Imagine this. You’re a healthy twenty-eight-year-old woman at the top of your game. You have a successful career as a fashion stylist and a wonderful social life. You’re in great physical shape.
Now imagine you’re the same person, laid up in a hospital emergency room with extreme muscle soreness and fatigue. Your abdomen is swollen to three times its normal size. Your kidney function numbers are through the roof, and your urine is a brown color usually seen only in a glass of cola. You are hooked up to a roadmap of tubes.

Confused and in pain, you’re also scared: This all happened literally overnight, and the doctors are stumped.

This frightening scenario isn’t something from a sci-fi novel—it happened last year to Melanie Pace, who has since become my client (I’m a nutritionist), my stylist, and my friend.
Melanie was diagnosed with a condition called Rhabdomyolysis. Her story is a cautionary tale about how the mind can lead the body into dangerous territory.

The picture of health

Melanie Pace has an uncanny eye for fashion. On a typical workday morning, she might deftly peruse the aisles of Neiman Marcus with a client or style a fashion model for a hot trunk show. She appears on television news segments, keeping the masses up-to-date on fashion trends.

Because she is immersed in the world of fashion, Melanie takes a special interest in staying physically fit. She’d sampled various regimens, but nothing helped her attain her ideal results—this is until she discovered CrossFit, a conditioning program centered around high-intensity, boot-camp-style group workouts.

A typical CrossFit class gathers participants at many levels of fitness, from elite, ramped-up athletes to de-conditioned newbies. That’s the problem—the CrossFit program, rather than an individual’s own ability, determines the timing, repetitions, and range of motion. Melanie was working faster and harder than her body could endure.

Melanie did a CrossFit workout five times a week, while maintaining a highly active lifestyle and playing in a competitive softball league at nearly the same intensity as her college softball days. She was so pleased with the results of her regimen that hours before her hospitalization, she documented her success with a photo of her rock-hard abs. Here is a picture taken just one day before her injury:

Then it all came crashing down in the ER.

Putting the pieces together

What is Rhabdomyolysis (aka rhabdo), and what brought it on in Melanie’s case? According to Gideon J. Lewis, DPM, FACFAS, a foot and ankle surgeon and sports medicine specialist, rhabdo is a potentially life-threatening condition in which damaged muscles release muscle fiber contents (myoglobin) into the blood.

The kidneys filter myoglobin out of the blood. But by-products of myoglobin can damage kidney cells, so in addition to destroying muscle, rhabdo can harm and even destroy the human kidney.
Dr. Lewis says, “Most of my experience with this condition has been with patients who suffered severe traumatic injuries [in which fibers from crushed muscle flood the bloodstream]. However, Rhabdomyolysis is also seen in individuals participating in athletic activities, especially heavy strength training, prolonged muscle conditioning, or endurance sports.

“Those at risk for exercise-induced Rhabdomyolysis are usually either out-of-shape individuals who jump into a high-intensity workout program or healthy people attempting a new high-level training program focusing heavily on muscles not often used. There’s also a high correlation with those who are insufficiently hydrated during workouts.”

Melanie fit the profile of a healthy individual who raised her workout ante to extreme levels. Her kidneys, plunged into crisis mode, couldn’t keep up, and she started to retain water. Her damaged abdominal muscles allowed her body to balloon. Her urine was brown because of dense concentrations of myoglobin by-products.

The week before her illness, Melanie ran the warrior dash—a mud-crawling, fire-leaping, extreme 5K run from hell, where participants conquer punishing obstacles and push themselves to be the first to cross the finish line. She played three softball games and conditioned with her team at softball practice.
The day before landing in the hospital Melanie engaged in a CrossFit core workout—intense rounds of glute-ham developer (GHD) sit-ups, back extensions, knees to elbows, and heavy-weight, stiff-legged dead lifts. She admitted she hadn’t consumed an adequate amount of water.

How much is too much?

Melanie’s account of her ordeal made me think about what we should expect of professional trainers: Shouldn’t a trainer know the reasonable limits for an individual doing a grueling workout? I consulted athletic-performance coach Bryan Meyer, owner of B Meyer Training and personal coach to NBA superstar Dwight Howard.

Coach Meyer said, “CrossFit is responsible for injuring a lot of people. Their concept is backward. Rather than determining the exercise based on the client’s range of motion, the exercise is prescribed without regard for range of motion. Forcing clients into movements where they have no control and then adding weight, thereby stressing the joints and muscles, is a recipe for disaster. It’s no wonder people are getting hurt.”

I mentioned the findings of Kenneth Cooper, MD, at the Cooper Aerobics Center, in Dallas, Texas. A few years ago, Dr. Cooper, then a proponent of intense workouts, did a total about-face on vigorous aerobic exercise when his research proved that the best prescription for health, weight, and fitness is low- to moderate-intensity exercise performed for just thirty minutes, three to four times a week.
Meyer agreed: “Contrary to what some fitness programs would have you believe, more is not necessarily better.”

No exercise routine should jeopardize your health. Never move too quickly through levels of difficulty or otherwise operate outside your comfort zone. In nearly all cases of exercise-induced rhabdo, the patient had attempted an unusual exercise load or an abrupt transition to a much greater load.
Coach Meyer offers advice for a properly designed exercise regimen:
∗ Extreme boot-camp-style group exercise can be dangerous. Have a credentialed trainer analyze your range of motion and prescribe an exercise regimen for you.
∗ Talk to your trainer. Be open and honest about how each exercise feels to you.
∗ Ask questions. Understanding your physiology and the intended result of each exercise will help you recognize when something isn’t right.
∗ Drink half your body weight in ounces of water daily. Drink fluids before and after each workout.

Here’s what Melanie looked like after hospital discharge, after a one week stay:

Recognizing the warning signs and getting treatment

Anyone who works out too hard and progresses too fast is susceptible to rhabdo—including triathletes, because of dehydration and heat stress, rugby players, who train with leg squats, and soccer players getting into condition with maximum-intensity sprints.
Dr. Lewis says to watch for these warning signs:
∗ Extreme fatigue
∗ Severe, delayed-onset muscle soreness
∗ Nausea and vomiting
∗ Dark or discolored urine
If you experience these symptoms, immediately seek medical treatment to minimize kidney damage. Treatment requires rehydration via intravenous fluids and removing toxic by-products from the bloodstream. Some patients must undergo dialysis (artificial filtering of the kidneys).

Returning to exercise after Rhabdo

A busy emergency room treats seven to ten cases of rhabdo each year, and its incidence is on the rise. The unlucky few must go through a proper post-recovery evaluation, including clearance from a kidney specialist, before resuming exercise.
Then follow these tips:
∗ Gradually return to low-intensity workouts.
∗ Stay hydrated.
∗ Stop at the first sign of abnormality in your urine.
∗ When attempting new exercises, work at 50 percent capacity for the first two or three weeks.
∗ Progress gradually. Never jump into something your body is not prepared for.

Moving Forward

More than a year after her diagnosis, Melanie Pace is back on track. She keeps me up to the minute on fashion, and I steer her away from fad diets and outlandish exercise regimens.
Melanie has embraced my philosophy: Metabolism is the sum total of all the chemical reactions in the body. Melanie used to view metabolism as simply a calorie-burning phenomenon, a process enhanced by grueling workouts. She has since learned physical abuse is not only unnecessary—it is counterproductive for sustainable weight management and overall fitness.
Melanie admits, “My inner voice told me working out at such an intense level was too much, but I was hooked. Never in a million years would I have guessed the serious consequences of my obsession with a healthy, fit body.”

Even after a long and arduous recovery, Melanie wanted to give CrossFit another go. That may surprise you, but it shouldn’t. It’s no exaggeration to say that exercise can become an addiction.
For each person the recipe for health and fitness is different. This may be the hardest part of all: finding our personal balance amid the clutter of information spewed out by the experts.

Metabolism does not occur in the body alone. It operates equally and simultaneously in body, mind, emotion, and spirit. If something is truly nourishing for the soul, it is quite factually nourishing for the body. That nourishment fuels Melanie’s metabolism today—and she has never looked or felt better.