Here’s a little more about Mark, answering some of the most common questions we get from clients and friends…
Please share a little about your educational and training history.
After studying biology and chemistry in college for three years, I was fortunate to be accepted into medical school at the University of Texas School of Medicine at San Antonio, graduating in 1984.
I then completed a residency in Physical Medicine and Rehabilitation via the University of Utah School of Medicine in Salt Lake City (1984-1987), meeting the requirements (a year in practice) and passing my specialty boards to become board certified by the American Academy of Physical Medicine and Rehabilitation the next year.
So what exactly does a physical medicine and rehabilitation specialist do?
Like many others in my specialty, I practiced for nearly 25 years in two distinct medical worlds.
For the first half of my medical career, I primarily served as the medical leader of inpatient, comprehensive rehabilitation teams caring for individuals who had suffered from catastrophic illness or injury, for example people with spinal cord injury, traumatic brain injury, cerebrovascular accidents, complex multiple trauma, and a wide variety of debilitating neurological disorders. Core team members most often included other physicians, physical therapists, occupational therapists, speech therapists, a doctor of pharmacy, psychologists, social support personnel, and a registered dietician.
For the second half of my career, I focused on the outpatient (non-surgical) management of spinal conditions, both traumatic and degenerative, performing diagnostic and therapeutic spinal injections under fluoroscopic guidance as well. During this time I also treated a host of different musculoskeletal problems, which mainly included knee, hip, and shoulder issues.
Why in the world did you retire from medicine early?
The answer is simple, and in two parts. I truly loved my time in medicine, though two issues became increasingly apparent mid-career.
One, from a purely objective business standpoint, and from the perspective of a guy who had always owned and run my own practices (often with a team of partners), during the last ten years of my time in medicine I earned less every year per unit of work, and every year during that time frame my operating costs went up. Traditionally, medicine’s answer to that issue is simply work more and see more patients; that’s in part why your doctor spends mere minutes with you face to face in the office. I found that experience increasingly frustrating, and a growing detriment to my family life.
Secondly, I’ve been very fortunate to have developed friendships with partners and mentors who’ve taught me a great deal about business and entrepreneurship, and while I’ve made impressive mistakes along the way, it’s been liberating and downright fun to pursue several other business interests during the past decade.
It’s a big world out there, and fascinating options abound.
So why step back into the health world as a health and wellness coach?
The short answer is simple – I’ve experienced, with some hard work and sweat equity, a personal health transformation that my family and I find to be extraordinary.
While body weight is often the wrong metric to use to measure success in transforming one’s health, as of 1 March 2019 I’ve lost over 172 pounds (on the way to likely what will be a 200 pound drop!), am more fit than since my days as a high school and college athlete, and feel 40 years younger in terms of energy, outlook, and overall function.
As friends and family have noticed my own transformation, I’ve been bombarded with questions and cries for help. And my transformation has rekindled, as corny as it sounds, a strong desire to help others live better lives – one of the reasons I was drawn to medicine in the first place.
How in the world did you get into such health trouble in the first place?
As is typical, there are a variety of reasons, but probably first and foremost is the fact that my family and I love great food, and in fact, had I not gone into medicine, I’d probably have been a chef.
I first began to put on extra weight during the medical school grind, and for the next twenty five years lived a very active lifestyle (working hard, raising a family, downhill and cross country skiing, hiking, camping, backpacking, fly fishing, and rafting) though I was above my ideal weight, and packing on extra pounds every year via the standard American diet (SAD).
Along the way we’d buckle down for an interval with one diet plan or another – Weight Watchers, The Zone, even Atkins for example – though like many others, we found the routines too restrictive and not built for the long haul.
Starting not quite a decade ago, a series of health challenges lead to more pounds and less activity, these challenges included a meniscal tear, two different serious rotator cuff injuries, a tibial plateau fracture (rafting injury!), and in 2015 a diagnosis of renal cell carcinoma (low grade, and treated very successfully – though my weight blossomed as a consequence). Finally, at my heaviest and at the point of my worst general health status, I developed out of the blue an idiopathic thrombocytopenia (low platelet count), very likely an autoimmune disorder related to, at least in part, a leaky gut and my metabolic syndrome.
I was discouraged, depressed, and after being harangued by a physician during my early cancer treatment, had very nearly lost hope I could ever come back.
What turned the tide for you to begin your recovery?
Every time I share my story, I’m asked this question. It was a variety of things, but I finally realized that a top to bottom life and health makeover was in order, and I frankly remember standing in front of the mirror, looking over my bloated body for new bruising caused by the platelet issue noted above, and saying “alright, it’s time”. That was the third quarter of 2015.
I had been reading a bit on Mark Sisson’s MDA site, and was also inspired greatly by (ironically) an economist/business guru I follow – Karl Denninger – who had recently been sharing his own health epiphany and journey into the LCMPHF world.
We jumped on the low carb/healthy carb bandwagon and things started getting better from there, albeit with some bumps in the road, along with a few pauses and restarts.
How would describe your coaching philosophy?
My prime coaching directive is that your nutrition plan, approach to fitness, and health maintenance MUST BE customized very specifically to where you stand metabolically (or physiologically) TODAY, understanding that your needs will very likely change as your body adapts and changes over time. Knowing what to change when is the tricky part, and let’s be honest, sometimes involves some educated guesswork and N=1 experimentation, and that’s OK.
A corollary to the customize, customize, customize principle above is this – it took years to learn in my medical practice, but I finally learned that if I really listened to a patient, intently, actively, and carefully, they’d share the keys to help them address whatever problem or need they sought care for. Really listening is a hard-earned and learned skill; if you’re going to seek help from a health and wellness coach, they need to listen very, very well.
What types of clients do you enjoy working with the most?
I love working with people of all shapes, sizes, backgrounds, and fitness levels who have made the decision to change their life for the better. Making the decision to engage might be the most critical step, though most people benefit dramatically from guidance getting started.
Given my own story, I have a particular interest in helping those who have lost hope in ever being fit, healthy, and well again.
What philosophy or approach are you most aligned with (i.e., Primal, Paleo, etc.)?
Recognizing that the many varied approaches to optimizing nutrition, fitness, and overall health around today bring different utility and tenets to the wellness table, I think it’s critical to customize an approach to improving health and maximize wellness for any given individual, applying the components that fit best at the given time. My family and I utilize the best information we can source from dozens of experts to fit our specific needs, and you should too.
That said, I really like the core principles and tenets of Mark Sisson’s Primal movement, and in fact, I’ve completed his Primal Health Coach Institute’s training program and certified as a Primal Health Coach. Did I need to do that as a retired physician? Absolutely not. Was it useful and instructive? Absolutely yes.
My wife and I personally consider ourselves for the most part Primally-aligned in how we view nutrition and activity.
What’s your take on carbs and how we should approach them?
Carbs as a macronutrient aren’t inherently evil, and anyone who suggests that Primal, Paleo, ‘keto’, or other folks “hate carbs” is trying to sell you some snake oil.
The carb game is pretty simple actually; the evidence is quite clear that highly refined carbohydrates, which are principally refined grains and sugars in the SAD, wreak havoc on the human system. Even if you constrict the discussion down to looking just at what these foods do to the blood glucose-insulin axis, their consumption is really indefensible for most people.
For most people, particularly if they’re above whatever they consider their ideal body weight to be, my spin on carbs is to immediately cut out highly refined grains, sugars, and legumes, at least until metabolic integrity is restored, coupled with rational and intentional consumption of protein along accepted guidelines.
Doing so basically immediately defaults you into a low carb, moderate protein, higher fat program (increased fats needed to make up for the now down-adjusted carb intake), and it becomes actually quite easy to eat generous amounts of nutritious, whole-food, varied carbs, enough to keep a menu interesting and sustainable for the long haul.
I find time and time again that once you make the break from the offensive carbs (think bread and sugar for example), when exposed again down the road they simply don’t taste good; their consumption makes you feel lousy.
Given your history, are you anti-traditional medicine?
Interesting question, and the answer is actually both “yes and no”.
Where I support traditional medicine: For example, if I were run over by a bus on my walk tomorrow morning and sustained complex multiple orthopaedic or neurologic injuries, the American medical system would provide the best care available in the world. And very likely ditto in the case of a catastrophic medical event or disease, such as an aggressive cancer, a devastating infection, or a major organ failure. It’s my opinion that the majority of physicians practicing in the country are well-trained in the diagnosis and management of disease, and most are pretty good at what they do.
Where I think traditional medicine is a disaster: Two somewhat different issues. One, as noted above, traditional American medicine does a very poor job at understanding and promoting wellness and health. For example, the explosion of obesity, CAD, and T2DM during the past decades of the anti-fat movement, led vigorously by establishment medicine, is a damning testimonial to missing the evidence unfolding before their eyes.
And secondly, the way we pay for medical care in this country is frankly insane, and unless addressed soon (within a matter of years from now in early 2019), will blow up the American economy in a very problematic way. This is a much larger topic than can be addressed here, is a cost of care issue and not an insurance issue, and is a bipartisan political failure, though worsened dramatically by “Obamacare” (prime example – the expansion of Medicaid and pushing costs down to the state level, particularly using block grant funding).
Sadly, unless physicians lead the way on addressing this issue (which by and large they’ve not done thus far), they clearly own part (and perhaps a big part) of the pending catastrophe. See more under the Medical Policy category on the blog…
What do you like most about the health and wellness world today?
I’d argue there’s more innovation and creative thought in how we look at human nutrition and the pursuit of genuine wellness than ever before, and much of that is being led, and pushed, by sharp minds in the health and wellness arena, very often outside of medical academia.
In fact, it’s pretty easy to support the argument that the health and wellness sector, again outside of traditional medicine, is pushing the discussion in key areas, like dietary recommendations, in the right direction after decades of misinformation.
What do you dislike most about the health and wellness world today?
Dogmatism – the “my way or the highway” approach to nutrition, exercise, etc. Nutrition, fitness, and exercise must be customized to fit your specific physiology, metabolism, and functional capacity; there’s no way a one-size-fits-all approach works. Beware anyone who suggests their magic plan is your only hope.
It’s noisy. There are lot of impressive voices sharing useful, evidence-based, and accurate information. There is also, as there has been throughout human history, a host of charlatans, wackadoos, preeners, and quick-buck profiteers sharing “advice” these days. Caveat emptor.
A focus on physical attributes (do these tights make my butt look big?) and not wellness. See Instagram.
Is wackadoo a medical term?
Yes, it is.
What’s a typical food day like for you currently?
As of March 2019, I’m in my 10th month of a run in nutritional ketosis, undertaken for a variety of reasons (intellectual curiosity, break a weight loss stall, N=1 experiment, and more). For the entire duration of my keto run, less than 5% of my daily nutrition has come from high quality carbs (anywhere from 12-25 grams per day), about 20-22% from good protein, and the rest from a variety of healthy fats.
Most days I awaken refreshed and not hungry, drink a cold or hot brew coffee with cream and a half scoop of collagen, and don’t eat until hungry, which is typically between 1-3 pm, most days after two fasted workouts. My wife, bound to a typical workday schedule, and I share our largest meal of the day in the evening, typically featuring a nice protein with a great slaw, salad, or other vegetable prep.
Rarely if ever do I experience a genuine sense of hunger, and at least every ten days will fast from evening meal to evening meal, usually because I got too busy during the day and simply forget to eat.
Tell us a bit about your family.
Something of rarity these days, I’ve been married 38 years (wow, how time flies!) to the same wonderful woman; she’s a linguist (French and Spanish, with a smattering of several others), gifted educator, and retail management savant. We have two adult offspring, both living in Montana. Our daughter is a talented photojournalist in the outdoor sector, traveling the world, and working in the marketing department of an outdoor company in Missoula. Our son is an avid outdoor creative working with a large agency in Bozeman, runs his own outdoor gear sales company, and is married to a lovely OR nurse; they’re busy raising our first grandchild who’s now 8 months old (Mar 2019).
What do you like to do for fitness and fun?
Current workouts include resistance training three days per week, a bit of martial arts, yoga, and daily walking/hiking (usually twice) for 60-90 minutes per day. For the first time in my life, I’m loving my daily workouts, and get a bit cranky if I miss more than a day.
For pure play – we’ve long been ardent fans of fly fishing, hiking, camping, hunting, gardening, reading, and photography; my wife and I very much enjoy travel and exploring new places. Finally, I’ve been working on a novel, though it’s a ways out at this point.
Ever considered going vegetarian or vegan?
Nope. I am an unashamed lover of great animal proteins and seafood.
Physicians are often deemed to be out of touch with the reality we all face everyday; what other kinds of work have you done before?
Farm laborer, warehouse laborer, construction worker, laborer at world’s largest copper refinery, backpacking guide, fishing guide, lawn service, catering business, owned and operated horse farm and event center, cofounded magazine, multifamily real estate. (An aside – life seems much more fun if you get your hands dirty…)
Favorite advice to someone debating whether to jump in and improve their health and fitness?
Just get started. Today. Even if just a single, seemingly insignificant baby step.
Setting goals is vital; longterm, intermediate, and short term. BUT don’t get overwhelmed looking at long term goals in particular. You just need to decide today to eat the next meal on plan, and power through your next movement block or workout. Just decide to do the next thing now.
Success comes from consistent effort over time, recognizing there will be some bumps in the road along the way.
