Rolling With Rhabdo - My Story

There's a lot of buzz about a Crossfit article out there this week.  It exposes a risk that, frankly, is my number one reason for refusing to ever endorse or condone it as a method for people who are out of shape to get fit: Exertion Rhabdomyoliosis (rhabdo to his friends).  But, as revealing as the article is, it left out what I belive should be the most important part of the story:  how rhabdo occurs and how you can identify it.  I mean, without that, the whole thing is just rabble-rousing for people that already have strong opinions on one side or the other.

See, I've been there.  I was hospitalized, near death, with one arm marked in marker "no needles - may need dialysis", just in case.  Today, I'm back.  Fully recovered and training hard.  But the experience has changed the way I approach training for good.  Hopefully, after reading this, you'll avoid this kind of scare, no matter what training regime you choose.

Background: "The best day of my life"

In 2008, I was selected to join a very small club: the ranks of Chief Petty Officer in the US Navy.  The Navy is big on rituals, and this is one of the biggest.  Upon selection, I, along with the rest in my cycle, were put through two months of intense training, supposedly to ensure that we had the mental and physical toughness to fill the role of a leader in this unique fraternity.  There were late-late nights, early-early mornings (even by military standards), lots of memorization and mental challenges.  And then there was the PT, laced quite liberally through all of it.  During this period, every time one of the senior Chiefs conducting the "training" asked the question: What day is it?  We all responded in unison "the best day of my life!"

Humph.

For me, I was in what you'd probably call "decent" shape.  I made my weigh-ins and passed my PT tests twice a year.  Never maxed out, but I was staunchly in the middle of the pack.  At 37 years old, I felt pretty good about that placement.  I was probably about 15-16% body fat.  This matters because most people that fall prey to rhabdo are not couch potatoes.  People who are completely unconditioned simply lack the physical capacity to push to the point of rhabdo.  

Setting the Stage for Disaster:  The Risk Factors

So I've already mentioned the first risk factor: "decent shape".  People that are prone to rhabdo are somewhat conditioned.  They also have relatively low body fat percentage (compared to the general population).  This sets your body up to hit a point where you can exert past your limits and your body lacks the stored metabolic fuel (i.e. fat) to compensate for the consumption level.

The next risk factor is environment.  Chief's training is conducted in August and September.  For me, it was in south Texas.  Heat and humidity both dramatically increase the risk for succumbing to rhabdo.  They add stress to your body during exertion and limit your ability to recover due to heat stress and dehydration.  San Antonio in August was a virtual incubator for rhabdo. 

The third block in the rhabdo virtual Jenga tower is stress, both in the active accumulation of it and the lack of ability to recover from it.  As if the training itself wasn't intense enough, I was going through a rather disasterous stage in my personal life.  Sleep just wasn't an option.  I was racking up tons of stress every day and doing nothing to recover from its effects.

And the final tipping point that brought it all down: ego. Both mine and on the part of my trainers.  I had a Navy dive master and a Fleet Marine Force Corpsman running the physical portion of the training.  These are two of the tougher professions in the Navy.  And they were merciless.  They set out to "break" each of us.  And I set out to match every challenge.  I can say I was hopelessly outmatched. 

The Tower Comes Down: The Symptoms I Missed

I've had the advantage of participating in some pretty cool training over my career.  One of the coolest things I would never ever want to repeat was the Air Force's combat survival school in Spokane, Washington (and undisclosed points well north of there).  I knew what dehydration looks like.  I knew what the symptoms of severe stress are.  But, in the moment, I glossed over a lot of things that should have set off alarm bells and sent me straight to the hospital.  

After one particuarly tough training session, I noticed that I was producing very little urine.  What I could produce was dark (we're talking almost Pepsi here) and cloudy.  I knew that was a bad sign, but I downed a gallon of water and hoped for the best.  Stupid?  Yes - but between the stress and ego components, I wasn't in a place to make a good decision about it. 

Then I started to notice the swelling.  Hands, feet, belly.  They all got progressively more puffy day by day.  Not normal?  Cause for concern?  Of course.  But I still figured it was just a temporary blip from a tough schedule.  

Finally, I noticed that I felt like I was in a mental fog.  I just could not form a straight thought in my head.  Since my whole adult life has been dedicated to problem solving as an analyst in various fields, strangely this alarmed me more than the physical symptoms.  It was now five days since the training session that had pushed me over the edge (with some additional sessions in between).  I drove myself to the hospital.  

The Diagnosis: Reality bites

Military emergency rooms are notoriously slow.  I checked in at the front desk and settled in for what I was sure would be a four-hour wait to speak to an actual doctor.  Fifteen minutes later, I was triaged by a corpsman.  I explained my symptoms, saying, "I'm not sure I should even be here, but I just don't feel right and I can't shake it."  After taking my vitals, the corpsman got very quiet.  My blood pressure was through the roof (symptom five).  I was admitted and hooked to an EKG in ten minutes.  

They started running diagnostics.  Thirty minutes later, the doctor came in.  "You're in some pretty bad renal failure.  We're going to admit you and see if we need to put you on dialysis."  For the first time in my life, I was truly afraid of dying.  

I spent the next week in the hospital.  I was put on heavy diuretics to flush my kidneys out.  My creatinine levels were checked constantly.  And my diet was regimented to put absolutely no strain on my kidneys through digestion.  No dairy, no sodium, and very little of anything else.  I was put on blood thinners and blood pressure meds to prevent any further cascade effects.  Thanks to showing up at the very end of my possible window and a very good nephrologist, I managed to avoid dialysis.  A week later, I was well enough to leave the hospital.  But I was in for a very long recovery.  Over the next six months, I very gradually returned to a normal diet, began light exercise, and finally weened myself off of the blood pressure meds as my kidney function returned.  I was lucky enough to get back to 100% function.  Not everyone is. 

What Happened to Me?

My nephrologist spent a good deal of time speaking with me.  In that critical training session, I hit the point where my exertion put such demands on my body that my muscle tissue started breaking down in heavy quantities (catabolism in the extreme).  The protein in my blood stream put such a strain on my kidneys that they simply stopped doing their job.  We're not talking nicely digested amino acids from eating meat.  We're talking about a direct injection of muscle protein straight into the blood stream.  I made it worse every day by continuing in the routine and conditions that got me where I was.

I hit that point because I pushed too hard in conditions that were too difficult for the body to overcome and I had no reserves to draw from.  Interestingly, of all the lifestyle conditions we discussed, the doctor was most alarmed by my long-term relationship with NSAIDS (Motrin, Tylenol, et al.) as a routine pain and swelling remedy (risk factor five).  These things are nasty.  I still only take them in times of serious need when I just can't tough it out.  

Crossfit and the Bottom Line

At the end of the day, I did this to myself.  I didn't exercise the maturity and judgement to stop before things got out of hand.  But... I put my trust in the hands of an authority figure who I expected to have my best interests at heart.  Having done that, I wholly gave myself over to the "mob mentality" of the ritual and the culture of the Chief's Mess.  That didn't work out so well.  Since that time, I can tell you that injury and relaps are always a factor that goes into my selection of training methods and intensities.  I don't leave that decision to anybody else. 

I'm not going to say that "all Crossfit is bad".  That is far too broad a brush.  But there is a real risk involved here, given the type and intensity of training involved.  If you have a personal trainer and you haven't discussed where you both stand, you should. 

Crossfit trainers (and any personal trainer, for that manner) take on a heavy degree of accountability when they take on clients.  But, without strong dialog between trainer and client, they can't be aware of the compounding set of risk factors that may be piling up on you.  That gets harder in a group "one size fits all" environment.  Add in a cultish culture of "push til you drop" and the chance that your trainer is keeping a watchful eye on you drops to an alarming low.  Since the vast majority of personal trainers are under-educated on the causes and symptoms of conditions like rhabdo, you simply can't expect them to have your back.  

What's the Big Deal About Antioxidants?

For our regular readers, you know that we take a skeptical approach toward the conventional wisdom around fitness and nutrition.  In fact, it seems like, the louder the media shouts about the "latest discovery" in weight loss, the more likely I am to just snort and change the channel.

Weep for our society...

Enter antioxidants.  These precious chemicals have bolstered blueberries to "super food" status.  Ask even the most casually health-conscious person on the street and they'll tell you, "antioxidants are really good for you; you should eat a bunch of them."  A few of the better informed might even mention those pesky free radicals, which "everyone" knows are the little Darth Vaders of human microbiology.  All of this consensus makes me a little itchy.  Perhaps that's because I've seen "Idiocracy" one too many times and the mantra is starting to sound like, "it's got 'lectrolytes! That's what plants crave!"  But I digress...

So we decided to do what we do: get smart on the subject.  This is not simple stuff.  Any of our readers who are medical professionals are welcome to pick apart the fine points, but this is our best effort at making the issue digestible to mere mortals like us.  

First, a few words about oxidation:

We're all familiar with the most common form of oxidation.  It's the process that causes iron to rust.  Oxygen is an interesting atom, and O2 an even more interesting molecule.  These guys have a free electron (or in the case of O2, two electrons) that make them very attractive to other atoms and molecules passing by.  The chemical bonding of intrinsic oxygen to these atoms turns them into other substances (like water, for instance), leaving the host compound behind.  

Put simply: oxidation is the loss of oxygen atoms or O2 molecules from a substance and the creation of new substances as a result.

The Oxygen Paradox: That which does not kill you...

Free radicals if I ever saw one...

Okay, so we know that all living organisms on Earth depend on oxygen to exist.  But, it turns out that oxygen is also chronically toxic to each and every one of those life forms as well.  Bummer, huh?  As a result, we puny Earthlings have generated all kinds of mechanisms to help deal with the harmful effects.  Plants have evolved to produce polyphenols and Vitamin C, for instance.  Humans, too, have developed complex systems to combat the negative effects of oxidation.  A combination of enzymes and chemicals, like uric acid, constantly work to render freed oxygen atoms and molecules into harmless substances, such as water.  

Okay, got it.  Oxidation = "bad," right?

Ahh, if only it were that simple.  Many oxidation processes are beneficial, even critical, to humans.  Oxidation can signal damaged cells to die off and be replaced by fresh, healthy ones.  And oxidation is a critical component to generating ATP, that all-important metabolic fuel that powers our cells and allows us to lift all the heavy things.  So, what's the difference between "good" oxidation and "bad" oxidation?

The bulk of it all seems to come down to two main components.  One is the amount of oxygen being released through oxidation (enter: oxidative stress), and the other is where the oxidation is taking place.  

In healthy cells, supported by the proper combination of enzymes and metabolic fuel, oxidation is just a fact of life.  And, with these components doing their jobs, it's no more dramatic than taking out the trash.  But, if the body undergoes an oxidative stressor, then the process is accelerated and the cell can lose its ability to keep up.  And, just like the trash, it starts to get ugly if things get backed up.  When there is too much oxygen for the cell mechanism to handle, it gets picked up by other substances and becomes things like hydrogen peroxide (H2O2) or Superoxide.  These guys are free radicals, who roam around and do damage to other cells.  What kind of damage are we talking about?  Inflammation, cancer, Alzheimer's disease, and many others.  Free radicals are also considered to be the primary operator in many symptoms of aging in general.

Some cells seem particularly prone to the type of oxidation which results in some of the nastier free radicals.  Low-density Lipoprotein, or LDL, cholesterol appears to be one of these.  We already know that LDL particles are the troublesome ones when it comes to factors promoting heart disease; now imagine them  also being cancer promoters as well.  I think we all agree: cancer sucks!

Okay, a quick recap of the facts thus far: 

- Oxygen is critical to life, but it's also chronically toxic

- The human body already knows this, and has several mechanisms to deal with it

- Oxidation isn't inherently bad, but can become a problem if accelerated or occurs in some types of cells, such as LDL cholesterol particles, among others

- When the oxidation management process is overwhelmed, free radicals are the result

- Cancer sucks

What promotes oxidative stress?

There wasn't as much information on this subject as I would have liked, but there are a number of common environmental stressors out there.  Not surprisingly: air pollution, hypoxia (as from high-altitude activity), smoking, and alcohol use all seem to increase cellular oxidation as well as inhibit the body's mechanisms to manage it.  But here's one you weren't ready for: exercise!  That's right, a natural and inevitable outcome of exercise is significant oxidative stress.  In fact, it's particularly dramatic if you're involved in the kind of training that produces adaptation, such as progressive weightlifting.  Now, before you freak out and throw away your running shoes, it also appears that exercise promotes the activity of our little oxidation-fighting buddies, balancing out the equation over time.  

Coming back to dietary antioxidants

Foods high in antioxidant properties (including Vitamins A, C, and E, as well as polyphenols)
touted for their ability to fight off these free radicals.  Remember how people once thought (and many still do) that eating fat translated directly into body fat?  Or how we once believed dietary cholesterol directly pours into your blood as serum cholesterol? We know better now.  It's not that simple.  The digestive system deconstructs, remakes, and employs these components as it sees fit.  This principle holds true with dietary antioxidants.  The dietary studies of the effect on the body of these supplements on free radicals are decidedly lukewarm.  In fact, there's some evidence that Vitamin E supplements have the effect of are inhibiting the kind of muscular recovery and adaptation that strength athletes are looking for. 

When you think about it, it makes sense.  The body works to bind those oxygen molecules in ways that makes them harmless.  The presence of free radicals occurs only after the oxygen has bonded in a harmful way.  The damage is done.  Antioxidant supplements don't run through the blood stream kicking free radical butt; they were proactive agents in the plant cells as part of their own defense mechanism. Besides, what if they did work?  Since oxidation is normal and often beneficial, how would we tell mister Vitamin C which processes to interfere with and which ones to allow?  

So, what am I going to do about it?

All of this, after a lot of reading and research, leads to a somewhat puzzling place.  Detection of the presence and amount of free radicals in the body seems impractical until some kind of negative condition develops.  The science doesn't seem to establish specific benefits of dietary antioxidants in preventing the little buggers.  My body seems to have the situation under control in ways I can only begin to understand.  I'm sure as heck not going to stop exercising, as those benefits still seem to greatly outweigh the risks.  So, I'm left to influence the few things I can.  It's somewhat frustrating that I can't offer a set of recommendations with the kind of confidence you might be hoping for; the best I can do is some variant of a nutritional "serenity prayer".

Here's what I know I can control:

   - Limit the influence of oxidative stress where I can through clean air and low-to-no alcohol use.

   - Stop smoking if you feel this is something you are ready to do.

   - Monitor and reduce my LDL cholesterol, particularly in relation to my HDL levels, through a continued diet that limits refined carbohydrates.

   - Support cellular health through the continued inclusion of healthy fats and proteins from whole sources

   - Support the production of growth hormones and protein turnover through a regular weight training regimen to stave off the metabolic slowdown associated with aging

   - Continue eating antioxidant rich foods, such as blueberries, because I enjoy them and they support the rest of my nutrition plan, whether or not they provide any particular antioxidant benefit

   - Continue to avoid excessive supplementation based on magical claims of health benefits

   - Continue to keep track of my overall health through regular doctor visits that include lifestyle and longevity blood panels

   - Given the above, trust my body to take care of the rest

Marketers, sales people, and those that just blithely regurgitate what they're told love to extoll the virtues of their pet products.  More often than not, these are overblown.  Be a skeptic.  Ask questions.  Make connections.  And look for evidence-based material before making drastic changes (or spending money) in things that will affect your health.

Do you have something that makes you "itchy"?  Don't know where to start?  Feel free to leave a comment with your question and we'll do our best to source the best information we can for you.  

Five Secrets to Smashing a Plateau

Whether your goal is to lose weight, gain strength, or improve athletic performance, we all fear the dreaded plateau.  A plateau is that point when your conditioning, your training, and your nutrition reach equilibrium and you stop seeing progress.  In order to kick-start your performance, try applying some or all of these simple ideas.

1. Examine your program

Look at your nutrition and training plan.  Do you actually have a nutrition and training plan?  Or are you following a general mish-mash combination of "eat less; move more". Even if you have a "great" program, it's not so great if it's not designed for the specific results you are seeking.  Let me say that again: if it's not delivering the results you need, then it's not a good program (for you). If you've been on the same plan for a while (six months or more) and are no longer seeing progress, well - variety is the spice of life.  

2. Examine your dedication

Even the perfect program doesn't get you results if you aren't following it.  This is akin to sleeping on your history book to study for the test.  Haphazard adherence will deliver haphazard results.  If time is the issue, find a program that works better with your schedule.  There are lots of ways to make your meal planning and training time more efficient.  Just remember: if nothing changes, nothing changes. 

3. Re-think "progress"

Be better than yesterday.

Probably the most frustrating thing for people that have just graduated from the "newbie" stage of fitness is that progress slows down dramatically.  Or so it seems.  This is especially true if you're only looking at one measure for success, such as scale weight.  As your body composition changes, lots of things are happening.  You may be losing fat, you may be gaining muscle, your body may be making a lot of changes on the inside that don't translate into a pound a week just now.  

Now I'm not saying that you rationalize away a lack of progress by saying "maybe it's muscle".  If you don't know it's muscle, then you need to figure it out.  Find out how to calculate your body fat percentage.  Or - even better - find elements you can measure and improve on every day.  Olympic clocks measure time in hundredths of seconds.  The smallest advantage can be the difference between a gold medal and a "well you really tried".  Tiny factors and minuscule improvements add up.  Whatever measures you choose, find something that you can make better than yesterday.  

4. Re-boot

If your program is on track and if you are following the program religiously and if you are looking at all aspects of your progress and still not seeing results, consider backing off for a short period.  Get rest, get hydrated, relax, and let your body recover for a few days.  Your body needs down time to do the critical work of adaptation.  A deload or break should be programmed in every four to six months, depending on your routine. This applies equally well to caloric restriction (diet) programs as well.  "Refeeds" have worked for many people on their weight loss journey.  

5. Push yourself

The bottom line here is that, as you condition, the same activities may not deliver results anymore because they just aren't challenging enough.  Just because your program says "perform five sets of five reps" doesn't mean you're finished.  There are no rep police.  You won't get a ticket for exceeding your awesomeness limit.  How do you know how much you're capable of if you clock out just because the set is over.  If you have more left in you, grind out another one.  Sprint to the finish!  You get the idea.  


Regardless of whether your particular plateau is related to performance in your sport or a weight loss journey, the methods you use to break through are the same.  Be honest with yourself, be skeptical, and be purposeful.  These tips may seem simple, but, at the end of the day, it is simple.  It's not easy, but it's simple.  

Why We Train: Moving Day

Those of you that follow Michelle and I in other social forums know already that we recently moved across the country.  Despite a couple of hiccups, I'm happy to report that we are happily settled in to our new digs and beginning to explore the possibilities that Arizona offers.  (Although, yes - it's REALLY hot here in August).

As the flurry of activity subsides, we've been talking about the experience.


The question: how do you stay motivated to keep training for the long run?
We hear this one a lot.  People get frustrated.  They don't see progress.  They don't have a concrete goal in their head about what their time at the gym should do for them in the long run.  We've often used the phrase that we're training for life.  And let me tell you, the past month has thrown an awful lot of life our way.  So I thought it would be interesting to share with you how we feel our training has come into play during that time. Do any of them surprise you?


Motivator 1: Keeping our Sanity
Studies show that moving is one of the most stressful life events a person can experience.  While I will immediately give credit to Michelle's supreme planning skills in making this the least painful move I have ever experienced (and that's a large sampling, folks), the ability to keep at least one point of consistency in our lives was a huge help.  We did some serious flexing in our schedule, but putting on the gym clothes and throwing around heavy things for an hour was a way of taking back control of our time and burning off some of that nervous energy.

Motivator 2: Lifting All the Things
Michelle and I lived in Minnesota together for two years.  And I can tell you, those flower pots in the garage were a lot heavier when we moved in than they were last month.  I'm not sure how that happens exactly.  Maybe our flower pots have been getting ripped on Hydroxycut.  (I'll leave it to you to decide.)  We were able to self-pack and unpack 90% of our household, which saved us a ton on moving expenses.

Motivator 3: On the Road
I don't know about you, but I've done a lot of long road trips of over 1,000 miles.  It beats you down.  Back pain, arms tingling, hands sore.  Not to mention the lovely elderly penguin walk you rock after getting out of the car.  This drive was over 1,800 miles and, I'm telling you, I didn't get any of the usual side-effects road trips usually throw at me.  Granted, I was ready to get the heck out of the car at the end, but we hit the ground running upon arrival.

Motivator 4: Adaptation and Execution

Okay - Phoenix is HOT.  I mean, it's called the Valley of the Sun for a reason.  And, in August, it's the hottest kind of hot you can imagine.  And Minnesota  - well - isn't.  It was no small change to acclimate to the desert environment.  And we had a week from the time we moved in to have everything up and running before I had to be back into the work groove.  Landscaping, painting, arranging furniture, you name it, we did it.  Heck, we even helped Michelle's niece move into her new house when we were done with ours.  Having a body that is strong with healthy energy levels was key to us pulling this off.


Motivator 5: Keeping our Figures
We see and hear from a lot of others on their weight loss journey who complain about weight gain after a vacation or a stressful life event.  It's such a common theme, in fact, that we basically assumed it was a given that we would put on a couple pounds.  I mean, we cut our training way back, were stuck in a car for three days, and were subject to whatever food was available at the exit where we needed gas.  It only made sense.

When we weighed in, however, we found that we both lost a couple pounds.  How?  Credit an optimized metabolism combined with a lifestyle that has made us completely re-think what "food" is.  We did lose some ground in the amount of weight we could push in the gym, but a couple of weeks of getting back into our program put us back on track.

I hope I'm getting the point across here.  Life Happens!  If you find yourself wondering why you keep getting out of bed early or stopping after work to hit the gym, then think about the events coming up (anticipated or not) you're going to weather.  Even if it's changing a flat on the side of the road, these kinds of things go so much better when you feel strong.  They don't knock you down so much and you get back up a lot faster.  What will it take for you to be better prepared for that next big change? 

So - why train?  Because... you never know.