In our previous menopause post, I mused on some perspectives of menopause that are positive and affirming for women. However, I don’t want to downplay the fact that many women experience menopause as a difficult, frustrating, and even disempowering time. (Again, I am using “menopause” to include the perimenopausal period.)
As I mentioned in the last post, some researchers estimate as many as 75% of women experience some type of “menopausal distress,” and we don’t talk about it enough. Today I want to examine some of the psychological and emotional facets of menopause. In the final post of this series, we’ll look at self-care techniques and non-hormonal therapies that seem to be the most beneficial.
What Research Suggests About Emotional Well-being During Menopause
Obviously menopause is a major life transition—significant biological changes wrapped up in a complex web of personal and sociocultural beliefs, fears, stressors, and stories. It can be a time of great apprehension, confusion, even despair for some women. Others pass right through menopause with hardly a bat of an eye. Still, others welcome and embrace it.
It’s extremely understandable why this would be a challenging time for women. Menopause can be a perfect storm of physical discomfort and cognitive symptoms (brain fog, forgetfulness), sleep deprivation (thanks to those night sweats and hot flashes), and emotional fluctuations. Besides how they feel, these symptoms can affect women’s personal relationships, ability to perform their jobs, and sense of self-worth and self-confidence.
For many women, menopause also coincides with the dual stressors of aging parents and raising teenagers or having a newly empty nest. Plus, menopause is an unmistakable marker of aging, which can evoke complicated feelings as well.
Overall, stress, depression, and anxiety seem to be fairly common during menopause. Recent Guidelines for the Evaluation and Treatment of Perimenopausal Depression commissioned by the Board of Trustees for The North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers describe perimenopause as a “window of vulnerability for the development of both depressive symptoms and a diagnosis of major depressive disorder.”
It’s difficult to know exactly how many women are affected. Studies of depression and anxiety are usually conducted on women whose symptoms are severe enough to seek help from their doctors. Researchers estimate that up to 40% of women will experience depression at some point during menopause; it’s unclear how prevalent anxiety might be.
It’s easy to assume that some women become depressed and anxious during menopause because their symptoms are so gnarly. To some degree, that narrative is probably true. Studies do find that women who experience more severe symptoms such as frequent hot flashes also exhibit more depression and anxiety. This makes sense—being physically uncomfortable and unable to get a good night’s sleep can certainly set the stage for poor psychological outcomes.
On the other hand, it’s likely that for some women, depression and anxiety exacerbate the physical and emotional symptoms. That is, depression and anxiety might be a lens that magnifies how bad menopausal symptoms feel, so these women report having more severe symptoms.
In any case, there’s more to it than “menopause is rough, and it makes women depressed and anxious.” One of the biggest risk factors for depression and anxiety during menopause is prior episodes of depression and anxiety. Women who are also experiencing other life stressors, including relationship stress and socioeconomic stress, are also more likely to become depressed.
In other words, women who are otherwise vulnerable are more likely to experience poor psychological well-being when hit with the additional stress of the menopausal transition.
Along these lines, one study compared depressed and non-depressed perimenopausal women on a variety of quality of life measures, including life enjoyment and satisfaction; ability to function in work, social situations, and relationships; and perceived social support. The researchers also assessed the severity of the women’s hot flashes. The depressed women scored lower than the non-depressed women on all quality of life measures. Severity of hot flashes had no effect for either group.
The authors concluded that future studies “need to distinguish between those women with [perimenstrual depression] and non-depressed women to avoid attribution of decreased [quality of life] to the menopause transition alone.” In other words, don’t blame the hot flashes for what the depression wrought.
This is an important point: We assume that menopause interferes with women’s well-being and quality of life because the symptoms stink (and they definitely do for a lot of women). However, the degree to which menopause actually impacts a woman’s quality of life might depend, at least in part, on whether she experiences concurrent depression or anxiety.
This is not to say that if you’re having a hard time dealing with your symptoms, you’re definitely also depressed. Rather, consider whether depression and anxiety are contributing so that you can address them directly.
Likewise, don’t assume that depression and anxiety will resolve on their own once the physical symptoms subside. Treating the physical symptoms is important, but for many women it might not be enough.
What We Need to Be Saying (To Each Other) About It
At the risk of stating the obvious, a lot of distress is surely rooted in the fact that women don’t feel like they can talk openly and honestly about their experience of menopause, perhaps especially the mental and emotional aspects.
In Becoming a Menopause Goddess, author Lynette Sheppard asserts that all of her friends experienced sadness, if not full-blown depression, during menopause. All of them. More than anything, she says, they needed to hear that it was normal, that there was nothing inherently wrong with them.
Instead, the stigma surrounding mental health struggles and the taboo nature of talking about menopause keep many women suffering in silence. Of course, it’s not like we talk freely about the physical symptoms, either. Sure, we can kvetch about hot flashes with our friends. How many women feel free to discuss brain fog and sleep deprivation with their bosses, even if they have very real consequences in the workplace?
I understand that “just talk about it” is neither easy nor sufficient—I’m not trying to be trite. It’s not like posting your hot flashes on social media will do anything to stop them. Nor can I promise that your boss will be super understanding if you march into his/her office and announce that you can’t finish your project on time because you simply can’t focus.
However, let’s think about what we can do to open up the channels of communication with our friends and partners at least to start. It’s no secret that social support can be an important factor in warding off depression during times of stress.
We Need A Multi-Pronged Approach
Besides talking about it, what else can women do to cope with physical, psychological, and emotional symptoms during menopause? Hormone therapy (HT) is the predominant approach that doctors prescribe (of course). I won’t cover the pros and cons, nor the safety questions, since Mark did so recently. Definitely check out that post if you are considering HT for yourself. Mark’s wife, Carrie, has also written about her experience with menopause symptoms in previous posts (1, 2).
I will point out that most symptoms aren’t clearly caused by the hormonal changes that characterize menopause. Vasomotor symptoms (hot flashes, night sweats) are the most strongly linked to hormonal changes, but other symptoms seem to be more related to psychosocial factors. Even vasomotor symptoms don’t map perfectly onto hormone fluctuations. Women with the biggest drops in estrogen won’t necessarily experience the most hot flushes, for example.
That doesn’t mean you shouldn’t try HT if you and your doctor decide it’s right for you. It clearly has benefits, including that it seems to help some women with depressive symptoms and anxiety. It’s not clear whether this is because it alleviates physical symptoms or because the depression and anxiety are directly caused, at least for some women, by hormone fluctuations.
However, it’s a mistake to assume that if we “fix” the hormones, or get rid of the hot flashes for example, the rest will fall into place.
Thinking about the quality of life study I mentioned above, it’s important not to get wrapped up in the story that hormones plummet, hot flashes and night sweats ensue, and then women become grouchy and depressed as a result.
In reality, the hormone stuff, the physical stuff, the emotional stuff, the sleep stuff, the relationship stuff, and more stuff all get thrown into the mix, each potentially feeding into and off of the others.
What we need is a multi-pronged approach. (I feel like there’s a pun here about protecting the flanks—I’ll keep working on that one.) Besides treating underlying hormone fluctuations with HT or herbal remedies, women and their doctors should also separately address specific physical and cognitive symptoms, general health, and psychological and emotional well-being.
The aforementioned Guidelines for the Evaluation and Treatment of Perimenopausal Depression, for example, offer this recommendation, “Proven therapeutic options for depression (antidepressants, cognitive behavioral therapy and other psychotherapies) should remain as front-line antidepressive treatments for major depressive episodes during perimenopause.” In other words, take care of the depression on its own.
For women who want to be holistic in their approach, and who perhaps want to avoid or minimize HT, there are a number of non-hormonal, complementary practices that have been shown to help. In the next post in this series, I’ll highlight some of the ones that show the most promise for relieving menopausal symptoms specifically, as well as for stress reduction, emotion regulation, and coping more generally.
Now I want to hear from you. Do you feel free to talk about your experience of menopause with the people in your life? Have you had positive or negative experiences when you have talked about it in the past?
Deeks AA. Psychological aspects of menopause management. Best Pract Res Clin Endocrinol Metab. 2003 Mar;17(1):17-31.
Schneider M, Brotherton P. Physiological, psychological and situational stresses in depression during the climacteric. Maturitas. 1979 Feb;1(3):153-8.
Zhou B, Sun X, Zhang M, Deng Y, Hu J. The symptomatology of climacteric syndrome: whether associated with the physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety-depression disorder. Arch Gynecol Obstet. 2012;285(5):1345–1352.
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For my entire athletic career, I considered the gold standard of recovery to be sleeping, resting on the couch watching T.V., and generally being still and inactive. Come on, what could be more effective than couch potato mode to recover from the hormonal and inflammatory stresses of marathon training runs or long days of extreme swim-bike-run workouts? I’m kidding (mostly), but it’s not a total exaggeration. Our understanding of fitness recovery has grown exponentially since I was in the elite arena, and it’s exciting to see new and better approaches taking root that genuinely speed recovery and stave off burnout. I’m sharing two such techniques today. They’re simple, mostly free, and accessible to anyone with the most basic fitness opportunities and venues.
Note: Here’s the thing…. This is the stuff you should focus on before considering advanced techniques like exposure to cold or heat, Theragun treatments (although I happen to be a fan of this device), hyperbaric oxygen chambers, etc.
The first recovery technique is to move more instead of just sit around. That’s right, science is validating the idea that if you make a concerted effort to increase all forms of general everyday movement in the hours and days after strenuous workouts, you will help minimize the inflammation and oxidative stress caused by strenuous workouts.
Let’s call this strategy JFW—Just F—ing Walk.
Moving your body through space helps you burn fat better, which will maximize the fat reduction goals of your workouts. Walking also helps boost brain function. A 2017 UCLA study comparing MRI scans revealed that active older folks (over 60 and walking more than three kilometers per day) have faster brain processing speed, better working memory for quick decisions, and better memory consolidation than inactive folks. In his book, The Real Happy Pill: Power Up Your Brain By Moving Your Body, Swedish researcher Dr. Anders Hansen reports that just taking a daily walk can reduce your risk of dementia by 40 percent.
Walking and general movement of any kind improve lymphatic function for a huge recovery boost. The lymphatic system is a plumbing network running throughout your body that detoxifies every cell, tissue and organ through a separate operating system from the cardiovascular system. The lymphatic system operates through a pumping process instead of a beating heart. This means that you’re obligated to move your muscles and joints to turbocharge lymphatic detoxification and avoid the pooling of lymphatic fluid caused by chilling on the couch in the hours and days after heavy workouts. Even the old-time exercise apparatus of the mini-trampoline has come into vogue recently because bouncing around for even a few minutes has been shown to significantly boost lymphatic function.
To help your lymphatic system function optimally, be sure to hydrate adequately at all times. While my original Primal Blueprint presentation suggested that you simply honor your thirst to achieve good hydration, recent science suggests that successful hydration can be a little more complicated. Stacy Sims, Ph.D., a hydration expert who studied thermoregulation at Stanford and is currently a senior research fellow at University of Waikato in New Zealand, is doing some great work in this field. Check out this fantastic infographic. Her research suggests that the female menstrual cycle can influence hydration needs and strategies. Another breakthrough insight is that strenuous workouts have the potential to mute your thirst mechanism; you may become too hot and tired or distracted to notice that you’re actually getting dehydrated. For most minimally active folks, going by thirst might be just fine; the kidneys do an excellent job regulating fluid and sodium balance in the body.
If you are a novice fitness enthusiast, a high performing athlete, or routinely exercise in hot temperatures, a deliberate pre- and post-workout hydration is a strategy worth considering and implementing. Sprinkle some high quality natural mineral salt in each glass of fluid, which will help it become better absorbed in the tissues throughout your body.
Joel Jamieson, a noted trainer of world-champion MMA fighters in Washington (8WeeksOut.com—as in eight weeks out from a title bout), and developer of the Morpheus Recovery app, advocates a system called Rebound Training where specially designed workouts can actually speed recovery time in comparison with total rest. The idea that a Rebound Workout can boost recovery is validated through the tracking of Heart Rate Variability. Joel is a pioneer in Heart Rate Variability and has been tracking his fighters and other high performing athletes for decades. Yes, decades, as in dating back to the original hospital grade $30,000 units that required placement of a dozen electrodes on your skin.
The idea that a Rebound workout can beat couch time is an extraordinary revelation. Amazingly, when you drag your tired, stiff, sore body into the gym and do some foam rolling, deep breathing exercises, dynamic stretches, and even very brief explosive efforts, such as short sprints with long recovery on the bike, or “positive-only” deadlifts (lift the weight then drop it to the ground to prevent soreness caused by eccentric contractions), you can stimulate parasympathetic nervous system activity and actually accelerate recovery. The parasympathetic is known the “rest and digest” component of autonomic nervous system, and counterbalances the sympathetic “fight or flight” component.
You can learn more about Rebound Training and see a sample workout here. If you just want to dabble in the concept, know that increasing your walking and general movement in the hours and days after a challenging training session will help boost blood circulation and lymphatic function to speed recovery. I always find ways to walk more and spend more time at my stand-up desk in the 24 hours following a tough Ultimate Frisbee match or sprint workout.
Sample Restorative Workout
The next time you throw down a killer workout, trying heading to the gym the following day and creating a restorative experience.
Start by lying flat on the mat and completing 20 deep diaphragmatic breath cycles. When you’re in the prone position, you can hone good technique by placing your hand on your abdomen and making sure that the abdomen expands upon inhalation. First expand the abdomen, which enables the chest cavity to then expand outward and enable the full use of the diaphragm for a powerful breath. You notice this sequence better when laying down.
After 20 deep breaths, commence 10 minutes of foam rolling, dynamic stretches and flexibility drills.
Then, get a little sympathetic stimulation going with some bike sprints or positive only deadlifts as follows:
- Exercise bike: Warmup five minutes, then sprint for 10 seconds, followed by 60 seconds of easy pedaling. Repeat for five repetitions.
- Deadlift: With 70% of your one rep maximum weight, raise the bar three-quarters of the way to the top, then allow it to fall to the ground with minimal muscle engagement. Repeat five times.
The idea with these efforts is that you’ll trigger a brief stimulation of fight or flight sympathetic nervous system activity, but because the effort is so brief, you’ll prompt a compensatory parasympathetic reaction during the recovery period. The net effect of the session is to turbocharge parasympathetic for hours afterward to a greater extent than just chilling on the couch watching Netflix.
Thanks to the gentle nature of the session, you enjoy an increase in energy and alertness from getting the oxygen and blood flowing throughout the body—but without the cellular breakdown and glycogen depletion of a more strenuous workout. You should leave the gym feeling relaxed and a little looser than before the workout.
Implementing “Rebound”-style workouts, along with making a general effort to walk around more in the hours following your most challenging sessions aren’t just fun diversions; they’re part of putting recovery as the central element of your training program.
Speaking of HRV, Jamieson offers a breakthrough insight that has helped me further appreciate the value of tracking HRV over time, and also alleviate some confusion that arose during some data accumulation over the past several years. If you’re a fan of HRV, you know a high HRV on the familiar 1-100 scale is indicative of a strong and rested cardiovascular system. You have a greater variation in beat-to-beat intervals than a lower score, indicating a harmonious balance between fight or flight sympathetic nervous system function and rest and digest parasympathetic nervous system function. A low HRV indicates a more metronomic heartbeat, and sympathetic nervous system dominance over parasympathetic. These are reliable signs of overtraining or a general overstress condition in life, or a weak cardiovascular system in general.
By tracking HRV for several weeks, you can establish a healthy baseline, then gauge your level of stress and readiness to train based on daily HRV fluctuations. Low equals overstressed, high equals healthy. That’s all well and good, but here’s an important nuance I learned from Joel about HRV readings significantly higher than your baseline: An 86 seems better than the usual 72-75, but actually an abnormally high HRV could be an indication of parasympathetic dominance versus a sympathetic-parasympathetic balance. When your parasympathetic kicks into overdrive, it’s possibly because you trashed yourself way beyond healthy limits, and you’re struggling to return to a rested and stress-balanced state. This explained some strange outlier readings where I felt pretty cooked after coming off a jet travel binge or a series of extreme workouts in a tight time frame but delivered a rock star HRV reading.
As I’ve written about before, I’m not a fan of overdoing biofeedback devices. I’ve used them and still do occasionally when I’m attempting something new or just want to check in with some hard data, but too much tech can disconnect you with your intuition—what should always be front and center in your assessments. Dr. Kelly Starrett references scientific research indicating that the single most valuable and accurate metric for your state of recovery is “desire to train.” I wonder how this goes up against the blood lactate meters at the U.S. Olympic Training Center and any ring or watch data you can accumulate. I have confidence it would hold its own in most scenarios.
Thanks for stopping by today, everybody. How do you do recovery? What have you learned over the years in your own study and experience. Have a great end to the week.
The post Recovery Workouts: Two Simple But Powerful Ways to Speed Fitness Recovery appeared first on Mark’s Daily Apple.
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Last week, I linked to a story about a popular vegan blogger, author, and influencer who found herself going into menopause at the age of 37 despite doing “everything right.” She exercised, she ate raw, she avoided gluten and refined sugar, and, most importantly, she avoided all animal products. Now, this wasn’t a randomized controlled trial. This wasn’t even a case study. But it was a powerful anecdote from someone whose livelihood depended on her remaining a raw vegan. It wasn’t in her interest to make it up.
So, it got me wondering: How do diet and lifestyle influence the timing of menopause?
Now, before I begin, let’s just state the obvious: Menopause isn’t a problem to be avoided. It’s not something to be feared or maligned. It’s not “the end.” I wrote an entire series on menopause last year, and there will always be more to come on the subject because it’s an important time of life with its own questions and possibilities. While it’s a natural, evolutionarily-preserved part of being a woman, it also follows a natural cadence. Menopause at the right time in accordance with your genetics is normal, expected, and healthy. Menopause that occurs earlier than your genetics would direct suggests something is amiss. Sure enough, early or premature menopause—defined in most places as menopause before the age of 40—has a number of troubling links to poor health outcomes.
Early menopause is linked to:
- A shorter life and an increase in the risk of type 2 diabetes.
- Reduced physical function in later years.
- Lower cognitive function.
- Increased heart disease.
Not to mention that all the other things normally associated with menopause, like osteoporosis and changes in mood, also have the potential to occur, only earlier.
Okay, so early menopause can have some health consequences. Is veganism actually linked?
What Research Says About Diet and Menopause Timing
There was one study that found people who’d never been a vegetarian developed menopause at a later age, which is a roundabout way of saying that vegetarianism may increase the risk of early menopause.
Other lifestyle factors linked to later menopause included regular strenuous exercise, never smoking, midlife weight gain, and drinking alcohol. Strange mix of behaviors, both classically healthy and unhealthy.
But then another study in Han Chinese women found the opposite—that vegetarianism was associated with a lower risk of premature menopause.
Those are the only direct (if you can call it that) lines of evidence, and they conflict. No solid answers there. That said, there’s more indirect stuff pointing toward a link between exclusion of animal foods and earlier menopause:
- A high intake of vitamin D and calcium from dietary sources has been linked to a lower risk of premature menopause. Oddly enough, supplemental vitamin D and calcium were not linked to lower risks, suggesting that it’s the food—dairy primarily, but also bone-in small fatty fish like sardines—and not the nutrients alone. So a vegan might not be in the clear simply by supplementing with D and calcium.
- The amount of protein and carbs a woman eats throughout her life seems to predict the age at which menopause occurs. More protein, later menopause. More carbs, earlier menopause. Protein is harder and carbs are easier to come by on a plant-based diet—that’s for sure.
- Another fairly consistent finding is that polyunsaturated fat intake “accelerates” menopause. Women who eat the most PUFA tend to have menopause earlier. High PUFA intakes are pretty unavoidable when your diet is awash in seeds, nuts, and other plant-based fat sources.
Then there was a different connection in another study.
The Nurses Health Study found that women who ate the most plant protein were more likely to avoid premature menopause; animal protein intake had no effect. They even found beneficial links between specific foods and protection against early menopause, including dark bread, cold cereal, and pasta. Those are about as unPrimal as you can get.
How Can We Make Sense of Conflicting Research?
In addition to smoking (which we all know is trouble for almost all markers of health), one thing that keeps appearing in all these observational studies—and they’re all observational studies, unable to prove causation—is that underweight BMIs predict early menopause. In the Nurses Health Study, for example, BMIs under 18.5 were linked to a 30% greater risk of early menopause and BMIs between 25 and 29 were linked to a 30% lower risk. If that’s true, and if that’s actually a causal factor, then the most important thing a woman who wants to avoid early menopause can do is avoid being underweight. In that case, filling up on foods known to cause weight gain in susceptible people like bread, pasta, and cereal would be protective (at least for early menopause).
And that could really explain why the vegan blogger developed premature menopause. In her own words, she “had run out of fuel.”
A big downfall of many plant-based diets is that they starve you. They starve you of vital micronutrients you can really only get in animal foods, like B12, zinc, creatine, cholesterol, and others. They starve you of vital macronutrients, like protein and animal fat. And they starve you of calories. It’s hard to maintain your weight and physical robustness eating a diet of leaves, twigs, and seeds (unless you’re a gorilla). Oddly enough, I think vegans who eat grains and vegan “junk food” like fake burgers and weird nut cheeses are probably better off than the gluten-free ones who live off salads, simply because they’re getting more calories. It’s true that there are many ways to eat vegetarian and even vegan—and some are healthier than others (I’ve written about Primal recommendations for vegetarians and vegans in the past), but the more restrictive a person is with animal products, the trickier it will be to stay well-nourished.
If I had to make a bet, it’d be that any diet that provides sufficient nourishment in the form of micronutrients, macronutrients, and total calories will help stave off early menopause.
What about you? What’s your take on this? Has anyone out there experienced premature/early menopause that didn’t follow natural, familial patterns? What can you recall about the diet and lifestyle leading up to it?
Wang H, Chen H, Qin Y, et al. Risks associated with premature ovarian failure in Han Chinese women. Reprod Biomed Online. 2015;30(4):401-7.
Velez MP, Alvarado BE, Rosendaal N, et al. Age at natural menopause and physical functioning in postmenopausal women: the Canadian Longitudinal Study on Aging. Menopause. 2019;
Sujarwoto S, Tampubolon G. Premature natural menopause and cognitive function among older women in Indonesia. J Women Aging. 2019;:1-15.
Løkkegaard E, Jovanovic Z, Heitmann BL, Keiding N, Ottesen B, Pedersen AT. The association between early menopause and risk of ischaemic heart disease: influence of Hormone Therapy. Maturitas. 2006;53(2):226-33.
Purdue-smithe AC, Whitcomb BW, Szegda KL, et al. Vitamin D and calcium intake and risk of early menopause. Am J Clin Nutr. 2017;105(6):1493-1501.
Sapre S, Thakur R. Lifestyle and dietary factors determine age at natural menopause. J Midlife Health. 2014;5(1):3-5.
Boutot ME, Purdue-smithe A, Whitcomb BW, et al. Dietary Protein Intake and Early Menopause in the Nurses’ Health Study II. Am J Epidemiol. 2018;187(2):270-277.
Szegda KL, Whitcomb BW, Purdue-smithe AC, et al. Adult adiposity and risk of early menopause. Hum Reprod. 2017;32(12):2522-2531.
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When you stop to think about it, mushrooms are remarkable.
They’re closer to animals than plants on the tree of life.
They can break down plastic and petroleum.
The single largest organism on the planet is an underground honey fungus spanning almost 3 miles in the the state of Oregon.
They carry messages along their underground fungal networks using neurotransmitters that are very similar to the ones our brains use.
They’re a kind of “forest internet” which plants and trees use to communicate with each other.
And, as it turns out, they possess and confer some very impressive health and therapeutic effects. Several years ago, I highlighted the culinary varieties and explored their considerable health benefits. Go read that, then come back here because I’m going to talk about the different types of adaptogenic mushrooms today. These are the real heavy hitters, the ones that appear to supercharge immune systems, stimulate neuronal growth, improve memory and focus, pacify the anxious mind, increase the libido, and enhance sleep quality.
Let’s go through the most important adaptogenic mushrooms and the evidence for each. I’ll primarily stick to human studies, but may relay some animal studies if they seem relevant.
Reishi has been used in traditional Asian medicine for hundreds of years to treat diseases of the immune system. (Reishi is its Japanese name; in China, it’s called lingzhi and in Korea, it’s yeongji.) Other folk uses include all the regular stuff you expect—aches, pains, allergies, “qi”—but the majority of modern clinical evidence focuses on immunity, cancer, and inflammation.
But the interesting thing to remember is that inflammation figures into pretty much every modern ailment. Even conditions like depression and anxiety are often characterized by a surplus of systemic inflammation. If reishi can soothe the inflammation, it could very well help with all the other seemingly unrelated conditions, too.
- Reduced anxiety, depression, and fatigue and improved quality of life in breast cancer patients.
- Reduced insulin resistance.
- Reduced inflammatory markers and restored kidney function in kidney disease patients.
- Suppressed the growth of more adenomas (benign tumors with the potential to become malignant) in patients with existing colorectal adenomas.
- Boosted the immune systems of late-stage cancer patients.
Reishi is also said to be very good for sleep, though I wasn’t able to find a supporting human study.
Exercise caution if you have an autoimmune disease, as using reishi to”activate” the immune system that’s attacking you may—theoretically—increase the attack’s severity.
Reishi may also lower libido in high doses, as it inhibits the conversion of testosterone to dihydrotestosterone—albeit in rats. More rat research suggests that low doses of reishi could increase libido.
No human studies indicate this, but a rodent study found that giving reishi reduced time to exhaustion in a forced weighted swimming challenge (throw a rat in the water with a weight attached). They got tired faster.
Cordyceps is another mushroom used in traditional Chinese medicine to promote vitality and energy. For the men, that’s code for “better erections.” What does the evidence say?
It is broadly anti-inflammatory.
It’s an effective immuno-adaptogen: it boosts immunity when immune function is too low and dampens it when it’s over-activated. Autoimmune thyroiditis patients who took cordyceps saw dual-direction immunomodulation—too low got higher, too high got lower.
As for the “energy and vitality” claims, that appears to be true in mammals. We have evidence that rats, pigs, mice, and even yaks, goats, and sheep get boosts to testosterone status and sexual function when taking cordyceps, and that it improves brain function and cognition in small mammals, but nothing solid in humans. Still, the fact that it helps other mammals probably indicates utility for us.
Chaga is a mushroom with a long history of use in Northern Eurasia (Russia, Siberia) as well as a considerable body of animal evidence and isolated human cell evidence in support, but no real studies using actual live humans. That’s unfortunate, because chaga appears to be the real deal:
- Immunomodulation (mice).
- Increased endurance and improved lactate threshold during exercise (mice).
- Reduced cancer progression and spread (mice).
- Reduced DNA damage (human cells).
I hope we get some strong human studies in the near future. In the meantime, you can always run your own!
Lion’s Mane is a mushroom that looks like a pom-pom. Or a brain, which is fitting. Lion’s Mane’s main claim to fame is its purported ability to increase neurogenesis, reduce cognitive decline, and even regrow damaged nerves.
Studies in fact show that Lion’s Mane can:
- Reverse mild cognitive decline in the elderly (for as long as they continue to take the mushroom).
- Help nerve-damaged rats regenerate destroyed nerves and regain their ability to walk.
- Improve the Functional Index Measure in patients with dementia.
- Reduce anxiety and depression in women.
The majority of Lion’s Mane customers aren’t interested in reducing decline. They want a boost. They want increased focus, improved cognition, more and better neurons. Judging from the reversal of cognitive decline in the elderly and the flood of online anecdotes about improved focus and cognition, I suspect that there’s something there.
That said, another common side effect I’ve heard about from many of the same people lauding its cognitive effects is reduced libido. So keep an eye out for that one.
You know how I do things here. I can’t in good faith make definitive claims based on mouse studies that show this or that mushroom improving memory, blasting tumor cells, and increasing sexual virility. Still, I also can’t discount the hundreds (and in some cases, thousands) of years of traditional use of these mushrooms for many of the conditions, nor can I ignore (or write off as “placebo”) the thousands of experimenters out there online deriving major benefits from some of these mushrooms.
The only option, of course, is to try it for yourself, which I may do in the near future (and will write about my findings).
How to Choose a Mushroom Supplement
When you’re buying an adaptogenic mushroom extract, look for products that come from fruiting bodies (actual mushrooms) rather than mycelium (the “roots” of the mushrooms). Fruiting bodies tend to have more of the active constituents than mycelium. Fruiting body extracts will also be more expensive—mushrooms take longer to grow than mycelium—but the added potency makes up for it.
Look for products that list the beta-glucan content, not the polysaccharide content. Beta-glucans are the uniquely active constituents. All beta-glucans are polysaccharides, but not all polysaccharides are beta-glucans.
In the meantime, I’d love to hear your experiences with adaptogenic mushrooms. Have you tried them? How have they been useful for you (or not)? Thanks for stopping in, everybody.
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Futrakul N, Panichakul T, Butthep P, et al. Ganoderma lucidum suppresses endothelial cell cytotoxicity and proteinuria in persistent proteinuric focal segmental glomerulosclerosis (FSGS) nephrosis. Clin Hemorheol Microcirc. 2004;31(4):267-72.
Smiderle FR, Baggio CH, Borato DG, et al. Anti-inflammatory properties of the medicinal mushroom Cordyceps militaris might be related to its linear (1?3)-?-D-glucan. PLoS ONE. 2014;9(10):e110266.
Lin WH, Tsai MT, Chen YS, et al. Improvement of sperm production in subfertile boars by Cordyceps militaris supplement. Am J Chin Med. 2007;35(4):631-41.
Parcell AC, Smith JM, Schulthies SS, Myrer JW, Fellingham G. Cordyceps Sinensis (CordyMax Cs-4) supplementation does not improve endurance exercise performance. Int J Sport Nutr Exerc Metab. 2004;14(2):236-42.
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Anxiety is normal. It’s something we all have experience with—to one degree or another. Most people are anxious about something that hangs over them and follows them around like a personal rain cloud. Then there’s the deeper but still familiar anxiety many of us carry. The anxiety about our self-worth. The anxiety of performance, of social situations. This type can grip us in an uncomfortable, but hopefully not chronic, way.
But not all anxiety is run-of-the-mill—or manageable. People with Generalized Anxiety Disorder, for instance, might have trouble leaving the house, ordering a coffee from Starbucks, going to work. Anxious thoughts cycling through their brains often keep them up at night. When untreated, people with this level of anxiety can end up living in a state of perpetual fear.
The conventional approach is to take anti-anxiety meds, which can be genuinely life-saving for some people. Nonetheless, these can come with downsides that vary depending on an individual’s dosage and reactions—and the nature of the particular medication itself. Some meds result in few side effects, but others’ effects can be heavy. For instance, there are the benzodiazepines, highly-addictive tranquilizers with the potential for abuse. They make driving unsafe. They lower productivity. They sedate you. When necessary for the severity of the condition, these side effects may be worth it.
In other cases, a person might have more space to experiment and want to explore a different route.
In some cases, people choose to try natural anxiety aids. These are supplements, nutrients, and herbs that have been designed across millennia by nature (and maybe some input from green-thumbed healers). They might not always be enough for something as serious as a clinical anxiety disorder (please talk to your doctor before making any adjustment or addition to your medication), but at least some may be important complements to a prescribed regimen.
For those who want or need an alternative strategy for anxiety beyond meditative practices and general good health, these natural remedies may be worth a try.
First, the NUTRIENTS….
These are basic vitamins, minerals, and amino acids that your body needs to work. They are non-negotiable. You don’t have to get them through supplements—in fact, that should be a last resort after food—and I wouldn’t expect “drug-level” effects, but you do need to get them.
1. Long Chained Omega-3 Fatty Acids
Some human evolution experts maintain that the human brain wouldn’t be the human brain without steady and early access to coastal food resources—fish and shellfish rich in long chain omega-3s. If the long-chained omega-3s found in fatty fish and other sea creatures made our brains what they are today, it’s safe to assume that our brains work better when we eat them today. And if we’re talking about anxiety, that appears to be the case:
Studies in substance abusers find that supplementing with enough fish oil (and, yes, here’s what I use regularly) to raise serum levels of the long chain omega-3 fatty acid EPA reduces anxiety, while increases in DHA (the other long chain omega-3) reduce anger. Rising EPA levels after supplementation predicted the reduction in anxiety.
In healthy young medical students, omega-3 supplementation (2 grams EPA, 350 mg DHA) lowered inflammation and anxiety. Follow-up analyses revealed that reducing the serum omega-6:omega-3 ratio also reduced anxiety scores.
And in early pregnancy, high DHA levels predict low anxiety scores.
Magnesium deficiency is a risk factor for anxiety. The evidence, considered by some to be low quality, nonetheless suggests that supplementing with magnesium can reduce subjective anxiety. The mechanistic evidence is stronger, as magnesium is one of those minerals that plays a role in hundreds of very basic and essential physiological processes—including the generation of ATP, the body’s energy currency. Without adequate energy production, nothing works well. One’s mental health is no exception.
Magnesium supplementation reduces subjective anxiety (the only kind that matters) in the “mildly anxious” and in women with premenstrual syndrome.
Magnesium L-threonate, a form particularly good at getting into the brain, is worth trying for more immediate, noticeable effects.
Zinc deficiency is common in people with anxiety, including Chinese males and Americans. And although mainlining oyster smoothies probably won’t fix serious anxiety, a follow-up in the group of Americans with low zinc levels found that zinc supplementation did reduce anxiety levels.
4. Vitamin B6
Vitamin B6, or pyridoxine, helps regulate production of serotonin and GABA—two neurotransmitters that control depression and anxiety. In mice exposed to anxiety-producing situations, pyridoxine increases GABA, reduces glutamate, and reduces anxiety. In humans, correcting a magnesium deficiency with magnesium and vitamin B6 has a stronger effect on anxiety than magnesium alone. (Good to note: women on hormonal birth control may be depleted of vitamin B6 as well as other vitamins and minerals.)
The best sources of vitamin B6 are turkey, beef, liver, pistachios, and tuna.
Now, the NATURAL INTERVENTIONS….
These aren’t essential nutrients. Rather, they’re plant compounds with pharmacological effects and, in most cases, hundreds of years of traditional usage for dampening, inhibiting, or resolving anxiety.
Kanna comes from a succulent plant native to South Africa. The story goes that an anthropologist noticed elderly San Bushmen nibbling on a particular type of succulent plant while displaying incredible cognitive ability and remaining calm, cool, and collected. The fact that they weren’t dealing with daily commutes, traffic jams, annoying bosses, and mounting bills probably had something to do with it, but it turns out that the succulent plant wasn’t hurting the cause.
Kanna has been shown to dampen the subcortical threat response, which is normally heightened in anxious states. It also increased well-being and resistance to stress in health adults who took it in a safety study.
Theanine, an amino acid found in green tea and available as a supplement, isn’t going to obliterate your nerves before a big performance. One study showed that it (along with the benzodiazepine Xanax) reduced resting state anxiety but not experimentally-induced anxiety. Then again, neither did Xanax.
Theanine is instead a mild anxiolytic. If you get anxiety from caffeine, take 200 mg of theanine with your coffee. It will smooth out the experience, reduce/remove the anxiety, and leave the stimulation.
Kava is a plant native to the South Pacific. Traditionally, its roots were chewed fresh with the resultant liquid often spit into communal bowls for consumption, pounded to release the moisture, or sun-dried, ground, and steeped in water to make an intoxicating, relaxing mild sedative. Nowadays, the active kavalactones are also extracted and pressed into capsules.
I don’t use kava, but I have tried it a couple times in the past. For what it’s worth, I don’t have anxiety issues but it did seem to pair well with caffeine (similar to theanine).
8. Rhodiola Rosea
Rhodiola rosea is a longtime favorite adaptogen of mine. It hails from the barren wastes of Siberia, where for millennia people from all over the ancient world coveted it. There’s something about the harsh environment of the northern tundra that made rhodiola rosea incredibly resilient—and bestows upon those who consume it a similar type of mental resilience.
A 2015 study sought to determine the impact of rhodiola on self-reported anxiety, stress, cognition, and a host of other mental parameters. Eighty subjects were divided into either a twice-daily commercial formula (containing 200 mg rhodiola) group or a control group. Compared to the controls, the rhodiola group showed notable improvements in mood and significant reductions in anxiety, stress, anger, confusion and depression after 14 days.
There’s a great lavender farm on the island of Maui. One of the favorite memories from that trip is strolling through the fields of lavender, brushing against the leaves and flowers, just basking in the relaxing scent that permeated the entire property. A very low-stress environment, to be sure.
One study gave lavender oil capsules to major depressive disorder patients suffering from anxiety who were already taking antidepressants. Not only did adding the lavender reduce anxiety, it also improved sleep.
Perhaps the most impressive study is this one, where generalized anxiety disorder patients either received lavender oil or a benzodiazepine anti-anxiety drug. Patients receiving the lavender had the same beneficial effects as the benzo patients without the sedation.
Lavender oil aromatherapy also seems to reduce anxiety, at least in cancer patients. One weakness of aromatherapy research is the difficulty of giving a “placebo smell.” Essential oil scents are quite distinct.
10. CBD Oil
As I wrote a couple weeks ago, CBD is the non-psychoactive cannabinoid found in cannabis.
Most recently, a large case series (big bunch of case studies done at once) was performed giving CBD to anxiety patients who had trouble sleeping. Almost 80% had improvements in anxiety and 66% had improvements in sleep (although the sleep improvements fluctuated over time).
In a five-year-old girl with PTSD (a category of patient that just shouldn’t exist) in whom pharmaceutical anxiety medications did not work, CBD oil provided lasting relief from anxiety.
What do you folks like for anxiety? What’s worked? What hasn’t? What did I miss?
Thanks for reading, everyone. Take care.
Cunnane SC, Crawford MA. Energetic and nutritional constraints on infant brain development: implications for brain expansion during human evolution. J Hum Evol. 2014;77:88-98.
Boyle NB, Lawton CL, Dye L. The effects of magnesium supplementation on subjective anxiety. Magnes Res. 2016;29(3):120-125.
Mccarty MF. High-dose pyridoxine as an ‘anti-stress’ strategy. Med Hypotheses. 2000;54(5):803-7.
Walia V, Garg C, Garg M. Anxiolytic-like effect of pyridoxine in mice by elevated plus maze and light and dark box: Evidence for the involvement of GABAergic and NO-sGC-cGMP pathway. Pharmacol Biochem Behav. 2018;173:96-106.
De souza MC, Walker AF, Robinson PA, Bolland K. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med. 2000;9(2):131-9.
Lu K, Gray MA, Oliver C, et al. The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum Psychopharmacol. 2004;19(7):457-65.
Terburg D, Syal S, Rosenberger LA, et al. Acute effects of Sceletium tortuosum (Zembrin), a dual 5-HT reuptake and PDE4 inhibitor, in the human amygdala and its connection to the hypothalamus. Neuropsychopharmacology. 2013;38(13):2708-16.
Nell H, Siebert M, Chellan P, Gericke N. A randomized, double-blind, parallel-group, placebo-controlled trial of Extract Sceletium tortuosum (Zembrin) in healthy adults. J Altern Complement Med. 2013;19(11):898-904.
Fißler M, Quante A. A case series on the use of lavendula oil capsules in patients suffering from major depressive disorder and symptoms of psychomotor agitation, insomnia and anxiety. Complement Ther Med. 2014;22(1):63-9.
Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94-9.
Shannon S, Opila-lehman J. Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report. Perm J. 2016;20(4):16-005.
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Folks, you know I’m a long-time believer in intermittent fasting for longevity, autophagy, mental clarity, fitness performance, metabolic health, and more. I’m excited that Dr. Jason Fung has stopped by the blog today to share a bit about common fasting mistakes. Enjoy!
So, you’ve decided to add some fasting to your lifestyle. Excellent. No matter how much you have (or haven’t) read on the topic, you’re likely to find aspects of fasting to be challenging or even frustrating. It can be hard to stay on track when you’re feeling hungry, irritable and not really noticing any changes.
It’ll become tremendously easier once you begin to experience the health benefits of fasting, but we all know it takes a little while for that to happen. Benefits like mental clarity and improved energy will show up sooner than significant weight loss. Plus, the benefits you experience will depend on what kind of fast you’re doing and how well you stick to it.
But if you’re making fasting mistakes, you might never accomplish the benefits you were hoping for. . Before you throw in the towel, I want to help you identify some possible fasting pitfalls you might not be aware of and also help you avoid them. Plus, don’t miss the Number One reason fasts fail, shared at the end of this article.
1. You’re Snacking or “Grazing”
Look, the entire purpose of a fast is to contain your eating within certain windows of time. Snacking or “grazing” all day long is basically the opposite of fasting, so stop thinking that you can get away with it. Fasting is “on” or “off”—there is no gray area. Even having “just a bite,” no matter how healthy or how little, will almost invariably kick your body out of fasting mode and will interfere with the healing process responsible for fasting’s many benefits. It also creates a situation where your body is producing insulin all day long. Bad idea.
Avoid grazing by putting snacks and food out of sight. The phrase “out of sight, out of mind” really applies here. You’ll be amazed how much easier it is to bypass snacking when the food isn’t sitting right in front of you. If you snack out of habit, get creative and find new, non-food based habits. If your snacking comes from genuine hunger, you may need to re-evaluate the meals you eat during your eating window. Make sure you’re getting enough healthy, unsaturated fats with each meal as these will keep you satiated for longer.
2. You Aren’t Drinking Enough Water
This is not only a common fasting mistake, but a mistake most people make no matter what their diet is. Drinking a minimum of eight glasses of water daily is essential to staying hydrated and healthy. Some signs that you aren’t drinking enough water include dizziness and lightheadedness, feeling tired, or constipation.
Even worse, when you don’t drink enough water, your brain may try to trick you into thinking that you’re hungry, so you get the vitamins and minerals you’re lacking. Minerals like potassium and magnesium are essential to your brain health. So don’t be surprised next time you feel hungry but find that drinking a glass of water makes the appetite disappear. Various kinds of tea are also a satisfying way to hydrate, or try some bone broth if you’re truly struggling.
3. You Aren’t Consuming Enough Salts
Speaking of vitamins and minerals, appropriate salt intake is vital to your health. Now, when I say “salt,” I’m not talking about the kind you put in a shaker. I’m talking about electrolytes, which are essential to your diet. Sodium (Na), which is also commonly known as table salt, is one of these electrolytes, along with potassium (K), magnesium (Mg), calcium (Ca), and chloride (Cl).
How can you tell if you’re low on electrolytes? Some symptoms of electrolyte deficiency are anxiety, irritability, trouble sleeping, muscle spasms, fatigue, digestive issues, and dizziness. If these are the kinds of symptoms you experience during your fast, lack of electrolytes could be the answer. Try taking some pink Himalayan rock salt and placing it under your tongue to dissolve. You can also try drinking some pickle juice — just make sure it’s from high-quality natural pickles and not the kind made with sugar.
4. You’re Eating Right Before You Go To Sleep
Your body needs time to digest all the food from your last meal before you go to sleep. If you’ve scheduled your eating window to happen right before bedtime, your body will be taking all the time you’ve allotted to rest to digest instead. That takes energy, and instead of waking up feeling restored and ready to take on the day, you’ll just feel tired.
When you’re following a fasting plan, a seven-hour window is an ideal amount of time to leave between your last meal and when you go to sleep. Even three or four hours is enough to make a difference. Unfortunately, with crazy work schedules and early mornings, a lot of people aren’t able to stick to that three- or four-hour window. It’s more like get home, eat dinner, and go straight to bed. If this is you, the next best thing is to eat a light meal, like salad, and avoid a meal filled with carbohydrates and protein.
5. You’re Eating Too Much of Some Food Groups
When we cut certain foods from our diet, especially carbs, it’s easy to rely on other food groups, like nuts and dairy. They’re readily available and a staple of most diets.
Nuts are a low-carb, healthy fat option, but only in small amounts. They’re great to add to fruit or veggie salads, and they’re easy to grab a handful of when you need a quick snack. But those quick snacks can add up, especially on top of eating full meals. Nuts are high in good fat, low in carbs, and are a good source of protein, but too much protein can be detrimental to your fast. Excess protein that your body doesn’t need is converted to glucose and stored as fat. If you’re fasting to lose weight, this is the exact opposite of what you want.
Dairy, the other easy food group that too many people defect to, can cause inflammation, upset stomach, bloating, gas, and other kinds of discomfort. If this is a pattern you’ve noticed with your own health and eating habits, try cutting out dairy for a few weeks and see if these symptoms improve. If you haven’t noticed these symptoms, be more mindful of your eating habits and track how you feel after eating dairy.
6. You Aren’t Eating Enough of Certain Food Groups
As easy as it is to eat too much of one food group, it’s equally easy to not get enough of another. Just because you can eat “whatever” you want during your eating window doesn’t mean you should. Empty calories and junk food are momentarily satisfying, but they don’t fuel your body. Eating the right foods provides your body with the nutrients it needs to thrive throughout the day; these foods will also keep you feeling fuller, longer.
Vegetables are one of the best food groups to keep you nourished and thriving. They’re low calorie and they provide different vitamins and minerals like potassium, fiber, folate, vitamin A, and vitamin C. Fruits are also healthy, but don’t overdo it, as most are high in sugar. Fruit juices typically have added sugar as well. Naturally flavored drinks and teas are the healthiest option. Nuts are high in fat and a good source of protein, as are eggs. Refined carbohydrates and sugars are highly unnecessary for your body and if you’re going to include them in your meals, there should be very little.
7. You’re Pushing Your Body Too Hard
Did you dive off the deep end and go from zero fasting to attempting 24-hr fasts every other day? Back up and take a more moderate approach first. Don’t expect fasting to be easy right away. Not only will your body need time to adjust, but your mind will, too. If you’ve been accustomed to three square meals a day, plus snacks and calorie-filled drinks, your body has gotten used to this routine.
Your body needs time to adapt. First it burns through stored sugar and then it will start burning body fat for energy. Start slow and get a feeling for this new practice. You can start with a twelve-hour fasting period and twelve-hour eating window. When eight hours of that fast are during your sleeping hours, this window is relatively easy. Once you’ve become accustomed to this schedule, you can reduce your eating window to ten hours. Continue decreasing your eating window by two hours every one to two weeks, until you’ve hit the fasting period you want.
8. You Have the Wrong Mindset
Fasting provides your body with everything it needs to thrive, but without the right mindset, you’re bound to fail. Focusing on the negative, like not being allowed to eat certain foods or at certain times, will easily spiral into other negative self-talk. The harder you are on yourself, the more difficult it is to achieve success.
Rather than thinking about how hard the fast is, focus on the positive that will come out of it. Fasting allows your body to heal. Fasting can help you lose weight. You’ll feel more energized and have a clearer mind. Whatever the reason you’ve chosen to fast, focus on that. Fasting with a friend, family member, partner, or online community is another way to hold yourself accountable and can be very helpful.
9. You’re Too Stressed
When you’re stressed, your body releases a hormone called cortisol. Cortisol is problematic when fasting because it can prompt your body to break down muscle tissue instead of fat. When fasting, your body should tap into stored body fat and preserve your healthy muscle tissue.
If you’re stressed on occasion, this shouldn’t cause much of a problem. But if you’re chronically stressed, that constant release of cortisol can lead to a breakdown of muscle tissue.
Not sure if you’re stressed? Here are some symptoms:
- Teeth grinding
- Muscle tension
- Digestive problems
- Trouble concentrating
Alleviate stress with deep breathing, positive visualization, an epsom salt bath, and stress-relieving teas. If you can, take some time off from work. If you’re an outdoorsy person, relax in nature.
10. You’re Inactive
Being inactive is one of the biggest mistakes people make during their fast. If you aren’t eating, you should rest and save your energy, right? Wrong. Exercise is a great way to improve your fasting. Activity increases fat burning and boosts circulation. Going outside and getting some sunlight and fresh air can improve your mood, making you more likely to stick to your fast. Movement generally makes people feel better than sitting on the couch inside all day; being inactive makes you cold, tired, and unfocused.
Since a lot of people work sedentary jobs that tie them to a desk all day, exercise isn’t a convenient way to stay active. But taking a short walk or stretching are two easy ways to get your blood flowing throughout the day.
Fasting shouldn’t be synonymous with suffering. If you’re feeling deprived during your fast, be sure that you aren’t making any of the above fasting mistakes. Ease yourself into your fast, stick with it, and enjoy the results when they come with time.
But there’s one more—in fact, the number one reason fasts fail….
Can you guess what it is?
***Giving Into Cravings
Which is why I want to tell you about my new favorite secret weapon for staying fasted longer and with less difficulty: Pique Fasting Teas. Why tea? The combination of catechins and caffeine gives you a higher chance of experiencing tangible benefits from fasting. It suppresses hunger cravings, boosts calorie burn and supports malabsorption of unhealthy fats and sugars.
These Fasting Teas include ingredients targeted at maximizing the fasting experience:
1) Organic highest ceremonial grade matcha, which increases levels of l-theanine to calm and tide you through your fasts with ease. 2) Organic peppermint, which is a natural appetite suppressant with calming properties. 3) Proprietary blend of high catechin green Tea Crystals, which regulate the hunger hormone ghrelin and increase thermogenesis (burning fat for fuel). This helps you to stay fasted and see quicker results. 4) Additional plant ingredients including ginger and citrus peel to support digestion and enhance autophagy.
As with all of Pique’s teas, you can rest assured these are pure and Triple Toxin Screened for pesticides, heavy metals and toxic mold. For a limited time only, if you order through the Mark’s Daily Apple link, you can get up to 8% off and free shipping (U.S. only).
Thanks again to Dr. Jason Fung for today’s post. Have questions on fasting protocols or missteps? Share them below, everybody, and have a great day.
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It seems every “keto for women” forum abounds with stories about menstrual cycles gone wild in the first few months of keto. Irregular cycles, breakthrough bleeding, and periods lasting much longer than normal are common complaints. Sometimes these stories are cited as evidence that keto isn’t good for women, at least not premenopausal women, and that we need carbs for healthy hormones. Yet, many women don’t notice any changes in their menstrual cycles at all, while others report improvement in PMS symptoms and cycle regularity from the get-go.
What gives? Why do some women’s cycles apparently become wacky when they start keto, while others feel like keto is the key to period bliss? Can keto “mess up” the menstrual cycle?
We know that diet—what and how much we eat—can profoundly affect our hormones. This is true for both women and men. One of the reasons people are so excited about ketogenic diets is specifically because keto shows promise for helping to regulate hormones and improve cellular sensitivity to hormones such as insulin and leptin.
At the same time, women’s hormones are especially sensitive not only to dietary changes but also to downstream effects such as body fat loss. Furthermore, one of the ways women’s bodies respond to stressors is by turning down the dial on our reproductive systems. It’s reasonable to hypothesize, then, that women might have a tougher time adapting to or sustaining a ketogenic diet. Keto can be stressful depending on one’s approach, and that might negatively impact women’s reproductive health. But do the data actually bear that out, or is so-called “keto period” more misplaced hype than genuine fact?
Note that throughout this post, I’m going to use the term “reproductive health” to refer to all aspects of women’s menstrual cycle, reproductive hormones, and fertility. Even if you aren’t interested in reproducing right now, your body’s willingness to reproduce is an important indicator of overall health. When your reproductive health goes awry—irregular or absent periods (amenorrhea) or hormone imbalances—that’s a big red flag. Of course, post-menopausal women can also experience hormone imbalances that affect their health and quality of life (and low-carb and keto diets can be a great option for them).
Menstrual Cycle 101
Let’s briefly review what constitutes a normal, healthy menstrual cycle, understanding that everybody’s “normal” will be a little different. A typical cycle lasts from 21 to 24 days on the short end to 31 to 35 days on the long end, with 28 days being the median. Day 1 is the first day of your period and begins the follicular phase, which lasts until ovulation. Just before ovulation, levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (a form of estrogen) spike. Next comes the luteal phase covering the approximately 14 days from ovulation to menses. LH, FSH, and estradiol drop, while progesterone rises. Estradiol bumps up again in the middle of the luteal phase. If a fertilized egg is not implanted, menstruation commences, and the whole cycles starts over again. All this is regulated by a complex communication network under the hypothalamic–pituitary–gonadal (HPG) axis, which is closely tied to the actions of the adrenal (the A in HPA axis) and thyroid glands.
Across the cycle, fluctuations in body weight are common as fluid is retained and then released along with shifts in estrogen and progesterone. Changes in blood glucose are also normal, and insulin-dependent diabetics often find that they need to adjust their dose at different times of their cycles to keep their blood sugar in check. The most common pattern is higher blood glucose readings in the pre-menstrual period (the second half of the luteal phase), and lower readings after starting your period and before ovulation. This is generally attributed to the fact that progesterone, which is highest during the luteal phase, is known to reduce insulin sensitivity. However, different women experience different patterns, which can also be affected by other factors such as oral contraceptive use.
Normal fluctuations in insulin resistance and blood glucose can mean that women get lower ketone readings at certain times of the month than others. When these occur premenstrually—and so they tend to coincide with a period of (transient) weight gain and food/carbohydrate cravings—women often feel as though they are doing something wrong. Rest assured that these variations reflect normal physiology.
The many factors that affect your cycle and the levels of your sex hormones include: other hormones, gut health and microbiome, metabolic health (e.g., insulin sensitivity), environmental toxins, stress, sleep, immune health, nutrient deficiencies, activity level and energy expenditure, and age. Each affects the others, and all (except age of course) can be affected by diet. It’s no surprise, then, that it can be extremely difficult to pin down a root cause of menstrual changes or reproductive issues.
What the Research Tells Us About Keto and Menstruation
As I said at the outset, there are lots of anecdotes, both positive and negative. In my experience, most women whose cycles seem to go crazy when they start keto find that things get back to normal—and often a better version of normal—after a few months.
First, it’s tricky to determine the effects of keto per se, since many people combine a ketogenic diet with calorie restriction (intentionally to lose weight or unintentionally due to the appetite suppressing effects of keto) and with fasting (intermittent and/or extended). Each of these can independently impact the factors listed above, lead to weight loss, and affect the menstrual cycle and reproductive health.
So, is there any evidence that keto itself causes changes to menstruation?
The scientific evidence is scant….
The one statistic you’ll see floating around the interwebs is “45% of (adolescent) females experience irregular menstrual cycles on keto.” This statistic comes from one small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls reported amenorrhea (loss of period) and three were diagnosed with delayed puberty. However, the ketogenic diet used for epilepsy is different and usually much stricter than an “everyday” keto diet needs to be, and epilepsy is frequently associated with menstrual dysfunction regardless of diet.
To extrapolate the findings of this study and argue that nearly half of teenage girls (or women generally) are likely to experience menstrual problems from going keto is a huge leap.
The fact is, I’m unable to find any studies done in healthy human females (or mice for that matter) demonstrating that otherwise normal menstrual cycles are disturbed by going keto.
5 Ways Keto-Related Factors *Might* Affect Your Menstrual Cycle
With the limited amount of research looking directly at keto and menstruation, let’s look first at whether there are direct effects of carbohydrate restriction or elevated ketone production on the menstrual cycle. Those are the defining characteristics of keto and what differentiates keto from other ways of eating. Then we can examine indirect effects that occur due to factors such as weight loss. These are not unique to keto, though they might be more likely on a ketogenic diet compared to other ways of eating.
There is no real body of evidence that looks at ketogenic levels of carb restriction and menstruation, but there are some clues. In this small study, functional hypothalamic amenorrhea (FHA) was associated with dietary fat restriction; women with FHA actually ate non-significantly more carbs than matched controls and nearly identical total calories. Likewise, in this small study, FHA was associated with lower fat intake but no significant difference in carb intake.
This meta-analysis looked at the effect of low-carb (not keto) diets on markers of reproductive health among overweight women. The researchers found four studies that examined effects on menstruation; all showed improved menstrual regularity and/or ovulation rates. Of six studies that looked at levels of reproductive hormones, five reported significant improvements.
Carb restriction also results in decreased insulin production. Hyperinsulinemia and insulin resistance are frequently associated with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility and a frequent cause of menstrual irregularity. There is currently a lot of interest in using keto to treat PCOS, but only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, with positive results.
No studies have looked at the direct effects of ketones on menstruation.
Of course weight loss is not unique to keto, but keto can be very effective for weight loss. Some women experience rapid weight loss when first starting a keto diet. Weight loss in and of itself can impact menstruation through a variety of pathways. A key way is by reducing the hormone leptin. Leptin’s main job is to communicate energy availability to the hypothalamus—high levels of leptin tell the hypothalamus that we have enough energy on board, which also means we can reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.
Body fat loss can also affect estrogen levels since estrogen is both stored and produced in adipocytes (fat cells). While fat loss in the long term will decrease estrogen production, it is possible that rapid fat loss might temporarily raise estrogen levels and can also affect estrogen-progesterone balance. These transient changes in estrogen levels might underlie some of the menstrual irregularities women report.
Stress can impact the menstrual cycle in myriad ways. Cortisol acts on the hypothalamus and pituitary glands, affecting hormone levels, sleep, immune function, and gut health, to name a few. Diets can be a source of stress, both at the physiological and psychological levels. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but this can be mitigated by following the Keto Reset tips for women.
Thyroid dysregulation is another common cause of menstrual irregularities, and there remains a pervasive belief that keto is bad for thyroid health. Indeed, the thyroid is sensitive to nutrient deficiencies and caloric restriction, and thyroid hormones, especially T3, do frequently decline on keto. However, as Mark has discussed in a previous post, changes in T3 levels might not be a problem, especially in the absence of other problematic symptoms. Moreover, many practitioners now use keto as a cornerstone in their treatment of thyroid disorders.
What Should I Take From These Findings?
The first takeaway: there just isn’t much direct evidence about how keto might affect your menstrual cycle, positively or negatively. We have some studies suggesting that low-carb diets improve some aspects of menstruation and reproductive health, but keto is more than just another low-carb diet. Ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.
Second, the ways that keto is likely to (negatively) affect menstruation aren’t unique to keto, they’re common to any diet: hormone shifts mediated by energy balance, stress, and weight loss.
Furthermore, since keto is so often combined with caloric restriction, time-restricted eating, and fasting, even the anecdotal evidence might not be able to tell us all that much. If a woman is eating ketogenically, in a big caloric deficit, and doing OMAD (one meal a day), and her leptin plummets, how are we to know what really caused it? We don’t have good evidence that otherwise healthy women start a well-executed ketogenic diet and end up messing up their menstrual cycles.
That said, women do need to be cognizant of the sum total of the signals they are sending their bodies when it comes to energy availability and stress. A lot of women come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues. It’s important that they’re extra careful about how they approach keto. Done correctly, it might be just what the doctor ordered. I encourage any woman who’s dealing with other hormonal issues to work with a medical practitioner to tailor a keto diet to her unique needs.
But I’m Telling You, Keto Made My Period Go Haywire!
Ok, I believe you, really! But changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but important—shift in your nutrition. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week before you planned while you’re on vacation. However, that doesn’t make them bad from a health perspective. We need to respect that our bodies are dynamic systems. Changing the input will invariably change the output, and the system might need a few months to adapt to a new normal.
If your cycle goes wonky but you’re otherwise feeling good, give it a few months to sort itself out. If after a few months it’s still all over the place (or definitely if you’re having other disruptive symptoms), enlist help. In the meantime, check to make sure you’re not short-changing yourself nutritionally or calorically. Scale back on fasting efforts, and consider shifting more toward a traditional Primal way of eating.
At the end of the day, if you go keto and experience negative effects, stop. Keto is super hyped right now, but if your body is sending you clear signals that keto is not a good approach for you at this time, don’t do it. You can always try again later. It might be that your first attempt at keto didn’t work, but with a few adjustments and some experimentation over time you can find a version of keto that works for you.
Thanks for reading, everyone. Do you have comments, questions, or feedback? Let me know below.
Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Human Reproduction Update 2014; 20(2): 153–174.
Fontana R, Della Torre S. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016;8(2):87.
Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obesity Reviews 2007;8(1):21-34.
Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014;37(11):1049–1056.
Tena-Sempere M. Roles of Ghrelin and Leptin in the Control of Reproductive Function. Neuroendocrinology 2007;86:229-241.
The post Keto and the Menstrual Cycle: Is There Reason To Worry? appeared first on Mark’s Daily Apple.
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The relationship between stress and carbohydrates is confusing, with seemingly contradictory arguments bouncing around the online health sphere.
There are those who say high-carb diets cause stress, and that eating more fat and fewer carbs is the solution.
There are those who say high-fat diets increase stress and eating carbs ameliorates it.
Who’s right? They can’t both be right, can they?
You’d be surprised.
Let’s dig into four common carb questions and assertions.
“Stress Increases Carb Cravings.”
This is well-established. You have a terrible day at the office, your kids have appointments twenty miles apart within fifteen minutes of each other, the traffic is backed up to your driveway, you’re late for work, the dog needs a walk, you haven’t even thought about what to make for dinner, you slept four hours last night—it adds up. People deal with a lot. And in that moment, a carbohydrate-based snack really does seem to take the edge off.
Across millions of years of hominid evolution, the human stress response developed in the context of real-world, short-term, and infrequent but intense stressors: battles, hunts, freak injuries, dangerous animal encounters, interpersonal conflicts. These were situations that demanded heightened senses, available fuel, and a rapid heart rate to deliver everything to the tissues that needed to move and act. It makes perfect sense for your body to pump out adrenaline to increase fat burning and glucose in the blood—you need that fuel to deal with the situation. It also makes sense for your body to follow that up with a blast of cortisol, which makes you crave high-carb junk food to replace the fuel you utilized. The problem is that our modern stressors are too frequent, they aren’t physically demanding, we aren’t utilizing the fuel we mobilize, and we have no real need for the carb cravings that come after.
What happens when we eat too many carbs that we never actually needed?
We get fat. Cellular energy supply becomes overloaded, impairing our mitochondria’s ability to process energy efficiently. This degrades metabolic flexibility—the ability to switch between different fuel sources—preventing us from burning the fat on our bodies in between meals. We become reliant on those carbs, and when we don’t get them fast enough, our bodies perceive that as a major stressor.
So while giving in to carb cravings can reduce stress in the short-term, it sets us up for longer-term, more chronic stress.
“What About Gluconeogenesis? Isn’t That a Stress Response?”
It can be.
A primary goal of cortisol is to increase glucose availability. It does this through multiple avenues. One I just mentioned is to increase carb cravings. Another is to make you insulin resistant, thereby preventing insulin from sucking up blood glucose. Gluconeogenesis—the creation of glucose from amino acids and other substrates—is another.
If you’re a sugar-burner, stressful situations will increase carb cravings, induce gluconeogenesis, and may even make you insulin resistant. If you’re fat-adapted, the story shifts.
A fat-adapted person will have ketones and fatty acids available to provide energy in between meals. A fat-adapted person will have ketones and fatty acids available to provide energy in stressful situations. A fat-adapted person will be able to utilize those ketones and fatty acids during stressful situations—their mitochondria will literally be primed to utilize those fuels, not just glucose. A fat-adapted person is less likely to perceive carbohydrate shortages as stress shortages because they’ve got all this other fuel available to burn.
This adaptation doesn’t happen overnight. If your diet is low-carb or keto, but your body is still reliant on sugar, you will perceive reduced carb availability as a stressor. That’s one of the hallmarks of the keto flu, and it’s one reason why some people have extended keto flu—their bodies are still expecting and demanding glucose.
Some people never get over the carb cravings; they never fully adapt. This is the subset of the population that doesn’t function or perform well on a long-term ketogenic diet. The cause is unknown, at least for now (I suspect it has to do with recent ancestry and genetic proclivities), but what matters is that these people exist. For them, a long-term keto or very low carb diet approach will probably always be stressful. But even in these folks, spending some time in ketosis—through short term low-carb eating, intermittent fasting, or even extended low-level endurance activity that primarily burns fat—is a good idea that will reduce stress and improve overall resilience.
“But Carbs Make Exercise Less Stressful!”
Exercise is stressful to begin with. But then you adapt to the stress and overcome it—and end up stronger, fitter, and faster than before. Without the stress, working out doesn’t work. A legitimate method for increasing your work capacity is to train-low (carb), race-high (carb). Athletes have been doing this for decades—training in a low-carb state to get better at performing without ample muscle glycogen, then going into a race with full glycogen reserves and the ability to perform without glycogen. Exercising in that low-glycogen state is stressful, but that’s the whole point. It makes them better, stronger, faster, and it conserves glycogen for when they really need it.
If you consistently perform glucose-intensive high-intensity anaerobic activity for extended periods of time—CrossFit style WODs done 3-5 times per week, for example—you will run up a glucose debt and should replenish some of the carbohydrates you expend or risk cortisol spikes. Fat-adaptation can improve your tolerance of anaerobic activity in a low-glucose state, but there’s a breaking point, a physiological limit.
Eat the carbs you earn. This is a subtle point I don’t often see made. The reverse is widely understood—don’t eat the carbs you don’t earn—because millions of obese and overweight people do that every day. It’s a big reason why we’re so overweight. But if you fail to eat the carbs you earn through intense, protracted physical activity, you’re creating an undeniable glycogen deficiency that your body may perceive as a stressor. It may turn out that fully fat- and keto-adapted athletes can perform intense medium-to-long-term activities at high levels, and there’s some indication that this is the case, but for the time being it appears that eating the carbs you earn can stave off the stress.
“Low-Carb Diets Are Stressful For Women.”
There’s a glimmer of truth here. Allow me to explain.
Women are inherently more sensitive to caloric fluctuations than men…on average. The reason is sheer biology. Human evolution is concerned with fertility and reproduction. Can you produce, foster, and support viable offspring? Awesome. Natural selection deems you fit.
To fulfill their biological role, men have to produce sperm. They can do so almost indefinitely. They don’t run out; they just make more. If a batch is damaged due to poor lifestyle or dietary choices, there’s more on the way. After a man gets someone pregnant, his biological involvement with the growing baby is done. What or when he eats has no impact on the survival of the growing baby.
To fulfill theirs, women have a finite number of eggs, or “chances.” Once an egg is gone, there’s no replacing it.
And so the body seeks to inculcate the egg from environmental insults.
When you are preparing to get pregnant, your body needs extra nutrients to build up a reserve and “prime the pump.”
When you are pregnant, the growing baby needs a reliable and constant stream of nutrients for almost a year.
After you’ve given birth, the growing newborn needs breastmilk. To make that milk requires additional calories and extra doses of specific nutrients. Modern technology allows us to skip nursing and go straight to the bottle, but your body doesn’t “know” that.
It all points to women being more finely attuned to caloric deficits. For example, women’s levels of ghrelin, the hunger hormone, are quicker to rise after meals. Even if you’re never going to have kids, your body is still wired to protect against these caloric fluctuations.
Where do carbs come in?
One’s carbohydrate consumption is uniquely hewed to our sense of caloric sufficiency. If carbs are plentiful, your body perceives that as a signal of environmental plenty: the weather is good, the plants are producing, the trees are bearing fruit, the men are bringing back lots of honey. Life is good. It’s the perfect time to get pregnant. Above all other macronutrients, carbohydrate consumption increases the short-term expression of leptin, a satiety hormone that signals the presence of incoming calories, caloric sufficiency, and environmental plenty.
There’s also the issue of extreme satiety. Low-carb diets often become low-calorie diets without you even trying. That’s why they work so well for fat loss, by inadvertently reducing the amount of food you eat and increasing satiety. But for some women, especially those at or approaching their ideal weight, going too low in calories can increase stress.
Are you unable to access your own body fat in between meals for energy? Then you’ll be a ball of stress unless you can get those Jolly Ranchers unwrapped quickly enough. It’ll be a constant battle. And yeah, if you keep pumping yourself full of carbs to keep your blood glucose topped off, you’ll keep stress at bay—but you’ll always be teetering on that precipice.
Are you exercising? Then you should strike a balance between gaining the adaptive benefits of training in a low-carbohydrate state and eating the carbs you earn.
Are you a woman? Then you’re probably more sensitive to diet-induced stress and may benefit from occasional carbohydrate refeeds. You should watch out for excessive satiety on ketogenic diets, which is great for fat loss but can lead to stress issues down the line if calories get too low.
The relationship between carbohydrates and stress isn’t exactly straightforward, but it is navigable. Hopefully after today you have a better idea of where you stand in the relationship.
What’s been your experience with stress and carbohydrates? Has your tolerance for stress gone up or down since going low-carb or keto? Thanks for stopping in today.
Mcallister MJ, Webb HE, Tidwell DK, et al. Exogenous Carbohydrate Reduces Cortisol Response from Combined Mental and Physical Stress. Int J Sports Med. 2016;37(14):1159-1165.
Dirlewanger M, Di vetta V, Guenat E, et al. Effects of short-term carbohydrate or fat overfeeding on energy expenditure and plasma leptin concentrations in healthy female subjects. Int J Obes Relat Metab Disord. 2000;24(11):1413-8.
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Ready for some hormone talk? In this episode, we chat with hormone health educator Candace Burch, founder of Your Hormone Balance, a consulting and hormone testing practice that helps women of all ages correct hormone imbalances. Because, here’s something you might not realize: hormones can wreak havoc on your health at any age. Hormones dictate our health in so many ways: mood, heavy periods, weight gain, adrenal fatigue, you name it. Candace’s mission is to educate and guide women toward a safe, natural approach to hormone balance so that they can live their healthiest life. Her own journey began with…
The post Podcast Ep 107: Candace Burch of Your Hormone Balance appeared first on Fit Bottomed Girls.
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For today’s edition of Dear Mark, I’m answering a couple of questions from the comment sections of the last couple weeks. First, it’s been established that fasting and exercise both raise growth hormone. What about fasted exercise—does that have an even stronger effect? And what about continuing to fast after your fasted workout? Then, I discuss the inevitability (or not) of wear and tear on the arteries from blood flow-induced shear stress. Is shear stress “bad,” or do certain factors make it worse?
Let’s dig in.
So fasting raises growth hormone levels? Interesting. So does weight lifting. I’ll bet fasted weight workouts would be pretty powerful.
They do, and they are.
What’s even better is to work out in a fasted state and keep fasting after the workout. This keeps the GH spike going even longer. And in my “just so story” imagination—which is actually quite accurate, judging from real world hunter-gatherers—it mirrors the circumstances of our Paleolithic ancestors. You’d get up early to go hunting without having eaten. You’d expend a lot of energy on the hunt. You’d make the kill, procure the food. And then you’d bring it back to camp to finally eat. Maybe you’d pass the heart and liver around the circle before heading back. And sometimes, you just didn’t make the kill. You didn’t eat at all.
Makes sense, right? Fasting, doing something physical, and continuing to fast shouldn’t be a monumental undertaking. It should be well within the realm of possibility for the average person.
Now, I wouldn’t do this all the time. There is such a thing as too much of a good thing. A hormetic stressor can become a plain old stressor if it’s prolonged for too long. Instead, I would throw post-fasted-workout fasting in on an occasional basis.
Nor would I expect huge “gains” from this. Physiological growth hormone production won’t make you huge or shredded. In fact, workout-related increases in testosterone and growth hormone don’t actually correlate with gains in hypertrophy. Instead, I’d expect more intangible benefits, things you won’t notice right away. It’s important in cognition. It helps maintain bone health, organ reserve, and general cellular regeneration. It’s great for burning fat.
Growth hormone does way more than promote overt muscular growth.
In the linked article it says:
“Endothelial cell dysfunction is an initial step in atherosclerotic lesion formation and is more likely to occur at arterial curves and branches that are subjected to low shear stress and disturbed blood flow (atherosclerosis prone areas) (7,8). These mechanical stimuli activate signaling pathways leading to a dysfunctional endothelium lining that is barrier compromised, prothrombotic, and proinflammatory.
So it seems that endothelial disfunction comes first, triggered by blood flow stresses. It’s common wear and tear in exposed areas. The patched knees on jeans. Managing endothelial health and healing may slow or diminish rate of progression or is it mostly too late for that?
I’m not a doctor. This isn’t medical advice. This is just speculation.
I find it rather hard to believe that healthy arteries are inherently fragile and prone to damage and incapable of weathering the “stress” of blood flowing through them, even at the “susceptible” curves. I find it more likely that poor health, poor diets, and poor lifestyles make us more susceptible to otherwise normal stresses.
Do the mechanical stimuli weaken the endothelium in people with healthy levels of nitric oxide production? Or are we talking about people whose poor nitric oxide status is exacerbating the damaging blood flow patterns, leaving their endothelium vulnerable to atherosclerosis?
Think about how much context matters in our response to stimuli. If you’re shy around girls, a school dance will be a traumatic experience. If you’re comfortable around girls, a school dance will be a great experience. If you’re weak, lifting a barbell will be scary, and you may injure yourself. If you’re strong, lifting a barbell will be second nature, and you may get stronger. The baseline context determines the quality of the response.
I’d argue that blood flowing through your arteries should be a commonplace occurrence. It shouldn’t be a traumatic experience. Now, maybe I’m wrong. Maybe it is stressful regardless of the baseline endothelial health and the amount of nitric oxide you produce. Maybe it’s just a matter of time. But:
- We know that, as you quote, atherosclerosis tends to occur at bends and curves of the arteries—the places most likely to be subject to “disturbed flow” patterns.
- We know that “laminar flow”—blood flowing smoothly through the artery—is protective of the endothelial wall, promoting anti-inflammatory effects and making the endothelium more resistant to damage.
- We know that “disturbed flow” has an opposing effect on endothelial health, promoting inflammatory effects and rendering the endothelium more susceptible to damage. This increases atherosclerosis.
- The question I’m wondering is if “disturbed flow” at the curves and bends of the arteries is inevitable or not. And if disturbed flow is always “bad.”
- We know that hyperglycemia—high blood sugar—makes disturbed blood flow more damaging to arterial walls. Diabetics have higher rates of atherosclerosis because their elevated blood sugar interacts with disturbed blood flow patterns.
- We know that nitric oxide increases vasodilation in response to shear stress—widening the arteries to accommodate the increased stress and mitigate the damage done. We know that people with hypertension don’t get the same vasodilatory benefits from nitric oxide.
- We know that “functional increases” of shear stress attained via exercise increase nitric oxide and oxygen production and induce autophagy (cellular cleanup) in the endothelial walls.
That sounds like there are a lot of factors that increases and mitigate the effects of shear stress on the endothelial wall. It sounds like some factors make shear stress more damaging, and some factors make it less. There may even be factors, like exercise, that make shear stress healthy.
This topic is really pretty interesting to me. It deserves a deeper dive, don’t you think?
What about you, folks? What’s your take on fasted workouts and GH secretion? Ever try one?
And do you think your arteries are doomed to fall apart at the seams?
Nyberg F, Hallberg M. Growth hormone and cognitive function. Nat Rev Endocrinol. 2013;9(6):357-65.
Park SK, La salle DT, Cerbie J, et al. Elevated arterial shear rate increases indexes of endothelial cell autophagy and nitric oxide synthase activation in humans. Am J Physiol Heart Circ Physiol. 2019;316(1):H106-H112.
The post Dear Mark: Fasting, Training, and Growth Hormone; Wear and Tear on the Arteries appeared first on Mark’s Daily Apple.
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