When most people worry about getting old, they focus on the obvious degenerative diseases like diabetes and cancer and Alzheimer’s or the catastrophic health emergencies that can occur, like strokes or heart attacks. They think about the melange of medicines they might have to take, the panicked rush to the ER in the dead of night, the slow but unmistakable descent into painful oblivion. But one of the deadliest health conditions afflicting older adults is also one of the most silent and unknown: sarcopenia, or the degeneration and loss of muscle mass and strength.
People just don’t think about losing muscle mass and strength as they get older. If they do, they assume it’s just part of the aging process. They figure it’s unavoidable, because, after all, everyone around them just gets weaker and more decrepit as they age. It’s one of those “inevitabilities” that you “just have to accept.”
Muscle loss is not your destiny. You don’t have to sit there and take it. In fact, sitting there and taking it is the single best way to get sarcopenia; standing up and fighting is the single best way to avoid it. Plus, taking the necessary steps to mitigate or even prevent sarcopenia will help prevent all those other age-related maladies I mentioned in the opening paragraph.
Health Problems Related to Muscle Atrophy, or Muscle Loss
Sarcopenia the specific condition is linked to a number of poor health outcomes:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060646/‘>2:
- It’s degradation of the muscle tissue.
- It’s conversion from fast-twitch Type 2 muscle fibers that can handle heavy loads and high intensity to slow-twitch Type 1 muscle fibers that can only handle lighter loads and lower intensities.
- It’s the loss of motor units at the muscle itself, forcing the few remaining motor units to pick up the slack and extending recovery times.
- It’s the loss of cardiac strength, which impairs cardiovascular function and lowers VO2max.
- It’s the impairment of tendon function, reducing strength and mobility and increasing the risk of injury.
The European Working Group diagnoses sarcopenia if you have two of three conditions:http://www.ncbi.nlm.nih.gov/pubmed/15571536‘>4
Normally I’d favor just sunlight, but the potential for impaired vitamin D production in older adults makes supplementation plus sun a wise choice.
Check Your Hormone Levels
For older men, low testosterone is a huge risk factor for sarcopenia. Inadequate testosterone makes building and retaining lean muscle mass harder than it should be, so even if you strength train and eat extra protein to fight sarcopenia, you get subpar results. Optimize your T levels, whether through natural means or, if required, supplemental.://journals.lww.com/menopausejournal/Fulltext/2020/05000/The_association_between_hormone_therapy_and.4.aspx‘>14
Get a Handle on Inflammation
Patients with sarcopenia tend to have higher baseline levels of inflammation.https://www.ncbi.nlm.nih.gov/pubmed/12473005/‘>16
Recover from your workouts with adequate protein and calories and fat.
Don’t overeat too much. Not only is overeating on a regular basis inflammatory, it can increase intramuscular levels of fat in the muscles which degrade their function and exacerbate the sarcopenia.
Lose Body Fat
For years, researchers assumed the causality went sarcopenia—->obesity. Makes sense on some level. The weaker and more frail you are, the less you’re able to get enough physical activity to stay fit and trim. But the latest research suggests the causality runs the other way: excess adipose tissue secretes inflammatory adipokines which impair muscle function and structure.https://pubmed.ncbi.nlm.nih.gov/12472346/‘>1 This strongly suggests that modern lifestyle factors that affect epigenetics, inflammation, and hormones, underlie much of what we see today.
What to Do About Your Acne
Because acne is multifactorial, there is no single magic pill for acne. Sufferers may try a variety of topical, pharmaceutical, and lifestyle interventions before (hopefully) finding the key that works for them. It can take trial and error, luck, and time. There are also a lot of old wives’ tales that send people down all sorts of rabbit holes looking for answers. Many fall into the category of “can’t hurt, might help.” A few are actually backed by science:
Many supposed dietary causes of acne aren’t substantiated by research. (Chocolate doesn’t seem to cause acne, thankfully.) However, the American Academy of Dermotology (AAD) agrees that two factors matter:https://pubmed.ncbi.nlm.nih.gov/12472346/‘>3 https://pubmed.ncbi.nlm.nih.gov/26897386/‘>5 The available data is observational, so take it for what it’s worth. Still, a recent meta-analysis found that folks who drink more milk are more prone to acne. There was no significant relationship for cheese or yogurt consumption.https://www.wjgnet.com/2218-6190/full/v6/i4/52.htm‘>7 Addressing underlying gut health issues, as well as supplementing with probiotics (Lactobacillus and Bifidobacteria), can reduce acne.https://www.ncbi.nlm.nih.gov/pubmed/20666829’>9 vitamin B3,https://pubmed.ncbi.nlm.nih.gov/24553997/’>11
Finally, work on your skin’s surface. Some people swear by using coconut oil on their face, but it can be aggravating for others. Try topical applications of manuka honey, tea tree oil (diluted), witch hazel, green tea extract, or apple cider vinegar. None of these is likely to be a slam dunk on its own, but use them alongside dietary changes and wise supplementation, and you might just arrive at a winning combo.
As with acne, there are several forms of eczema. The most common is atopic dermatitis. Eczema is characterized by dry, itchy, swollen rashes that appear most often on the face, neck, elbows, and knees. People of any age can develop eczema, but it’s more common in babies and children. Up to 20 percent of children and 5 percent of adults are afflicted.https://pubmed.ncbi.nlm.nih.gov/22831283/‘>13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516982/‘>15 and relieve eczema symptoms.https://www.ncbi.nlm.nih.gov/books/NBK91608/‘>17
However, a recent Cochrane review concluded that there is insufficient evidence to recommend probiotics as an effective eczema treatment.https://pubmed.ncbi.nlm.nih.gov/24320105/‘>19 If nothing else, it will moisturize dry skin and smell great.
Acupressure, acupuncture, and massage
A few small studies have found that acupressure https://pubmed.ncbi.nlm.nih.gov/30477869/‘>21, and massage[/ref]https://pubmed.ncbi.nlm.nih.gov/9796594/[/ref] may provide some relief. In addition to physiologic benefits, these treatments may reduce stress, which is known to trigger flare-ups.
Your doctor may use phototherapy treatments, but you can also reap the benefits of ultraviolet light simply by getting out in the sun.https://pubmed.ncbi.nlm.nih.gov/28601680/‘>23
Dermatologists caution that sun exposure is not recommended for severe cases, and it exacerbates symptoms for some people. Be careful not to overdo it. Besides the risk of burning, getting too hot and sweaty leads to itching and discomfort.
With plaque psoriasis—the most common form—red, scaly, often itchy or painful patches rise on the scalp, knees, elbows, lower back, or really anywhere on the body. Other types of psoriasis cause red lesions in folds such as the armpit, small dots, or blisters. Psoriasis can also affect the fingernails and toenails.
Psoriasis shares a lot in common with eczema. Doctors don’t know exactly what causes it, but it has a genetic component and is classified as an autoimmune disease. Symptoms come and go, and different people may have different triggers. Doctors usually treat psoriasis with topical creams, but they may also prescribe oral medications to try to get at it systemically.
Unlike eczema, though, psoriasis is more common in adults than children. Up to 30 percent of people with psoriasis develop a related condition called psoriatic arthritis. Because it is associated with systemic inflammation, psoriasis puts you at greater risk for other chronic health conditions such as metabolic syndrome and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666891/‘>25
Treating Psoriasis with Diet
Gluten sensitivity is probably more common among psoriasis sufferers than in the general population. I think gluten sensitivity is more common than is generally recognized, but that aside, I’d strongly suggest that anyone with psoriasis try eliminating gluten completely for a period of time.
Calorie-restricted diets also yield significant improvements in symptom severity for obese individuals, but it’s not clear whether that is due to the calorie restriction per se, weight loss, or something else.https://pubmed.ncbi.nlm.nih.gov/29926091/‘>27
If you have psoriasis, you should also limit your alcohol intake. A growing body of evidence suggests that alcohol can worsen symptoms. Psoriasis also comes with a higher risk of liver disease, making excess alcohol consumption potentially more dangerous.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134971/‘>29 (Vitamin D is commonly applied in topical creams.) They may be helpful for some people, though.
There is also a lot of interest in curcumin, a compound found in turmeric. A number of small clinical trials have yielded some success, but it’s still early. A recent meta-analysis concluded that the available data do not support using curcumin topically, but taking it as an oral supplement shows promise.https://pubmed.ncbi.nlm.nih.gov/8513683/‘>31 Therefore, anything you do to moderate stress may help prevent or manage symptoms. Meditation and guided imagery seem to work.https://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/herbal-remedies‘>33
Ultraviolet light, especially UVB, can help with psoriasis symptoms. Certain topical treatments make you more susceptible to sunburn, so check out any medications you’re using.
A 2017 review of studies involving more than 1,000 participants concluded that acupuncture and acupressure can help with psoriasis.http://www.ncbi.nlm.nih.gov/pubmed?term=RHEB-1‘>1
One study (full PDF) from the 1940s found that varying amounts of twenty-four hour IFs (every other day, every fourth day, every eighth day, etc) prolonged the lifespan of rats without retarding or stunting the growth (as occurred with calorie restricting them). Female rats responded best to every eight day fasts, while males responded best to every other day fasts.
Reductions in brain insulin signaling have been shown to increase lifespan in animals, either by calorie restricting or actively knocking out brain insulin receptors.http://www.ncbi.nlm.nih.gov/pubmed/21244426‘>3
Going in and pharmaceutically manhandling your cholesterol synthesizing equipment is one thing; eating real food and exercising, resulting in possible alterations to your lipid profile, is another. We don’t set out to force your blood lipids into submission, but lifestyle changes that happen to change them for “the better” are usually a good thing. Fasting brings potent changes to blood lipids in an “organic” way – you’re just letting your machinery do its thing on its own – and this is probably a very good thing.
Intermittent fasting is as effective or even more effective than calorie restriction in improving metabolic syndrome markers in overweight women, and it’s a whole lot easier to stick with.http://www.ncbi.nlm.nih.gov/pubmed/20300080‘>5
I discussed this last week, but it can’t hurt to mention that short-term alternate day fasting wrought improvements in LDL particle size and distribution in obese adults.http://www.ncbi.nlm.nih.gov/pubmed/20815899‘>7
Heck, intermittent fasting even helped cocaine addicts stick to their treatment and rehab program.http://www.ncbi.nlm.nih.gov/pubmed/18184721‘>9 In fact, here’s a review of most of the animal anti-cancer evidence.http://www.ncbi.nlm.nih.gov/pubmed/19135806‘>11 This is refreshing news. A preliminary studyhttp://ajpregu.physiology.org/content/296/1/R29.full‘>13 I’ve found this to be the case for me. If the body “needs” food right after a workout, why would hunger be blunted? This is why I tend to hold off on the eating post-workout. Every little bit helps, especially as you age.
Fasting doesn’t cause your brain tissue to waste away, contrary to what some people will tell you. It’s actually good for brain health. Any dietary restriction tends to increase neuronal plasticity and promote neurogenesis, but it was IF that had the greatest effect (with the fewest downsides).http://onlinelibrary.wiley.com/doi/10.1046/j.1471-4159.2003.01586.x/full‘>15 That is, mice who ate larger meals more infrequently saw greater increases in brain and overall bodily health. Still another study found that IF was beneficial for peripheral nerve function in mice by promoting the maintenance of the neuronal pathways responsible for locomotor performance.http://www.ncbi.nlm.nih.gov/pubmed/21106691‘>17), which is the process by which cells recycle waste material, eliminate or downregulate wasteful processes, and repair themselves. Why is autophagy so important? It’s required to maintain muscle masshttp://www.ncbi.nlm.nih.gov/pubmed/20104028‘>19 It reduces the negative effects of aginghttp://www.ncbi.nlm.nih.gov/pubmed/17934054‘>21
Without the autophagy that fasting provides, you would get very few of the benefits. Fasting even increases neuronal autophagy,http://www.ncbi.nlm.nih.gov/pubmed/21051570‘>23 (which mean better performance down the line), improved muscle protein synthesis,http://www.ncbi.nlm.nih.gov/pubmed/20187284‘>25 (you’ll earn your meal and make more muscle out of it if you train on an empty stomach). Studies on Muslim athletes during Ramadan show no effect on performance while fasting,http://www.ncbi.nlm.nih.gov/pubmed/19787180‘>27 in those who exercise and fast rather than just fast. When you train in a fasted state, glycogen breakdown is blunted28 and more fat is burned, leaving you more glycolytic energy in the tank for when you really need it and less body fat. Those are just a sampling of the benefits to fasted training; there are dozens more.
Mental Well-being and Clarity
A lot of health influencers will tell you that failure to eat something every few hours will cause mental fog and sluggishness, so keep a banana or a granola bar on your person at all times. Of course, this is all based on an assumption that we need to supply exogenous carbs on a regular basis to properly fuel the brain. This notion that fasting is only the province of anorexics or “caveman” has kept many people from experiencing the vast array of benefits.
I maintain that one’s comfort in handling intermittent fasting effortlessly does increase dramatically when you’ve reprogrammed those cells (and genes) to predispose your body to derive most of your day-to-day energy from fat, as opposed to constantly dipping into glycogen stores (as happens when we rely so much on refeeding carbs every few hours).
Overall, fasting just seems right. It’s like a reset button for your entire body, presumably across a large spectrum of maladies and dysfunctions. It puts your body into repair mode – at the cellular level – and it can restore normal hormonal function in the obese or overweight. Now, you don’t have to fast, but it’s definitely something to consider.
Have you tried intermittent fasting yet? Let me know how intermittent fasting has worked – or hasn’t – with your lifestyle in the comment section!
Powered by WPeMatico
Powered by WPeMatico
Powered by WPeMatico
Powered by WPeMatico
Many people get to age 60 or so and, if they haven’t lived a healthy, active life up to that point, assume it’s too late for them. After all, things only get harder the older you get. You’ve got aches and pains. Your doc is always reminding you about your weight. Things creak and crack. You look wistfully at the gym you pass by every day, thinking to yourself, “It would never work.”
At least, that’s how most people deal with getting old: they lament their “inability” to do anything about it as oblivion approaches and overtakes them.
Forget all that. While you can’t turn back the chronological clock, you can “de-age” yourself by engaging in the right diet, exercise, and lifestyle modifications. So—how?
Realize That It’s Never Too Late
The scientific literature is rife with examples of older individuals making changes to their lifestyle, diet, and exercise and seeing great results.
How about 68-year-olds still getting gains from strength training?
Older women switching to high-fatty-meat or high-cheese diets and enjoying better heart health.
Verifiable examples (or “anecdotes”) from people online are also available. Like PD Mangan, who went from this to this. That’s not impossible, or even difficult to achieve. What you need is the will and means and know-how—all freely available.
Know that it’s possible. Know that it’s probable. Know that your efforts will not be in vain.
Realize That It’s Your Fault—And Even If It’s Not, It’s Your Responsibility
I don’t care where you fall on the belief spectrum. It could be that “your body is a temple ordained by God and you’d be remiss to let it fall to ruin and in doing so fail your creator.” It could be that “your body was the work of hundreds of generations of ancestors who fought and suffered and scrounged and died to ensure you’d make it and to fail to maintain your health is a huge insult to their sacrifices.” It could be that “your body is the product of millions and billions of years of evolution through natural selection, a chance byproduct of a process that probability says shouldn’t have even happened, and you’re going to waste it?”
However you approach it, what matters is that you have a remarkable body (and mind) that deserves your attention, care, maintenance and nourishment. Only you can do anything about it. Maybe you were fed bad food as a kid and bad info as an adult (this is most people). Doesn’t matter. You still have to own it and take the steps necessary to improve your condition. Responsibility means ability to respond. Claim it.
Eat More Protein
If you’re over 50, you need more protein than you think.
If you’re over 50, your ability to utilize protein isn’t as good as it used to be.
If you’re over 50, you need more protein to do the same job as a person 25 years younger.
If you’re over 65, the supposed negative relationship between meat and mortality the “experts” are always crowing about reverses, magically becoming a positive relationship.
And if one of your issues is trouble losing body fat, more protein will also help you beat back exaggerated hunger and keep food intake low enough to lose weight. Many people in the ancestral community don’t like acknowledging this, but it’s true for a great many people: protein is the most satiating macronutrient.
Moreover, protein will help you lose body fat and retain (and even gain) the all-important lean muscle mass. Losing muscle when you’re over 50 is harder and harder to recover from.
The only catch is that if one of your “aging-related maladies” is kidney failure, you may have to slow things down and keep your protein intake low to moderate. Emphasis on “may.” Check with your doctor if that’s the case.
Get As Insulin Sensitive As You Can
The relationship between insulin signaling and aging is a bit unclear. What we know is that people with higher insulin sensitivity live longer and healthier lives. We know that insulin resistance is strongly linked to most degenerative diseases, like cancer, diabetes, sarcopenia, and osteoporosis (to name only a few). But researchers are always oscillating between “cause” and “effect.” Is insulin resistance a cause or a sign of aging? Are insulin sensitive people healthier into old age because they’re insulin sensitive, or are they insulin sensitive because they’re healthier?
I’m not sure it really matters. Either way, to become more insulin sensitive you have to do a bunch of things that will also make you healthier and age better like lifting weights, quitting overeating, taking more walks, doing more low level aerobic work, and regulating your carb intake.
I’ve always said that you should burn as little glucose as possible. The more you can rely on stored body fat for energy and daily maintenance, the better. Well, the more insulin sensitive you are, the less insulin you’ll have blunting your ability to liberate stored body fat, the more fat you’ll burn and the better you’ll age.
Walk Every Day
One of my favorite predictors of mortality in older people is walking speed: they ask people to walk at their normal speed and then track how fast they go. The slower the walk, the higher their risk of dying earlier. It’s my favorite because it’s so elegant. And no, actively forcing yourself to walk more briskly when you get tested won’t increase your longevity. But if you get up and walk every single day, walking will be second nature. Your walking speed will increase naturally, and it’s the natural increase in walking speed that presages a longer, healthier life.
Walking will also force you to get out and see and experience the world. It’ll lower your fasting blood glucose and postprandial blood glucose (hint: walk after meals). It will introduce novelty to your life and in doing so extend your time horizon.
Eat Tons Of Collagen
Collagen improves skin health, elasticity, and reduces wrinkling. This might sound superficial, but altering those “surface level” signs of aging indicates that you’re also modifying the internal aging markers.
Another reason to up your collagen intake is to balance out the meat you’re eating. As an older person, you’ll need to eat more meat to counter your suboptimal protein utilization. That means you need to process more methionine, which requires more glycine, which comes from collagen.
The easiest way to get collagen and hit a few birds with one stone is to eat lots of collagenous meats—shanks, skin, knuckles, oxtails, ears, snouts, feet, tendons. That way you get your muscle meat protein and collagen protein. Collagen protein powder is another option.
Lift Heavy Things To Build Your Musculoskeletal System
Exercise isn’t just good for your muscles and your heart. It’s also the only reliable way to build and maintain bone mineral density. But in order for exercise to improve bone mineral density, it must satisfy several requirements. It should be dynamic, not static. It needs to challenge you. It needs to challenge your muscles. In other words, you need to lift (relatively) heavy things. You need to progress in weight, intensity, and duration. It should be “relatively brief but intermittent.” No long drawn-out sessions that do nothing but overwork and overtrain you. Keep it short and intense. Also, the exercise should place an unusual loading pattern on the bones. That could be different movements, or increased resistance, as long as you’re introducing something “new” to the body; don’t just do the same old weights forever. Finally, for exercise to improve bone mineral density it must be supported by sufficient nutrition, especially calcium, vitamin D, sufficient protein, and vitamin K2.
Develop Your Balance Yesterday
The number one cause of death and degeneration after age 70 is falling and breaking something. You step out of the shower, slip, and break a hip, then never recover. You step off a curb and fall on your knee, breaking your femur, and never recover. Avoid this at all costs. Improve your balance as soon as possible.
Get a slackline: Keep it low to the ground, have a partner to help, or use something like a walking stick to support you. Focus on simply balancing rather than trying to walk.
Try standup paddling: Not only is it a great workout and a great time, paddling forces you to balance—constantly. And as long as you can swim, falling is totally safe.
Walk on uneven surfaces (carefully): Go for hikes, walk in the sand or in the grass, walk along cobblestone streets, walk on slopes.
Walk along curbs (very carefully).
Wear footwear that is as minimalist as you can handle (or just go barefoot if you’re up for it): The bottom of the foot is loaded with nerve endings that inform you and guide your balance as you make your way through the world. They help you subconsciously make those micro-adjustments to your posture and body position that make up “good balance.” A big clunky rubber sole blocks that out and cuts you off from your body.
Play Every Day
They say that when you stop moving, you start dying. I say when you stop playing, you start dying. We see this in dogs; once a dog no longer wants to play, chase the ball, roughhouse, or do the things he or she used to love doing, they’re on the way out. I firmly believe the same is true for people—just spread out across a longer timeline.
So have fun. Play sports. Try Ultimate Frisbee (my favorite).
Don’t forget about the mental games. Game nights. Crosswords in the morning (that’s what I do). Play cards. Do a weekly poker night with friends and make it a potluck.
What I’m not saying is that doing the crossword will stave off Alzheimer’s or make you smarter. What it will do is send the message to your brain and body that “this person hasn’t given up.” Ideally, your physical play will train your muscles, bones, and balance—that way you can satisfy all those requirements and have fun doing it.
Don’t Do It Alone
If you’re an older person reading this and actually preparing to make the changes necessary to be healthy and vigorous, you are a rare bird. Most of your peers have given up. Most have resigned themselves to being less healthy and less vigorous with every passing day. Don’t let that happen. Enlist a friend, a loved one, a peer. Not only will it give you another person to play, train, and walk with, but it will help you stay the course and enjoy doing it. It will also save another person—or at least give them the best chance they’ve got.
Those are the big tips. There are others, though. And for anyone interested in better health and longevity and more life in the years you have, Keto for Life, offers more information than I could fit here. All the points I covered today and many more are fleshed out and expanded upon twenty-fold.
But if you just focused on these 10 tips, you’d be pretty far along on your way to health (no matter what age you are).
That’s it for today, folks. Take care, drop your own tips down below, and have a great Thanksgiving!
The post Late To the Healthy Living Game? 10 Essential Tips Making the Transition to Better Health appeared first on Mark’s Daily Apple.
Powered by WPeMatico
The treatment usually prescribed by doctors, hormone therapy (HT), is controversial and not appropriate for some women. I won’t get into the HT debate here—Mark did a great job covering the pros and cons recently. Suffice it to say that HT isn’t the answer for everyone, and it’s not a panacea by any means.
Whether or not they choose to go the HT route, many women desire additional support during perimenopause and beyond. For the sake of keeping this post from becoming a novella, I’m going to focus on mind-body therapies today.
This is not meant to be an exhaustive list of nonhormonal options, nor is it meant to try to dissuade you from trying HT. That’s a decision you have to make for yourself with your doctor. The approaches below can be used alone or in combination with other modalities, including HT.
As with any medical-adjacent tools, if you are considering any of the options here, take the time to educate yourself, talk to your doctor, and find qualified practitioners to help you implement these practices.
A Note Regarding Research Evidence…
Because so many women are interested in complementary or alternative approaches, there’s a fair amount of research into nonhormonal treatments. There are also important limitations.
A lot of the randomized control trials—experiments that are best for establishing causal effects—are small. There is considerable variability in research design, so it’s difficult to generalize across studies.
Participants in these studies tend to be white and well-educated. Since there are cross-cultural differences in the experience of menopause, we shouldn’t assume that the findings apply to all women. Likewise, a lot of the research focuses on women with a history of breast cancer because HT is generally contraindicated in this population. While the results of these studies probably generalize to other women, it would be great to have more data.
Finally, vasomotor symptoms—hot flushes and night sweats—are studied more than other types of symptoms. Though they are the most common complaint, many women do not experience debilitating vasomotor symptoms. They might, however, experience mood fluctuations, depression, sexual issues, memory problems, and more. We know less about how these approaches might help those women.
Nevertheless, I’ll highlight some of the potentially fruitful avenues you might explore. When possible, I’ll focus on systematic reviews and meta-analyses. They pool the results of multiple smaller studies to help a more reliable picture emerge.
Cognitive Behavioral Therapy (CBT)
In CBT, individuals are encouraged to explore how their thoughts (cognitions) affect feelings, behaviors, and physical symptoms. With help, they change their thoughts or beliefs about a situation to help manage their responses and improve coping skills.
Although there isn’t a ton of research on CBT for menopause, available studies are very promising. Whether or not CBT reduces the actual number of hot flushes—and the data here are mixed—CBT should work by changing women’s perceptions of their hot flushes. Multiple studies do find that after CBT women view their hot flushes as interfering less with daily life. As expected, they are also less bothered by them.
Women who see themselves as having less control over their hot flushes also tend to experience more distress. Changing their perceived control could be an effective intervention for improving quality of life. Indeed, in one study, 95 women received either group-based or self-help CBT. After therapy they reported feeling greater control over hot flushes and having better coping skills compared to women in a no-CBT control condition. Further analyses showed that women’s beliefs about control and coping predicted how problematic they found their hot flushes to be. (Having more positive beliefs about how hot flushes affect sleep also helped.)
Women who participated in CBT also experienced fewer sleep issues and insomnia as well as fewer depressive symptoms and sexual concerns. They also noticed less impairment at work. Positive results were found with in-person therapy, self-help programs, and telephone-based therapy. When studies included a follow-up assessment, the beneficial effects of CBT persisted for at least six months.
Mindfulness, Meditation and Relaxation Training
A cross-sectional study of 1744 women found that women with higher scores on a mindfulness assessment tended to report less severe menopausal symptoms. For women with higher life stress, this association was especially strong. The idea here is that when women are able to be present-focused and observe their symptoms without judgment, they are protected against some of the distress, and possibly the physical symptoms, associated with menopause.
Although some of the women in that survey are probably mindful by nature—lucky them—mindfulness is also a skill that can be learned and cultivated. Among the many reasons to do so, mindfulness and meditation training can apparently lessen menopausal symptoms.
For example, researchers assigned 110 women to either an intensive eight-week mindfulness-based stress reduction program or a control group. The women who received mindfulness training reported having less bothersome hot flushes, better sleep quality, less anxiety and stress, and greater overall quality of life compared to the control group. When the researchers followed participants over the next 11 weeks, these results persisted or became even stronger.
A few other studies found that women who receive mindfulness or meditation training report fewer and less bothersome hot flushes, improved sleep, and better psychological functioning, though the results have not consistently endured over time. However, when looking at more general relaxation training and paced breathing techniques, effects are minimal, at least for hot flushes.
An ethnographic study of nine female yogi masters concluded that they tend to skate fairly easily through menopause. The authors concluded that menopausal women should be encouraged to practice yoga. Of course, in addition to yoga, these yogi masters’ lifestyles included “healthy food habits, adequate sleep, and the use of nature cure techniques (i.e., fasting, detoxification, selection of suitable food products, and living in well-ventilated houses) that facilitated the art of living in tune with nature.” This sounds pretty great, but can we give really yoga all the credit here?
Probably not. However, two recent meta-analyses did conclude that yoga offers small but significant relief from symptoms of all types: vasomotor, psychological (including depression), somatic (including fatigue and sleep disturbances), and urogenital. Women also report better overall well-being and quality of life after receiving yoga training.
In one study, a group of breast cancer survivors received twelve weeks of yoga and meditation instruction, and they were encouraged to practice daily at home. Compared to women in a control group (no instruction), they reported fewer symptoms and improved quality of life at the end of the twelve weeks and again when asked three months later. A later analysis found that many of the effects were mediated by improved self-esteem in the yoga group.
Note that most of the individual studies are small, and they employ different types of yoga practices. This might be considered a strength insofar as different practices have been shown to work, or a weakness in that it’s not clear if one approach is particularly effective.
Cross-cultural surveys find that women who are more active tend to have an easier time with menopause. For example, two large surveys of Swedish women found that women who exercised at least once per week reported less intrusive symptoms than women who never exercised, and women who exercised more than three hours per week were significantly less likely to experience severe symptoms than their less active counterparts. Sedentary women in this Finnish study experienced more vasomotor, psychological, and somatic/pain symptoms than women who were at least somewhat active.
While promising, experimental studies have not yielded such favorable results. When women were assigned to “physical activity” conditions (often walking), some studies report improvements, but others find no improvements or even worsening symptoms (perhaps depending on women’s baseline fitness). Multiple reviews have concluded that there is no systematic effect of exercise, particularly not for vasomotor symptoms.
Does that mean menopausal women shouldn’t exercise? Obviously no. It’s clear that being active—or at least not being sedentary—is important for overall health, and it probably helps menopausal women through the transition. However, there isn’t enough research to know what types of exercise are most effective and when. Do the types of movement you enjoy and that make your body feel good.
A recent review concluded that acupuncture is effective for reducing vasomotor symptoms, both frequency and severity, as well as for improving quality of life. However, the reviewers also found that acupuncture was not reliably better than sham acupuncture where needles are inserted at points other than the prescribed pressure points and at a shallower depth—a placebo condition.
A handful of studies have shown that clinical hypnosis can reduce hot flush frequency and distress among breast cancer patients. Another study of 187 women without breast cancer found that women who received hypnotherapy had fewer, less severe, and less bothersome hot flashes, as well as improved sleep. These results were evident at the end of the five-week treatment protocol, and they remained or got stronger in the six-week follow-up period.
The Experts Weigh In…
In 2015, the North American Menopause Society released a position statement on nonhormonal management of vasomotor symptoms. Of the approaches discussed here, the only ones NAMS recommended based on the strength of the available evidence were CBT and hypnosis. Mindfulness-based stress reduction earned a “recommend with caution,” which means, “We think it might work, but the evidence isn’t conclusive.”
The others—yoga, exercise, relaxation and paced breathing techniques, and acupuncture—were not recommended. This does not mean they are not worth trying! It simply means that based on their standards, the evidence was not strong enough for the committee to conclude that they are likely to be effective treatments for vasomotor symptoms specifically. This says nothing about other types of symptoms, nor about general well-being or quality of life.
Mind-Body Therapy Pros and Cons
So where does this leave us? Each of these therapies shows promise for alleviating at least some symptoms of menopause. Moreover, all these therapies have the potential to improve overall quality of life, sleep, stress, and general health. While reading these studies, I did wonder whether some of the women felt better simply because they were investing time and energy in taking care of themselves. If so, is that a problem? I don’t think so. They are low-risk interventions with a lot of potential upside.
That said, these aren’t quick solutions. The effective mindfulness/mediation trainings included six to eight weeks of classes and multiple hours per week. Women practiced yoga for two to four months during the study periods. Hypnotherapy was five weeks or longer. It’s not clear what the minimum time frame is for each of these therapies to be useful, but they’ll certainly involve a time commitment that might not be practical for all women. However, yoga, mindfulness/meditation, exercise, and even CBT can all be practiced at home once you know the proper technique.
As I said at the beginning, this is not an exhaustive list of nonhormonal therapies. There are also various supplements that might help, as well as lifestyle modifications that most of you Primal-savvy readers are probably already implementing: eating a variety of nutrient-dense foods, getting plenty of sunlight, practicing good sleep hygiene, and nurturing social connections.
Whatever you choose, be patient. Don’t just focus on one symptom; focus on the big picture. Pay attention to how you’re feeling more globally. Consider that while an intervention might not hit its desired mark, it might help you in ways you didn’t expect.
Have you used mind-body techniques (these or others)? What’s been your experience? Share your insights and questions below, and have a great week, everyone.
Atapattu PM. Vasomotor symptoms: What is the impact of physical exercise? J SAFOMS. 2105 Jan-Jun;3(1):15-19.
Goldstein KM, et al. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric. 2017 Apr;20(2):178-182.
McMillan TL, Mark S. Complementary and alternative medicine and physical activity for menopausal symptoms. J Am Med Womens Assoc (1972). 2004 Fall;59(4):270-7.
Molefi-Youri W. Is there a role for mindfulness-based interventions (here defined as MBCT and MBSR) in facilitating optimal psychological adjustment in the menopause? Post Reprod Health. 2019 Sep;25(3):143-149
Moore TR, Franks RB, Fox C. Review of Efficacy of Complementary and Alternative Medicine Treatments for Menopausal Symptoms. J Midwifery Womens Health. 2017 May;62(3):286-297.
Sliwinski JR, Johnson AK, Elkins GR. Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind-Body Medicine to Improve Cognitive Performance. Integr Med Insights. 2014;9:17–23.
van Driel CM, Stuursma A, Schroevers MJ, Mourits MJ, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG. 2019;126(3):330–339.
Powered by WPeMatico
Today I’m overjoyed to announce the release of my latest, greatest, and certainly broadest attempt at a comprehensive plan to live long and live awesome: Keto For Life. The book’s official on-sale date is December 31, and—as tradition goes on Mark’s Daily Apple—I’m offering an incredible group of free bonus materials as a pre-order gift. Here’s a link where you can access your favorite online retailers to order, but know you can also visit your favorite brick and mortar bookstore to pre-order, too.
Folks, I know many of you have been here with me and the MDA community for enough years to remember how this all began with the Primal Blueprint. It’s been such an awesome journey—and one that keeps evolving in incredible ways. I genuinely feel like it’s all been leading toward this one. I’ve poured my personal experimentation and hard-gained insight into every book I’ve written, but this one feels, well, like a whole new level of inquiry and practice. Keto has kicked off not just a dietary trend the last few years but truly a whole new realm of scientific research. I’ve been knee-deep in it in writing this book, and I’ve not only delved into these revolutionary findings but have also taken the integration of keto science and Primal lifestyle principles to an entire new level. Let me tell you about it….
With ground-breaking connections for how keto and Primal principles can literally reset your biological clock, Keto For Life is a revolutionary gateway into eating and living for increased longevity and resilient vitality. With endless how-tos in every chapter, a 21-Day Biological Reset plan with multiple holistic lifestyle prompts for each and every day, and more than 80 delicious keto recipes, it’s a deeply comprehensive and fully actionable resource for living Keto For Life—and all it’s meant to be.
Longevity is about much more than just healthy eating. However, oftentimes when you’re stuck in the disease state of carbohydrate dependency, you might as well forget about other lifestyle strategies until you can escape that certain destiny of pain, suffering, accelerated aging and disease. If you’re an ancestral health enthusiast, you likely realize the amazing health awakening that comes when you upregulate your fat burning genes and get off the carb dependency train. Favorable blood test values, dropping excess body fat, and escaping the common problems of energy, mood and appetite swings are indications that your metabolic flexibility is robust. While Keto For Life dutifully cleans up some of the misconceptions, hype, and misinformation that have come with the explosive popularity of keto, I’m expanding the entire picture into “Four Pillars of Longevity.”
I’ll give you a little teaser today about each section so you’ll be eager to dive right in when your book arrives! In the Introduction, you’ll learn how hectic, high-tech modern life is becoming more and more at odds with longevity, especially the hidden costs of hyperconnectivity, destruction of meaningful social connections, and forces like consumerism, flawed and manipulative marketing messages relating to diet and medical care, and even the fitness industry’s obsession with struggle and suffer instead of a more sensible approach to exercise. You’ll learn perspective-altering insights about our actual healthspan as well as intriguing multi-plane views of aging that will revamp the way you look at your later decades—and the journey leading to them.
A new perspective shows us that aging as we know it isn’t a normal and inevitable result of chronology but actually what Dr. Art DeVany describes as “the unrepaired accumulation of routine cellular damage… a loss of cell function, loss of cell integrity, loss of the ability of stem cells to renew tissues.” Embracing this truth, you can take tremendous control over the rate at which you experience decline, instead appreciating and optimizing the variety of human “peaks” we can achieve and harness throughout our lifespans. Chronology has far less to say than we’ve given it credit for.
Pillar #1: Metabolic Flexibility
This is the best catch-all term to convey the magnificent journey of escaping carbohydrate dependency and becoming a fat-burning beast. Literally, metabolic flexibility describes the ability to burn a variety of fuel sources—not just external ingested calories, but also internal sources such as stored fat, stored glycogen and ketones manufactured in the liver as a byproduct of fat metabolism—when carb intake is low. At the highest level of sophistication, you become a “closed loop system” that can survive and even thrive without needing the constant intake of external calories and certainly without needing to adhere to any regimented macronutrient eating patterns.
In this pillar, you’ll reacquaint with the importance of a comfortable, minimally stressful step-by-step process to escape carb dependency and progress toward metabolic flexibility. As detailed in the Keto Reset Diet, you’ll execute a 21-Day Metabolism Reset, a fine-tuning period, and a 6-week nutritional ketosis period. We’ll discuss some advanced strategies for fasting and eating in a compressed time window, particularly the importance of limiting your digestive function to 12 hours. You’ll get guidance on integrating the hottest longevity superfoods and supplements, as well as help sorting through the weight loss hype around them and pinpointing the best ways to use these products.
You’ll learn some of the best long-term keto strategies, including living in what I call the “Keto Zone,” where you eat in a general keto-aligned pattern without stressing about macros, as well as incorporating days or periods where carb intake might increase beyond keto limits without you stressing about it. You’ll also learn what NOT to do with various popular keto strategies that are ill advised or overhyped, including (but not limited to) the ridiculousness of dirty keto, obsessive weekend refeeds, and cheat days.
Pillar #2: Movement and Physical Fitness
Movement and physical fitness are two distinct concepts. Together, along with preserving sharp cognition, they represent the essence of aging gracefully. In contrast, when we lose cognition and mobility, our life expectancy and quality of life plummet as we are relegated to wheelchairs, beds, and medications that limit our physical freedoms and compromise our mental well-being.
The desperate obligation to increase all forms of general everyday movement can be best handled by JFW—Just F—ing Walk! Today, many fitness and health experts assert that simply moving around more (especially avoiding the prolonged periods of stillness that are so common in the digital age) has surpassed the importance of following a structured workout routine as the top priority to be fit for life. How can this be? Because moving around all day is one of our fundamental genetic expectations for health. Our genes crave movement and are averse to stillness. In as little as 20 minutes of sitting still, we can experience impaired glucose tolerance and acute insulin resistance, along with diminished cognitive function. When prolonged periods of stillness dominate your daily routine, it can cause chemical changes in the brain that promote further inactivity. This is quantified by a lower measurement of Non-Exercise Activity Thermogenesis (NEAT)—you burn fat less efficiently at rest and consequently crave more carbohydrates for energy.
Now, because modern life is so comfortable, we also have a desperate need for ambitious fitness endeavors like Spinning, CrossFit, or even completing a half-marathon, but these goals must be only contemplated after you have established a foundation of basic everyday movement, which I detail in the book.
Once your movement looks good, you can get into the genetically optimal workout pattern ala Primal Blueprint with a strategic blend of comfortably paced cardio, regular short duration, high intensity resistance workouts (weights, machines, or just bodyweight exercises like pushups), and occasional brief, all-out sprints (the ultimate Primal exercise to delay aging under the “use it or lose it” natural law.) Let’s also add what I call “play” endeavors that can feature each of the aforementioned. As you know from being a Primal enthusiast, there are massive hormonal and physiological benefits to be gained from putting your body under resistance load regularly, and opening up the throttle occasionally with all out efforts.
These activities, which have been almost completely neglected by most modern humans, give us a boost of adaptive, anti-aging hormones like human growth hormone and testosterone. Brief, intense efforts also help preserve muscle mass as you age, improving the critical longevity component of organ reserve. This is the functional capacity of your organs to perform above baseline level, one of the most fundamental ways to assess your state of health and longevity potential. This Primal approach to fitness is simple, time efficient, and within reach of everyone. It also gives you awesome protection against the accelerated demise associated with inactivity.
Unfortunately, many fitness enthusiasts follow an overly stressful approach that leads to breakdown, burnout, illness and injury. Chronic exercise leads to hormonal and immune dysfunction, and compromises metabolic flexibility—instead pushing you back in the direction of carbohydrate dependency. You’ll learn how to schedule and conduct the various workouts correctly, avoid chronic patterns, and apply an intuitive approach instead of a regimented approach to your fitness goals.
Pillar #3: Mental Flexibility
Mental flexibility makes you resilient for life in the same manner that metabolic flexibility makes you resilient enough to skip meals and maintain energy and focus. While looking after the physical vessel is essential, we must acknowledge the strength of the mind/body connection as previously discussed with the insights from Dr. Chopra and Dr. Lipton.
This section details numerous strategies to hone mental flexibility, starting with pivoting: going with the flow when facing life change. Pivoting entails knowing both when to persevere when your peak performance goals are aligned with your deep beliefs and calling to make the world a better place, and also recognizing when it’s time tone down the influence of your ego and quit when things don’t feel right in your gut.
You’ll learn how to avoid the disease state of ruminating, that is, the act of engaging in obsessive or destructive thoughts about the past or the future that cause you feel anxious, depressed, irritable, overwhelmed and downright sad. Instead, we can cultivate the esteemed skill of mindfulness—accessing a state of calm, present awareness through repetition and endurance.
Next, you’ll learn the importance of journaling, actually taking pen to paper and recording your thoughts, hopes, dreams and worries. Journaling can help you identify and correct self-limiting beliefs and behavior patterns. The specific practice of gratitude journaling, for example, has been scientifically validated to reduce stress levels, dissipate negative emotions, boost levels of the love hormone oxytocin, and activate calming parasympathetic nervous system function.
You’ll also read about learn to nurture meaningful, reciprocative interpersonal relationships—which might very well be the most powerful and important way to improve your longevity prospects in the entire book. Our genes are wired for connection, and the digital connections that are dominating modern life and coming at an extreme cost to our physical and psychological health. You’ll learn to cultivate a thriving social network, a smaller cluster of your closest family and friends, and place particular importance on the make or break health element of a loving partnership.
Pillar #4: Rest and Recovery
Optimizing your sleeping habits and environment will be the prominent focus here, but we must also consider a broad-based approach to chilling out amidst the hectic pace and constant stimulation of modern life. Strategies include disciplining your use of technology, taking frequent breaks from peak cognitive function to refresh depleted brain neurons, conducting recovery-centric workouts designed to promote relaxation and rejuvenation, and becoming competent at napping when cognitive function declines from afternoon blues. You’ll learn to pair mellow evening habits with a high energy morning routine (plenty of ideas included).
You’ll also turn your attention to proper recovery, both from fitness regimen and workplace overstimulation. You’ll learn about specially designed “Rebound Workouts” that can actually speed recovery in comparison to total rest by stimulating parasympathetic activity. And you’ll learn how to get better about focusing and prioritizing during the workday to avoid the dreaded cognitive middle gear, where you’re busy but ineffective. Finally, you’ll learn the importance of disconnecting on multiple levels to deliver profound hormonal and psychological benefits, stuff we have overlooked and disrespected with our warp speed technological progress.
21-Day Biological Clock Reset
After a comprehensive education and practical instruction about the 4 Pillars, it’s time for a transformative challenge: The 21-Day Biological Clock Reset. The reset features daily action items representing each of the Four Pillars. The journey, while short in duration, is designed to be highly focused and demanding. This is the only way to stimulate lasting lifestyle transformation and release you from the powerful pull of decades-old ingrained habits and powerful cultural forces pushing your out of a balance and stuck in carbohydrate dependency.
You’ll be exposed to a variety of strategies and concepts over the 21 days, and the idea is that you will pick and choose your favorites to integrate permanently into your lifestyle. You’ll be challenged to perform breakthrough workouts, increase daily activity, actually sit down and do stuff like a gratitude journal and create dark, mellow evenings instead of maximum screen time. It’s going to be fun, but it’s also going to be intensive, not to mention life-changing. Completing the Biological Clock Reset once a year is an excellent way to fine-tune your longevity muscles and clarify your focus amidst the constant distractions of modern life.
But the food… Folks always want to know about the recipes. The 80+ Keto For Life recipes are a collaborative effort among numerous authors, coaches, chefs and well-known keto experts, including Dr. Cate Shanahan, Keris Marsden and Matt Whitmore of The Paleo Primer series, William Shewfelt of the carnivore diet movement, Dr. Lindsay Taylor and Layla McGowan, my co-authors on the Keto Reset Instant Pot Cookbook, Tania Teschke, author of The Bordeaux Kitchen, and more.
You’ll find everything you need for beginning, recommitting or reinvigorating your keto eating enjoyment with this diverse selection of dishes, from gourmet to quick and easy, from breakfast to beverages, snacks to side dishes and everything in between.
Let me share one today that might appeal….
Sneak Peek Recipe: Keto Cheesecake
Prep Time: 40 minutes (plus refrigeration time)
Cook Time: 60 minutes
FOR THE FILLING
- 16 ounces (453.59 g) organic cream cheese, at room temperature
- 2 tablespoons pure vanilla extract
- 2 teaspoons fresh lemon juice
- 1 teaspoon sea salt
- 1 large egg
- ¼ cup powdered stevia or 1-2 tablespoons honey
FOR THE CRUST (OVEN METHOD ONLY)
- 1 cup (96 g) almond flour or 1 cup (128 g) coconut flour
- 4 tablespoons (60 g) butter, at room temperature
- 1–2 tablespoons powdered stevia
- 1 tablespoon pure vanilla extract
FOR THE CHOCOLATE CRUNCH TOPPING
- ¼ cup (34 g) macadamia nuts or assorted nuts
- 1 bar (3.5 ounces/100 g) dark chocolate (85% cacao or greater), broken into pieces
- 1 tablespoon coconut oil 2–3 tablespoons fine coconut flakes
Make the filling: In a large bowl, combine the cream cheese, vanilla, lemon juice, sea salt, eggs, and sweetener. Mix thoroughly with an electric mixer on low speed.
Choose between the Instant Pot Method and Oven Method and proceed as directed.
Instant Pot Method: Pour the filling into a round glass bowl or springform pan that can fit inside the Instant Pot. Cover the bowl carefully with foil. Pour 2 cups water into the Instant Pot. Place the cheesecake on the handled steam rack (or in a steamer basket accessory if you have one), and lower the cheesecake into the pot. Cook on High pressure for 25 minutes. When the Instant Pot beeps, allow the pressure to release naturally, about 15 minutes, then lift out the cheesecake.
Oven Method: Preheat the oven to 350°F (180°C).
Make the crust: In a bowl, combine the almond flour, butter, stevia, and vanilla until well blended. Press the mixture into the bottom of an 8-inch springform pan or round glass or ceramic baking dish.
Bake until the crust darkens slightly, about 10 minutes. Allow to cool for 10 minutes (leave the oven on). Pour the cheesecake filling mixture into the pan and smooth out the top with your hand (just kidding, use a spatula).
Bake until the middle is almost firm, but not quite, about 50 minutes. Allow to cool for 10 minutes.
While the cheesecake is cooling, make the chocolate crunch topping (use for either version): In a small food processor, blend the macadamia nuts until they resemble a crumbly flour. In a double boiler or a heatproof bowl set over a pan of simmering water, melt the chocolate and coconut oil. Mix the nuts and coconut flakes into the melted chocolate.
Drizzle the topping carefully across the top of the cooked and cooled cheesecake. Refrigerate the cheesecake until the crust feels hard, 30 minutes to 1 hour. Slice and serve.
Macronutrients Per Serving:
Instant Pot Method: 323 calories; 29 grams fat; 8 grams carbohydrate; 7 grams protein
Oven Method: 459 calories; 42 grams fat; 12 grams carbohydrate; 10 grams protein
I realize that there is an overwhelming amount of content hitting us today from books, magazine articles, blogs, podcasts, YouTube and streaming media, and it’s easy for a new book to get lost in the shuffle or buried on a “read later” list. That’s why I want to reiterate what a hugely expansive and life-changing this book Keto For Life represents. My longtime writing/publishing partner Brad Kearns and I joke that we always underestimate the difficulty and duration of a book project by half, and this was no exception. Keto For Life represents an intensive project that took an entire year to complete, with devoted efforts from a sizeable team of researchers, editors, agents, publicists and publisher. It’s designed to stand proudly for years to come as an owner’s manual for longevity. I hope it can help you claim your fullest and longest life.
Now For the Keto For Life Pre-Order Bonus Gifts…
This is always my favorite part. For those who order the book early, I have a few gifts for you (available right away even though the book itself comes out 12/31/19).
Bonus Audio Summary
Enjoy a detailed overview of every section of the book to get you excited and prepared to begin your Keto For Life journey. My co-author, Brad Kearns, describes the 4 Pillars in detail.
Sneak Peek Excerpt Booklet
Read some choice excerpts to give you a feel for the comprehensive nature of the book, where you obtain a deep education and scientific rationale for the 4 Pillars, as well as get practical, step-by-step guidance to implement, and (finally) enjoy a few of the delicious 80+ recipes from the book.
$10 Discount at Primal Kitchen®
Grab some of your favorite keto-friendly products to add variety and ease to your keto cooking ventures.
That’s what I got today, and I’m thrilled to offer it up to the community where it all began and where it’s still evolving. Folks, I hope you enjoy reading the book and putting it into practice as much as Brad and I enjoyed writing it. Thanks for being here.
Reprinted from KETO FOR LIFE by Mark Sisson with Brad Kearns. Copyright @ 2019 by Mark Sisson. Photos copyright @ 2019 Jennifer May. Published by Harmony Books, an imprint of Penguin Random House.
Powered by WPeMatico