She Was A Hamburger Shy Of A Heart Attack.
August 19, 2026 // Episode 155 // The Honor Roll ShowThe nurse who could not help herself
Julie has been a nurse for 25 years. Wound care, UCLA, endocarditis, diabetes education. She knew the pathology of every condition she was walking into. She also weighed 265 pounds, could not climb a flight of stairs, and had plantar fasciitis, fatty liver, pre-diabetes, high blood pressure, and high cholesterol.
She calls herself, back then, the fat friend with the funny sense of humor. What the humor was covering, she did not have a name for until recently.
Nurses and doctors get almost no training in nutrition. They are trained to manage disease. As Julie puts it, she could mitigate illness and carry out a doctor's orders, but she could not get anybody healthy, including herself. Six years as a health coach, she says, have let her help more diabetics than 25 years of nursing did.
The telehealth call that changed it
April 2020. The world had shut down in March and she was an essential worker in an N95 she could barely breathe through. She booked one of the first telehealth visits her clinic ever ran, with a doctor she had worked beside in primary care for 10 years.
She asked him for Lasix. A water pill. She figured she was just retaining fluid.
He looked at her through the screen and said he had known her 10 years and she was scaring him. No, he was not writing that prescription. He was sending her to cardiology, because he thought she was in congestive heart failure. Then he said the line she still repeats: Julie, go lose some weight, you are a hamburger shy of a heart attack, and if you do not do something you are going to die.
She is emphatic that he is the best man on the planet in her book, and equally clear about the sad part. He only said it because he knew her. Most doctors will not say it to a patient at all.
It was not what she was eating
Here is the sentence she gives her clients, and it reframes the entire problem: I realized it was not what I was eating, it was what was eating me.
The food was doing a job. It was managing a dysregulated nervous system, dousing grief, and handling emotions she had no other tools for. Which explains the pattern anyone who has dieted knows by heart. She could hold a plan perfectly until a party, a dinner out, or a bad day.
She has no patience for the phrase cheat meal. She asks clients, most of whom are married, how many days a week they cheat on their husband. The reaction is always the same. Then she asks why not, and they say they made a commitment. Well, she says, you made a commitment to yourself too. So who are you actually cheating?
She compares it to somebody 90 days clean planning to use again. For her the substance was sugar, and she did not even recognize it as sugar. She thought she was a carboholic. Sourdough bread breaks down into sugar all the same, and it sets off the same monster.
Dopamine is the trap
This is where the nurse takes over the conversation. Food, and sugar in particular, spikes dopamine, and dopamine is the short-acting one. It is the fix, not the fill. What the body is actually looking for in those moments is serotonin, which lasts far longer in the brain.
So you get upset, you eat the chocolate, you feel better for a moment, then the dopamine drops and now you are beating yourself up for the argument and the chocolate. And it is conveniently their fault for causing it.
Her intervention is almost aggressively simple. Pause. Take one deep breath, which she notes will drop your shoulders and loosen your chest on its own. Then ask three questions: why am I doing this, what am I going to get from it, and is that what I want long term. She points out that the emotion driving it will not survive the pause anyway. Emotions are the weather. You are the sky. Even the greatest joy of your life only lasted a few minutes as a feeling.
The part nobody teaches: it is easier to create a new habit than to go back and break an old one. Every time you choose the different thing, you are not fighting the old pattern. You are building the one that replaces it.
She did not do it by overhauling her life. Six small meals, drink the water, get the sleep. That was the entire starting instruction. More got added only when the first set stopped requiring thought.
Ex-smoker versus non-smoker
Julie quit smoking on her eighth attempt, on her birthday in 2008, and never went back. She is precise about why the eighth one held when seven did not.
The first seven times, she wanted to give up the habit. She was not willing to live the life of a non-smoker. She kept going to the same places, standing in the same spots, with the same people. She never saw herself as anything but a smoker who was not currently smoking.
An ex-smoker, in her framing, is still a smoker. A non-smoker is a different person. She says the same shift is what finally ended a lifetime of dieting: she stopped chasing a number on a scale and started creating health, and today she cannot get back into the head of the woman she was six years ago, because she is not her.
Symptom-free is not the same as healthy
She says roughly 9 in 10 Americans are walking around with metabolic dysfunction. That figure lines up with the published research: a University of North Carolina analysis of national survey data found only about 12 percent of American adults were metabolically healthy across five standard measures, without medication.
Most people read the absence of a diagnosis as health. Julie separates the two hard. Symptom-free means it has not shown up yet. The visceral fat, the deep fat wrapped around the organs rather than the inch you can pinch, disrupts hormones and interferes with insulin for years before anyone hands you a prescription.
She points to PCOS being renamed to reflect exactly this, describing it plainly as diabetes of the ovaries, because the underlying problem was always insulin resistance.
Her line for it: there is a difference between lifespan and health span. She might live to 90 on genetics alone. Intentionally building health for longevity is an entirely different project, and the medical system is not set up to run it for you. It manages sickness. It does not create health.
Which is why she pushes resistance training as hard as nutrition. Everyone loses muscle with age, and skeletal muscle ties directly to bone density. The goal is not water skiing in your 70s, though she fully intends to. The goal is getting out of a chair at 70 on your own, and never taking the fall that breaks the hip.
The dog on the nail
Two men are sitting on a porch, and the dog beside them keeps howling. What is wrong with your dog? He is laying on a nail. Well why doesn't he get up? It doesn't hurt enough.
Most of us are that dog, she says. It just does not hurt enough until it does, and some of us get the chance to change it while others do not. She has watched people say no, and no, and no, and then have a stroke, and come back saying they should have listened. That one clearly still costs her.
Her doctor's contribution was not sympathy. She reached out already uncomfortable, and instead of telling her to get off the nail, he pushed her down harder on it until she got up. And once you see it, she says, you cannot unsee it.
Dear Her
I asked what she would say if she could go back 10 years and talk to herself. It stopped her, and it got her emotional, because back then she believed she was broken beyond repair.
What she would say: It is already inside you. Nobody is coming to save you, because you do not need saving. You are going to save yourself.
Her own Day One was May 25, 2020, the morning she took the before photo in harsh bathroom light and wrote that she was not just unhealthy, she was disappearing. She kept the picture she wanted to destroy. She has been writing a blog called Dear Her, letters to the woman she used to be, signed with the thing she was most afraid of back then, because she is not afraid of it anymore. If the version of her sitting in my studio today could walk through the door and stand in front of the version at 265 pounds and say I am you, this is who you become, she says she would follow her anywhere, and she would carry a bulletproof belief that she could be, do, and have anything.
She got that belief from somebody else first. Someone believed in her before she believed in herself. That is exactly what she now hands clients: you do not believe in yourself, fine, believe in me, because I have been you.
Why she coaches
August 31, 2020. She was too busy to coach anybody, working through a pandemic and looking for a second job because money was tight. She kept sending people to her own coach. One woman refused to go to anyone but her, so Julie signed up to coach her, because she knew the woman was in worse shape than she had been.
That client then got COVID and never came back. Julie almost quit coaching right there, since she had only signed on for one person. Her coach told her to go help some more people.
Thousands of clients later, she says you fall in love with coaching one client at a time, and she thanks God that one woman would not go to anybody else. She also says something worth sitting with: be careful what you ask for, because you will be shaped into the person you need to become in order to get it.
What fires her up now is not just the client in front of her. It is that there is a little girl out there who may not even be born yet whose whole life will be different, because Julie helped someone that child will love get healthy, and it will be a struggle she never has.
If this one hit something, two other conversations pair with it. The Last Addiction is where I write about the food and the demons behind it. And the episode on rewriting yourself covers the same ground from the other side of the table.
Common Questions
What did Julie Hittleman actually change to lose 120 pounds?
She stopped dieting and started building health, which she describes as two different projects. The nutrition change came first and produced the physical loss over 11 months. But the part she credits for it lasting is the mindset and habit work that began about five months in, when her coach handed her a book on habit loops. In her words, the biggest weight was the one between her ears, and losing that took longer than losing the body weight.
What does it mean that it was not what she was eating, it was what was eating her?
It is her shorthand for using food to manage a dysregulated nervous system rather than hunger. She was covering grief, stress, and emotions she had no other tools for. That is why telling her what to eat never worked for long. She could hold any diet until a party, a hard day, or an argument, because the food was doing a job that the food rules never addressed.
Why does she object to the phrase cheat meal?
She asks clients how many days a week they cheat on their spouse. The reaction is always the same, and that is the point. A commitment to yourself is still a commitment. She compares a planned cheat meal to someone with 90 days clean planning a relapse, and says the framing itself keeps you tied to the thing you are trying to leave.
What is the difference between an ex-smoker and a non-smoker?
Identity. Julie quit smoking on her eighth attempt, in 2008, on her birthday. The first seven times she wanted to drop the habit but kept living the life of a smoker, in the same places and situations. She says an ex-smoker is still a smoker who is not currently smoking, while a non-smoker is simply not someone who smokes. The same shift applied to her health years later.
What is metabolic dysfunction, and how common is it?
It is the cluster underneath high blood pressure, high cholesterol, high blood sugar, and excess visceral fat, and it builds for years before it earns a diagnosis. Julie says roughly 9 in 10 Americans have some form of it. Published research supports that scale: a University of North Carolina analysis of national survey data found only about 12 percent of American adults were metabolically healthy across five standard measures.
Is being symptom-free the same as being healthy?
No, and this is one of her sharpest points. Symptom-free means it has not shown up yet. She draws a line between lifespan and health span, arguing that the medical system is built to manage sickness and mitigate disease rather than create health. Prevention, she says, is a different project than treatment, and nobody is going to hand it to you.
Why does she push resistance training and not just diet?
Because everyone loses muscle with age, and muscle loss is strength loss. She points to the connection between skeletal muscle and bone density, and frames it in practical terms. The goal is not water skiing at 73, though she plans on it. The goal is getting out of a chair at 70 without help, and not taking the fall that breaks a hip.
How do people reach Julie Hittleman?
Her site is HittlemanHealth.com, where you can read her story, see client results, and take a free metabolic scan to see where your own numbers sit. She is on Facebook and Instagram as Julie Stern Hittleman. Nothing in this episode is medical advice, and results described here are one person's outcome, not a promise of yours.
Find Julie Hittleman: her practice is Hittleman Health, metabolic health coaching, with the tagline that sums up this whole conversation: stop managing symptoms, start restoring health. By her site's own numbers, that is 120+ pounds released personally, 500+ lives transformed, and 20+ years in healthcare, with advanced certifications in metabolic health and nutrition science.
Free metabolic health scan: take the scan here. It runs 3 to 5 minutes, costs nothing, needs no credit card, and Julie reviews every one personally and follows up with your next steps.
More from her: the Hittleman Health blog, her Substack show, and for anyone who wants to do what she does, the coach opportunity. On Facebook and Instagram she is Julie Stern Hittleman.
Her wall of results is worth your time. Her husband Scott released 103 pounds, and together they are at 223, which she notes is an entire person. Stephanie, who was Julie's patient back when Julie was a nurse at UCLA, released 165 pounds, came off 3 diabetic medications and a walker, and is now a coach herself. Lanney started just after his 80th birthday and beat his goal. Richard was 71 and convinced nothing would work. Ian released 60 pounds in 90 days. Age is not the factor, as she puts it. The decision to start is.
This episode is a conversation, not medical advice. Julie's results and her clients' results are their own, not a promise of yours. Talk to your own physician before changing anything about your health.