Today we’re taking a peek under the hood and looking at some of the hormones involved in hunger and satiety, a.k.a. appetite hormones.
You might think of hunger as a gnawing feeling in your stomach and satiety as that feeling of fullness when you’ve eaten enough… or maybe too much. That’s how we experience the feelings we call hunger and satiety, true; but I’m talking today about the physiological drives to eat or stop eating that is driven by hormones.
Eating behavior is coordinated mostly in the brain by the hypothalamus, which acts as the control center for appetite. Hunger and satiety hormones deliver information from the body about how much energy you are taking in and whether you need more. The overarching goal here is energy homeostasis—balancing the energy coming in (via food) with the energy needed for the everyday functions of being alive.
When you have sufficient energy, your body is free to invest in growth, repair, and reproduction. Taking in more energy than you need can lead to excess fat storage and issues like hyperinsulinemia, insulin resistance, and metabolic syndrome. Energy deficits result in adaptations designed to conserve energy. In the long run, energy deficits might increase longevity, but they can also seriously undermine health and, for example, impair fertility.
Today I’m going to cover some of the key hormones that are involved in this delicate dance. This is by no means a complete list. Let me know in the comments if you have a burning desire to learn more about one of the hormones not covered here.
Ghrelin: the Hunger Hormone
Ghrelin is usually called “the hunger hormone” because it directly stimulates your drive to eat. In fact, it is the only known peripheral (outside the central nervous system) hormone that has this effect. Other peripheral appetite hormones all act to suppress hunger and reduce food intake. I always use the mnemonic “ghrelin gets your stomach growlin’” to keep it straight. I’m sure the endocrinologists in the crowd are groaning at that one.
Ghrelin is released primarily by cells in the stomach. Levels rise before meals and correlate with subjective feelings of hunger.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443295/‘>2
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Should I Just Take a Ghrelin Blocker?
After it was discovered in 1999, ghrelin became a target for drug companies hoping to cash in by developing ghrelin inhibitors as a treatment for obesity. These efforts haven’t panned out for several reasons. First, ghrelin doesn’t stimulate overeating in normal physiological conditions. If you administer ghrelin to a human or lab rat, they will eat more, even to the point of becoming obese in the case of rodents. Normally, though, ghrelin levels don’t stay consistently high. They rise and fall to reflect energy balance. After you eat, ghrelin levels fall in proportion to the number of calories you ingest,https://pubmed.ncbi.nlm.nih.gov/15528308/‘>4
Ghrelin doesn’t stimulate eating just for the heck of it. Its main job seems to be preventing a negative energy balance. Obese individuals actually have chronically lower ghrelin than their lighter counterparts.https://www.ncbi.nlm.nih.gov/pubmed/15713718‘>6
Drug trials have also been stymied because ghrelin has wide-reaching effects on other aspects of health besides eating behavior. Some of the known activities of ghrelin include:https://www.ncbi.nlm.nih.gov/pmc/articles/4443295/‘>8 https://pubmed.ncbi.nlm.nih.gov/21785007/‘>10
In other words, suppressing ghrelin could be very costly indeed. You can focus on metabolic flexibility instead. More on that later.
Leptin: the Satiety Hormone
Leptin’s main job is to signal to the brain when you have sufficient energy available. It is produced by adipose (body fat) cells. More body fat means more circulating leptin. Leptin is also released after you eat. Carbohydrate intake prompts a particularly strong leptin response, protein less so, and fat probably only minimally.
Sometime leptin is characterized as ghrelin’s counterbalance. Whereas ghrelin is “the hunger hormone,” leptin is “the satiety hormone” (although in truth there are many, as you’ll see). If ghrelin tells the brain GO, leptin tells the brain STOP. I think that characterization isn’t exactly correct, though.
It seems to me that both leptin and ghrelin prevent negative energy balance. If you think about it, for most of human history, energy shortage—which, in the extreme, means starvation and death—was a much bigger problem than energy abundance. Consuming too much food is a thoroughly modern problem. We should be more strongly attuned to shortages.
Elevated ghrelin levels signal to the brain that it’s in danger of going into the red; low levels of leptin do the same. This explains why low leptin is particularly problematic from a health perspective. It’s associated with mood disturbances and infertility, among other issues.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454393/‘>12 Low leptin and high ghrelin both put the body in an energy conservation state. Leptin decreases, and ghrelin increases, in response to dieting and weight loss.https://pubmed.ncbi.nlm.nih.gov/15181038/‘>14 In fact, leptin decreases more than you’d expect just based on how much body fat is lost while dieting. It’s one of the reasons hunger increases and can become unbearable when you’re on a diet. Presumably, these hormonal changes reflect the body’s efforts to defend its energy stores and restore homeostasis.
As with ghrelin, leptin’s functions extend well beyond appetite. Leptin has a hand in bone and cardiovascular health, insulin sensitivity, regulating thyroid hormones, insulin sensitivity, and glucose metabolism.
How to Increase Leptin Levels
It is possible to increase your leptin levels naturally, without medication. Here’s how to do it.
- Eat enough food. If you are severely depriving yourself, leptin will be suppressed and ghrelin will take over. That’s no way to live.
- Be sure to get healthy fats. Fats signal to your body that you’ve consumed enough calories, and they take longer to break down than carbs do. Some of my favorite sources of healthy fats include avocado oil, coconut butter, ghee, and macadamia nuts, among others.
- Restrict carbs for a time. Carbs need to be constantly replenished. Once you get past the “low-carb flu,” you’ll find that you have energy without constantly having to reach for snacks.
- Cycle in carbs. To optimize your leptin and ghrelin balance, you’ll want to achieve metabolic flexibility.
For more details on leptin and how to control it, read this article.
Neuropeptide Y, or NPY, is the most abundant peptide in the central nervous system. Found mostly in the hypothalamus, it acts as a hormone and neurotransmitter. It’s involved in a host of actions locally in the brain and throughout the body.
Most importantly for the present purposes, NPY is considered the most potent appetite-stimulating compound in the human body. Each of the other hormones discussed in this post regulates food intake by acting on NPY in the hypothalamus. For example, ghrelin increases NPY activity, while leptin suppresses it. Elevated NPY strongly increases the drive to eat, especially carbohydrates.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668104/‘>16 It’s also expressed by fat cells, and research suggests that NPY promotes fat storage.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830398/‘>18, and it has known neuroprotective effects. There are a number of reasons to think that NPY is the key that explains how caloric restriction extends lifespan.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775646/‘>20 This may be one reason you don’t stay full for long after eating high-carb meals.
Cholecystokinin (CCK) was the first known satiety hormone. It is secreted in the gastrointestinal tract, especially in the small intestine. CCK rises quickly after eating, especially in response to fat and protein in the meal, and it triggers the initial release of PYY.
Like PYY, CCK is involved in various processes related to digestion, especially the digestion of fat. CCK also has interesting effects in the brain. The hippocampus contains a large concentration of CCK receptors, indicating that CCK plays an important role in learning and memory, though it’s still not well understood.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005241‘>22
Abbreviated GLP-1, this hormone is secreted by the ileum and colon in response to nutrient intake. It acts as a satiety hormone, but researchers are especially interested in how it stimulates insulin secretion, improves insulin sensitivity, and helps regulate blood glucose.https://www.ncbi.nlm.nih.gov/pubmed/16478824‘>24 which can persist for decades after the procedure.https://pubmed.ncbi.nlm.nih.gov/25673670/‘>26
Let’s end with a familiar one. You probably know that the pancreas releases insulin after you eat, especially following carbohydrate intake. Insulin is sometimes called the “storage hormone” because one of its main jobs is to “unlock” adipose cells in order to store fat for future use. In healthy individuals, it also supports energy homeostasis by inhibiting lipolysis (fat burning) when there is sufficient glucose in the bloodstream to supply energy.
As with the other hormones discussed here, insulin also acts as an energy barometer for the brain. It crosses the blood-brain barrier, where it regulates NPY expression and suppresses appetite.
Can You Control Your Hunger Hormones?
It’s tempting to think that if we understood these hormones’ actions, we could learn to control hunger and eating behavior and solve all the problems related to overeating. As great as that sounds, we’re a long way off.
As you can see, energy homeostasis depends on the coordination of many different signaling pathways within the body. Too often, people try to hone in on the effects of just one variable—leptin or ghrelin, say—hoping to manipulate hunger and satiety. None of these hormones works in isolation, though. There is still a lot to learn about the physiological significance of each of these hormones individually, not to mention how they work in tandem with one another.
Furthermore, in human studies, hormone levels don’t consistently map on to our actual eating behavior as you’d expect. This might be because scientists haven’t uncovered the whole picture and don’t understand how all the various pieces work together to produce hunger. Probably, it’s also because we humans are complicated creatures who eat for a lot of reasons other than pure physiological hunger.
What does it all mean? I think it means don’t look for a magic pill that will allow you to control appetite and hunger. If you struggle with unwanted hunger, the first thing to ask is whether you are eating enough to meet your energy needs. Are sending your brain scarcity signals by not eating enough, or perhaps not often enough? That’s an easy fix.
Next, you can try manipulating your macros. One of the advantages of low-carb, high-fat (LCHF) diets over low-fat, high-carb (LFHC) diets is that appetite is managed much better on LCHF.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775646/‘>28 If you go very low-carb, you might experience the appetite suppressing effects of ketosis as well.
Check in with your stress levels and sleep habits. Too much of the former and not enough of the latter can drive up appetite.
If none of those is the answer, it might be time to make an appointment with an endocrinologist or functional medicine practitioner who can help you dig deeper.
Hunger isn’t something to be avoided, though. Hunger and satiety are normal physiological signals. Their job is to keep us alive and thriving. Rather than trying to manipulate or hack hunger, it’s useful to understand where it comes from so that we can respond appropriately and have the energy we need to be active and healthy.
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At this point, intermittent fasting isn’t a new concept, nor is it a difficult one. You take in all of your calories for the day within a limited window of time, and the rest of the day, you stick with water, maybe a cup of coffee, or tea in the morning if you feel so inclined. The idea is that giving your body a period of time “off” from digesting food allows your cells to heal and renew in other ways.
A Practice Born Because Calorie Restriction is Unpleasant
Intermittent fasting became popular because calorie restriction was found to contribute to healthy aging. A few mouse and worm studies seem to show that drastic reductions in food intake over a long period of time could prolong your life.
The research is compelling, but I’m not convinced actively restricting your calorie intake through sheer will is the true path to enjoyable longevity. I don’t want to be thin, frail, distractible, or preoccupied with food. I’d rather be vibrant and full of zest. I want to eat big strapping meals of steak and veggies smothered in butter without worrying about calories. I want to maintain muscle mass and have enough energy to go on long hikes and have the legs to still leap for high passes (over the young guys) at the end of Ultimate games. And as I appreciate the neuroprotective and autophagy-promoting qualities of calorie restriction, I’d rather not expend the mental energy and fortitude required to maintain such a regimen day-in and day-out.
Intermittent fasting is the workaround. Pushing off breakfast for a few hours gives me all of the benefits of calorie restriction, without all the misery.
Fasting is the way to have your cake and eat it too. Beyond the already proven benefits of a Primal Blueprint low-carb lifestyle, fasting once in a while seems to offer many of the same benefits of calorie restriction – you know, stuff like increased longevity, neuroprotection, increased insulin sensitivity, stronger resistance to stress, some cool effects on endogenous hormone production, increased mental clarity, plus more – but without the active, agonizing restriction.
You just eat Primally, focusing on meat and vegetables with plenty of animal fat, and skip meals on occasion. A sixteen-hour fast is on the low-but-still-effective end, or you could opt for longer, more intermittent fasts – say, a full twenty-four hours once or twice a week. Women may need to time fasts a little differently than men. More on that here.
When you’re done with the fast, eat as much as you want (which usually isn’t an issue, once you’re keto-adapted). It essentially turns into “eat when you’re hungry,” because let’s face it: eating the types of foods we evolved eating induces powerful satiety and makes eating the right amount of food a subconscious act. Fasting becomes a whole lot easier (and intuitive) when you’ve got your food quality dialed in. And I’ll come back to that little caveat at the end here.
“Fasting” was the top search term for MDA last week, and I hadn’t done a big post on it in a while, so I thought I’d do a comprehensive rundown of all the benefits (some conclusive, others prospective) you can expect to obtain from IF.
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Intermittent Fasting and Longevity
Everyone wants to live longer, but I find longevity pointless if you’re not enjoying yourself. Otherwise, life becomes dreary.
The popular c. elegans worm enjoys increased longevity with both twenty-four and forty-eight hour IFs via signaling through a gene that we all have.full PDF) from the 1940s found that varying amounts of twenty-four hour IFs (every other day, every fourth day, every eighth day, etc) prolonged the lifespan of rats without retarding or stunting the growth (as occurred with calorie restricting them). Female rats responded best to every eight day fasts, while males responded best to every other day fasts.
Reductions in brain insulin signaling have been shown to increase lifespan in animals, either by calorie restricting or actively knocking out brain insulin receptors.http://www.ncbi.nlm.nih.gov/pubmed/21244426‘>3
Going in and pharmaceutically manhandling your cholesterol synthesizing equipment is one thing; eating real food and exercising, resulting in possible alterations to your lipid profile, is another. We don’t set out to force your blood lipids into submission, but lifestyle changes that happen to change them for “the better” are usually a good thing. Fasting brings potent changes to blood lipids in an “organic” way – you’re just letting your machinery do its thing on its own – and this is probably a very good thing.
Intermittent fasting is as effective or even more effective than calorie restriction in improving metabolic syndrome markers in overweight women, and it’s a whole lot easier to stick with.http://www.ncbi.nlm.nih.gov/pubmed/20300080‘>5
I discussed this last week, but it can’t hurt to mention that short-term alternate day fasting wrought improvements in LDL particle size and distribution in obese adults.http://www.ncbi.nlm.nih.gov/pubmed/20815899‘>7
Heck, intermittent fasting even helped cocaine addicts stick to their treatment and rehab program.http://www.ncbi.nlm.nih.gov/pubmed/18184721‘>9 In fact, here’s a review of most of the animal anti-cancer evidence.http://www.ncbi.nlm.nih.gov/pubmed/19135806‘>11 This is refreshing news. A preliminary studyhttp://ajpregu.physiology.org/content/296/1/R29.full‘>13 I’ve found this to be the case for me. If the body “needs” food right after a workout, why would hunger be blunted? This is why I tend to hold off on the eating post-workout. Every little bit helps, especially as you age.
Fasting doesn’t cause your brain tissue to waste away, contrary to what some people will tell you. It’s actually good for brain health. Any dietary restriction tends to increase neuronal plasticity and promote neurogenesis, but it was IF that had the greatest effect (with the fewest downsides).http://onlinelibrary.wiley.com/doi/10.1046/j.1471-4159.2003.01586.x/full‘>15 That is, mice who ate larger meals more infrequently saw greater increases in brain and overall bodily health. Still another study found that IF was beneficial for peripheral nerve function in mice by promoting the maintenance of the neuronal pathways responsible for locomotor performance.http://www.ncbi.nlm.nih.gov/pubmed/21106691‘>17), which is the process by which cells recycle waste material, eliminate or downregulate wasteful processes, and repair themselves. Why is autophagy so important? It’s required to maintain muscle masshttp://www.ncbi.nlm.nih.gov/pubmed/20104028‘>19 It reduces the negative effects of aginghttp://www.ncbi.nlm.nih.gov/pubmed/17934054‘>21
Without the autophagy that fasting provides, you would get very few of the benefits. Fasting even increases neuronal autophagy,http://www.ncbi.nlm.nih.gov/pubmed/21051570‘>23 (which mean better performance down the line), improved muscle protein synthesis,http://www.ncbi.nlm.nih.gov/pubmed/20187284‘>25 (you’ll earn your meal and make more muscle out of it if you train on an empty stomach). Studies on Muslim athletes during Ramadan show no effect on performance while fasting,http://www.ncbi.nlm.nih.gov/pubmed/19787180‘>27 in those who exercise and fast rather than just fast. When you train in a fasted state, glycogen breakdown is blunted28 and more fat is burned, leaving you more glycolytic energy in the tank for when you really need it and less body fat. Those are just a sampling of the benefits to fasted training; there are dozens more.
Mental Well-being and Clarity
A lot of health influencers will tell you that failure to eat something every few hours will cause mental fog and sluggishness, so keep a banana or a granola bar on your person at all times. Of course, this is all based on an assumption that we need to supply exogenous carbs on a regular basis to properly fuel the brain. This notion that fasting is only the province of anorexics or “caveman” has kept many people from experiencing the vast array of benefits.
I maintain that one’s comfort in handling intermittent fasting effortlessly does increase dramatically when you’ve reprogrammed those cells (and genes) to predispose your body to derive most of your day-to-day energy from fat, as opposed to constantly dipping into glycogen stores (as happens when we rely so much on refeeding carbs every few hours).
Overall, fasting just seems right. It’s like a reset button for your entire body, presumably across a large spectrum of maladies and dysfunctions. It puts your body into repair mode – at the cellular level – and it can restore normal hormonal function in the obese or overweight. Now, you don’t have to fast, but it’s definitely something to consider.
Have you tried intermittent fasting yet? Let me know how intermittent fasting has worked – or hasn’t – with your lifestyle in the comment section!
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The treatment usually prescribed by doctors, hormone therapy (HT), is controversial and not appropriate for some women. I won’t get into the HT debate here—Mark did a great job covering the pros and cons recently. Suffice it to say that HT isn’t the answer for everyone, and it’s not a panacea by any means.
Whether or not they choose to go the HT route, many women desire additional support during perimenopause and beyond. For the sake of keeping this post from becoming a novella, I’m going to focus on mind-body therapies today.
This is not meant to be an exhaustive list of nonhormonal options, nor is it meant to try to dissuade you from trying HT. That’s a decision you have to make for yourself with your doctor. The approaches below can be used alone or in combination with other modalities, including HT.
As with any medical-adjacent tools, if you are considering any of the options here, take the time to educate yourself, talk to your doctor, and find qualified practitioners to help you implement these practices.
A Note Regarding Research Evidence…
Because so many women are interested in complementary or alternative approaches, there’s a fair amount of research into nonhormonal treatments. There are also important limitations.
A lot of the randomized control trials—experiments that are best for establishing causal effects—are small. There is considerable variability in research design, so it’s difficult to generalize across studies.
Participants in these studies tend to be white and well-educated. Since there are cross-cultural differences in the experience of menopause, we shouldn’t assume that the findings apply to all women. Likewise, a lot of the research focuses on women with a history of breast cancer because HT is generally contraindicated in this population. While the results of these studies probably generalize to other women, it would be great to have more data.
Finally, vasomotor symptoms—hot flushes and night sweats—are studied more than other types of symptoms. Though they are the most common complaint, many women do not experience debilitating vasomotor symptoms. They might, however, experience mood fluctuations, depression, sexual issues, memory problems, and more. We know less about how these approaches might help those women.
Nevertheless, I’ll highlight some of the potentially fruitful avenues you might explore. When possible, I’ll focus on systematic reviews and meta-analyses. They pool the results of multiple smaller studies to help a more reliable picture emerge.
Cognitive Behavioral Therapy (CBT)
In CBT, individuals are encouraged to explore how their thoughts (cognitions) affect feelings, behaviors, and physical symptoms. With help, they change their thoughts or beliefs about a situation to help manage their responses and improve coping skills.
Although there isn’t a ton of research on CBT for menopause, available studies are very promising. Whether or not CBT reduces the actual number of hot flushes—and the data here are mixed—CBT should work by changing women’s perceptions of their hot flushes. Multiple studies do find that after CBT women view their hot flushes as interfering less with daily life. As expected, they are also less bothered by them.
Women who see themselves as having less control over their hot flushes also tend to experience more distress. Changing their perceived control could be an effective intervention for improving quality of life. Indeed, in one study, 95 women received either group-based or self-help CBT. After therapy they reported feeling greater control over hot flushes and having better coping skills compared to women in a no-CBT control condition. Further analyses showed that women’s beliefs about control and coping predicted how problematic they found their hot flushes to be. (Having more positive beliefs about how hot flushes affect sleep also helped.)
Women who participated in CBT also experienced fewer sleep issues and insomnia as well as fewer depressive symptoms and sexual concerns. They also noticed less impairment at work. Positive results were found with in-person therapy, self-help programs, and telephone-based therapy. When studies included a follow-up assessment, the beneficial effects of CBT persisted for at least six months.
Mindfulness, Meditation and Relaxation Training
A cross-sectional study of 1744 women found that women with higher scores on a mindfulness assessment tended to report less severe menopausal symptoms. For women with higher life stress, this association was especially strong. The idea here is that when women are able to be present-focused and observe their symptoms without judgment, they are protected against some of the distress, and possibly the physical symptoms, associated with menopause.
Although some of the women in that survey are probably mindful by nature—lucky them—mindfulness is also a skill that can be learned and cultivated. Among the many reasons to do so, mindfulness and meditation training can apparently lessen menopausal symptoms.
For example, researchers assigned 110 women to either an intensive eight-week mindfulness-based stress reduction program or a control group. The women who received mindfulness training reported having less bothersome hot flushes, better sleep quality, less anxiety and stress, and greater overall quality of life compared to the control group. When the researchers followed participants over the next 11 weeks, these results persisted or became even stronger.
A few other studies found that women who receive mindfulness or meditation training report fewer and less bothersome hot flushes, improved sleep, and better psychological functioning, though the results have not consistently endured over time. However, when looking at more general relaxation training and paced breathing techniques, effects are minimal, at least for hot flushes.
An ethnographic study of nine female yogi masters concluded that they tend to skate fairly easily through menopause. The authors concluded that menopausal women should be encouraged to practice yoga. Of course, in addition to yoga, these yogi masters’ lifestyles included “healthy food habits, adequate sleep, and the use of nature cure techniques (i.e., fasting, detoxification, selection of suitable food products, and living in well-ventilated houses) that facilitated the art of living in tune with nature.” This sounds pretty great, but can we give really yoga all the credit here?
Probably not. However, two recent meta-analyses did conclude that yoga offers small but significant relief from symptoms of all types: vasomotor, psychological (including depression), somatic (including fatigue and sleep disturbances), and urogenital. Women also report better overall well-being and quality of life after receiving yoga training.
In one study, a group of breast cancer survivors received twelve weeks of yoga and meditation instruction, and they were encouraged to practice daily at home. Compared to women in a control group (no instruction), they reported fewer symptoms and improved quality of life at the end of the twelve weeks and again when asked three months later. A later analysis found that many of the effects were mediated by improved self-esteem in the yoga group.
Note that most of the individual studies are small, and they employ different types of yoga practices. This might be considered a strength insofar as different practices have been shown to work, or a weakness in that it’s not clear if one approach is particularly effective.
Cross-cultural surveys find that women who are more active tend to have an easier time with menopause. For example, two large surveys of Swedish women found that women who exercised at least once per week reported less intrusive symptoms than women who never exercised, and women who exercised more than three hours per week were significantly less likely to experience severe symptoms than their less active counterparts. Sedentary women in this Finnish study experienced more vasomotor, psychological, and somatic/pain symptoms than women who were at least somewhat active.
While promising, experimental studies have not yielded such favorable results. When women were assigned to “physical activity” conditions (often walking), some studies report improvements, but others find no improvements or even worsening symptoms (perhaps depending on women’s baseline fitness). Multiple reviews have concluded that there is no systematic effect of exercise, particularly not for vasomotor symptoms.
Does that mean menopausal women shouldn’t exercise? Obviously no. It’s clear that being active—or at least not being sedentary—is important for overall health, and it probably helps menopausal women through the transition. However, there isn’t enough research to know what types of exercise are most effective and when. Do the types of movement you enjoy and that make your body feel good.
A recent review concluded that acupuncture is effective for reducing vasomotor symptoms, both frequency and severity, as well as for improving quality of life. However, the reviewers also found that acupuncture was not reliably better than sham acupuncture where needles are inserted at points other than the prescribed pressure points and at a shallower depth—a placebo condition.
A handful of studies have shown that clinical hypnosis can reduce hot flush frequency and distress among breast cancer patients. Another study of 187 women without breast cancer found that women who received hypnotherapy had fewer, less severe, and less bothersome hot flashes, as well as improved sleep. These results were evident at the end of the five-week treatment protocol, and they remained or got stronger in the six-week follow-up period.
The Experts Weigh In…
In 2015, the North American Menopause Society released a position statement on nonhormonal management of vasomotor symptoms. Of the approaches discussed here, the only ones NAMS recommended based on the strength of the available evidence were CBT and hypnosis. Mindfulness-based stress reduction earned a “recommend with caution,” which means, “We think it might work, but the evidence isn’t conclusive.”
The others—yoga, exercise, relaxation and paced breathing techniques, and acupuncture—were not recommended. This does not mean they are not worth trying! It simply means that based on their standards, the evidence was not strong enough for the committee to conclude that they are likely to be effective treatments for vasomotor symptoms specifically. This says nothing about other types of symptoms, nor about general well-being or quality of life.
Mind-Body Therapy Pros and Cons
So where does this leave us? Each of these therapies shows promise for alleviating at least some symptoms of menopause. Moreover, all these therapies have the potential to improve overall quality of life, sleep, stress, and general health. While reading these studies, I did wonder whether some of the women felt better simply because they were investing time and energy in taking care of themselves. If so, is that a problem? I don’t think so. They are low-risk interventions with a lot of potential upside.
That said, these aren’t quick solutions. The effective mindfulness/mediation trainings included six to eight weeks of classes and multiple hours per week. Women practiced yoga for two to four months during the study periods. Hypnotherapy was five weeks or longer. It’s not clear what the minimum time frame is for each of these therapies to be useful, but they’ll certainly involve a time commitment that might not be practical for all women. However, yoga, mindfulness/meditation, exercise, and even CBT can all be practiced at home once you know the proper technique.
As I said at the beginning, this is not an exhaustive list of nonhormonal therapies. There are also various supplements that might help, as well as lifestyle modifications that most of you Primal-savvy readers are probably already implementing: eating a variety of nutrient-dense foods, getting plenty of sunlight, practicing good sleep hygiene, and nurturing social connections.
Whatever you choose, be patient. Don’t just focus on one symptom; focus on the big picture. Pay attention to how you’re feeling more globally. Consider that while an intervention might not hit its desired mark, it might help you in ways you didn’t expect.
Have you used mind-body techniques (these or others)? What’s been your experience? Share your insights and questions below, and have a great week, everyone.
Atapattu PM. Vasomotor symptoms: What is the impact of physical exercise? J SAFOMS. 2105 Jan-Jun;3(1):15-19.
Goldstein KM, et al. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric. 2017 Apr;20(2):178-182.
McMillan TL, Mark S. Complementary and alternative medicine and physical activity for menopausal symptoms. J Am Med Womens Assoc (1972). 2004 Fall;59(4):270-7.
Molefi-Youri W. Is there a role for mindfulness-based interventions (here defined as MBCT and MBSR) in facilitating optimal psychological adjustment in the menopause? Post Reprod Health. 2019 Sep;25(3):143-149
Moore TR, Franks RB, Fox C. Review of Efficacy of Complementary and Alternative Medicine Treatments for Menopausal Symptoms. J Midwifery Womens Health. 2017 May;62(3):286-297.
Sliwinski JR, Johnson AK, Elkins GR. Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind-Body Medicine to Improve Cognitive Performance. Integr Med Insights. 2014;9:17–23.
van Driel CM, Stuursma A, Schroevers MJ, Mourits MJ, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG. 2019;126(3):330–339.
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Inflammation gets a bad rap in the alternative health world: “Inflammation causes heart disease, cancer, and autoimmune disease! It’s at the root of depression.” These are all true—to some extent.
Name a disease, and inflammation is involved.
Crohn’s disease is inflammatory.
Major depression is inflammatory.
Heart disease is inflammatory.
Autoimmune diseases, which involve an inflammatory response directed at your own tissues, are inflammatory.
Arthritis is inflammatory.
Even obesity is inflammatory, with fat cells literally secreting inflammatory cytokines.
Yes, but the story is more complicated than that. Inflammation, after all, is a natural process developed through millions of years of evolution. It can’t be wholly negative. Just like our bodies didn’t evolve to manufacture cholesterol to give us heart disease, inflammation isn’t there to give us degenerative diseases.
So, Why Does Inflammation Happen?
When pain, injury, or illness hit, the first responder is the acute inflammatory response. In other words, it is brief, lasting several days or less. All sorts of things can cause an acute inflammatory response. Here are a few:
- Trauma (punch, kick, golf ball to the head)
- Infection by pathogens (bacterial, viral)
- Burn (sun, fire, seat belt buckle on a summer day)
- Chemical irritants
- Allergic reaction
Things happen pretty fast in an acute inflammatory response and involve several different players, including the vascular system (veins, arteries, capillaries and such), the immune system, and the cells local to the injury.
- First, something painful and unpleasant happens; choose one of the above injury options.
- Then, pattern recognition receptors (PRR) located at the injury site initiate the release of various inflammatory mediators, which in turn initiate vasodilation (or widening of the blood vessels). This allows increased blood flow to the injury site, which warms the site, turns it the familiar red, and carries plasma and leukocytes to the site of the injured tissue.
- The blood vessels become more permeable, thus allowing the plasma and leukocytes to flow through the vessel walls and into the injured tissue to do their work. Emigration of plasma into tissue also means fluid buildup, which means swelling.
- At the same time, the body releases an inflammatory mediator called bradykinin, which increases pain sensitivity at the site and discourages usage of the injured area. These sensations—heat, redness, swelling, pain, and a loss of function—are annoying and familiar, but they’re absolutely necessary for proper healing.
Why Is (Acute) Inflammation Essential?
Allow me to explain why the four primary symptoms of acute inflammation are necessary, despite being unpleasant:
- Increased blood flow warms the injury and turns it red, which can be irritating and unsightly, but it also carries the guys—leukocytes—that will be cleaning up the injury site, mopping up pathogens, and overseeing the inflammatory process.
- Swollen body parts don’t fit into gloves, are really sensitive, and don’t work as well as their slim counterparts, but a swollen finger is a finger that’s full of a plasma and leukocyte slurry and therefore on the road to recovery.
- Pain hurts, but if an injury doesn’t hurt and it’s serious, you’ll keep damaging it because you won’t know not to use it.
- Loss of function prevents you from using what could be one of your favorite body parts, but you don’t want to make it worse be re-injuring it. Besides, it’s only temporary.
What About Chronic Inflammation?
These symptoms both indicate and enable inflammation (and, thus, healing), but what’s the deal with inflammation being linked with all those chronic illnesses—like obesity, heart disease, and depression? How does something normal and helpful go haywire and become implicated in some of the most crushing, tragic diseases of our time?
When inflammation becomes chronic and systemic, when it ceases to be an acute response, when it becomes a constant low-level feature of your physiology that’s always on and always engaged, the big problems arise.
The inflammatory response is supposed to be short and to the point. And because a big part of inflammation is breaking the tissue down, targeting damaged tissue and invading pathogens, before building it back up, the inflammatory response has the potential to damage the body. That’s why it’s normally a tightly regulated system: because we don’t want it getting out of hand and targeting healthy tissue. But if it’s on all the time—if chronic inflammation sets in—regulation becomes a lot harder.
Acute vs. Chronic Inflammation
A perfect example of the acute inflammation versus chronic inflammation dichotomy is exercise.
A single hard workout raises inflammation. It’s a stressor, a damaging event imposed upon your body. See for yourself.
A hard run spikes C-reactive protein for up to two days.
During exercise, skeletal muscle releases the inflammatory cytokine IL-6, a marker of damage.
Volleyball practice elicits spikes in IL-6 in both male and female elite volleyball players.
Acute exercise spiked CRP in cardiovascular disease patients (but a four-month exercise program lowered it).
This table of inflammatory responses to strenuous endurance events shows some massive spikes in CRP, some up to 20-fold the baseline value.
Yet, study after study (epidemiological and clinical alike) shows that extended exercise programs generally reduce markers of inflammation (like C-reactive protein) over the long-term:
- In elderly Japanese women, a 12-week resistance training program reduced circulating levels of inflammatory markers compared to baseline; reductions in CRP were associated with increases in muscle thickness.
- American adults who engaged in frequent physical activity tended to have lower CRPs than adults who were more sedentary.
- In type 2 diabetics, (key term coming up) long-term high intensity resistance and aerobic training reduced inflammatory markers over the course of a year (independent of changes in body weight, meaning activity was the key factor).
- Endurance combined with resistance training reduced CRP in young, healthy women better than endurance training alone.
- In obese, post-menopausal women, a basic moderate cardio program lowered CRP without really affecting body weight either way over the course of a year.
There are many more out there, but the general gist is that regular exercise tends to lower markers of systemic inflammation while acute exercise increases markers of acute inflammation. And sometimes what’s acute can become chronic. How do we make sense of this? How do we avoid making those acute spikes a chronic, constant thing?
Identifying Chronic Inflammation: Objective Markers
First, we need to be able to identify chronic inflammation. What symptoms and biomarkers can we use to track our inflammation levels?
CRP, or C-Reactive Protein
CRP is a protein that binds with dead and dying cells and bacteria in order to clear them from the body. It can always be found (and measured) in the bloodstream, but levels spike when inflammation is at hand. During acute inflammation caused by infection, for example, CRP can spike by up to 50,000-fold. CRP spikes due to acute inflammation peak at around 48 hours and declines pretty quickly thereafter (post acute-phase inflammation CRP has a half life of 18 hours). Thus, if the incident causing the inflammation is resolved, CRP goes back to normal within a few days. If it persists, the infection/trauma/etc. probably persists as well.
Highly sensitive to many different kinds of stressors, CRP rises in response to essentially anything that causes inflammation. This makes it valuable for determining that inflammation is occurring, but it makes it difficult to determine why that inflammation is occurring—because it could be almost anything. But if you’re looking for confirmation that you are chronically, systemically inflamed, an elevated CRP (in absence of any acute infections, injuries, burns, or stressors) is a useful barometer.
“Normal” CRP levels are supposedly 10 mg/L. Absent infection or acute stressors, however, ideal CRP levels are well under 1 mg/L. You want to stay well below 1; you don’t want “normal.” Between 10-40 mg/L (and perhaps even 1-9 mg/L, too) indicates systemic inflammation (or pregnancy), while anything above that is associated with real acute stuff. Note that exercise can elevate CRP, so don’t get tested if you’ve worked out in the last couple days.
IL-6, or Interleukin-6
T cells (type of white blood cell that plays a huge role in the immune response) and macrophages (cells that engulf and digest—also known as phagocytosing—stray tissue and pathogens) both secrete IL-6 as part of the inflammatory response, so elevated IL-6 can indicate systemic inflammation.
Tissue Omega-3 Content
This is a direct measurement of the omega-3 content of your bodily tissue. It’s not widely available, but it is very useful. Remember that anti-inflammatory eicosanoids draw upon the omega-3 fats in your tissues and that inflammatory eicosanoids draw upon the omega-6 fats. People having a higher proportion of omega-6 fats will thus produce more inflammatory eicosanoids. Now, we absolutely need both inflammatory and anti-inflammatory eicosanoids for proper inflammatory responses, but people with high omega-6 tissue levels make way too many inflammatory eicosanoids. Studies indicate that people with the highest omega-3 tissue levels suffer fewer inflammatory diseases (like coronary heart disease).
Research (highlighted and explicated here by Chris Kresser) suggests that omega-3 tissue concentrations of around 60% are ideal, which is a level commonly seen in Japan—the seemingly paradoxical land of high blood pressure, heavy smoking, and low coronary heart disease rates.
This measures the EPA and DHA, the two important omega-3 fatty acids, as a percentage of total fatty acids present in your red blood cells. It doesn’t correlate exactly to tissue amounts, but it’s pretty good and a powerful predictor of cardiovascular disease risk. The omega-3 index doesn’t measure omega-6 content, but those with a low omega-3 index are probably sporting excessive omega-6 in their red blood cells.
Anything above 8% corresponds to a “low risk,” but levels of 12-15% are ideal and roughly correspond to the 60% tissue content mentioned by Chris’ article. Four percent and below is higher risk and can be viewed as a proxy for increased inflammation (or at least the risk of harmful systemic inflammation developing from normal inflammation).
Heart Rate Variability
Systemic Inflammatory Response Syndrome Score
There’s the systemic inflammatory response syndrome, which is incredibly serious and has four criteria. If you have two or more of them at once, congratulations: you qualify—and should probably see a health professional immediately. This isn’t relevant for low-grade systemic inflammation, like the kind associated with obesity or autoimmune disease.
- Body temperature less than 96.8 F (36 C) or greater than 100.4 F (38 C).
- Heart rate above 90 beats per minute.
- High respiratory rate, 20 breaths per minute or higher.
- White blood cell count fewer than 4000 cells/mm³ or greater than 12,000 cells/mm³.
Of these objective markers to test, I’d lean toward CRP, HRV, and one of the omega-3 tests. CRP is pretty comprehensive, HRV is a two-fer (inflammation and general stress/recovery), and, while omega-3 tissue or blood cell content doesn’t necessarily indicate the existence of systemic inflammation in your body, it does indicate the severity of the inflammatory response you can expect your body to have. Taken together, these tests will give you an idea of where you stand.
Identifying Inflammation: Subjective Markers
There are also subjective markers. They may be harmless artifacts, but they may indicate that something systemic is going on.
Flare-up of Autoimmune Conditions You Haven’t Heard From In Ages
Sore joints, dry, patchy, and/or red skin, and anything else that indicates a flare-up. For me, this is usually mild arthritis.
Acute inflammation is often characterized by swelling at the site of injury. The same effect seems to occur in states of systemic inflammation, although they aren’t localized, but rather generalized.
If you feel stressed, you’re probably inflamed. I’m talking about the kind that has you rubbing your temples, face palming, sighing every couple minutes, and pinching the space between your eyes very, very hard.
Persistent But Unexplained Nasal Congestion
Could be allergies, sure, but I’ve always noticed that when I’m under a lot of stress and generally in an inflamed state, my nose gets clogged. Certain foods will trigger this, too, and I think it can all be linked to a persistent but subtle state of inflammation.
If you fit the bill for the eight signs of overtraining listed in this post, you’re probably inflamed.
Ultimately, though? It comes down to the simple question you must ask yourself: How do you feel?
I mean, this seems like an obvious marker, but a lot of people ignore it in pursuit of numbers. If you feel run down, lethargic, unhappy, your workouts are suffering, you struggle to get out of bed, you’re putting on a little extra weight around the waist, sex isn’t as interesting, etc., etc., etc., you may be suffering from some manner of systemic, low-grade inflammation. Conversely, if you’re full of energy, generally pleased and/or content with life, killing it in the gym, bounding out of bed, lean as ever or on your way there, and your sex drive is powerful and age appropriate (or inappropriate), you’re probably not suffering from chronic inflammation.
Causes of Chronic Inflammation
We need to determine why inflammation is “on” all the time—and then take the steps to counter it. I’m going to fire off a few things that both induce inflammation and tend toward prevalence in developed countries. You let me know if anything sounds familiar to you.
- Toxic diets: High-sugar, high-processed carb, high-industrial fat, high-gluten, high-CAFO meat, low-nutrient food is a pretty accurate descriptor of the modern Western diet.
- Insufficient omega-3 intake: Omega-3 fats form the precursors for anti-inflammatory eicosanoids, which are an integral part of the inflammatory response. Poor omega-3 status means insufficient production of anti-inflammatory eicosanoids and a lopsided inflammatory response to normal stimuli.
- Excessive omega-6 intake: Omega-6 fats form the precursors for inflammatory eicosanoids, which are an integral part of the inflammatory response. High omega-6 status (especially when combined with poor omega-3 status) means excessive production of inflammatory eicosanoids and a lopsided inflammatory response to normal stimuli. The more omega-6 you eat, the more omega-3 you crowd out for anti-inflammatory eicasonoid formation.
- Lack of sleep: Poor sleep is linked to elevated inflammatory markers. Poor sleep is a chronic problem in developed nations. Either we go to bed too late, wake up too early, or we use too many electronics late at night and disrupt the quality of what little sleep we get. Or all three at once.
- Lack of movement: People lead sedentary lives, by and large, and a lack of activity is strongly linked to systemic, low-grade inflammation. People don’t have to walk to get places, they take escalators and elevators, they sit for hours on end, and they don’t have time for regular exercise.
- Poor recovery: Other people move too much, with too little rest and recovery. When I ran 100+ miles a week, I certainly wasn’t sedentary, but I was chronically inflamed. Overtraining is a form of chronic inflammation.
- Chronic stress: Modern life is stressful. Bills, work, commuting, politics, exercise that you hate – it all adds up and it doesn’t seem to let up or go away. And if it becomes too much for you to handle (I know it’s too much for me at times), your body will have a physiological, inflammatory response to emotional stress.
- Lack of down time: When you’re always on the computer, always checking your email/Facebook/smartphone, you are always “on.” You may think you’re relaxing because your body is stationary, but you’re not relaxing.
- Lack of nature time: We spend too much time contained in cubicles, cars, trains, and cities, away from trees, leaves, and soft earth. In a way, nature is home for us. Going home certainly has its measured benefits.
- Poor gut health: The gut houses the bulk of the human immune system. When it’s unhealthy, so is your inflammatory regulation. A healthy gut is also selectively permeable, allowing beneficial compounds passage into the body and keeping toxins out. An unhealthy gut often becomes leaky, allowing toxins into the body to stimulate an immune, inflammatory response.
- Poor acute stressor/chronic stress ratio: We respond far better to acute stressors than repeated, sustained stress – even if the latter is of a lower intensity.
See what I mean? Since we’re set up for acute stressors requiring an acute inflammatory response, all this other low-level, evolutionarily-discordant, superficially mild stuff set against a backdrop of misaligned fatty acid ratios and impaired gut health throws us off and sets us up for a lifetime of chronic inflammation.
Inflammation is a complex physiological process that can go wrong in a lot of ways. But luckily, sticking to the tried and true dietary and lifestyle measures will get you most of the way toward preventing inflammation from becoming chronic and untamed.
If you have any further questions about inflammation, fire away down below! Thanks for reading.
Eliakim A, Portal S, Zadik Z, et al. The effect of a volleyball practice on anabolic hormones and inflammatory markers in elite male and female adolescent players. J Strength Cond Res. 2009;23(5):1553-9.
Lara fernandes J, Serrano CV, Toledo F, et al. Acute and chronic effects of exercise on inflammatory markers and B-type natriuretic peptide in patients with coronary artery disease. Clin Res Cardiol. 2011;100(1):77-84.
Ford ES. Does exercise reduce inflammation? Physical activity and C-reactive protein among U.S. adults. Epidemiology. 2002;13(5):561-8.
Balducci S, Zanuso S, Nicolucci A, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis. 2010;20(8):608-17.
Daray LA, Henagan TM, Zanovec M, et al. Endurance and resistance training lowers C-reactive protein in young, healthy females. Appl Physiol Nutr Metab. 2011;36(5):660-70.
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The ketogenic diet has exploded in popularity over the last few years. Hordes of people are using it to lose body fat, overcome metabolic diseases, improve their endurance performance, attain steady energy levels, make their brain work better, and control seizures. And increasing numbers of researchers and personal experimenters are even exploring the utility of ketogenic diets in preventing and/or treating cancer. After all, back in the early part of the 20th century, Warburg discovered an important characteristic of most cancer cells: they generate their energy by burning glucose. If a particular cancer loves glucose, what happens if you reduce its presence in your body and start burning fat and ketones instead?
It’s taken a while, but the research community is finally beginning to take a few swings at this and similar questions.
So, what do we know?
First, let’s just go through a few recent human studies and case studies.
Keto and Cancer Treatment
Women with endometrial or ovarian cancer improved energy levels, appetite, and physical function on a ketogenic diet.
A Bayesian approach to studying the effects of ketogenic diets in humans and animals with high grade glioma (a brain cancer) found an “overall survival-prolonging effect.”
In gliomas, an analysis of available case studies using ketogenic diets found increased overall or progression-free survival. These were not randomized controlled trials, however, so they say nothing definitive.
A recent review paper gives a good overview of the current state of ketogenic diet and cancer research, finding that:
- Ketosis targets tumor metabolism.
- Ketosis improves effectiveness of conventional therapies.
- Ketosis has favorable effects of anti-cancer gene expression.
One thing you might notice is that there are no studies showing that standalone ketogenic diets cure cancer. There aren’t very many randomized controlled trials in general.
What there are are studies showing that ketogenic diets are safe and potentially effective adjuvant treatments—treatments that supplement conventional cancer treatments. You don’t see keto “defeating” cancer alone. You see keto enhancing the effect of chemotherapy. You see keto enhancing the effect of radiation. You see keto protecting normal cells and increasing the vulnerability of cancer cells to conventional treatment.
That’s not to say that keto can’t beat cancer. Maybe it can. But the clinical research simply isn’t there to say one way or the other.
Where keto seems even more promising is in prevention of cancer.
Keto and Cancer Prevention
Diabetes is a disease of carbohydrate intolerance. It’s a disease in which carbohydrate consumption results in elevated blood sugar, exaggerated insulin response. The way most people with diabetes eat leads to chronically high levels of insulin and blood sugar. Yeah, yeah, I know about all the badass Primal eaters who are “technically” diabetic but keep their blood sugar pristine and insulin minimized by watching what they eat, exercising regularly, and just generally leading a healthy lifestyle—but those people aren’t a large enough a group to have an effect on the category known as (and studied as) “diabetics.” Most people with diabetes unfortunately keep eating the same junk that got them there.
What does research say about the cancer rate of most people with diabetes? It’s usually higher.
One of the most consistent risk factors for many types of cancer is having diabetes and experiencing all the metabolic fallout that entails—high fasting insulin, insulin resistance, elevated blood glucose. Cancers of the liver, pancreas, breast, endometrium, bladder, and kidney all have strong associations with type 2 diabetes. This should come as no surprise. Not only do many cancers thrive on glucose as fuel, the high insulin levels typical of people with diabetes and insulin resistance increase the availability of growth factors that promote cancer growth.
Meanwhile, therapies that are known to reduce the symptoms of diabetes—lower fasting insulin, increase insulin sensitivity, normalize blood sugar, etc—tend to lower the risk of cancer. A perfect example is metformin.
Metformin activates AMPK, the same autophagy pathway activated by exercise, fasting, polyphenol consumption, and reduced calorie intake. It lowers blood sugar, increases insulin sensitivity, and extends the lifespan of type 2 diabetics.
Metformin also seems to protect against cancer. It lowers hyperinsulinemia and may protect against insulin-related cancers (breast, colon, etc). Early treatment during adolescence, for example, protects rats against later tumor growth.
What does this have to do with ketogenic diets?
Ketogenic diets have many similar effects. They activate AMPK. They lower blood sugar. They’re great for fat and weight loss, which enhances insulin sensitivity. Recently, researchers have even used ketogenic diets to resolve type 2 diabetes.
Now, not all cancers are linked to diabetes. For example, diabetes doesn’t increase the risk of gastric cancer. That’s because it’s linked to bacterial infection, not elevated blood sugar. And that’s why taking metformin doesn’t reduce the risk of gastric cancer. This actually supports my hypothesis that, when diabetes does not increase the risk of a cancer, neither does metformin reduce it—like gastric cancer. Diabetes doesn’t increase it, so metformin doesn’t reduce it. That’s the mechanism in play.
Nor do all cancers burn glucose exclusively. Some thrive in a ketogenic environment.
There is a mutation called BRAF V600E in certain cancer cells that allows them to utilize ketone bodies to stimulate growth. About 50% of melanoma, 10% of colorectal cancer, 100% of hairy cell leukemia, and 5% of multiple myeloma cases exhibit the ketone-utilizing BRAF V600E mutation. Indeed, a cancer cell’s inability to break down and metabolize ketone bodies is the best predictor of whether a ketogenic diet can even help against a given cancer.
But if we’re talking prevention. If we accept that not developing diabetes—all else being equal— probably reduces the risk of getting cancer, then using ketosis to improve all the same symptoms linked to diabetes should also reduce the risk of getting cancer. And if it doesn’t reduce the risk, it probably won’t hurt. I mean, is there a doctor alive who claims that increasing insulin sensitivity, lowering hyperinsulinemia, and losing body fat will increase the risk of cancer?
A Few Takeaways To Consider
As I see it—and this is not medical advice—the most promising use of ketogenic diets in cancer are as follows.
Adjuvant therapy: Using ketosis to enhance the efficacy of conventional therapies like chemotherapy and radiation, increasing the susceptibility of cancer cells to treatment and increasing survival of healthy host cells.
Prevention: Using ketosis (whether intermittently or long term) to lower fasting blood glucose, reduce diabetes risk (or resolve extant diabetes), and improve your ability to burn fat and not rely on exogenous glucose so much should in theory reduce your risk of most cancers.
Whatever you do, if you’re an actual cancer patient, discuss this with your doctor. Make sure your particular variety of cancer isn’t partial to ketones. Make sure it’s one of the cancers that actually craves glucose. If you end up with a cancer that thrives on ketone bodies, and you go deep into perpetual ketosis, you could be making an enormous mistake.
But the bottom line is that, assuming you don’t already have one of the cancers known to utilize ketones, going into ketosis from time to time isn’t going to hurt—and it will probably help reduce the risk of cancer.
I’m going to close this post with an anecdote from one of my employees. His father passed away a dozen years ago from multiple myeloma, a type of white blood cell cancer. This was before he worked at Primal Nutrition; he was just getting involved in alternative forms of health and nutrition research. What struck him most, particularly in retrospect, was how his father’s appetite changed during his battle with cancer. He began craving candy—Reese’s peanut butter cups, Hershey’s kisses, Now-and-Laters, and all other kinds. As he says it, looking at his dad’s snack drawer was like looking at the archetypal bag of Halloween candy.
I don’t know if this is evidence of anything. Can cancer actually tap into your specific appetites? Can it change how you perceive and desire specific foods? Was his father actually being programmed by his cancer to over-consume sugar?
What I do know is that no one needs garbage candy. A few seconds of momentary gustatory pleasure, followed by regret and the incessant need to repeat—is it worth it? Is it worth the off chance that eating lots of sugar feeds and promotes cancer? Don’t do it, folks. I know my longtime readers are right there with me. I know you guys who’ve been here from the beginning are probably getting egged on Halloween because you’re giving out collagen packets and mini-kettlebells. But if you’re new to this site and way of eating in general—maybe a co-worker passed my info along to you, maybe you’re trying to make a big change in the way you eat and live—avoiding the obviously terrible-for-you stuff like candy and baked goods is the biggest change you can make. And not just for cancer.
So, do I want you to walk away from this post thinking that keto is a cancer cure? No. I’m a fan of ketosis, and I think almost everyone should spend time in that metabolic state, but I don’t consider it to be magical. The jury is definitely still out. Does ketosis look like a strong candidate for improving efficacy of various therapies in certain cancer patients? Yes. Can keto improve health markers shown to reduce a person’s risk of getting cancer in the first place? Yes.
The keys to good health are generally speaking pretty consistent.
- Maintain good insulin sensitivity.
- Avoid glucose intolerance.
- Get plenty of sleep.
- Consume hormetic stressors.
- Avoid obesity. Lose body fat.
- Exercise, or at least move every day.
- Dip into ketosis on a regular basis, either from ketogenic dieting, fasting, meal skipping, or (non-chronic) hard training—or all of the above.
There’s no guarantee against cancer, but I think the advice I just mentioned supports a good fighting chance.
Take care, everyone. Be well.
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The fitness world is booming these days. You can see it in the popularity of CrossFit boxes, obstacle course and endurance events, and record-breaking gym construction. It’s encouraging. Inspiring even. But there’s also a downside to the rising gym memberships and event registrations. There are still too many people dealing with recurring patterns of breakdown, burnout, illness and injury. More people are trying to do the right thing, but the flawed approaches they often gravitate to end up derailing them.
Nonetheless, there are changes afoot. It’s an evolution of thinking that’s slowly spreading its way through fitness circles. More forward-thinking coaches, trainers, and researchers are helping right the wrongs of the fitness boom with a general rejection of the “more is better” approach for one that respects the importance of balancing stress and rest, one that moves toward an intuitive approach to workout planning.
More people are implementing strategies to maximize workout return on investment and minimize the risk of injury and burnout that too often result from an indiscriminate approach. The endurance world, for example, is finally rejecting the narrowly focused, overly stressful chronic cardio approach of old in favor of emphasizing aerobic development at lower heart rates, avoiding chronic patterns, and becoming fat adapted instead of sugar addicted. Endurance athletes are embracing the importance of strength training and explosive sprinting just as strength/power athletes are doing more aerobic conditioning. The CrossFit movement itself is an ode to the health and longevity benefits and increased enjoyment that comes from achieving broader fitness competency.
What’s Wrong With HIIT?
I’ve talked recently about microworkouts and recovery-based workouts. Today, I want to delve in further and share a radical transformation in the way high intensity workouts are conducted that will generate fitness breakthroughs while simultaneously minimizing the risk of exhaustion. Specifically, I’m taking aim at the extremely popular workout pattern known as HIIT—High Intensity Interval Training. Sprinting is a part of the Primal Blueprint Fitness Pyramid, but I’ve been wary of the details around traditional HIIT practices because these workouts are quite often too stressful and exhausting to deliver the intended fitness boost they promise.
Yes, you have to challenge your body regularly with hard efforts to build fitness, but most of us do it the wrong way. When you complete a killer HIIT session at morning boot camp or spin class, at home on your Peloton bike, or with the Tuesday night track group, you get a tremendous sense of accomplishment and a flood of feel-good endorphin chemicals into your bloodstream. Unfortunately, the typical HIIT workout can also be depleting, exhausting, and stimulate an assortment of unnecessary cellular damage and inflammation.
It doesn’t have to be that way. Be redesigning your high intensity workouts, you can get leaner and fitter with higher quality, more explosive, less physically stressful workouts that are easier to recover from and thus can be performed more frequently. In short, a better approach involves transitioning from HIIT to HIRT, High Intensity Repeat Training. HIRT is an acronym coined by Dr. Craig Marker, psychologist, certified strength and conditioning coach, and CrossFit instructor from Florida.
Here’s a compare and contrast that can revolutionize your approach to intense workouts….
Comparing HIIT and HIRT
The problem with a typical HIIT workout is that it’s too strenuous—too many repetitions of hard effort that (each) last too long, and with insufficient rest between hard efforts. This results in cumulative fatigue during the workout, a diminishing quality of performance over the course of the workout, increased cellular damage due to this cumulative fatigue, and extended recovery time afterward. These kinds of sufferfests are a great source of satisfaction and personal growth when you high five your fellow bootcamp classmates after an hour of power, or cross the finish line of a big event in which you’ve trained for months to prepare. But including them as a major and recurring element of your training program is a really bad idea. Unfortunately, the sufferfest mindset is incredibly common these days, perhaps suggesting that the ego has more influence that strategic planning or intuitive decision making.
A HIRT workout stops short of the exhaustive nature of HIIT. The essence of HIRT is to conduct maximum efforts, typically of shorter duration, with much longer recovery, and fewer total efforts than a HIIT session. The word “Repeat” in the acronym suggests that you maintain a consistent quality of effort on every repetition of hard work. This means not only the same performance standard, but also the same level of perceived exertion.
For example, say your workout entails running 100-meter sprints across a football field, and you hit 18 seconds for your first sprint. This is a nice controlled, explosive effort with excellent technique, and you assign a perceived exertion level of around 90 out of 100. Hence, you’ll want to do successive sprints in 18-19 seconds each, preserving explosiveness and excellent technique—delivering what you still discern to be 90 out of 100 on the effort scale. If you have to “dig deep” (the implicit objective, and badge of honor, with a HIIT session) just to arrive at 19 seconds on your fourth effort, that’s it, you’re done. If you notice a slight attrition in explosiveness or breaking form during the effort, you’re done. Typically, this might be a little twinge in the hamstrings or lower back, a tensing of the face or chest, or any other indicator that you have played your best cards of the day.
In Dr. Marker’s landmark article titled “HIIT versus HIRT” at www.BreakingMuscle.com, he explains that after HIIT sessions we bask in self-satisfaction of a job well-done, but disregard the health-destructive consequences of these sufferfests: “[Y]our subjective feeling of the effectiveness of a workout is not as important as what science tells us is important to building an impressive base of endurance and changing your body composition.” (That sound you hear is a slap to the face of highly motivated, goal oriented, Type-A fitness enthusiasts across the land. Don’t worry, I’ve been there, too….)
This admonition applies to everyone from elites to novices. Elite athletes are notorious for constantly pushing the envelope and frequently succumbing to injuries or periods of declining performances. Novices generally don’t concern themselves with training strategies, often leaving their fates in the hands of the bootcamp instructor. Without sufficient experience or reference points, they exercise themselves into exhaustion, believing that pain and suffering are part and parcel of the fitness experience.
The (too often) result? Ambitious, well-meaning enthusiasts burn themselves out and then are down for the count. The most dedicated keep going to their detriment, all the while accumulating fatigue, injuries and even pounds. Others simply stay away from the gym by invisible magnetic force. Alas, the subconscious is very good at avoiding sources of pain and suffering. Can we dump this suffering-and-attrition dynamic already?
Side note for those who love to read about sports: For inspiration, check out this article about the greatest marathon runner in the history of the planet, the amazing Kenyan Eulid Kipchoge. The article describes his training regimen as extremely devoted and incredibly impressive, yet he maintains a relaxed mindset, remains in control of his energy output, and never extends beyond his limits into exhaustion. Even the march to the unthinkable two-hour marathon (Kipchoge’s current world record stands at a mind-bending 2:01.39) comes from a sensible approach instead of an extreme one.
Marker explains that there’s an optimal duration for sprinting where you can obtain maximum benefits with minimal cellular destruction, and this is typically around 15-20 seconds. Try to maintain maximum effort for any longer than that and you’re not really sprinting anymore anyway, since it’s impossible to maintain maximum energy output.
Here’s why this works:
Look at what’s happening physiologically over the duration of a near-maximum intensity sprint of any kind (running, cycling, rowing, or kettlebell swings). During the first five seconds of your sprint, lactate starts to accumulate in the bloodstream. Lactate levels double between five to ten seconds, then double again from 10 seconds to 20 seconds—up to what Marker calls the highest acceptable level. As you increasingly feel the burn, lactate doubles again from 20 seconds to 30 seconds. It doubles again from 30 seconds to 60 seconds, causing cellular destruction, ammonia toxicity, and extended recovery time.
As Marker explains, “The amount of lactic acid produced up to 20 seconds [of sprinting] is still manageable, but the next doubling is over the top. Even a single 30-second sprint spikes ammonia levels almost five times! Why trash the body for no good reason? Rebuilding broken down cells is a costly and time-consuming process. And while it’s taking place, you feel tired and run down, with your ATP short of a full stack.”
You may be familiar with the Tabata concept of interval training, which entails a repeating pattern of work efforts lasting twice as long as rest intervals until you complete a Tabata set of a certain total duration. The original Tabata protocol, developed by Japanese physician and researcher Dr. Izumi Tabata and colleagues at the Japanese Institute of Fitness and Sport in Tokyo, calls for four minutes of a 20-second sprint, 10-second rest, 20-second sprint, 10-second rest pattern. In the original studies, Japanese Olympic speed skaters achieved massive boosts in VO2 Max in a short time with Tabata training. Unfortunately, the original Tabata concept has been widely misappropriated into workouts that honor the 2:1 work-to-rest ratio, but carry on for too long and generate cellular damage and exhaustion: multiple sets of kettlebell swings, pushups, box jumps, running sprints, cycling sprints, and so forth. Bottom line with sprint workouts: a little goes a long way, and too much can really mess you up.
How To Transition From HIIT To HIRT
To transition into a more effective, less stressful high intensity workout pattern, pick the sweet spot of 10-20 seconds for your explosive efforts. Take what Marker calls “luxurious” rest intervals to ensure that your cells have a chance to partially or fully regenerate ATP (takes around three minutes) and minimize the disassembling and deamination that occur when you ask your body to perform again and again with rapidly depleting cellular energy.
Finally, conduct between 4 and 10 sprints. You should be able to manage four shorts sprints even if you’re a novice. If you claim you can complete more than 10 and feel great, you’re better off going faster and doing fewer more explosively.
Keep in mind that a properly conducted HIRT workout is going to feel different than a HIIT sufferfest. It may require an adjustment in your mindset to feel confident and satisfied that you’re training with maximum efficiency and minimal suffering like a “real athlete.” If you’re a focused, driven, goal-oriented type, be vigilant about resisting the addictive allure of the endorphin rush that happens after a sufferfest. Remember, the blissful feeling of powerful pain-killing chemicals flooding your bloodstream is a fight or flight reaction to the extreme stress of the workout. Realize that the genetic purpose of the endorphin response is to help you continue to run for your life instead of lay down in exhaustion! If you abuse this delicate mechanism with a chronic pattern of extreme workouts, you’re going to pay a heavy price. Dr. Tommy Wood calls this overactivation of the fight or flight response, “liquidating your assets,” and I couldn’t agree more.
Several friends who have recently updated their approach to a HIRT protocol report feeling much better in the days following their most challenging sessions—more energy, less soreness and stiffness. That’s how it should be.
Combine the HIRT strategy with recovery-based workouts and walking. See how it goes for you, and let me know. Thanks for stopping in. Share your questions and thoughts below, too.
The post HIIT vs. HIRT: Reducing Workout Stress To Increase Fitness appeared first on Mark’s Daily Apple.
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