Award-winning public speaker, New York Times bestselling author and world-renowned health expert, Dr. Sarah Ballantyne, PhD (aka The Paleo Mom) believes the key to reversing the current epidemics of chronic disease is scientific literacy. She creates educational resources to help people regain their health through diet and lifestyle choices informed by the most current evidenced-based scientific research.

This has been a hard post to write. It has always been important to me to be honest with you about my own challenges and successes, but when things aren’t going well, it’s hard to strike a balance between sharing my struggles and not sounding like a whiny ungrateful brat.

I’m actually doing so much (much, much) better now than I was, which I think allows me to write this post in a more mature and reflective way. I have shared most of this as bits and pieces in my newsletters and previous posts, but it’s time for a good long update. In fact, it’s passed time.

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The truth is that the last year and a half have been super tough for me healthwise. I have really struggled with both my physical and emotional health as the result of high stress. Primarily, my complaints have been gaining weight, fatigue, joint pain and some tendonitis, mild depression, and active lichen planus lesions. And the source of of those health problems has been the stress of writing (illustrating and photographing) and publishing two books back-to-back, both bestsellers and award-winning; continuing to be active on social media; co-hosting a top-rated podcast every week; traveling for book signings, conferences and seminars; doing interviews and online conferences; launching a consulting company and generally running a small business (this blog); and working on a super secret super huge project (more on that below)–all while also trying to be an engaged mother, living far away from family (and thus help and support), and with a husband who has his own high-powered career to worry about. That’s why it was so hard to talk about my health struggles: because the reason for them is this amazing opportunity and privilege to be a mentor and educator for millions of people.

It’s hard to be honest about what this spectacular career has done to my health while still emphasizing just how much I appreciate all of it. And I really do. And while it’s definitely been a learning experience, I don’t regret a moment of it.

So, today I’m playing catch-up a little. I’ve had the tendency to downplay my health struggles, while also attempting to continue to share them. It’s been a hard balance to strike. So, today, I want to be honest with you about how doing all the things I’m doing has affected me. I often get asked “how do you do it all?” and the short answer is “I can’t.”.

The reason for this post is that it was brought to my attention that my recent diagnosis of Hashimoto’s thyroiditis has allowed some people to doubt the therapeutic potential of the autoimmune protocol and the recommendations in The Paleo Approach. It makes me so angry that my philosophy on sharing with you that I’m a real person, who lives a fairly average life, who has real and common challenges to overcome, that wearing my heart on my sleeve and connecting with all of you, that this could undermine my credibility as a science writer or educator or mentor. It scares me that my honesty gives naysayers more momentum to dissuade people from taking control of their health and seeing the kinds of amazing success that I’ve experienced (because despite my health struggles, I have been extremely successful managing my health with diet and lifestyle) and that hundreds of thousands of other people have experienced on the Paleo diet and the autoimmune protocol.

Most of the big bloggers/authors don’t share the ebb and flow of their own health battles with their fans. It’s a marketing decision, because personal struggles can be seen as proof that even the most rigorously-proven diet and lifestyle recommendations are somehow faulty. Someone who writes a weight loss book doesn’t want to confess to gaining 10 pounds even if the cause of it was something completely out of their control like injury or illness. It’s the same with Paleo and Alternative Health bloggers. There’s a careful filter over what gets shared with you.

I am privileged to know what goes on behind the scenes, and it’s not my place to share personal information about other bloggers and authors with you. But, I can generalize a few things. Writing a book is one of the most strenuous and stressful tasks one can undertake. Health issues/crashes/crises during or following publishing a book are extremely common. And of course, I’m no exception. In fact, between having an undiagnosed underlining autoimmune condition while writing two very big books back-to-back, I definitely was impacted on the more severe end of the spectrum (but far from the worst of everyone I know!). My kind of health battles do not make me unique and certainly reflect the stress of a high-powered career rather than the validity of the autoimmune protocol.

Because health is not just about food.

I am going to quote myself, from page 144 in The Paleo Approach: “If you do not manage stress, it will completely undermine all the other positive changes you make. ” Yes, I wrote those insightful words about two years ago, just when my own stress level was kicked into high gear. If fact, the importance of stress management is discussed in three chapters in The Paleo Approach and was summarized in this post from last week. And the irony is that stress has been my major obstacle to better health for almost 2 years.

I know it’s hard for people who have never written a book to understand the process. Perhaps the easiest way to explain it is just the sheer amount of work it is. For 22 months straight, I worked 70-80-hour weeks, while trying my best to only work while my kids were at school or asleep. And the first year, my youngest was home with me full-time. During that time, I also traveled for conferences and seminars. Once The Paleo Approach was published, I traveled for book signings two weekends a month. Every trip took time away from the other tasks I had on my plate. I had real, firm deadlines which meant late nights and skipping out on exercise to get more work done. I also had the pressure of “getting it right”: writing books designed to guide people with chronic illness to regain their health is intensely psychologically stressful. Being wrong could mean someone’s life. So, there was a lot of double and triple checking, all of which I had to do myself due to the technical nature of The Paleo Approach. I am definitely a perfectionist, but that’s a good thing to be when writing a book like this.

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The detriments to my health crept up on me. At first, my body seemed to tolerate the later bedtime, the lack of downtime in the evenings, fewer walks and yoga classes. Sure, I was relying on caffeine in the morning more, and maybe I was a bit quicker to snap at a kid, but it seemed tolerable. I kept this pace going for more than six months before the effects started to accumulate.

And then it started to get to me. My weight started creeping up in May/June 2013. I was needing more caffeine in the morning to get me going but enjoying these wonderful second winds at night (terrible indicator of adrenal and hormonal health, but handy for working). I started yelling. When I’d realize that I was yelling for no good reason, I’d start crying. There was a lot of strain on my marriage. My kids still talk about the time that I sat in my youngest daughter’s bed and just cried and hugged them and apologized over and over again through blubbering sobs for an hour.

I hit this point where any additional stress just threw me over the ledge. If I burned the broccoli (which started happening more and more frequently), I’d either start yelling while throwing the pot into the sink, or I’d sink to the floor and cry, feeling powerless. I had frequent arguments with my husband, and there was lots of “when this [expletive deleted] book is done” talk.

And yet, I always felt like I was hanging on, albeit by a thread… I felt like I was handling the stress and even though things were tough, it was okay. I was mostly just living in denial. Survival mode.

There were times where things were a bit better. When I first got my treadmill desk, I felt so much better. When summer hit, and I was outside more, that boosted my mood. When my manuscript first went to the editor, I had a much-needed break while I waited for her feedback. But with all the ups and downs, each down was a little more than each up.

And then, we hit a crisis point in June 2013: my publisher and I realized that the book that I was writing was too big to bind. The original all-in-one book that I had intended on writing needed to be turned into The Paleo Approach and The Paleo Approach Cookbook. And, we discovered that there was no way we’d meet the deadlines so the publication date was pushed back. It was a PR nightmare. Fans who followed me closely were excited to be getting a huge sciency guidebook. Many, many people felt ripped off that they would have to wait for the recipes. I was inundated with requests for free books from people who pre-ordered before the project became two books. Many others were just confused. The book stayed in the Amazon cookbook categories (The Paleo Approach is still listed as a cookbook on Amazon, which my publisher and I have no ability to change!), and confused even more people once it was released.

And right on its heels we hit a second crisis point: we couldn’t find a medical illustrator who could do the illustrations I wanted for The Paleo Approach. The only solution was for me to do them myself. This would mean a further delay in publication, another PR challenge, and a whole lot more work for me. I didn’t have an assistant until this point: just when I was starting in on the over 40 technical illustrations that I did for The Paleo Approach while also editing the 250,000 word manuscript (a tedious job even with a professional editor). Given that I now have 4 employees, it’s hard for me to even remember back then, when I was working so much on the book, trying to keep up with blog posts, replying to all the blog comments, every Facebook wall post, emails from fans, and generally trying to continue to grow my social media presence. Worst, all the illustrating meant hours and hours of work that could only be done sitting down. My treadmill desk started gathering dust, as did my workout clothes.

This was when the weight gain became noticeable. I was having more sugar cravings, and found myself eating in the evenings to keep myself awake while I worked. I couldn’t take time off. Not even a single day off. If I took an evening off to go to bed early or spend some time with my husband, then I’d pay for it with an even longer and more stressful To Do list the next day. Every spare minute was spent working. By the last couple months of getting The Paleo Approach ready to be printed, I was nearly completely sedentary and getting several hours less sleep every single night than what I needed. I relied on caffeine and huge amounts of fruit and Paleo-friendly treats to keep me going. I was starting to experience joint pain that would come and go. My moods were erratic. And I’d gained 15 pounds.

I still felt like I was surviving. If you asked me how it was going, I’d say “tough, but the light is at the end of the tunnel”. I believe that my clean nutrient-dense diet is actually what kept the wheels on the cart. I managed all this without any medications or supplements. Plus, I found the work that I was doing incredibly rewarding. It felt like I had finally figured out what I am meant to do. I was loving how The Paleo Approach was coming together and that kept me going. I was enjoying beginning to being viewed as a thought-leader in the Paleo community. My talk at the Ancestral Health Symposium in August 2013 got so much attention, and established me as an important voice in the community. It felt good to be successful. It felt good to make a difference in people’s lives.

The morning after The Paleo Approach went to the printer in early December 2013, I woke up with pneumonia. I had infection after infection for the next 6 weeks. I was exhausted and slept all the time. I hired a second assistant to help share the burden of maintaining the blog and social media sites. We delayed the release of The Paleo Approach Cookbook so that I could recover for a while before diving into finishing it. I focused on activity, got back to some yoga classes and started taking strength classes with my husband. And I put more effort into quality time with my kids. I had until this point thought that once I was sleeping and more active, my health would bounce back. I figured my super nutrient-dense diet would continue to protect me. But my health didn’t bounce back. And that was scary.

A third-degree burn which first got infected and then had me suffering a systemic allergic reaction to the antibiotics didn’t help either. There’s absolutely no scar now, but it’s hard to forget the drama of those few months in early 2014. Broad-spectrum antibiotics and prednisone were not what my body needed to heal.

And then an amazing thing happened: I found out about Dr. Lynn Flowers, a local functional medicine MD with a passion for Paleo. We did a bunch of testing and found out that I had complete adrenal burnout and hormone imbalances (see this post on why those go together). I had high markers of inflammation. I started on supplements, and felt better immediately. In fact, I’m absolutely certain that working with Dr. Flowers is what kept me together while I finished The Paleo Approach Cookbook.

At this point, I also started traveling more. Traveling more meant more risky meals in restaurants, including accidental nightshade, gluten and dairy exposures (all foods that really, really don’t work for me). It meant jet lag, and late nights, and then more stressful weeks either preparing to travel or catching up from travel. But I managed. Mostly.

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I even started CrossFit in the Spring of 2014, which was a tremendous stress relief and seemed to give me more energy rather than take it away. I saw myself gain strength, even if the scale didn’t budge, and my moods began to improve again. Maybe at this point, the ups were bigger than the downs.

And then it was the last few stressful weeks of another book. I finished The Paleo Approach Cookbook while traveling alone with my kids, getting ready for my brother’s wedding (my daughters and I were all in the wedding party so there were lots of responsibilities), and looking after my mother who was ill at the time. If I thought the final weeks of finishing The Paleo Approach were rough, this was ten times worse. My hair started falling out, which should have been a major clue that the stress was impacting my thyroid, but I blamed it on hormones.

But, I didn’t wake up the next day with pneumonia. I held on. In part, I held on because my diet was dialed in and I was more active than when I finished the first book. And in part, I held on out of sheer willpower. I went straight from sending The Paleo Approach Cookbook off to the printer to filming a television pilot. In fact, I had been working on the pilot (I co-created and co-produced it, meaning I had my hands in every single aspect of the show) already for months. Yes, as if publishing two books last year wasn’t enough, I took on this third monumental task. I can’t tell you more about this right now, but there’s a big announcement coming in the very, very near future.

I took a 2-month break from traveling, after finishing The Paleo Approach Cookbook. After finishing filming the pilot, I focused more time on looking after myself. The news that The Paleo Approach made the New York Times Bestseller list was the best medicine. But then the traveling started again. My schedule started to fill up with interviews. A documentary team came to my home and filmed our life for a couple of days. It seemed like every single commitment that I had put off to finish writing the books arrived on my plate all at the same time. I couldn’t keep up.

I hired again and added to my team at the beginning of November, but I should have done it much, much sooner. The backlog of work was enormous, and my energy was plummeting. And then, I went on a week-long book tour. It was an amazing experience, but it was the straw that broke the camels back.

Upon returning from the book tour, my weight started creeping up again, but very disproportionately to how well I was eating. I gained a further 10 pounds. My energy was non-existent and my sleep quality was terrible. I started experiencing severe joint pain, muscle fatigue, loss of coordination, and headaches. My lichen planus lesions got much worse. The mild numbness that I always had in my left ring finger turned into both arms going completely numb and tingly on a regular basis. I again went from infection to infection to infection. I was sleeping a ton, working far less, spending more time with my family, and not getting better. And I was depressed. When my husband asked when the last time I truly felt happy was, I answered “when I was last pregnant”. That’s five and a half years ago. I don’t know if that’s true, but it’s the answer I came up with at the time.

All this culminated a month ago in a diagnosis of Hashimoto’s thyroiditis. And I want to emphasize that while being a new diagnosis, this does not make it a new disease. As I’ve already discussed in this post, I believe that I’ve had Hashi’s since before puberty. I believe that it’s my primary autoimmune disease and the root of all of the health struggles I’ve had for the last 30 years. And Hashi’s is notorious for being particularly sensitive to stress.

And this diagnosis makes all the symptoms I suffered in response to high stress make sense. And it explains why even in periods of relative calm, I didn’t bounce back. Thyroid hormones are immune regulators, so an underactive thyroid is a barrier to healing from immune and autoimmune diseases. It explains why the weight didn’t fall off as soon as I had all my ducks in a row. An underactive thyroid directly increases hunger and cravings while lowering metabolism. But, I wrote two books and filmed a television show pilot and it meant that I gained 25 pounds and felt crummy for a couple of months. If I didn’t have everything else dialed in, think how much worse it could have been. While I still feel some anger that no doctor was able to diagnose me earlier in my life, I see the triumph in being able to keep my disease at bay until stress overwhelmed me.

I don’t regret any of it. I am glad I wrote The Paleo Approach and The Paleo Approach Cookbook. They are amazing books that are helping hundreds of thousands of people and I’m so proud of them. And I am super proud of the pilot. I am so appreciative of the honor I have of being a thought-leader, educator, mentor, and role model. But, I’m human. And I was not proactive enough in managing my stress levels to prevent a major health crisis. But, I also learned a whole heck of a lot.

The number one thing I learned: I am strong. Stronger than I ever knew. And I’m resilient. I’m stubborn as an ox, ambitious, and passionate about helping others. I have more confidence now that I’ve ever had in my life. I’ve learned how to be assertive. And I’ve learned how to style my hair (yes, that makes this list). I’m a type A personality and a perfectionist, but I’ve learned how to say “no”, to ask for help, and to accept “good enough”. And I’ve learned that what I’m doing is important–so important that I have to figure out how to do it in a way that preserves my health.

This post isn’t about whining, but instead about sharing the dark side of an incredible journey that brought me to both an amazing place professionally but at the expense of my own health. I want people to understand that it was extreme stress that caused my health issues, not any fault of my scientific knowledge. And I want others to critically evaluate their own lives, and their own careers. I plan to demonstrate that you don’t have to give up a high-powered career in order to find work-life balance. And that’s a worthy goal for everyone.

I also want to assure you of something. I’ve learned some very valuable lessons. I’m currently healing rapidly, feeling amazing, and losing weight (finally! I’ve lost 7 pounds already! woot!). My joint pain is nearly gone, my energy level has skyrocketed, my skin is looking great, and I truly feel happy again. In part, I’m feeling fantastic because I’m finally taking disease-appropriate medication to support my thyroid function. And in part, I’m feeling fantastic because I’ve expanded my team enough that I can really take care of myself. I’m active, I’m sleeping a ton, I’m getting massages, laughing, playing with my kids, reading fiction, and spending quality time with my husband. Really, I’m feeling fantastic because I’m finally following ALL of the recommendations in The Paleo Approach. Sometimes the lifestyle recommendations are the hardest ones to actually implement.

And knowing that I have Hashimoto’s thyroiditis, and all the work I’m doing now to better nurture myself, is helping me to figure out how to make this sustainable. I’m developing an entire toolkit of strategies to make this amazing career sustainable while continuing to improve my health, rather than the other way around. And I won’t be starting another book until I’ve got this part completely figured out.

I’ve seen more personal growth over the last two years than any other time in my life. And I can honestly say, from this side, that it was worth it. And the future is looking pretty darned sunny.