A year ago I had just run my first half-marathon and was enjoying my third year of deep remission from Crohn’s disease. My company, Levered, had also raised a pre-seed round and grown our little impact-driven math curriculum company from the two to ten employees. By September, COVID had made it nearly impossible to sell curriculum, as superintendents were dealing with student safety, angry parents, and even driving school buses because of staffing issues. Flat revenue when you’ve 5x’d your burn rate feels like the iceberg no one expected in the water.
The same month, an ulcer in my intestinal wall nicked an artery and I went from cooking dinner to being pulled out of my bathroom by EMTs after losing a liter of blood in minutes. Life-saving measures were taken in the ambulance and I narrowly escaped needing a blood transfusion in the ER. My inflammation levels were 20x higher than the normal range, and I was put on a course of high-dose Prednisone to attack the inflammation.
Since then, life at a fledgling startup hasn’t gotten easier and the Crohn’s disease I worked so hard to reverse has been a rollercoaster of complications and corresponding medical interventions, with little in the way of answers.
Crohn’s disease is characterized by inflammation and damage that can show up across the entire digestive tract, causing painful cramping, bleeding, diarrhea, and a host of other complications. This constellation of issues also make it difficult to absorb necessary nutrients, further spiraling health issues. Crohn’s and ulcerative colitis, the other form of IBD, can not only cause and various others health problems but make social interaction and even leaving the house incredibly difficult. Treatment often includes steroids and potent immune blocking drugs to reduce inflammation, and can lead to a string of surgeries removing all or part of the digestive tract.
That thing we call stress
Stress is unavoidable, and can even be beneficial, as Kelly McGonigal writes in her book, The Upside of Stress, “Everyone has an Everest. Whether it’s a climb you chose, or a circumstance you find yourself in, you’re in the middle of an important journey. Can you imagine a climber scaling the wall of ice at Everest’s Lhotse Face and saying, “This is such a hassle”? Or spending the first night in the mountain’s “death zone” and thinking, “I don’t need this stress”?”
Having an autoimmune disease can often be medical shorthand for, “we don’t know what’s causing this, or how to stop it.” Now what we are finding is that autoimmunity is the canary in the coal mine for the potential consequences of much of the modern life we’ve created—high anxiety, high environmental toxin load, very little movement, poor sleep, and a largely poisoned food supply. For those of us with autoimmune and chronic illnesses, inflammation is our Everest, and mitigating the harmful effects of stress is our route to the top of that mountain. Add in the life of a founder and now there are two Everests to conquer, often feeling in competition with each other.
The pressures of startup life, with a cultural emphasis on working all day, every day, and relentless pressure to grow, can make life more difficult for people living with chronic illnesses. The pandemic made it even easier to work endless hours as all of our interactions moved to Zoom. Many of the people I’ve met who have Crohn’s and have put it into remission have given up a high-stress, unhappy, or abusive life to pursue their dreams and passions.
I was the president of an e-commerce startup when I got sick 10 years ago and was unable to work full time as I struggled to get my health back. I never expected to be back in a founder role, but after seeing the power of the platform my co-founder, Mitch, built to truly erase the achievement gap for kids learning math, it was hard to ignore the call to work on something so meaningful. In the last couple of years, with issues of equity in education becoming even more visible and important, the question I’ve been left with is how do we build something that can impact millions, while staying healthy (and having strong and loving relationships!) at the same time?
Given the story I started out with, I clearly don’t have all the answers, but having hacked my own disease before, I have shown I understand the factors and have a blueprint to fall back on. In broad strokes, I’m focused on accomplishing what matters, diet, movement, meditation, and taking advantage of current nutrition science and epigenetics.
Accomplish what matters
While I was sick and unable to work full time, I consulted with early-stage founders to try and get what was inside out into the real world where someone would pay them for it. One of the key concepts I used was, that at any given point and time there is really only one thing, that if you accomplished right now, would have a significant impact on your work. When feeling stuck, that “thing” is often a block that we are aware of but maybe consciously or subconsciously avoiding. Understanding the top 3 to 5 things that can be accomplished daily that make a meaningful impact on moving things forward, either directly or that allow others on your team to move forward, is a realistic path to heading in the right direction. I like to focus on effectiveness over time spent working as the measure of success.
You are what you eat
Only recently have doctors and gastroenterologists begun to acknowledge the diet’s role in Crohn’s and IBD. It seems like a flat-Earth scenario to me to think that what you put into your body would not affect or exacerbate digestive problems, but historically, doctors have preferred pharmaceutical approaches over some proven-effective dietary strategies. I just published a cookbook on the Autoimmune Protocol Diet (also known as the Paleo Autoimmune Diet). There was a study in 2017 that showed the AIP approach helped 73% achieve remission in just six weeks. I mostly follow what I call, a “slow food” approach that is close to a ketogenic diet, low in carbohydrates that are mostly made up of vegetables high in soluble fiber which is key for a healthy digestive tract, along with high-quality proteins and fats.
One hallmark of autoimmune diseases is low energy, often due to high inflammation that stems from the gut but can have a serious impact on brain function, making it difficult to work at your best. With IBD, the ulcerations and Inflammation of the intestinal walls also mean it is difficult for the body to break down and absorb nutrients.
To fortify my body’s resiliency, I focus on reducing inflammation and increasing metabolic function and flexibility. The most potent way I’ve found to achieve both is by increasing my body’s ability to produce and utilize ketones. To boost ketones, I use time-restricted eating, try to get a 2:1 ratio of fats to carbs and protein daily, and exercise 3-5 times per week.
Just keep swimming
The high-stress startup culture looks at hours worked as a video game score—the higher the better—which leaves little time for moving the body. Ironically, consistent movement and exercise (especially outside) are powerful antidotes to the cascading damage of a high-stress lifestyle and can even counter genetic predispositions to depression. In fact, with my five years of microbiome testing, cycling outdoors five times per week was the only intervention (including taking probiotics) that increased the quantity and diversity of beneficial bacteria in my gut. Training to ride my bike for 50 miles changed my life and sent me on a path to reverse my disease. I never expected or set out to be an athlete but as an Autoimmune Athlete, I’ve competed in triathlons, ran several road races including a half marathon, and even rode from San Francisco to Los Angeles with the AIDS/Lifecycle Foundation on a single-speed bike!
However you feel called to move—doing it often and with occasional intensity will not only help avoid the damage of high stress but will likely make you better at all of your pursuits.
Cultivate stillness for resilience
I started meditating daily about six years ago and hadn’t missed a day until recently.All those years ago, I began by challenging myself to meditate for 30 minutes per day for three months, as this is the threshold that had been shown to make changes to neural pathways. There is no technology out there more powerful at growing a baseline for mental and emotional resiliency than meditation. Without my daily practice, I’m sure that my recovery and how I was able to meet the last ten years of medical intervention and surgeries would not have been possible.
There are a ton of resources and apps to get started with meditation, or mindfulness practices. I’ve been using the Insight Timer app for ten years and appreciate the community of teachers and other practitioners. While I’m not a Buddhist, I like Mindfulness in Daily Life’s (MIDL) systematic approach.
Thriving vs. Surviving
The key takeaway from the Upside of Stress is that stress isn’t inherently bad. Some stressors have a hormetic or beneficial effect after the period of stress ends, like exercising, which breaks down our muscle tissue to rebuild stronger. With an autoimmune disease like Crohn’s, normal hormetic responses may cascade into out-of-control immune responses. Chronic stress from overworking is an easy way to trigger this response and diet, meditation, and movement may not be enough, but we can also look to the rapidly evolving understanding of the microbiome’s effect on everything from mood to inflammation and brain function. We can also look to epigenetics, how our genes are being expressed in response to the environment, as a way to biohack our genetics for an edge. Ben Lynch’s book, Dirty Genes is a great starting point.
When I started training on the bike, I was incredibly sick and needed to figure out how to generate energy out of a broken system. That led me to ketosis and experimenting with exogenous ketones. Today these things are far more common, but in 2015, it was voodoo, Now, rather than diving into a very restrictive keto diet limited to 20 grams of carbs per day, it’s easy to track blood ketones daily and supplement with ketones from places like HVMN to sustain therapeutic levels of ketones easily and feel amazing while working and training.
Few studies are looking at solving inflammation for IBD and autoimmune disease, but inflammation has become the prime target for aging research for longevity and cognitive decline and there are several compounds in addition to ketones that can dramatically increase cellular health and mitochondrial function, like, Resveratrol, NAD, CoQ10, peptides, and more.
Heal your gut and health and vitality follows.
Despite all I’ve learned and the progress I’ve made, it is a real challenge to balance the expectations of running a company and the reality that if I don’t take care of myself, things go sideways quickly and with potentially dire consequences. It is easy to be a frog in the boiling pot, minimizing the daily signals of my disease both physical and emotional. A recent review of studies found that 1 in 5 people with IBD suffers from high anxiety and 1 in 7 from depression. It seems like a reasonable response to all of the challenges faced by people with Crohn’s and UC, but studies are showing rumination and anxiety may be directly related to the health and diversity of the microbiome. A supplement company, Just Thrive, has even identified a “psychobiotic” strain of bifidobacterium longum that has been shown to provide support for interrupting anxiety cycles, even for people with stage fright.
Solving the multifactorial issues related to IBD takes more than taking a simple pill, or even an effective medicine. For me, it takes all the strategies I’ve described above, infusions of an immune blocker every five weeks, and knowing that I’ve gone through harder things and have seen bigger accomplishments than I ever saw for myself before being diagnosed with Crohn’s to get in the saddle, look over at my partner, and continue to drive the herd that is a startup.
If you aren’t doing something you believe in and that feels worth doing, I suggest that you find something that does. There are likely a lot of people ready to pick up where you leave your current job, but there is only one of you looking at the world the way you do, and no better time to take care of yourself.