my anorexia vs orthorexia post--i.e. healthy eating is good until it goes too far becoming a sick obsession. I've been down that road. Over it... I'm sure even the health experts have to watch themselves and not get trapped in a bubble of trying to be perfect, and thankfully I hear more of this being discussed in podcasts and written about in articles--living a life balance, seeking happiness, and having a healthy mindset is just as important if not more than what your blood test or whatever test results show!!!

So then you implement healthy practices to avoid health problems:

Part of my journey to optimal health and healing is learning to not be neurotic about things---because I know I can be that person looking at my history :). I still have to work at managing my stress, my tendencies to want to over-obsess and get neurotic, and I have to work to consciously turning on the parasympathetic (aka rest and digest mode) more often so it becomes habit and feels normal. I have to work at being present and mindful. I've taught myself to not look at my life as being too busy; I've let go of relentless and mindless multitasking; I've worked on just being lazy and doing little things that simply make me happy and smile. This often requires another level of self-discipline, for example avoiding overtraining even though all I wanna do is just run run run, going on that walk when I know its needed. Or avoiding letting a jam-packed schedule, traffic, long lines, etc, send me off into a state of anxiety and panic. Just stop and smell the flowers, really! See how it feels. Scary at first, and then scary good...

Achieving this mindset requires, of all things, another level of self-awareness. Meaning you have to know what it feels like when you're in an elevated sympathetic (stress) state vs. a more mellow parasympathetic (chill made) state. HRV is good for this. Many of us think we're chill but really, we're not--we're stressed. When we measure HRV we may be in for a shocker. Reality hits. I've heard Dave Asprey discuss this and I've even seen my fiance go through the process. "Whoa, I thought I was fine but the numbers clearly say otherwise." All it takes is a little tool like HRV to recognize the difference. But then you have to do something about it! Understand the feelings and what real stress feels like, and make changes as needed, if needed.

And at the end of the day if you don't want to be all biohacker about it, just know that you need to keep it real and loosen up. Your quest to be healthy doesn't have to be all uptight. And if you derail from healthy norms for a day or even a week it's ok! Just get back on track no drama.

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Can you create food intolerances?

This is another one I hear a lot. Let's assume someone gets the bug up their butt to adopt a healthier diet and lifestyle, and let's assume this person is pretty healthy to begin with--no history like mine or the others mentioned. Say they give up gluten, dairy, sugar, grains and whatnot to adopt more of a paleo-ish clean diet. Not low carb or high carb per se, just a clean diet. Will this person cause food sensitivities and/or intolerances by eating more healthy? For example, if they give up gluten and dairy then go back to eating those things will they suffer the consequences?

I do think that clean eating and healthy living does make you more sensitive to the lower quality food and drinks for a couple reasons:

1) You become more intuitive and realize how quality food and healthy living actually makes you feel awesome!!! Even if you're not necessarily intolerant, clean eating makes you feel superhuman.

2) Or maybe you were intolerant and didn't realize it until you quit the trigger foods and drinks. You were operating at a 5, now you're feeling like a 10. Our food today--gluten, dairy, sugar and whatnot--is not what it once was and it often makes us ill, have allergies, etc. So you go off it, you get healthier. Then you slip up and go back to old ways for days in a row and find yourself wheezing, bloated and with brain fog. Well, this basically is showing you had detoxed from the "poison" and going back on it triggered those same sensitives you once thought were normal. Then the light bulb goes on. You were always intolerant, just never realized it. It doesn't mean you can't occasionally "cheat"--it's usually a dose thing. Just know your limit. Barring a full-on disease like celiac or nut allergy, a little moderation is fine.

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Can healthful intentions backfire on health and hormones?

This is a rabbit hole. In fact, very soon I will be recording a podcast on the dangers of low-carb/keto eating for athletes and women, as well as things like falling victim to the female athlete triad (males included), because it's important to address: yes you can screw shit up with the wrong approach to diet and exercise. It's actually really easy to do. Too easy. Don't do it. We'll save this talk for another day.

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Bottom Line

We all have our shit.

Generally, it seems like the health experts/pros--at least the ones I follow--are much more willing to openly talk about and discuss their issues, and what they've learned, in hopes they can help, inspire, and educate others on building better health and optimal living. Power to the folks who are brave enough to open up and empower us to be proactive. Even more power to them when they admit mistakes, sensitive stuff, and such. You all inspire me to do the same.... It's always going to be an ongoing quest, the best we can do is share information and foster a supportive environment.

Just remember: Have that set of checks and balances in place to avoid letting healthy intentions backfire.

Till next time....

Recommitting to Balance

I subscribe to Chris Kresser's email newsletter which says a lot about what I think of him and what he has to say because a) I disdain unnecessary emails, b) email subscriptions and most newsletters are generally just crap or sales pitches, c) I have enough other emails coming in daily that warrant my attention, d) it took me forever to unsubscribe from all the stuff I got signed up for (unwillingly) over the years from entering races and whatnot; these days I have that shit well-managed and I want to keep it that way. I refuse to spend an hour a week just deleting junk.

But Chris is one of a few who I'll let in. And below is a good example of why. I've copied and pasted his recent newsletter into this post, and what he said here is exactly what I was mentioning about slipping up recently with some of my stuff (stress). It's good to see that other experts do the same thing and are mature enough to call themselves out in a public manner like he did, especially when he's the one teaching people to avoid the very things he caught himself doing. All class.

For me, in addition to slowly but unintentionally allowing a bit more stressful living back in my life and that go-go-go attitude, I also recently realized I have been slipping up with my approach to training. I am getting way too addicted to exercise/training/racing again in an unhealthy way. Even though my intensity of exercise has drastically improved and I'm not faking it by secretly working out really hard (promise!), I still am mentally and physically obsessed to my workouts and losing sight of what is best for me. Not just for me but for John, our future, etc. Furthermore, I am losing sight of the very clear-cut goals John and I set together, as a team, for the events we have planned together. Our goals? Well, let's put it this way, we're not trying to get on any podiums. We just want to have fun, be adventurous, keep it loose and maintain balance. Maybe that's an oxymoron--ultra training and balance--or maybe not? Maybe we're on to something?

It's time to set some boundaries and get back to balance. I can dish that to my athletes and on the podcast, but I have to be honest, when it comes to my own self, it's easier said than done. When it comes to training and having a race/event on tap I tend to be an "all or nothing person." Shocking, I know. It's like an alcoholic who either has no beers or all the beers--there's no in between. For me, it's usually that I either train for a race with an absurd amount of focus, or I don't--I haven't mastered the in between. I got close with the marathon this year.

It's good to be committed, disciplined and focused, but that can go too far in my opinion, especially if you're a Type A'er like me who easily gets obsessed. A guy like David Goggins might disagree with me and say "go that extra distance" and that we all should find a way to go the extra mile(s), get uncomfortable, push the extremes, and be an "I can" not an "I can't" person. I get that, and I agree we need to get uncomfortable and not feed ourselves the "I can't" bullshit. David may be that guy who works out at any given opportunity putting in immense hours and volume. He may push his body to set world records like doing 4,030 pullups in 24 hours. He has his reasons for his approach of going all in, every day, year-round. I can do that too, if I wanted, but is that what I need? No. Individualization, folks. I can still get uncomfortable--in a healthy way--with my approach, and I plan to do that.

Now it'll be: Can I find that ability to casually train and not go overboard? Like Chris says below, it's just a matter of recommitting to the principles you value....

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"Hi everyone,

When most of us think of addiction, we typically think of substances like alcohol, heroin, or tobacco.

But a more inclusive definition of addition, according to author Tony Schwartz, is 'the relentless pull to a substance or an activity that becomes so compulsive it ultimately interferes with everyday life.'

If we use this definition, it’s fair to say that nearly all of us are addicted to the Internet.

I’m no exception. In fact, when I became aware several years ago of how my compulsive behavior around the internet was affecting my productivity, health, and relationships, I set up some practices that would limit my exposure. I discussed these in two podcasts here and here.

These strategies included turning off notifications on my phone and mobile devices, only checking email 2-3 times a day, and focusing on my most important daily tasks before engaging with email/social media/meetings. Overall they've worked well and I've been able to stay on track and minimize distraction.

But over the last few months, I’ve started slipping. I’ve been checking email regularly throughout the day, looking at social media accounts more regularly, pulling my phone out of my pocket way more often, and spending a lot more time randomly browsing the web.

All of this started during the launch of my new clinician training program. I told myself that I had to be more connected during this time, so I could be available for any pressing issues that came up. While there may have been some truth to that, I think the Internet addict in me was also looking for any excuse to take over the reins.

Since I’ve fallen off the wagon, so to speak, I’ve noticed a decline in my overall health and well-being, and a definite drop in productivity. I’ve also found it more difficult to focus on the research and writing that is so important to my work.

But the worst part—and the effect that makes me feel more upset than anything else—is how these changes have affected the time I spend with my 4-year old daughter, Sylvie.

I’ve always been the person that cringes when I see a Mom or Dad pushing their kid on the swings and obsessively checking their phone the entire time. I haven’t gone that far, but I do notice that I’m looking at my phone a lot more than I ever did before when I’m with Sylvie, and I see how negatively this impacts the quality of my connection with her during these interactions.

One of the hardest parts of dealing with Internet addiction is that, unlike booze, drugs, or gambling, it's socially acceptable—and in some ways, even encouraged.

In fact, it seems like every day a new technology is introduced that promises to make us “more connected”: we can now check our email, social media, and the web at any time, from any place.

But is this really a good thing? It seems to me that the net effect of these technologies has been less connection, not more. Instead of simply being present in each moment and feeling connected with the people around us, our attention is increasingly elsewhere.

I worry about the effects of this. It’s yet another way that our modern lifestyle differs dramatically from the environment we evolved in, but it’s one that is rarely discussed or addressed.

With this in mind, I am recommitting to the principles I discussed in the two podcasts above. More specifically, I’m going to limit checking email and social media to 3 times a day, and avoid using my phone at all when I have dedicated play time with Sylvie.

If this is also an issue for you, what can you commit to? What steps will you take? Let me know on my Facebook page."

On MAF Tests, Preparation and Progress

It was time for me to do another MAF Test. I hadn't done one since the beginning of the year, and even though it's a straight forward format (warmup; 3-7 miles at strict MAF; cooldown) every time you learn a bunch, not just about splits and HR. After this last round, I'm making it a monthly thing. Because, why not? It's good data collection, an MAF Tests are obviously not aggressively intense like an LT/FTP test, either, so this kind of frequency is ok. Personally I got an really good lesson on the importance of preparation and some--take note for your own tests.

So, in this post, I'll use my own data and experiences, complete with fresh input from Dr. Phil Maffetone, to give insight on how to:

- avoid mistakes before your test begins;
- use a MAF test to assess progress (or lack thereof);
- further develop the ability to be an intuitive athlete (whether coached or self-coached);
- use MAF results to structure/tweak training going forward;
- use these tests to avoid accumulating too much fatigue, overtraining or plateaus;
- correlate the tie in's with health, stress and lifestyle.

For a refresher on MAF Tests or if you're new to the concept click here. And to make sense of the heart rate (HR) info I discuss and why 150 is my number, click here.

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Lead-up Preparation

So let's start here. You can examine exactly what I did exercise-wise in the week leading up to MAF testing, starting 11/14/15. Note that when I was doing the 30k I wasn't even thinking about a MAF Test coming up in the near future.

Sa- 30k trail race
Su- IMAZ spectating/sherpa'ing
M- Off, rest, travel day
T- 60' weighted hike (mostly flat)
W- AM: 8 mile ez trail run (sub MAF); PM: 60' strength (functional + weights/KB circuit)
Th- Incredibly ez activity (aka day of movement). AM: 40' fasted spin on bike trainer; NOON: 15' non-wetsuit ocean swim/flop; PM: 40' easy walk no vest
F- 15' slow weights (inc. KB swings); 75' SUP- 1mi ez/1mi hard/1mi ez + "SUP farmer carry;" it counts ;)
Sa- MAF test, round 1
Su- MAF test, round 2, yes, you will see....

Food factor: Friday pre-test I felt fresh and like I could have done more, but I didn't. Then dinner happened. I got creative, making some grain-free pizzas, experimenting with a few "clean" crusts and topping combos. That's fine, but there was cheese. Quality cheese, and all variations that I've been ok with in the past, but cheese. Lots of it. I ate too much of it. Not wise for a gal who's essentially dairy-free and still in recovery from severe gut issues.

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MAF Test Round 1: Ugh

The next morning I felt the cheese effect. I woke up as usual about 5:45 but my gut was in knots. I went to the bathroom 3 times, not good news there. Damn dairy. I decided to wait it out a bit instead of starting the test right away. I had some breakfast and cold brew. Headed out around 9:30 en route to the track, and--in typical crazy SoCal style--it was a fall heat wave with dry, santa ana wind conditions.

I was not feeling well at all (and now I was slightly dehydrated from the bathroom situation), legs heavy, breakfast not fully digested. I thought, "maybe it was the weights and SUP this week; maybe it's still the 30k in the legs; maybe it's the f*$&ing dairy... maybe it's all that... maybe I should shut up and just try." I ended up prolonging the warmup to 40 minutes (!), which consisted of walking, sub-MAF jogging, and eventually settling into some MAF intervals on the track. It was hot by the time I started. I was trying not to chug my water, but I was thirsty--a red flag.

The Saturday test went like this:

Mile 1- 8:40
Mile 2- 8:53
Mile 3- 9:06
yup only 3 miles

Avg: 8:53

HR was wanting to be high-ish around mid-150s instead of steadier MAF ~150, and by mile 3 it was already creeping to 160 forcing me into a couple walk intervals. I'm sure the caffeine played into this.

I may not do a ton of MAF tests, but I've run MAF enough, and I knew this was not normal data for me at all. Body was dragging, and HR was wanting to be way too high for the pace/effort. Intuition clicking in...

During that third mile I could see the writing on the wall and decided to pull the plug because I had an idea brewing: Instead of forcing this shitty test, I would stop there, recover like a rockstar for the rest of the day, eat like a champ, and re-do the test the next morning. Since it's a MAF test, aka aerobic and moderate, doing a repeat test that soon is fine; I would not recommend the same for LT, FTP and VO2max tests though!!

Dr. Phil Maffetone agrees: "The back to back MAF Tests are OK. Normally, when healthy, you should be able to run at MAF regularly. Many people can train daily at MAF."

I was frustrated that I perhaps sabotaged the test, but I made my peace with it. I was actually motivated and fired up to give it another go and do better--I knew I had a better performance in me. The rest of Saturday I laid low, did a little cold therapy in the ocean, ate a "safe" dinner (no trigger foods), and got to bed early around 9.

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MAF Test Round 2: Not giving up so easy

Sunday I woke up without an alarm around 5:15. Lately I'm sleeping like a rock again, uninterrupted sleeping bliss almost every night. I woke up feeling ready to dominate. Preparation success this time.

For the second MAF test I opted to do it even earlier and fasted, no coffee nor breakfast before (not hungry), beat the heat. I had a glass of water with lemon juice; typical morning ritual. Had a good/normal poop (sorry, TMI, but yay) and got going. My fat-adaptation is great so I don't need food or caffeine in order to function, and my body is used to fasted workouts; however, I'm certainly not training fasted all the time, too risky.

I wore the same shoes, did the same warmup route, and got to the same place--the high school track--well before sunrise, at about 6am. This time it was cooler in the 60-70s, not 80-90F hot pounding sun. I wasn't feeling 100 percent fresh and springy, but I was certainly feeling better than Saturday. I needed less warmup, about 25-30 min of the same protocol: walk, sub-MAF jog, finishing at MAF for a couple laps. I like to make sure I get in just a bit at MAF before I start the test so my body easily slips into and stays that mode once the test starts.

The Sunday test went like this:

Mile 1- 8:16
Mile 2- 8:22
Mile 3- 8:36
Mile 4- 8:41
Mile 5- 8:44

Avg: 8:32

Overall avg HR was 152, and I was able to much better control it around 150. I don't have an alarm on my watch, and I also don't stare at my watch the whole time I run, so I know it bounces around a tiny bit, but generally it was on target for MAF (sometimes even sub 150). Hydration on Sunday was so much better/normal. I only "needed" about 100ml of water for this workout, vs. saturday when I drank 700+ ml.

Decent splits, and nothing earth-shattering but a stark improvement from the day prior, even in just how I felt. (That day I had great energy--saw a client at the gym, tooled around on the SUP, and went to a friend's party. No soreness/fatigue from the tests.)

Lessons learned on preparation:

1. Don't eat potentially sketchy and/or trigger foods in the 24-48 hours before a test.

2. No caffeine before a MAF Test.

3. If metabolically efficient (fat-adapted) consider doing the MAF test fasted, or at least on an empty stomach.

4. Don't discount weather and its effect of performance.

5. Try to avoid anything overly strenuous (i.e. a race, hard strength training) in the week before a MAF Test.

~~~

Analyzing Results 
Ok so there's that. Fun right? Now, what to make of these numbers?! Because what's testing without geeking out over results and data ;)

Comparing Tests
These recent splits are all slower than the MAF test I did in January. Not a ton slower (still within 30 seconds of the average then), but still slower. Hmmmm. So then I start to question all the things like any coach and athlete should do:

My specific questions, and ones you can ask yourself!

1. Was I simply too fatigued when I tested? (That 30k! Re-test?)

2. Is slower ultra training making me slower? 

3. Is my overall training "not specific" enough for a better MAF Test result?
(Not enough time training at MAF?)

4. Other factors: Could it be an underlying health issue or stress? 

5. What to do going forward?

6. Do MAF Test results even matter, especially if I feel good and am happy?!?!?

Fresh vs. fatigue factor
January: I was arguably more fresh/rested overall coming off an extended 5-month rest break July-Nov 2014. I had transitioned to moderate MAF-based marathon training, 6 weeks later tested.

Currently: The 30k race/travel happened, and I guarantee I didn't do a 30k right before the January test, lol. Plus other potential variables may have skewed results. As for overall training fatigue? Ya, we've been actively building volume and time on our feet. No, I am not exhibiting signs of burnout/overtraining.

Specificity of training
January: I was at about ~6 weeks into a MAF-specific running (20-30 miles per week (mpw)) program. It was all about training for a marathon at MAF!

Currently: I'm not running exclusively MAF anymore. Instead, my running/hiking is majority sub-MAF (under 150 HR) and slower paces, but more mpw. I do occasional but inconsistent longish runs at all MAF, plus sprinkled in hill repeats or strides. The rest of my training is crosstraining, which varies in intensity.

Training Breakdown, Aug-Nov:

42% - running

35% - hiking and walking*

12.5% - strength training

10.5% - other (bike, sup, swim)

11:30 - average weekly volume 

(15hr/wk at most)

*this includes strenuous hiking, some backpacking, weighted vest hikes, 

and recovery walks--all types of intensity.

Health
I feel fine, but who knows. So, this is why you test. I'm getting blood and hormones re-tested soon, and also a gut/stool re-test to check status of the nasty infections I've fought: H. Pylori, SIBO, and candida.

Dr. Phil Maffetone chimes in!!
Summary of what Phil had to say in response to my questions: 

Feedback: "Of course, you were a bit trashed the first test on Saturday. No surprise that stress raises the HR and slows the pace. Only part of this was due to the previous week's race (then add travel stress, food stress, etc.). The second test was much better... What would the results be after another week or two when you were fresh? Maybe even better, with appropriate recovery! I don't think the slower training is make you slower, but rather the stress [this includes life stress too; see below]."

Going forward: "Maintain once- or two-a-week MAF runs when your body is feeling like it can do that well, and for as long and as often as your brain dictates. Re-do a MAF in a week or two, and hopefully it will be faster than 8:16 on the first mile. There's no reason to reduce training leading up to a MAF Test. Just make sure you're recovering really well (especially sleep, and no muscle soreness). Might be good to reduce or eliminate any strength training until your MAF test improves. The primary need is to remain healthy."

Takeaways from Phil:

1. Be an intuitive athlete and exercise the brain not just the muscles.

2. Health comes first. And there is a way to be healthy, get faster and have success in ultra. (Phil did NOT say it's probably a good idea to pull the plug on ultra training.)

3. Be honest about your overall stress, and manage it.

4. Recovery is paramount.

5. Less is more.

~~~

The Plan Going Forward
With this one little weekend of MAF Testing, I have so much more clarity and a plan:

Train smarter not harder
My recent training is making me a better long-slow-distance (LSD) athlete who physically and mentally has no problem being on foot for 3-6 hours now, which is good because that was always lacking in my years doing triathlon (my long runs were traditionally 90 minutes). But I believe I'm starting to plateau and/or am being too random with training--random just like I was before the marathon this year before buckling down. So, I'm going to experiment by laying out a bit more structure in the form of a "MAF-based polarized training approach" rather than just winging it. Polarized training is proving to be safe and very effective, and I'm intrigued by it which I'll discuss more in an upcoming post. Basically for me it means I'll avoid the "gray zone" in all of my training, work the aerobic (sub-MAF+MAF) and also work the high-end anaerobic (over threshold). The goal here is to train smarter not harder and always adhere to smart recovery.

It's fine to have a generalized (random) approach to get a good base level of fitness and athleticism, but then the plan must come together with specificity for the sport--these are the basics of periodzation (and you can periodize whatever style of training you want whether a traditional threshold-based program or the MAF Method or in my case a hybrid of MAF+polarized). Meanwhile, it's always important for athletes to be flexible with the plan, intuitive and go-with-the-flow (i.e. bail on a workout if fatigued; add volume if feeling phenomenal; add recovery when needed even if the plan says workout; etc.), and not be a mindless robot executing a pre-set schedule. Don't disconnect from listening to the body.

On more recovery
Generally, I don't think too much training stress + not enough recovery is my problem these days. I even re-checked on TP, and I'm very good at taking one day off a week on average, sometimes two days off if I feel it's needed, plus having very easy recovery days. I'm not afraid to rest from training (or life) anymore. My weekly training volume is clearly not insane. I don't get wrapped up in needing to be like other runners who are doing 100-200 mpw; I do what's right for me. I think the slower MAF Test was just more acute fatigue, not me blowing up again. I'll plan MAF Tests better so they're consistent with reliable results. Reliable, meaning I do generally the same things in the week-ish leading up to a test.

Better focus on stress management
Putting the training/race fatigue factor aside, I got to thinking more deeply about my overall stress and non-training stressors, realizing it was time to touch base with these things again. I got really good in 2014 and into 2015 of finding a peaceful, low stress and more chill approach to life that works for me, and I consciously eased up on my aggressive Type A tendencies with tremendous success. But I can see in recent months how I've slipped up here and there and am tending to push myself hard again, in more ways than one. I recognize it. I will reel myself back in. It's funny, on a recent NBT podcast with Dr. Tommy Wood and Chris Kelly, they discussed that even as health practitioners who know the tools for optimal health, they still struggle because they have sh*t to do, big goals, and often crazy demanding schedules. People like us have chosen these lifestyles, and I think they're admirable ways to live, but we often need to step back and take a dose of our own medicine...

John and I are always on the go and living it up, I love our crazy life, but I know I have a hard time just relaxing especially when I feel good. I just like to be doing things. I love my work, so I work a lot even work on weekends. I love adventure, so I hate just sitting around at home. August/September had something "big" (often requiring travel) nearly every weekend--backpacking trips, music festivals, weddings, vegas and even food poisoning for me. Then October was a tough month--don't hate but for real, Kona/Ironman week was (as always) very demanding and I burn myself out, while drinking way too much coffee (my poor adrenals). Even our few days in hawaii post-Ironman are all about adventuring (probably not enough R&R). Then after kona, I had a hard time emotionally revisiting some past life things, aka the anorexia, which had been shoved down in me and needed to come out to get more closure and peace. Letting things out like that are great, but they still take a toll and are a stress. I have also been clearing out that H. Pylori infection and my gut/digestion issues have been a roller coaster. November has been starkly different in that I've back to better balance, fewer stressors and breakthroughs with gut issues (as such, I'm sleeping better as mentioned earlier). But I know the calm periods don't last forever. I fly out of town next week and will be pulling close to an all-nighter at John's 25-hour endurance car race, then the holidays, and most of all: Our 2016 is going to be a huge year for us. It's on me to work harder than ever at stress management, self-management and prioritizing. If we're going to race ultras and get married next year, among all the other plans, I need to manage my life so that I remain healthy and perform optimally. There's no negotiating this. It means everything to me to put health first.

Do MAF Tests matter?
Yes. But I also want to emphasize that it is not my goal to become an elite ultrarunner or the fastest chick around. I just want to be healthy and continue to be able to put one foot in front of the other for a long time. So the MAF Tests for me are check-in's to make sure I'm in a good state of health, managing stress, not overtraining and not undertraining either. My training is also a constant ongoing experiment in how to further understand endurance athletes in order to be a better coach. Learn by doing.

Strength Training?
Lastly, where I might actually disagree a bit with Phil is in his opinion that I eliminate strength training (ST). "That will give your body a change to focus more on re-building the aerobic system--something that's most important right now for health and a great fat burning foundation, and before building more miles and more strength," he says.

Valid point, and I agree that I shouldn't be doing ST that wrecks me, compromises my running and leaves me with ridiculous DOMS, especially the week before a MAF Test. However, I think that some ST--whether an easy functional routine or an occasional heavier weight session or slow weights--is important for health and balance so it's not simply chronic endurance. The ST keeps healthy muscle mass on my body; I don't like getting too lean from just aerobic running nor is that healthy IMO especially given my history. I don't personally think my approach to ST is overdoing it--I rarely break a sweat during sessions outside the occasional day of sledgehammer swings ;) And most of all, I love ST. I don't want to stop. It's fun, it keeps me functional (mobility and stability), strong and injury-free. But I won't completely rule out his advice.

...ok, your turn to MAF Test!

Into the Wild 30k OC Trail Run and IMAZ Weekend

happy campers

And back to some regularly scheduled "tritawn" programming, ya know, race reports and cool vibes ;) I find it incredibly important to dive into the recent topics (like this and this post), and I'm certainly not done with those, but thankfully I can flip flop back and forth and follow some rather serious posts with ones that get back to my present reality.

This past weekend was one of those that I live for: racing, more racing, a little travel, and being surrounded by incredible people.

Starting with MY race! This is only my second race of 2015 (three if you count ragnar). Toeing the line becomes extra special if you’re not doing it 24/7. In fact, in a recent podcast with Michelle, at the very end (aka the “outtakes”), we decided that over-racing was a huge problem of ours in the past and one of the variables that led to burnout/overtraining, so instead we agree it’s better to invest in quality, healthy training so you shine ever brighter in the races that matter. That said, I am still a huge fan of multisport athletes jumping into events that are C-races for practice, i.e. try some open water swim races, bike TTs, running races etc.—in particular, choose races where you have to face your fears and weaknesses so you get stronger. I digress…

30k Trail Race Report
There’s a great trail-race series I’d heard about for years called Into the Wild OC Trail Runs, but I never felt quite confident that my trail running fitness was up to par for tackling longer distances with gnarly hills. This year, that all changed. I didn’t even question the idea of whether I could just jump into a super hilly 30k (18.6 miles) spur of the moment—I knew I was fit for it, and more importantly I had the right state of mind going into this one. I had simple goals: I did not intend to go out and hammer as hard as possible, but rather use it as practice for our future ultras—practice the art of pacing for this style of racing, manage intensity, adapt to the terrain, enjoy the process, and get in the zone vs. sit there thinking “shit, when will this be over?!” It was certainly not about outcomes, finishing times, or beating other runners. I was not "in it to win it."

Course profile

Mid-race picture-taking. Probably less of this in the future...
Fun fact: that trucker hat may very well be a one of only a few in the world! Ben had them made for us
in 2012 when we went to the Endurance Live awards. Lucho was there... wonder if they still have theirs.

My training has been consistent and steady. I’m not doing a ton of MAF HR-specific runs, and certainly not running harder than MAF! Most my runs/hikes are actually sub-MAF, and this is all in effort to build volume in a way that’s healthy and sustainable for me. In order to have the energy and health I want, I can’t be running all this new volume at MAF—I’d crash. So maybe in 2-3 years when this kind of ultra volume is more the norm for my body I’ll be able to handle most of it at MAF, but for now I like my approach, I feel good, and I’m not wrapped up in obsessions to get faster and have it be all about pace—I’m on a mission to build mega endurance and the ability to be on my feet for hours. My overall energy remains great: I can do a 3-plus hour workout then get back to work, talk to clients for the rest of the day, go to the gym, and not be trashed. I’m also adding about 1-2x a week of intensity in the form of hills or sprints. So I guess you could say it is a form of MAF Method polarized training.

My partner-in-crime John did the race too. The race was Saturday, and since we like to keep things interesting, we added a bit of an added challenge to the weekend: We booked at 12:30 Saturday afternoon flight out of OC en route to Arizona to be in Tempe for Sunday’s IMAZ. That meant we had to, no matter what, be done with the 30k within 4 hours to make the transition and catch our flight. Neither of us were worried about those numbers, sub-4 hours was totally doable. I was thinking that I’d be finishing around a 3:30 or a bit faster (logically I figured I could do a 30k just as fast or faster than my open marathon time back in May).

I also convinced one of my local athletes to do the race with us. He’s only been into road marathon racing up until this point, but he loves crosstraining in the trails. He wasn’t so sure about jumping into the 30k distance for his first-ever trial race, and he didn’t think he was ready or prepared for it at all, but this is where the art of coaching is awesome: I knew he was ready and fit for it, so I encouraged him to just give it a try and step outside his comfort zone—you never know what you will discover about yourself in the process, right? So with my vote of confidence he pulled the trigger on the race too. Had he truly not been prepared I would have never put him in a compromising position… but I was certain he was fit and fine for it. A lesson in learning to believe in yourself!

I had zero pre-race nerves or anxious thoughts going into this event, and none of my crazy old mind games reared their ugly heads. It was hard for me to even classify it as an actual race given the weekend on tap—I knew I had to run smart because we still had a lot of activity ahead. Although, since it was just 30k I knew I didn't have to totally hold back. I was reminded of past Xterra Trail Races I did in which I would run so freaking hard that I would be beyond trashed after—that wasn't going to happen this time. I did take a solid rest week going in, just so I could have my best energy for all of it.

Race morning was rad, about the exact opposite of an Ironman. While not technically not an ultra, it still had the ultra vibes: Show up to a random field/dirt parking lot in the hilly wilderness, where about 50 people have casually gathered and head out for an adventure together. Super mellow.

We got going about 7:05 am, and oops, I forgot that it can actually get cold in SoCal, especially in this area near Saddleback Mountain. I was dressed in shorts and T-shirt, no layers. Meanwhile, some folks had on long-sleeve everything and beanie-type hats or gloves. Needless to say, those first 20 minutes I dealt with some excruciatingly cold hands. The rest of my body, even feet, were fine, it was those hands! Finally I wised up and stuck one hand at a time under my shirt on my core to generate some heat. That worked, plus the sun came over the mountains and started shining down on us—before I knew it, the weather was as I expected—pretty hot.

I was running calmly, comfortably going off RPE not even looking at pace or HR. I thought about John (who was on my heels) and my athlete (who was already way ahead of me), and that was about it. I was immersed in my tunes! The night before I made an epic playlist for my ipod, and I was jamming—only one ear bud in so I could still have awareness of my surroundings.


 The first couple miles were more singletrack and nothing too hilly, then miles 3-13 had all the hills—either crazy up, or crazy down, and some little flat sections mixed in occasionally. I love hills, they are like the adult’s version of a rollercoaster to me. This course delivered with about 3,900 feet of elevation gain. I am really confident in my hill climbing right now—and I am totally OK with power hiking up the hills vs trying to run them and burn myself out. I really feel good about the training I’ve been doing, especially using the weighted vest on hike/slow jog days—that’s been a FAST way to ramp up fitness without having to pound more run miles and overly fatigue myself. If you are injury free, resilient to injury and have a solid functional and strength base I highly recommend crosstraining with a weighted-vest. But don’t do it if you’re injury prone, overcoming an injury or working out a known biomechanical issue—fix that shit first.

I was loving all of it. I was totally content stopping to take a picture here and there on my phone (we were on a special trail that’s normally not open to the public so I felt obligated to capture some images lol), and I was also literally singing out loud at times when a really good song came on—for real, ask John. This approach and mindset was huge for a girl like me who spent years being way too overly focused on outcomes, what my competition was doing, what my final time/ranking would be, or what the world would think of my splits—yuck.


Meanwhile, I was actually running pretty well overall in the field—but I had no idea. At that point I could have cared less.

Nutrition 

Pre race dinner included this spaghetti squash dish
with fresh herbs.

Nailed it. I had a very light breakfast of a small bowl of paleo cereal (wasn’t hungry at 5am, didn’t need to force it), and I expected that I'd want more calories during the race. I had on board 1.5 liters of plain water in a camelback, 2 of Lindsay Cotter’s Healthy Bites, and a Chocolate Chip Simple Square bar. Here’s how it went down and I timed it also with the course terrain (I knew the last 8k ish was going to be flat/downhill with faster running, no more hills, so I wanted all solid nutrition totally done prior to that):


10 Perfect Amino at 40’ mark

1st Healthy Bite with water at 1:15

2nd Healthy Bite with water at 1:45

½ Simple Square bar with water during mile 12 which was all a steep power hike hill climb.

Other than that, drank water to thirst, getting through ~ 1.25 L during the race, and finishing the rest after the finish, and some.

Healthy bites!

Competitor Mode Switches On
At mile 10-11ish there was an out-and-back section so you could see the runners in front starting to make their way back. Of course, like any normal athlete, I started counting guys and girls. My athlete was running strongly in fifth behind the “big-time” guys! Awwww ya!

I counted three girls who had a decent but not crazy gap on me, which put me in fourth/fifth—I was switching places casually with another girl throughout the race so far. There was a long decent then U-turn and climb right back up the steepest hill of the day, brutal. After that I knew it would be mostly smooth sailing.

Knowing that my position was decent, I couldn't help it—I suddenly slipped into competition mode, just like that. Said to myself, “I guess I should stop jacking around with pictures and singing and dancing to my songs. I don’t know if I can catch any of the girls, but I know I feel good enough to run strong still. Final 8k, let’s do this!” 

The last 5.6 miles were very strong for me, and the last 4 in particular were between 7:15-8:45 pace (helped that it was a moderate decent lol). My cardio and heart rate felt phenomenal like I could hold that effort forever, but muscularly I could start to feel signs of fatigue, soreness and normal breakdown from those hills that had taken their toll. I was actually glad to feel the soreness in my glutes and hamstrings—proved that I hadn't been pacing too easy. I passed a couple guys during this section, but otherwise I was totally alone in the wild. John had fallen off my pace at mile 11, and my other athlete was ahead still. It was nice to be alone on a random trail in my own rhythm.

My longest workouts lately have been 3:00-3:15 on trails, but overall this race was faster than my training days usually go. It was comforting to know I could easily be running in the 8’s or faster at 13-plus miles into a hard trail.

I would look ahead in the distance in the off chance a competitor ahead might pop up, who I could then “hunt down” but saw no one. All good… even though I was feeling more of the competitive vibes, I was still focused on me and my effort, and I felt proud. Body moving well, no issues. I then came up on another dude, who I proceeded to pass in the final mile, then in the finishing chute he came back to battle me in a sprint to the finish; putting ego aside I let him have it.

Finish, Mind Games & More Fun
I crossed at 3:15 on the clock, feeing awesome. That was my longest trail running race ever, and I think I nailed it physically and mentally. On track for what's ahead… 

I found out that the first-place female finished in 3:01, and the second and third place girls finished back-to-back in 3:13 and change—which means I was just TWO minutes from the podium and actual prize money! I won’t lie, I got a bit down on myself after learning this news, and I was kicking myself thinking that without the dilly-dallying and picture taking, and without the couple stops for John, I could have easily shaved off 2 minutes or more off my finish time. My brain was going there—i.e. the woulda-coulda-shoulda crap. But I quickly shut that shit down and found peace with my performance. I had been truly happy and in control the entire race, and I couldn’t let finishing times and rankings ruin that or get me down—I couldn't play those mind games. Too many times I've beat myself up over race performances thinking about where I could have saved a minute here and there for a better finishing time/ranking. I'm over that.

Still, flirting with a top finishing spot and the taste of competition again, well, it felt good. Can you blame me? I'm a bit hungry for some more, hehe. But I am also patient and set on doing things my way, the healthy way, this time around, and certainly not being a results-driven athlete. Did I mention our approach to Badwater Salton Sea is about making the cutoffs, not about how fast we can go?! At 81 miles, I have no desire to push the pace this "early" into my ultra racing.

John finished in 3:40ish, very on par with his current training, but I think he's ready to step it up a bit. It's time. I'm doing more than he is, and you could tell in my performance vs. his—he also dealt with a bit of cramping and whatnot, which I think was more training-related.

This guy has grit. Proud of him! It's all good. We got this.

He recovered just fine, and we felt great for the rest of the weekend.

We ended up getting to our flight with time to spare, then had an epic day with my athletes and the rest of the racers at IMAZ. If you follow Ironman you probably heard that it was a cold, wet, dreary day. Oh boy, yes it was… 12-plus hours of spectating with a good amount of shivering and lunges to stay warm. But every second was well worth a bit of personal discomfort—seeing my athletes and friends kill it, and be so tough, was priceless.

And I got to meet Maffetone in person finally!

Analyzing Healthy Eating vs. Eating Disorders (including Orthorexia), and The Need to Get Out

Whoa long title... but lot's to follow up on in regard to my last post.

Among all the lovely comments, emails and replies to the anorexia post (btw, thank you!), a couple stood out, which makes me want to dive deeper into this very important conversation. Basically the jist of those comments was, "But, Tawnee, it is OK to 'fear' today's food, ingredients and restaurants!"

The folks who said this, folks whom I highly respect for the record, suggested that it's better to prepare your own food (aka cook at home), be seriously skeptical of the restaurant industry and what really goes on in their kitchens (especially in the U.S.), and find ways to socialize or go on dates that don't center around food and dining out.

Valid points.

However, I said, "Yeah, but it's different if you've had an eating disorder (ED). In fact, it's really complicated...."

Letting Go of Control and Loneliness
For one, I've had to work my ass off to overcome some serious fears over food, control issues with food, body dysmorphia, and self-imposed social isolation. When you're suffering from an ED, you are lonely--extremely lonely no matter how many people love you and how many friends you have. And loneliness is not fun. In fact, the latest NBT podcast with Dr. Bryan Walsh explains how loneliness has very negative impact on gut health and overall health. I had to step up and stop isolating myself. There where times where I'd go hide in my car at SDSU (while it was parked in a hot parking structure) to eat my "lunch" for fear of people seeing what I actually ate, and what they may think of me. Those were sad times. I've had to overcome anxiety eating in groups (even with family!), anxiety over dining out, and anxiety over what my body looks like to the world. Thus, it is incredibly important that I continue to GET OUT and make sure I don't get "stuck" in my safe place at home, eating my "safe" meals. Not only physically get out the door to sit at a restaurant but also build up the comfort and confidence to enjoy the company of others--and not feel isolated but rather feel engaged, connected and truly part of a group. (And this isn't just specific to those with ED's either; think about how often we're lonely when we're around others; in or cubicle or social media are good examples too....)

Not to mention I love the experiences and life-lasting memories that often come from dining out--even at the risk of a few less-than-perfect ingredients. John and I have had some amazing times, amazing meals, and guess what? I survived, and he and I thrive as a couple. Plus, since 80 to 90 percent of the time I am cooking at home and eat an incredibly clean diet (even when we travel we do VRBO to get places with kitchens so that we can home-cook some of our meals) I think that extra 10 to 20 percent of the time I'm perfectly ok stepping outside into the world and take risks--and so are you.

My risks don't include "extreme eating" like sketchy hole-in-the-wall buffets, questionable hot dog stands, Outback Steakhouse-type fare or fast-food joints, etc. Hell no! I'll sit out on eating truly bad stuff, and/or go there to be social but not eat--then before (or after) eat something better quality. When we dine out, I am usually very conscious of choosing good restaurants, for health reasons above all--not for the need to control/restrict calories or lose weight. Ok maybe I am too conscious at times of searching for "the perfect" restaurants (getting a little obsessed with Yelp), but I truly care about fueling my body with the best quality foods possible--organic produce, free-range/grass-fed meats, wild fish, healthy fats, locally sourced fare, etc. Especially since I have knowledge (maybe too much knowledge) on nutrition and today's food supply--it is a scary world out there if you're not careful--and because I want to fuel for performance in sport and life. I'm the first to agree, and recommend, that we should give a lot of thought and concern into the the quality of food we eat, the restaurants we choose, and the meals we cook at home.

Happy times at a random restaurant in DC...

...trying creamy, buttery escargot--worry free!

New-Age Eating Disorders
This begs the question.... what's the healthiest approach? Does it always have to be about adhering to the best-quality ingredients, or should we let go more often--let go of the associated stress that comes with seeking perfect food--and be more free and go-with-the-flow. If you get too wrapped up in always trying to eat a perfect, pure, healthy diet, you go down a scary road--one that's lonely and isolated--and risk developing a new-age eating disorder known as orthorexia, the obsession with eating healthy food to the point where it disrupts your life, behavior and happiness.

I've thought about it in my own case: Has my ED past manifested into some form of orthorexia? Are my aforementioned friends who told me I should fear the food and only cook at home also orthorexics? (They both work in the functional health field, after all.) There's plenty of reason to believe, as you'll see below, why a former anorexic could easily fall become orthorexic. I don't want to think that's the case with me... and I'll argue why I don't think I'm orthorexic. But at the same time I don't think you'll ever catch me eating McDonald's or even the salad at Chuck E Cheese's, ever.

So now to the meat of the post. I've got some 'splaining to do. 

Breaking it Down
Gets confusing though, right? You're telling me. There are multiple situations going on, and they can't be lumped together. What the former anorexic feels--often irrational fears--is very different than what a non-pathological human feels when going to a restaurant with intent to eat healthy--which is different but similar to the orthorexic. Thus, my friends who promote cooking at home have a fair, valid point, but they have to understand there are reasons why I choose to eat out that are more important to me than ingredients alone. Below I'll attempt to distinguish the differences among the types of people we're talking about:

Person 1: 

Those who strive to eat quality/healthy food but are flexible with no disorder

Person 2: 

Those who've suffered from an eating disorder such as 

anorexia nervosa ("AN") and/or bulimia nervosa ("BN")

Person 3: 

Those who've developed Orthorexia Nervosa ("ON") by taking healthy eating too far

Person 4: 

Those who are all or some of the above

It could be a good practice to find out where you fall on the spectrum in your quest to develop a healthy relationship with food, your body, your mind, and stress levels--and to avoid any loneliness or isolation caused by fear over food.

Person 1: Health-Conscious but Non-Pathological 
This is the person who seeks healthy food and clean ingredients for smart reasons, with no underlying pathology. Their reasoning to eat healthy may include achieving and maintaining good health status, avoiding harmful substances (i.e. pesticides, GMOs, chemicals, additives, hormones, etc), disease prevention, and building a well-functioning body that's not overloaded with sugar, gluten and other disruptive forms of food. Or it's the person who wants to eat healthy and clean as part of their health and fitness routine--perhaps they're in high training mode and need/want to feel their best, or they achieved great weight loss and don't want a setback. Or it's the person who's doing it for more ethical and moral reasons. With the increase of documentaries, books and articles exposing what really goes on behind the scenes in the food industry--from poor treatment of animals to GMO crops--some folks will not support these poor practices and avoid conventional foods for better alternatives--they consciously seek labels that say "organic" or "free range" or "grass-fed" (hint: labeling something "natural" doesn't count--that term is total BS with no governing regulations). Person 1 may develop a sense of pride in choosing quality over the "evil"' stuff, as well as realize how much better quality food in terms of its nutrient density, nourishing properties and superior taste*. Or maybe Person 1 doesn't even care so much about health-food per se, but simply realizes that junk food and empty calories make her feel like crap--and she chooses not to feel like crap.

That said, Person 1 is not overly obsessed with only eating healthy, quality, pure food. She likely has no pathological condition surrounding food or her body and its size/shape. She allows for balance--realizing we can't all be perfect--and sometimes living life means the occasional situation where the food may not be the best, so she adapts, doesn't freak out and understands that the 80-20 rule (or some variation) will ensure she'll be okay. For example, she's flexible and willing to eat most things at holiday gatherings or parties, she can find something to eat at most restaurants or during travel without any food-related stress, she's okay having the occasional "conventional" piece of birthday cake or pizza. Person 1 has good intentions to eat well, but realizes we can't be perfect so we can just do our best, and the idea or reality of a "bad" meal or "bad" day of eating won't shatter her world or have lasting psychological implications like anxiety, fear, doubt, and obsessive thoughts.

Bottom line, she's not eating the Standard America Diet ("SAD") by any means, and rather is much healthier and making conscious decisions for clean, quality food the majority of the time, but she is flexible and doesn't see food, or control over food, as a source of stress.

Btw: I think my fiance, John, is person 1, and I admire him. He definitely makes efforts to eat as healthy as possible but realizes it'll never be perfect, so he doesn't stress it and instead lives a balanced, happy life and goes with the flow. Could he be healthier in his meal choices at times, sure. Does he know that? Yes. But at what price? Maybe more stress that then makes him less healthy?

~~~

Person 2: Healthy-Eating-Turned-Orthorexia
For argument sake, let's assume Person 2 does not have a history of an eating disorder nor a per-existing condition. It started out innocently enough: She got on a health kick, liked how it felt, saw results, and even liked how it felt to be part of an "elite" community of fellow healthy-eaters. She spent free time reading/following blogs and websites on nutrition, clean eating and healthy recipes. She started obsessing more over "pure" eating, eliminating anything that was not deemed healthy, and even letting her obsession with healthy food cut into her social life by declining invites if she knew there's be unhealthy options. She'd get angry if she couldn't stick to her healthy routine, fussy if ingredients weren't up to par. It snowballed, and healthy eating went too far turning into the latest of eating disorders: orthorexia.

Orthorexia was coined by Steven Bratman, MD, in 1996 and literally means "the fixation on righteous eating." Although it's not listed as a disorder in the DSM-5, it is an increasingly growing REAL eating disorder in today's population, and happens when people who let a once-innocent desire to eat clean, quality, and pure go too far. The quest for quality food dominates their life. How does it differ from healthy eating? According to Dr. Bratman, "healthy eating is a conscious choice. Orthorexia is an obsession with healthy food that involves other emotional factors and has become psychologically and perhaps even physically unhealthy. It is an eating disorder."

I can certainly see this being the case for many athletes, especially endurance athletes, who are very in tune with their bodies and very particular about the food they allow in order to look and perform a certain way. In fact it took two seconds to find research validating that theory. On one hand, I think it's fair for an athlete to be strict with diet--or any human, it doesn't have to be athlete--but how do you know that strict approach has gone too far?

When it invades your life and "creates psychological distress and impairs various life dimensions, but does not present a physical danger," says Dr. Bratman (who recovered from orthorexia). Dr. Bratman was also quoted on nationaleatingdisorders.org saying, “I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed. … I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life's meaning had been transferred inexorably to food, and I could not reclaim it.”

Still, there are some who think it's silly that healthy eating could be considered a terrible thing, but in my eyes--as someone who's lived through an ED--I don't think it's too silly at all. Those addictions and obsessions can go too far, I think. However, I would NOT consider ON on the level of AN or BN.... I just wouldn't...

More on healthy eating vs. ON - and don't be a "wannabe orthorexic."
Here's a test used to assess ON. 
Here's a critical look at ON.

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Person 3: The Recovered ED
I don't want to take the space here to define an ED other than they are mental disorders, often life-threatening; read more here. What I do want to distinguish is the difference between ON and other EDs: AN/BN are more related more to the quantity of food, while ON is more about quality. AN/BN patients seek an ideal body image, while ONs seek a pure body. Usually there are strong biological roots in AN/BN cases (my story supports this), whereas I would argue that ON may be more of a phenomenon of our modern world (and the person with the "right" traits falls victim). ON often has roots in obsession to look good and fit in, including on social media--AN/BN not so much. Not too many ANs want to post full-body selfies. Instead, AN/BN often reach a level where they knowingly don't take care of their bodies--they realize the harm but still continue on. TO complicate it further, as you will read in Person 4, it seems that these days the lines are often blurred between ON and AN/BN.

So for the Recovered ED (aka Recovered AN/BN), it's complicated... there are stages to get through. Let's assume we're talking about someone in a maintenance and relapse-prevention stage, or beyond. Whether you finished rehab yesterday or 20 years ago, it doesn't just shrivel up and die as soon as treatment is over. If you've never experienced an ED don't assume that this illness can be expelled from the mind and body once and for all.

There's a lot of shit that can still surface, those unwelcome inner "demons" that rear their ugly heads:

1) Sometimes food choices may or may not not have pure intentions about healthy, clean eating. Perhaps eating healthy is just another manifestation of restriction or quantity control. Research supports that some Recovered ED's still have a strong urge to control food, ingredients and/or weight even in the management post-ED phases, and healthy eating or having dietary restrictions (i.e. vegan, gluten free) is the perfect excuse; for more see Person 4.

2) Maybe exercise addiction is still present along with body dysmorphia and the need to control weight. The Recovered ED may be a normal weight but inside feels strong impulses to keep strict control over bodyweight, fears getting fat, and maybe even feels fat or obese even if that's not the case. An "easy solution" is to take up a sport that requires a lot of training, or some highly-regimented fitness routine. There's a bit of comfort found in the calories-in, calories-out equation.

3) Speaking of punishment, it's hard for the Recovered ED  to let go of feelings of guilt and self-hate. For example, say she over-indulged--not binged--but simply enjoyed eating whatever food was present and let go of that damn voice telling her to control. It felt so good for a second--free and liberating--but then... then the guilt set in. The desire for self-punishment and future restrictions started brewing... 

4) Or, there is some presence of obsessions, the need for control, and anxiety issues. There are still "pizza stories" that pop up. Perhaps these obsessions manifest into a new issue. Enter Person 4.

I could go on... keep in mind I'm highlighting the problematic behavior for a Recovered ED (for the purpose of this post) not the positive gains they've made. Whatever the problem is, it's all about self-management and belief in one's self that they are better than the ED.

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Person 4: The Recovered-ED-Turned-Othrorexic
Yikes. Person 4 is not just someone I made up, there is strong evidence in the research of this being and actual person. This study, for example, had a small sample size, but it showed how "easy" it is to develop ON if there's a history of AN or BN. ON symptoms are highly prevalent among patients with, or recovering from, AN and BN. ON tends to increase after treatment of and improvement from AN/BN--it's migration toward a "less severe" form of an ED.

I see how this can be. Coming off AN/BN it seems very logical that one would develop a new obsession for eating healthy--the obsession for quality, to some degree, replaces an obsession over quantity. Let's assume that she even lets go of obsessing over weight loss and calorie control. Now the obsessions are about organic, gluten-free, chemical-free, etc--all those distinguishing variables I listed with Person 1 (oh, Person 1, it was so simple then lol). Again, seems innocent enough, right? But not so fast...

Since there are biological roots in someone who develops AN/BN, the new ON obsessions may trigger the same old anxiety or irrational fears over food, and bring back the same old habits, rituals and tricks. More and more food is "off the table" for being considered edible, dining out once again becomes a problem (god forbid eating non-organic), there's more secrecy and seclusion surrounding food. The fun is taking out of food, anxiety comes back, and the quest for healthy food is no longer pure. All of a sudden it appears a worse relapse may be occurring: social isolation, psychological disturbance and even treating the body maliciously again.

Perhaps even the desire to control weight and calories comes back. Dr. Bratman says there are "covert anorexics" who use healthy food as an excuse for low calorie. Even the diagnosis of "anorexia" now includes one's desire to eat healthy food--not just restriction. Equally confusing, there's research to support that some orthorexics start to take on AN/BN behaviors like binge/purge or severe restriction and weight loss obsessions. It gets to a point where you have to question what really is going on here? What's the diagnosis?! It's complicated!

"Today, the majority of people with orthorexia may best described as having orthorexia with anorexic features, and a large percentage of those with anorexia as having anorexia with orthorexic features," says Bratman.

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Final Thoughts
I can't help but think about where I fall.... I wish I was Person 1. I'm not quite there. I'm likely some hybrid of a Recovered ED with ON tendencies--but I certainly don't consider myself to be ON. If I weren't careful, I probably could go down that road. I won't go down that road. I don't want to be lonely and isolated due to food ever again. So I have to be proactive. How so? Keep it real. Go outside my comfort zone. Face situations that will allow me to toughen up and manage it. I don't like going out of my way to introduce stress (like the pizza episode), but sometimes risking a little potential stress up front ends up saving a lot of big stress down the line--and could even promote better health going back to the Bryan Walsh/NBT podcast. It's the same with sport, the podcast, entrepreneurship, even backpacking--none of these things are "easy" and there are definitely associated stresses and fears at times, but that doesn't mean I hide from them by quitting or getting a "safe" desk job instead. I step up to the challenge--and I also become a part of some great communities as a result, making life-long friends and lasting relationships in the process. Just look at lucho and I--he's my BFF! All because I got over myself and public speaking fear to do the podcast AND bring on a co-host who at first intimidated me due to his amazing race resume/reputation.

So with food, hell yea, I will proudly eat healthy and clean, and hell yea, there are still certain unhealthy foods that I'll absolutely refuse to eat for health reasons. But I'm equally set on branching out and maintaining balance and quality relationships--let me say that again QUALITY RELATIONSHIPS. I do my best to maintain an open mind and a flexible approach and attitude. I don't want to go down a path of stress, isolation, loneliness and misery just because of food... 
Sometimes that means facing those very stressors to stand up to them, and sometimes I have to fight really hard to overcome the old demons. But I got it. I can and will stay strong. Attitude prevails.

ED or not, maybe we can all take this as a lesson to ease up a bit... don't always stress... think deeply if you are feeling lonely or isolated (for food reasons or otherwise), and know that we won't be perfect, but there are tools to have a damn fulfilling, fun life--pizza included.

What do you think: 

How far should we take our healthy habits? How far is too far?

Have you ever felt lonely or isolated because of your eating habits/dietary needs?