Ep. 333 Overtraining, Body Image and the Power of Strength Training with Dr. Sean Pastuch

Your trusted source for nutrition, wellness, and mindset for thriving health.

I am honored to engage in a conversation with Dr. Sean Pastuch today.

Dr. Pastuch spent more than ten years treating patients and training clients. He has worked with some of the most elite athletes in the world, guiding them toward success by seamlessly connecting fitness with healthcare. 

In today’s conversation, we discuss the sustainability of New Year’s resolutions, explain why strength training is essential, and talk about chronic cardio and muscular independence, the pitfalls of overtraining, and the impact of body image marketing. We explore advocacy within the current healthcare system, emphasizing the need for confidence-building to become effective advocates for ourselves and our children. Dr. Pastuch also explains the simplicity of his morning routine, highlighting the importance of uncomplicated habits for maintaining a balanced and healthy lifestyle.

Stay tuned for simple-to-apply behavior changes, mindset shifts, and exercise protocols to help you live a life of freedom without compromise.

“My advice, especially to women is to think like a bodybuilder and you will burn fat.”

– Dr. Sean Pastuch


  • Dr. Pastuch shares his thoughts on New Year’s resolutions
  • How fitness planning in 5-year rather than 1-year chunks can make your progress feel less daunting and more achievable
  • Why mindset is such an essential aspect of fitness
  • Dr. Pastuch shares advice for finding a good trainer
  • Some strategies for weight loss and fitness
  • Why do we need to adapt to our body changes during perimenopause and menopause rather than relying on methods that worked in the past?
  • The benefits of focusing on overall health and well-being instead of striving for a specific body ideal
  • The importance of addressing underlying issues before focusing on exercise and nutrition for weight loss
  • Why passive solutions are not enough to address generational problems
  • How to become your own best health advocate


Dr Sean spent over a decade treating patients and training clients. He has worked with the most elite athletes in the world, the people who need the .01% edge on their competition, like professional baseball players, CrossFit games champions, and Olympic medalists. He found his success by bridging the gap between fitness and healthcare, using his expertise in both the gym and the clinic to create a new way to help people consistently get out of pain without going to the doctor or missing out on their active lives. Since leaving practice in 2017, Dr. Sean has taken the methods he used to help over 10,000 people perform at their best, free of pain, and made his methods and mindset shifts available to the masses through the founding of his company, Active Life, where his team not only help people from around the world to get out of pain without going to the doctor or giving up their active life, but they mentor fitness and healthcare professionals to do the same for their clients and patients.

Connect with Cynthia Thurlow

Connect with Dr. Sean Pastuch


Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:29] Today, I had the honor of connecting with Dr. Sean Pastuch. He’s spent over a decade treating patients and training clients and he’s worked with some of the most elite athletes in the world. And he’s helped find success by bridging the gap between fitness and healthcare. 

[00:00:44] Today, we spend an extensive amount of time talking about the sustainability of New Year’s resolutions, the importance of strength training, overwhelming the problem, chronic cardio and muscular independence, overtraining, body image, marketing and advocacy within our current healthcare system, and understanding that in order to be our own best advocates, we need to gain confidence and become not only advocates for ourselves, but also our children. And why his morning routine is focused on keeping it simple. I know you will enjoy this conversation as much as I did recording it. 

[00:01:24] Well, Sean, it’s such a pleasure to finally connect with you. You came so highly recommended from two good friends, Robb Wolf and Dr. Gabrielle Lyon. Welcome. 

Sean Pastuch: [00:01:33] Thank you. I’m really excited to be here, Cynthia. 

Cynthia Thurlow: [00:01:35] Yeah. I would really love to start the conversation. I mean, obviously you have a lot of experience with personal training and strength training, and my listenership is very interested and it’s the beginning of a new year, so this is super relevant. People are making a lot of New Year’s resolutions. They are recommitting themselves to a healthier lifestyle whatever that looks like. They are very likely making some substantive changes. What I find interesting is the gym goes from being, you get to the end of December, there’s not a ton of people in the gym to January, it is just booming with business and people, they’re recommitting themselves to workouts. What’s your prevailing philosophy about New Year’s resolutions? Do you believe in them? Do you think they’re helpful? Or do you think they set people up for a disaster? 

Sean Pastuch: [00:02:21] I don’t think there’s a right answer to that. It depends on the person and the time in their life. So, for example, let’s say there’s a lot of energy and resistance to getting something started. And you need the mental prep. You need the two-week, three-week, seven-week mental, I’m going to do this when this happens. The nice thing about a New Year’s resolution is New Year’s is coming it’s not when my work lightens up, it’s not when the weather turns. It’s New Year’s is coming and it’s binary, it’s January 1st. So if you need a New Year’s resolution to get yourself in the mind frame that you’re going to change some of the things about what you do and then you do them. I’m all for that. If you’ve made a New Year’s resolution every year and you haven’t changed, then New Year’s resolutions are showing you that they’re not the way that you’re going to institute change in your life. I hope that answers the question that you were asking. It’s going to depend for each person, but I think that a simple way to evaluate it for yourself is do I do It when I say I’m going to do it? And if you don’t, then a New Year’s resolution isn’t going to be the thing. And if you do, then it could be. 

Cynthia Thurlow: [00:03:26] Yeah. Well, I think you’re really speaking to bio-individuality. Like for each one of us, that might be all we need to get back on track. And for others, I’ve come to find that I don’t so much do a New Year’s resolution. I do a themed word for the year. And so, for 2024, it’s alignment because I spent a lot of 2023 getting very clear and granular about the direction of my business, things I wanted to be doing, things I didn’t want to be doing. And so, part of being in alignment is not doing things I don’t like doing. And I’m not referring to like, there’re certain things I don’t love doing in my life that I do, but meaning that when I’m in full alignment, whether it’s with regard to a workout, whether it’s a nutritional philosophy, it means I’m leaning into things that make me feel good. I’m avoiding things that don’t make me feel good. So as an example for listeners, I don’t really have a lot of vices, but I do like dark chocolate. And I ate way too much during the holidays. I was out with my mom’s, Italian mothers always have way too much food. They know exactly what your trigger foods are and they just have a plethora of it. 

[00:04:21] And so, I came home and I said to my husband, “January 1st, I’m giving myself, I’m going to enjoy the holidays. But January 1st, I am back on really avoiding processed sugars because it is such a slippery slope, even for people that eat healthy diets.” And I’m just at a stage in life where if I eat too many brownies, gluten-free brownies, or if I eat too much chocolate, it shows up way earlier than it used to. And so, it doesn’t make me feel good, it impacts my sleep. I wear an Oura Ring, so I like to track metrics. And so for me, that is the way that I’m starting 2024 is recommitting to getting to the gym three days a week to do strength training consistently and avoiding processed sugars. But I think for each person listening, there’s probably a couple of things that people are focusing in on. 

[00:05:11] I think it’s much easier to focus in a couple of things than it is to try to change 10 things in your personal life. And then two weeks in, you’re like, “It’s too much change.” And so that’s usually the thing that I start seeing with most clients and patients, is that if they’ve committed them self to changing 15 things at once, that’s not sustainable. But one or two typically can be. 

Sean Pastuch: [00:05:30] Yeah. There’re a few things you said there that I would love touch on. One is both of the things that you described, the thing that you want to do less of and the thing that you want to do more of are emblematic of inertia playing a major role. I used to eat a piece of dark chocolate every night before I went to bed. And it was always well sourced, high quality. I was spending good money on chocolate bars and eating, like, a chocolate bar would last me almost a month, you know what I mean? But it became the thing, like, “Oh, I eat chocolate before bed.” And then when you don’t have chocolate before bed, when I would travel to do podcasts and I would go be on someone’s show, I’m like, “I got to go to a store and buy a bar of chocolate before bed.” I don’t need to go and buy a bar of chocolate before bed. But you start to look for it, identify as it, and prioritize it, which is crazy. And the gym thing, you saying, “I’m going to go three times a week.” You build the inertia to be the person who just like, “I’m going to find a way to get there three times a week.” And what I think was really good about the way that you were describing that is I like to tell people two things. 

[00:06:28] One, stop planning in years and start planning in five years, because the year very quickly gets away from us. If we have a bad January. We throw out the year and it’s likely we’re going to have a bad January. I want people to know you’re not weird or a failure for having a bad January. You’re trying to change something about yourself that’s been grooved in over the years, and you’re expecting that January is just going to go seamlessly. And it’s not. You’re going to fail in January more times than you would like to. If we’re doing this on a one-year thing, we feel like we’ve just lost one of our 12 months and what’s the point. If we’re doing it on a five-year thing? It’s one of 60. It’s not even 2%. It’s not a big deal. Let’s just stay with it. So that’s one is plan in longer chunks.

[00:07:14] The second is start absurdly small. So you described going to the gym three days a week. You didn’t say for how long and that’s okay. I talk to people all the time who think they need to go at least three days a week for at least an hour. You don’t have to go at all. Let’s pretend that right now you don’t exercise and going into the gym is intimidating for you. And you don’t want to walk in there because the smells, the sounds, you don’t want to get into somebody’s way, you don’t know where the equipment belongs, what you should use, or even how you should use it. And today you don’t exercise. Why don’t you start just by going on a 10-minute walk every day? That’s it. You don’t need to do more than that. If you start going on a 10-minute walk every day, after three to six weeks, you’re going to identify as a person who moves every day. And you will naturally start to look for the more efficient use of your time. You might start going for 20 minutes walks. You might start saying, every other day, I’m going to do some strength training at home. 

[00:08:07] Start absurdly small, plan in five-year chunks, and you won’t recognize who you are five years from now. And the simplest way to prove that is look back five years. Who were you with? What were you doing? Where did you live? What was your job? What was your fitness? What was your happiness? What was your education? What was your clarity? Look back five years. You are a completely different person. And some of those things are better and some of those things are worse. That’s not the point. The point is you’re a completely different person than you were five years ago. You’re going to be a completely different person five years from now. But if you look back one year, not that much has changed. So I’m asking you to plan in five-year chunks because A, it’s easier to get back on the horse when you fall off. You don’t feel like all is lost and it’s more likely to be what it takes for you to get where you want to go. 

Cynthia Thurlow: [00:08:57] Well, and I think that mindset shift is so important. I think there’s very much this all or nothing philosophy that prevails. And I would agree with you that many people are intimidated to go to the gym and what you’re encouraging them to do is if you’re not currently physically active, walk for 10 minutes a day. And there’re ways to fit that into your lifestyle. Like today is a good example, I have three back-to-back podcasts and in between I’m going to walk my dogs because I don’t like being sedentary. But it’s also a good way for me to get out in the sunshine, just kind of get out the circumstances that I’m in. It’s like, “Okay, let’s clear our head. Let’s connect with nature, not think about anything. Let’s just walk our dogs.” 

[00:09:33] But I think a lot of the prevailing dogma about New Year’s resolutions and getting back to the gym is that people think they have to spend hours in the gym. And what I love about a lot of your messaging is that workouts should be efficient. They should be sustainable. For me, I get in and out in at about 40 minutes, start to finish, and I work out hard and I work out intensely. Now, that’s probably not the way I worked out five years ago. I was probably still doing these really tough conditioning classes that would leave me really depleted. And so, when you’re working with men or women, how do you help them understand the mechanics of structuring a workout? And we’re speaking kind of in high level terms because I think that you brought up some good points. 

[00:10:17] You don’t have to go to the gym to work out. You could do something as simple as walking. Maybe you’re doing body weight exercises to start. But what are some of the common helpful ways when you’re helping someone get more acquainted with rank training as an example? Because a lot of the focus of my work, and I know yours as well, is helping people understand the value of building muscle, maintaining muscle, especially as we’re getting older, certainly for my population of women, helping them understand that doing chronic cardio is not going to get you where you want to be. You really do have to build and maintain muscle. What are some helpful tips that you have found to help people make that transition? Going from maybe they’re at home doing body weight exercises to transitioning to the gym. How do they connect with good trainers to find people to help them do things safely? 

Sean Pastuch: [00:11:00] I really believe, first and foremost, it starts with the mindset. So a good way to think about getting into shape is like comparing it to financial debt. If you have a financial debt and you’re making a payment on it every month, the debt is coming down. You have less and less debt every month, but you’re still not out of debt when you start paying it. But you understand that paying that debt every month ultimately is going to lead to you living a debt-free life. This is the same. The problem is too often people look at their waistline, their weight on the scale, the cuts in their shoulder, how does their jaw look? And they say, “I am not getting the results I want to get.” And the truth is you are. You’re just still in debt and you’re moving closer and closer to being at baseline, which is when you start to see the things that you want to see. 

[00:11:43] But first comes the behavior change, second comes the physiological adaptation, third comes the refinement. It’s like any business, a simple thing that people who are running businesses understand is that first we build the thing. In your case, this is habits. Then we grow the thing, which in your case is going to be consistency. Then we stabilize the thing, which in your case is going to be understanding, having clarity around why am I doing all the things that I’m doing? What do I do when I miss? What do I do when I fail? Then we go into innovation, which in your case is starting to refine. It’s, “Oh, I want to change this part of my body. I want to change this part of my performance.” It starts off with everything works. So what you talked about were three things. You talked about people being cardio machines, training perhaps with too much intensity too early on, and with the all or nothing mentality of going in and having to train for 40 minutes to an hour all day. 

[00:12:35] So here’s what I would tell people if you also mentioned finding a good trainer. The shameless plug I’ll give, because I feel like I have to here, is that we develop the best trainers in the world. Active life develops the best trainers in the world. My background was I was a personal trainer first. Then I became a chiropractor because I was uninspired by what a personal trainer could do. So I wanted to become a doctor, became a chiropractor, was uninspired by what I could do in the clinic. And so, I started teaching coaches how to do what I was doing. That was getting Olympians, professional athletes, and CrossFit games champions to fly out to my little office in Island Park, New York for care and then fly home and have me coach them from a distance. So that’s turned into well over a thousand coaches going through our education and they’re all over the place. If you send me a DM on Instagram or an email at drseanpastuch@activeliferx.com I will ask you where you are. I will connect you with one. In a few months we’ll have a map built where you can just go and search it. 

[00:13:25] But the best way to find a good trainer outside of that is ask people who are happy with their trainer. Just allow word of mouth to do the thing and ask them why they went. Ask them what they like about them. Ask them what they would change if they could change something about that person, because it’s not always going to jive. But generally speaking, the best trainers are not the ones with the best book smarts. They’re the ones who can connect with you as a person, meet you where you are. And when you come in and you say, listen, “I didn’t sleep well last night. My kids woke me up. I’m stressed out because I got to get this thing in for work, and I’m here because I show up for myself.” You want that trainer to understand that and not say, “Well, let’s get it in, let’s go, we’re going to work that stress out.” That’s not what you want to do. 

[00:14:10] So finding somebody who can connect with you as a human is priority one because they’ll help you be consistent. Making sure that what they’re doing is efficacious is priority two. That sounds ridiculous from the guy who has an 800-page textbook and a 13-month mentorship to make sure they’re efficacious. But it’s all about connecting. I would also suggest put price aside. Think about it like you’re buying eggs. What you’re doing in the case of buying a trainer is you are overwhelming a problem. You’re overwhelming a problem with a solution that has to solve it. I have a friend who was working in local government and he always yoyos on his weight and then he left local government and he got a really good job working for a hospital system, and he’s like, “What do you think I should do now that I have the time and some money to solve this?” I said, “Overwhelm your problem.” 

[00:14:54] Hire somebody to do food prep, who comes to your house, who prepares meals, snacks in the macro quantities that you need. Pay a couple thousand dollars a month until your palate changes to prefer that food, until your habits change to seek that food so that you’re not having to punish yourself for asking someone at the restaurant what kind of oil they’re using and how they’re preparing the food. You’re doing that because you want that. Overwhelm your problem, whatever it is that the problem is. When it comes to the cardio, I think there are two reasons why people do cardio so frequently. One is fear of weights. I don’t want to get bulky and I don’t want to get hurt. I’ll come back to that one in a second. The second one is I feel like I did more when I get a really good sweat, when my heart is pounding, and when I walk out drenched. I want to speak to the physiology of that for a second, if it’s okay with you. 

Cynthia Thurlow: [00:15:44] Of course.

Sean Pastuch: [00:15:46] The way that we actually burn calories and actually lose weight has a lot less to do with the time we spend in the gym and a lot more to do with the adaptations that our body goes through as a result of the time we spent in the gym. When we do a lot of cardio, we break down very little muscle. We actually break down more tendon than we do muscle by a percentage. When we’re doing a bunch of cardio that’s repetitive. That’s why we run into ankle issues, Achilles issues, knee issues, hip issues, that kind of stuff, and you burn tons of calories while you’re doing. You might look at the StairMaster and say, “Wow, I burned 600 calories today. That’s amazing.” But then you’re only going to burn another 600 for the rest of the day as a result of that workout because you didn’t really build very much muscle. If you instead focus on the strength development, which will give you the toning that you’re looking for, and the muscular independence that you’re looking, you will burn fewer calories during the workout, but you’ll be tearing down muscle. And the energy expense to repair that muscle throughout the rest of the day is an exponentially greater number of calories than recovering from cardio.

[00:16:54] So while you burn fewer calories while you’re in the gym, you will burn more calories overall if you focus as if you were a bodybuilder. Now here’s the good news. You’re afraid of getting bulky. I don’t want big man muscles. I’m not looking for six pack abs and boulders for shoulders. It is so unlikely that that would happen because of the way you would need to eat, the amount of fatigue you would need to work to that. You could probably pursue it for the rest of your life and not achieve it unless you had a coach who specifically was helping you do it. But I want to speak to your subconscious doubts. You’ll see it happening along the way. If it starts to happen, it’s not irreversible. You just go from doing shorter sets with 8 to 12 reps to doing longer sets of 20 reps with shorter breaks in between. You build stamina muscle. There’s always the opportunity to change your direction at a fork in the road. My advice, especially to women, think like a bodybuilder and you will burn fat. It’s like our friend Gabrielle Lyons says, “Instead of focusing on what you have to lose, which is the fat, focus on what you have to gain, which is the physical freedom through muscle and strength development.”

Cynthia Thurlow: [00:17:58] I think you bring up so many good points and for a lot of women that I see struggling in perimenopause and menopause in particular, what worked for them in their 20s and 30s that they would take these really long runs, they did really intense HIIT training, they did CrossFit or intense conditioning classes, and all of a sudden, they’re not getting the same gains. They’re worn out, they’re not sleeping well, their cortisol is high. Unfortunately, cortisol, much like insulin, gets a really bad rap. And I’m like, “It’s not a bad hormone. But if you’re not leaning into the changes that are occurring in your body and perimenopause and menopause, you’re going to start seeing some loss of gains.” And I think the most powerful thing about strength training not only is the fact that you are burning more calories at rest, so when you’re not in the gym, you are burning more calories than you would be otherwise, but it’s helping people understand that muscle is this metabolic organ that helps with insulin sensitivity. 

[00:18:53] And if we know 92% to 93% of Americans right now are not metabolically healthy, maintaining and working on building muscle is critically important, especially for women, especially as we’re navigating middle age. I speak very openly about the fact that this is oftentimes when women will say to me, “What used to work is no longer working.” So we have to change some of our patterns. And you’re really speaking to that. Not just the mindset, but also understanding we have to adapt to where we are in time and space. 

Sean Pastuch: [00:19:21] You know a lot of people who end up coming to me and us at Active Life come to us as a result of what was working for me once is no longer working. And so, I started doing more and things broke down. And when they come to us, we have them doing much less. And the results that they get are so surprising because they’re like, “I used to have to destroy myself to do this.” Now I leave my workouts and I don’t even feel like I deserve the brownie that I said I was working out for. And then we have a conversation about working out to deserve food, which is a totally different conversation. 

Cynthia Thurlow: [00:19:55] [laughs] Yes.

Sean Pastuch: [00:19:56] There is a minimum effective dose for all of us. And then what happens is the fitness industry in general comes top down. So, it’s bodybuilders down if you’re in the aesthetic world, professional athletes down if you’re in the performance world and those people are chasing diminishing returns, those people understand that what they are doing to their body and with their body is not healthy, but it is in the pursuit of momentary glory. You’re not in the pursuit of momentary glory. So, when you’ve done enough work to achieve minimum returns, like the minimum necessary dose to get to diminishing returns, you should stop. Go focus on eating real foods and spending time with your kids and going out into nature and sleeping really well. You don’t need to do any more than that because you’re going to spend– It’s like I tell our team all the time, what we do well is we obsess over the 5% that everybody else gets to in business and says that’s good enough. 

[00:20:54] Because we believe that if we obsess over the 5% that everybody else says, “We’re good enough, we don’t need to give that last 100% to get that last 5%. Then we stand out in the crowd.” But you as a client or you as an individual, that does not need to be your focus. Because you’re not looking to be a professional athlete. You’re looking to live a long, healthy life, to be confident in your body, to know that you’re going to be able to go on a hike with your friends and family without being a burden, without getting left behind. When summertime comes, you’re going to take your shirt off at the beach and not feel like you need to hide something. I have a story that changed everything for the way I look at serving a client. 

[00:21:31] I had a woman walk into my office for back pain when I was still treating patients. And she’s like, “I really need to get out of back pain.” I said okay, “why?” Because one of the things I like to do is help people. Oftentimes people will say, “I can’t do this because of this pain.” When the reality is you can, you just can’t do it to the degree that you’re accustomed to doing it. And so, you cut it out and now you have negative thoughts and all this stuff, and it persists the problem. Anyway, we get to the point that she tells me in the story, “Well, really, I need to work out more because I want to lose 20 pounds,” because I go to the beach with my daughter, she’s going to be seven this year, and she’s going to know I’m lying when I tell her I don’t want to take my shirt off at the beach because I’m cold. When the truth is I’m ashamed of the way my body looks. 

[00:22:12] And so, we sat in that moment for a little bit, and I remember having the conversation with her about allowing the kid to see that mom can be imperfect in her own eyes and then become somebody different over time while loving herself all the way through. But it stopped being about destroying yourself in the gym. It’s not going to work. We have to do this totally differently. 

Cynthia Thurlow: [00:22:34] And I think it’s helpful and important. And I have started to kind of watch this triad emerge. So, obviously, I’m known for intermittent fasting, which is both good and bad. I’m known for talking to women of a certain age, but I see a lot of women who still have very dysfunctional relationships with themselves. So, they think if a little bit of fasting is good, more is better, a little bit of exercise is good, more is better. If a little bit of food restriction is good, more is better. And I think that it’s so important for us, especially if we’re modeling behavior for children. And I have two teenage boys now, but helping them understand that part of evolving as an adult is accepting things about yourself. Our bodies are changing, whether that’s good or bad, but there’re things we can do to counteract it without punishing ourselves. 

[00:23:19] That is something that I see. I mean, it’s the way women speak to me about themselves because it also represents– their internal dialogue is probably incredibly negative if what they’re saying outwardly is incredibly negative because it gives me a sense of what they’re probably doing internally to punish themselves for whatever outcome, whether it’s a scale outcome. And I know we share the disdain for a scale for most prevailing normal scales. And this focusing on body objectification, I’m not suggesting it’s not important to be healthy, but I think for a lot of people, it becomes something that becomes almost obsessive. They’re so fixated on those numbers or a particular size they want to be, or comparing themselves to others, and that can be incredibly destructive. 

Sean Pastuch: [00:24:05] I like to say that, “If you show me your car, I can see your brain.” [Cynthia chuckles] If the inside of your car is a mess, don’t start by working out. Start by cleaning your car. And that might sound like the most ridiculous thing in the world, but the reason to clean your car before you go start working out is because if you are struggling to keep fast food cups out of the back seat or the passenger seat on the front, if you’re having to apologize to people when they get into your car and move things off of the seat and move them around, it’s just an indicator that your mind is not yet in the place to be organized enough to do this sustainably. And when we talk about the mindset of things, Cynthia, that’s what I’m describing. It’s people try things at the wrong time in their life, and then they hold it against themselves. I can’t be successful at this because I’ve always failed. Well, you may have gone out of order. I think of health and fitness like a Plinko board. You ever played the game Plinko? Everyone ends up there, but no one’s going to take the same path. 

[00:25:03] So we tell people right now who are struggling with excessive weight gain, it’s all the choices that you’re making. Well, sure it is, but choices come from knowledge and experience, and someone can only make the best choice that they have the knowledge and experience to make. You know, our friend Robb Wolf would be a great person to talk to about this. The idea that, “Look, you eat steak, great, what kind? What cut?” There are continuums to all of this. And exercise and nutrition to me come naturally, when you’re in the right place in your life for those things to come. Typically, if you’re struggling to start exercising and eating better, there is something else that you need to solve for before you make exercise and eating better a priority. There’s something in your relationship, there’s something in your finances, there’s something in your relationship with yourself. Whatever it is, focus on that first, because when that’s gone, you’re going to have all of the mental clarity to do this. 

[00:25:58] And what you were discussing before, Cynthia, I want to make sure people understood clearly. You were talking about, there are things we need to accept about ourselves as we age, but there are things we can do to counteract it. And what I hear when you say that is accept, don’t compromise. Because what people do is we hear, I’m 40 now, that means I can’t do this, this or this anymore. Well, no, that’s not true, because there’s a 40-year-old doing it. So, what’s the reason why you’re struggling to do it? We can figure that out and we can solve for it.

[00:26:27] Would like people to know me for is the guy who will stomp out all of the compromise in you, in your relationship, in the way you approach life. We’re going to compromise in the micro in the, like, when my wife wants something for dinner that I don’t want, I’m going to eat what she wants for dinner and I’m going to cook it like I love to. [Cynthis laughs] But that’s because the priority is our relationship. I’m not going to compromise on the quality of our relationship. So, yeah, I’ll compromise on Chinese food over sushi, but I’m not compromising on the way that we love each other. So, I think too often people get stuck in the micro and it becomes a spiral instead of zooming out saying, “Okay, everything can happen on a long enough time span. What needs to happen first?”

Cynthia Thurlow: [00:27:12] I think that’s deeply profound because it’s much easier– I’m going to speak in generalities. It is much easier to say, “I’m going to start exercising than it is to work on your relationship.” 

Sean Pastuch: [00:27:21] Yeah.

Cynthia Thurlow: [00:27:22] Let’s be honest. If we’re going to look at what’s foundational in our lives, it’s the love of our family. It’s our relationships with our family. It’s things like sleep, it’s things like hydration that seem so simplistic. But I say all the time to women as an example. I probably don’t speak as enough about the relationship piece, but I would be the first person to say I wouldn’t be where I am if it weren’t for my relationship with my husband. We’ve been together for 21 years, married for 20. We have an 18-year-old and a 16-year-old. But when I think about women that come to me and they’re like, “I need to lose 30 pounds.” And we talk about sleeping foundational and hydration, I mean, very basic things. And they’re like, “No, no but I’m going to do all the exercise and I’m going to do the fasting and I’m going to carb restrict and I’m going to go keto,” and I’m like, “Wait a minute, we got to fix the fasting part.” Completely foundational. So what you’re saying is to focus on the macro, focus on the big things before you worry about the minutia, before you start worrying about cold plunges and infrared sauna, which are wonderful, please focus on the basics first so that you can have sustainable success. 

Sean Pastuch: [00:28:26] Well, yeah. So right now, societally, we’re succumbing to really good marketing. It’s unfortunate, but the incentives are aligned for our society to not be healthy. Insurance companies make more money when they spend more money. There’s a lot. I don’t want to go too deep down that rabbit hole with you today, but what happens is we’re all looking for some reason for passive solutions to active problems. And we all see this in politics. We see a president come into office regardless of who you vote for and they promise to change everything in the next four years. And we know it’s not happening because this is a generational problem that we need to turn around consistently, slowly, and meticulously. But we keep trying to solve generational problems every four years. When we come to ourselves, we don’t govern ourselves as well as we armchair quarterback our federal or state or local government. It’s what pill can I take? What modality can I use? What practitioner can I go to so that I don’t have to do the things to unwind how I got here. 

[00:29:29] When someone comes to me and says, “I need to lose 30 pounds,” the first question I ask, “Is for who?” Because if they say, “Well, I want to look like I looked in college.” Okay, “For who?” What do you mean– Well, I just think my husband and he said a few things or like my friends have said something, “Well, wait a minute.” Do you care if they weren’t around? Do you care? And it really has to come down to a yes there or we don’t even start because if it’s a no there, then you’re doing these things for somebody else and you’re never going to be able to stick with it. It’s never worth it when it’s somebody else’s goal. Now the important thing about that is let’s pretend that every day your husband does go work out and he’s like, “Why don’t you come with me. Why don’t you come with me? Why don’t you come with me?” Because I was in this phase with my wife for a while. She wasn’t physically fit, she wasn’t physically active, I’ve been a personal trainer since college.

[00:30:21] And I was like, “Why don’t you come with me? Like, you’ll just work out with me, you’ll work out with me.” And it really put a strain on our relationship because she would come, but she wouldn’t like it. And then I wanted to talk about it. I wanted to help her get better at it, because I’m a fixer. It’s what I do. It wasn’t until I stopped talking to her about it at all for years that she decided on her own she wanted to do it. And since she decided on her own, she wanted to do it, she’s been consistent. But what happens is I had the good fortune of having a mentor tell me to stop doing that. So if you’re in a relationship with somebody who doesn’t have a mentor, who’s going to tell them to stop doing it, you need to learn the communication skills to have the conversation with your significant other to improve your relationship so that they can support you in the way that you need to be supported, so that you can make these decisions for yourself and be successful. Like you were saying, “That’s way harder than cutting out gluten.” This is why I say five years. I don’t care if you spend the next six months to a year not in the gym. If the people around you don’t exercise, don’t eat right, don’t put health as a priority, you need to figure out how to put new people around you first. 

Cynthia Thurlow: [00:31:35] Yeah, it’s a huge influence. I think many people probably don’t realize this, but the five people you spend the most time with are the ones that have the greatest influence on your behavioral and lifestyle. And so it’s interesting, as I, over the past 25 years, have worked with patients and clients and trying to find motivational interviewing skills and all these things to help people come to a degree of realization about are the readiness to change model. I wrote a thesis many years ago. It was Prochaska and DiClemente’s Transtheoretical Model of Change therapy. So where are people on this trajectory? Are they just contemplating it? Like maybe your wife, when you introduced the concept of going to the gym with her, might have been contemplating but wasn’t ready to take action and helping people assess where they are? 

[00:32:18] Because your ‘why?’ Becomes critically important, especially on the days where you don’t want to get out of bed, you don’t want to go to the gym, you don’t want to stay on that anti-inflammatory diet or intermittent fast or whatever it is that you’re doing. Reflecting back on why you’re doing it, you also brought up some good points that I know we’ve talked a lot about on this podcast about our current medical model, current traditional allopathic model, which does a great job with emergencies and acute injuries and doesn’t do such a stellar job. And I’m doing a podcast this afternoon. So, this statistic is fresh in my mind. From the Centers for Medicaid & Medicare, the US healthcare spending grew by 4.1% in 2022, reaching 4.5 trillion or $13,493 per person. 

Sean Pastuch: [00:32:59] How much $13,493? 

Cynthia Thurlow: [00:33:00] Yep, per person. 

Sean Pastuch: [00:33:01] So there is a law that went into place in 2011 when Obamacare went into place. It’s called the 80/20 law or 80/20 rule whatever. I’m not going to get caught up in the language of it. Effectively, what it did was, let’s just pretend for a second, because I don’t know anyone who was in the government when they did it. Let’s just pretend it was well intended and not make this a political conversation about left versus right. In 2024 that can still be done, by the way. 

Cynthia Thurlow: [00:33:26] [laughs] It can. 

Sean Pastuch: [00:33:27] The 80/20 rule went into effect presumably to make it so that insurance companies could not gouge clients for profit. So the rule is 80% of the money that the insurance company collects from its members must go towards medical care, general experience improvements, and things of that nature. The other 20% can go towards administrative costs, marketing, and profit. Now ask yourself this as a consumer, because the reasonable thing is, well, health insurance companies want to spend as little money as possible on health care spend, so why aren’t they paying for my gym membership? You’re misunderstanding the game. They get to keep 20% of the premiums that they charge if they only have to pay out $8. Let’s just do very simple math. The national healthcare expense is only $8. Great, they get to keep two. But if the national healthcare expense is 8 billion or 8 trillion, they get to keep 2 trillion. Which would you rather have? Two or 2 trillion. So what happens is all of the incentives in place are for the health insurance companies to actually need to spend more money on healthcare. 

[00:34:38] Now, what happens next is somebody will say, “But Dr. Sean, my healthcare got denied. They wouldn’t even pay for an X-ray for me. How could that be true? They’re being frugal.” What you’re failing to understand is that you are supposed to be the profitable 20% for them. Your friend who’s been on diabetes medication their whole life doesn’t run into a problem with their diabetes medication being covered. They might have a problem getting it because other people are taking it to lose weight, but their insurance is going to cover it forever. You are supposed to be the 20% that’s profitable. You fight hard enough, what happens? They approve the X-ray and then what happens when it’s time for your premiums to come back around? They go up because you’re not as profitable as they thought you were going to be. I don’t believe that there are malicious actors who were just set up to say, “Let’s make them fat and sick and hurt.” But I do believe that the incentives are what they follow. 

[00:35:26] And when you’re a big company, 2 trillion or in the case that you were just describing more like 5.5 trillion in profit is much better than 5.5. So that’s what happens there. If we can go back for a second to let me stay there for 1 second, actually, your doctors are trying their best. What you have to understand here is this. I practiced for the better part of a decade and the most frustrating thing that ever would happen for me was recurring. I would tell a patient; these are the things that I think we need to change about your lifestyle if you’re going to be able to recover. And they would say, “Can you just adjust me?” I’m like, “Well, yeah, but I adjust like 10% of my patients.” And you don’t really need one. Well, I came here for an adjustment, so now take that out to the medical world. 90% of people are happy to get their pill and go home. You don’t fit in the 90%. You fit in the 10%. 

[00:36:13] But the doctor has been treating patients for 5 years, 10 years, 20 years, and they’re beat down by trying to help people live a better lifestyle and struggle to get paid for that. And they do get paid when they just do the job that the patient wants. So now 90% of people are walking in wanting a pill. You’re the 10% who doesn’t. You should not expect the doctor to know that you’re the 10% who doesn’t. And to treat you as though you’re the 10% who doesn’t. You need to make the doctor aware that that’s who you are. How do you do that? You tell the doctor, “I’d like to resolve this problem without whatever constraints you want to put on the way you’re cared for, without exogenous supplements or medications that I have to be on for a long period of time, without a medication that doesn’t have an end in mind, with a KPI, without lifestyle change.” Like, you have to let the doctor know, this is what I want help with. For us at Active Life, they come to us and they say, “I want to be able to continue being active without going to the doctor or giving up exercise in the gym.” Well, great, “We can help you with that.” But you have to know that it’s not the doctor trying to fail you, it’s the system failing the doctor and then the doctor having to act within the system. 

[00:37:23] And this is why, Cynthia, people like you, people like me, people like Gabrielle are seeing success because what’s happening, fortunately or unfortunately, is there’s a cleaving within the health space and the fitness space. They’re the people who have enough money to decide, “I want to be served outside of the medical model by people who don’t play the insurance game.” And there are people who would say, “I don’t have enough to do that. So, I’m going to play the insurance game.” And sometimes that works. Usually, it doesn’t. What I believe happens next is that the group of have nots and I feel bad calling you a have not if right now you’re in that situation. But if you don’t have the financial means to access the people outside of the model, it’s already starting. Businesses like Life Time Fitness are starting to offer Ozempic in their membership. So, what happens is the haves of the have not group, the top class of the lower financial class group, are going to get the best that the medical model has to offer, become more and more dependent on medications, devices, practitioners, and they’re going to live a normal life until a regular age that people would die at. 

[00:38:29] The have nots of that group are going to go to the least means, fitness models and medical models. They’re going to continue to eat the least expensive, most convenient foods that they can find. They’re going to continue to deal with the mental health issues that they’re dealing with because nobody is telling them, you have to do this because they’re not incentivized to tell them to change their life, and they’re going to continue to gain weight, get injuries, decrease health span, and decrease lifespan. And then you’re going to have the people who are in the court of, “I’m going to work with whoever I need to work with to change my life,” and we’re going to see this huge separation that really saddens me unless we start taking action and responsibility for ourselves now. 

Cynthia Thurlow: [00:39:08] I mean, you bring up so many good points and many of the reasons, and I don’t know how much you know about my background, but I was in clinical cardiology, both inpatient, outpatient for 16 years and left in 2016 because I was so disillusioned with the current medical model. Granted, if you have an emergency or an urgency or an acute issue, our current allopathic model does a great job. I benefited from it almost five years ago when I was hospitalized. But I speak very openly about the fact that most of what I saw in cardiology were lifestyle-related problems. And our patients were very conditioned to take a medication for nearly every lifestyle-related problem. And I started to kind of pivot probably from 2010. I mean, I still when I was working, I was 100% evidence based and worked within that model. But I became so disillusioned with saying to my patients, “Hey, before we add more medication for your diabetes, let’s talk about your sleep quality. Let’s address your stress. Let’s perhaps consider eating in a 12-hour feeding window. Let’s talk about adjusting your carbohydrates and your protein intake.” 

[00:40:10] And I would say maybe 10% of my patients were willing to make those kinds of changes, but most of them were not. They’re like, “I’m not going to stop smoking. I’m not going to be more physically active. I can’t manage my stress. I lived in a very much a pressure cooker part of the United States, very affluent, very expensive.” A lot of people had horrible traffic and commutes and just the pressures of life in general. And I agree with you that we’re starting to see these chasms that’s occurring in traditional allopathic medicine. There are people that are focusing on what I would consider to be precision medicine. Really looking at complementary therapies and the haves and the have nots, as you kind of alluded to, is really, I’m starting to see that happen more and more, especially for women of a certain age. I certainly think of myself this way, and understanding and hearing from women across social media in our podcast emails, people who can’t find good care, they can’t get, they’re gaslit over the option of HRT as an example, which should be an option for everyone provided that they’re working with a practitioner who’s willing to tailor it to their needs. 

[00:41:13] But people who are really suffering and whether it’s poor metabolic health, their sleep quality is terrible, they’ve become insulin resistant, they’re in perimenopause, or menopause, or heck andropause, how many men are really dealing with lowered levels of testosterone, whether it’s related to insulin resistance or exposure to endocrine-mimicking chemicals? And so, helping people understand that in many ways, what I call them, these anti-aging pop-up clinics that are emerging, that are offering GLP-1, semaglutide, Wegovy, etc., are offering pellet therapy and all these other things. I think that we have this kind of emerging stratified class system for healthcare and that bothers me enormously. I trained in a very underserved environment. I trained in inner city Baltimore, and I know what a lot of people deal with and I think everyone deserves to have WellCare, everyone deserves to have preventative care. But the current allopathic model is not designed to help support that for everyone. 

[00:42:09] So I love that you touched on helping your healthcare provider understand what your needs and desires are. If someone comes to you as a patient and says, “I really want to do as much as I can lifestyle wise to address X problem before we consider medication, if it ends up being that I need medication, there’s no shame in that.” But understanding that you are being your own best advocate and that’s a very, very important message.

Sean Pastuch: [00:42:33] There’re a few things at play here and I would love touch on them. The first is, and I think this underlies all of it, people talk a lot about confidence. Confidence is circumstantial, and so when you’re going into a conversation with a doctor, it’s reasonable that you would not be confident about overcoming one of their objections because you are not confident that you know as much as they do, and you don’t know as much as they do. Self-esteem is the willingness to go through that discomfort because you know who you are, you know what you want for yourself, and you’re going to get it. So again, let’s break those two down. Confidence is the circumstantial esteem to do what’s necessary. Self-esteem is your ability to endure the pain, emotional or physical, whatever it is, of being challenged, because you know who you are, it doesn’t affect your identity. 

[00:43:19] Now, my father is 70 years old. He’s the first man in my family to live to 70 in three generations, which is, like, terrified me growing up, put a lot of urgency on me to get things done. He’s in fine health. He’s not in great health, but his doctors keep telling him everything’s within normal ranges. Like, yeah, but you have him on a cholesterol medication, and your normal range for cholesterol is 200 points lower than it was 20 years ago. Who influenced that change? You have him on a blood pressure medication, but you don’t have him exercising. You’re not monitoring his stress, and you refuse to even look at his hormone profile because you believe that testosterone replacement or any kind of hormone replacement therapy should never happen because it’s permanent. So is living without it. So I’m not suggesting that I know what he needs, but I’m suggesting that he needs to go in and advocate for himself and say, “I want these tests and I don’t want to be within normal ranges.” I got out of the medical model as a patient when my doctor told me, everything looks great. You’re within normal ranges. I’m like, “I’m 35 years old. I’m an entrepreneur. I work out, I watch everything I eat. I don’t want to be within normal ranges. I want to be excellent.”

[00:44:22] So now the next thing is you were talking about the people in inner city Baltimore. I went to University of Maryland. I know inner city Baltimore very well. We need to take responsibility for the education of our children, both at home and in school. It used to be the kids had Phys Ed every single day. In the 1960s, it was federally mandated. The kids had Phys Ed every single day. Now the likelihood is, in your district, they have Phys Ed once every six. Go to your district and demand more. We can’t complain as parents that our kids are not being treated well in school if all we do is complain about it. We have to go to the halls of power with an audience and influence. When I knew my kids were coming into the elementary schools, my wife and I spent a year going to school board meetings just to get an extra day of Phys Ed every six, because I didn’t want my kids going to school with one day of Phys Ed, now they have two. So, what do you think I’m doing now? I’m continuing to push the ball down the hill or up the hill. I want 3, 4, 5, 6 and I want the food that’s served in the cafeteria to start being food, because my kids, it’s cool to buy lunch, but it’s not cool for me when my kids are buying a meatball sub made with mystery meat and rubber bread. And I don’t want to tell them, “No, that’s not health.” Like, that’s not a fun game to play. 

[00:45:38] So I’m involved. I don’t have a school board seat, but I’m at school board meetings, speaking respectfully, bringing solutions, asking questions that are thought provoking without taking aside or pointing fingers, and assuming those people want the kids to fail. And I’m asking for one-on-one meetings with the superintendent, with the assistant superintendent, with the principals. And they’re giving me good answers to the reasons why some of these things are very difficult to do right now. And now, here’s the beauty in that. I am an entrepreneur. I think I’m one of the most unemployable people you’d ever meet. But what that means is I see a problem as an opportunity where somebody else might see a problem as a problem. And they’re great at operating within the system and I’m terrible at operating within the system, but I’m here to change the system. 

[00:46:23] So I can hear them say, “It’s very difficult to do this, Sean, because the kids, when they go home, they’re still eating these other foods. So now they come to school and they don’t even eat the food that was given to them.” So, they’re not going to eat that. So we’re just going to waste our money on that. They’re not going to eat it because they’re getting this at home. Okay, what’s a one-degree change? Can we throw fruit on that? And, like, the kids who eat a little bit of the fruit just can come up and get extra fruit if they want? Yeah, we could do that. Well, let’s start with that. And in 10 years, when my youngest, who isn’t born yet, is in fourth grade, we will have real food in the school. 

Cynthia Thurlow: [00:46:57] I love that. It’s interesting. When my boys were in elementary school, along with another mom who is a college friend of mine, we were the co-presidents of real food for kids. So, we got local farmers to donate meat and vegetables. Most of the elementary schools had gardens that the parents were actively involved in, and I remember the degree of advocacy that we needed to do. We were fortunate that we lived in a county where we had access to a lot of fruits and vegetables and farmers there. Most of the cattle that were in that county were for meat purposes. They weren’t dairy cows. And so, I think for each one of us, irrespective of where you live or what stage your kids are in, you can always advocate for them. And I think that’s a really powerful way to help shift this narrative, when we really look at the health of our children. This is the first generation of children that may not outlive us, meaning that they may not have the same quality of life that we have had. 

[00:47:52] And I grew up with an Italian mother. We were eating organ meats when it was not something that was considered to be the norm. We were having fruits and vegetables. My mother made almost everything from scratch because we just didn’t have the money to be able to go out to eat. It wasn’t something that we did regularly. And I always say my mom was crunchy before we even knew what that concept was. And so, I sit in complete gratitude for that. But it really does start at home, and we can, even if we did not grow up that way, we can be our children’s own best advocate. So, thank you for that.

[00:48:19] I would love to kind of wrap up today talking about what is your morning routine like? I would imagine that listeners are curious and I do ask this question often of guests. What is your morning routine is like, is it something where you’re doing a lot of biohacking, or is it just, again, the macros focusing on the big picture as opposed to the little minutiae? 

Sean Pastuch: [00:48:41] I wake up at about 05:00 AM. I go to the bathroom. I brush my teeth. I drink a glass of water and then I go work out. And then I come home. I make breakfast for my wife and my kids and myself and then I go to work. I think the morning routine thing goes back to what we were discussing earlier, the whole concept of, like, “Win the morning, win the day.” It doesn’t have to be an elaborate win. If you set your alarm for 05:00 AM and you don’t hit the snooze button because you made a promise to yourself, I’m going to get up at 05:00 AM and you keep promises to yourself, you already won the morning. I don’t care if you lounge around your house and do nothing. You didn’t hit the snooze button. I have a post on my Instagram that talks about “I do hit the snooze button,” but I used to hit the snooze button when I woke up a little bit later. But I hit it because I like to lay in bed with my wife. I wasn’t setting the snooze button to go back to sleep. I was hitting the snooze button to snuggle and to talk and to just get ready to start our day. But there’s so much like I jump into a red light, I jump into an ice bath, then I walk barefoot, look at a low sunrise, like, whatever. If that gets you going, great. I wake up, go to the bathroom, brush my teeth, drink the glass of water I poured the night before, and then I get off to the gym. 

Cynthia Thurlow: [00:49:51] I love that you keep it simple. And I think for most of us, we do best when we focus on the big things. For me, it’s all of the above. And if it’s not working out immediately, it’s taking the dogs out. Because now I have teenagers, you’ll get to this point. Now I have teenagers that if they were allowed to, they’d sleep till 10:00 AM or 11:00 AM. So on morning school days, I’m making sure they’re physically up so that they’re not late getting to school. But for me, it could be as simple as taking a walk with our dogs in the sunlight can be very helpful. And I think during the pandemic, for so many of us, our morning routines shifted and changed, just given our circumstances. And so that’s been something that we’ve really focused on, and we get to laugh at our dogs. And more often than not, I was like, “We’re becoming that couple, that kind of cliche middle-aged couple that does this one or two-mile walk in the morning, depending how hot it is outside.” Obviously, I would love to have you come back. We only touched on about a 10th of what I thought we would. Please let listeners know how to connect with you if they want to work with you or one of your trainers, how to connect with you on social media or listen to your podcast. 

Sean Pastuch: [00:50:51] First thing I’ll say is, I would love to come back. I had a great time speaking with you, and I appreciate you having me on. Second thing I’ll say is, I do have one rule in the morning, and I don’t listen to podcasts in the morning because I want my creative juices flowing. I don’t want to be stunted by somebody else’s. So I like to listen to jam [Cynthia laughs] music in the morning, or jam music or rap, which is interesting because they’re diametric opposites. But one of those two in the morning, then I get going. You can find me on Instagram. It’s fastest way to do everything @drseanpastuch. I imagine that will be in your show notes. If you want to work with somebody on our team, connect with me. Just connect with me in the DM. And what I will promise to anybody who comes along is that we really take seriously screening people before asking them to work with us. It’s to our short-term financial detriment and to our long-term financial success to be vigilant about people we take on to make sure that they’re a good fit to either work with us as a company or to be placed with a client who we’ve developed somewhere in the country. We’ve worked with over 10,000 people worldwide online. So if you reach out to me, you can ask questions. You cannot become a client. I’m agnostic to who ends up getting paid for your results. 

Cynthia Thurlow: [00:52:02] I love that. Well, thank you again for your time and I look forward to connecting again later in the year. 

Sean Pastuch: [00:52:06] My pleasure. 

Cynthia Thurlow: [00:52:08] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.