It’s Good Friday 2011, and Paul Underhill, 41, is being wheeled into surgery at Toronto General Hospital. Instead of being fearful—a typical response to a double lung transplant—Underhill is cheerful. He’s singing.
“I’m on my way, I don’t know where I’m going, I’m on my way!”
Smiling from behind his rectangular, black-rimmed glasses, he sings me the Paul Simon refrain he performed for his nurses six years ago. Sandra Underhill, his wife of 19 years, joins in the singing, but she wasn’t sure what to make of her husband’s playfulness pre-transplant. She was still in shock from it all—numb from months of cleaning blood her husband coughed up, sometimes a cup at a time, and traumatized by all the ambulance rides, not knowing whether he would survive the wait for new lungs.
Born in Victoria, British Columbia, Canada, Paul Underhill was diagnosed at six months of age with cystic fibrosis (CF), a genetic disease that affects the digestive system and the lungs. In the 1960s, a CF patient was lucky to survive to age 10. Today, many still succumb before their 30th birthdays—fluid fills the lungs and hardens, gradually shrinking lung capacity until there is none at all.
Most people with Underhill’s type of CF don’t live to adulthood. The lungs that saved him arrived in the nick of time, the blessed news delivered by a nurse named Grace while Sandra’s father prayed for a miracle at the church across the road from the hospital.
It takes a special kind of person to face a seven-hour transplant surgery with a smile and a song. That’s Underhill—fearless, and a fighter.
It takes a special kind of person to face a seven-hour transplant surgery with a smile and a song.
“The question that is inside of me is ‘why not?’” he says. “What I’ve learned about myself is that I’m powered by possibility and passion for things that I love… I don’t let fear interfere with what could be.”
Growing up, Underhill performed his lung-clearing exercises twice a day, then participated in his favorite activities—running, soccer, and cycling. At age 15, he competed in the British Columbia Summer Games for cycling. At the University of Victoria, he met his wife and graduated with a bachelor of arts and a bachelor of laws.
“Paul always had a cough, ever since I’ve known him,” Sandra says, referring to the characteristic feature of a person with CF. “When you find a partner and you fall in love, you don’t think about things getting worse. I never thought about [cystic fibrosis being fatal].”
By his early 30s, Underhill’s health was deteriorating rapidly. He was forced to leave a job he loved with the provincial government, but he stayed active, even kite surfing as long as he could. (He maintains it’s the best lung-clearing exercise around.)
To fill the void, he devoted himself to a new passion: keeping himself well nourished, which would aid his recovery come transplant day.
“I realized I couldn’t rely on my doctors, no matter how great they were, to keep apprised of the latest research,” he says. “You have to look at what the science is right now.”
Underhill poured through medical journals, researching new treatments for CF and lung health. Sandra helped, too, studying nutrition and the link between diet and disease.
“It’s not in Paul’s personality to sit back and wait for things to unfold,” Sandra says. “When he wants something, he goes full steam ahead—and he wanted to stay as healthy as possible.”
Combining their research, husband and wife noted a high correlation between inflammation and many degenerative conditions. Add to that evidence that CF patients with good nutrition have better lung function, and Underhill set out to concoct a nutritious super shake that his body could thrive on.
“I was looking for a beverage of the highest quality that was easy to digest. I looked everywhere and couldn’t find (what I needed),” says Underhill, who is diabetic in addition to having difficulty absorbing nutrients, because of his CF.
The recipe for what would eventually become the drink Rumble took six months to develop in the Underhills’ kitchen. The shake had to be gluten-, lactose-, and soy-free, low in sugar, and free of genetically modified organisms.
“Most important of all, it had to taste great. That’s what took so long in the kitchen, perfecting the taste,” says Underhill.
Rumble—named for the sound the body makes to declare its need for nourishment—comes in three flavours, Dutch cocoa, vanilla maple, and coffee bean, all naturally sweetened with organic maple syrup, organic agave nectar, and vanilla bean. Using organic oils as its base, the drink is light and fluid, not chalky, and has no aftertaste.
Once Underhill was satisfied with the shake, he realized he had a product he could bring to market. In 2008, he launched Rumble with three partners.
Throughout the process of creating the business, Underhill’s CF worsened. At one point, he needed two oxygen tanks to breathe. He couldn’t even brush his teeth without help. As he waited for a life-saving double-lung transplant, he relied on his shake for nutrients to keep his body as healthy as possible.
“The biggest risk pre-transplant is that you get so skinny you’re not going to do well afterward,” he says, noting that three years post-transplant, he was “two pounds heavier than the day I got transplanted, because Sandra made my shake, the essence of Rumble, every day.”
Underhill was living proof the drink lived up to its promise to be a nutritious, protein-rich super shake.
Rumble’s biggest challenge was finding a production partner who could work with its delicate ingredients like organic flax oil, which is rich in omega-3s and believed to reduce inflammation. The team persevered, determined the oil would remain an ingredient alongside pomegranate, red beet juice, organic spinach, kale, and Rumble’s signature protein blend.
“We searched for months until we found a partner who could work with organic flax seed oil,” says Underhill, noting the beverage is made in a secret facility in the Unites States.
Rumble is also the first drink in Canada to be labeled a “nourishing drink” by the Canadian Food Inspection Agency. The category was created in 2012 just for Rumble, which didn’t qualify as a meal replacement because its ratio of omega-6s to omega-3s didn’t match CFIA guidelines. To be a meal replacement, a drink needs to contain a 4:1 ratio, but the Rumble team follows new research that shows the quantity of omega-3s should be double that of omega-6s for ultimate health benefits—hence the importance of the flax seed oil.
Branded aluminum bottles highlight the protein content – 20 grams – and the drink’s promise to “feed the good,” with its more than 3000 mgs of omega-3s, eight grams of fibre, 400 mgs of calcium, and natural fruits and vegetables.
In Canada, Rumble is available in more than 3,000 grocery stores and online on Amazon.ca. The company did a test launch of Rumble in the U.S. in 2015 and 2016 to great success; now, the Rumble team is working with a new production partner to prepare to re-launch online sales in the U.S. in 2018.
“Rumble didn’t exist when I was waiting for transplant, but what did exist was Sandra,” Underhill says. “She made my shake—the essence of Rumble—daily to keep me alive.”
“A lung transplant isn’t a cure. I’ve exchanged one set of difficulties for another.”
With new lungs and a new lease on life, Underhill forged ahead after his surgery. A year post-transplant, he won five gold medals in the Canadian Transplant Games. Two years post-transplant, he biked 750 miles for a fundraiser for Cystic Fibrosis Canada and helped raise hundreds of thousands of dollars for CF research.
Rumble has brought Underhill full circle: he developed the drink to keep himself alive, and now, the success of the business has become the perfect platform for him to advocate for both CF and organ donation to help prolong the lives of others.
Meanwhile, he continues to face health challenges. The anti-rejection medication he takes is harsh on his kidneys, which have been causing him problems. “A lung transplant isn’t a cure. I’ve exchanged one set of difficulties for another,” he says good-naturedly.
But like every other challenge Underhill has encountered in his 47 years, he faces those to come with a positive mindset. “When I meet a challenge, when I hear I can’t do something, I think ‘Yes, I can.’ If you want to see me do something, just tell me I can’t.”