I know we missed Valentine’s Day, but I’ve always said love cannot be contained. Besides: People are always going on dates. People are always searching for new ways to break out of the regular mold, which is completely understandable. Dates are try-outs. You’re spending time with another person to determine how they fit into your life. Unconventional dates that branch out from “dinner, movie, drinks” into more adventurous, creative realms provide excellent feedback for making that determination.

Dates are also a way for established couples to keep things fresh and exciting, to keep the relationship moving. There’s no better way than to try something new.

As it happens, most work for friends, too.

Now, some of these dates are silly or out-of-left field. Some are more serious. And one is a Primal Costanza date—what not to do. But regardless, they are all worth exploring. And—as always—I’d love to hear what you’d add.

1) Watch a Movie and Fill In the Dialogue

You know that scene in Eternal Sunshine of the Spotless Mind where Jim Carrey and Kate Winslet are watching a drive-in movie without sound and filling in the dialogue themselves? Do the same thing, only make all the dialogue health and fitness-related. For example, The Empire Strikes Back would work great.

Just before Han is frozen in carbonite, Leia speaks. “I love cold therapy, so many benefits. I can send you the PubMed links.” Han replies. “I know.”

Vader gives Luke the bad news. “Luke, I am a vegan.” “Nooooooooo!”

Pick your favorite movie, and try it out yourselves. Drive-ins aren’t necessary (do they even still have those?); you could just put the T.V. on mute.

2) Couples’ Spa Day

A couple hundreds years ago, you didn’t really go to the doctor. You’d go to a spa. Spas were healing centers erected around natural springs of mineral-rich water. People would bathe in it (many were hot springs), drink it, and engage in other healthy pursuits. Many of today’s most popular bottled mineral waters come from springs that doubled as health spas back in earlier days.

The average person may think of a spa as a pleasure center, a superficial luxury. But getting a massage, soaking in hot mineral water, smearing yourself with mud and/or clay, exposing yourself to extreme temperatures in the sauna, steam room, and cold water pool? These are all objectively healthy and pleasurable experiences with measurable benefits.

Go for a hot soak, followed by a cold plunge. Do the mud bath thing. Get a deep tissue massage. Soak in the salty mineral-rich brine. And do it with your date, as your date.

3) Get Physical

No, not like that (necessarily). I’m talking about doing something physically demanding together, like a yoga session, a tough hike, a Tough Mudder, a Krav Maga class, or even a CrossFit workout.

Intense physical exertion—performed together—increases bonding. You’re sweating, you’re touching, you’re working hard toward a goal. You’re a team. Make it a little dangerous and the juices really flow. For the same reason, going to see a scary movie helps couples get closer.

4) Go Dancing or Take Dance Lessons

Dance is the prelude to closer, more intimate physical contact. And it’s incredibly healthy learning to move with cohesion and fluidity and precision through constantly varying ranges of motion. Dancers are some of the most athletic folks around—think b-boys, ballet dancers, practitioners of modern dance. I’m not a follower of the show, but seriously just look at an episode of “So You Think You Can Dance” for plain evidence of their athleticism.

Go dance, or take dance lessons if you can’t dance yet. If the latter, don’t make this a one-off. Keep the lessons going. Build that skill together. Move together.

Dancing together in your living room to music on your smartphone is completely valid, too.

5) Cook the Farmer’s Market

This is a fun little date to try. Carrie and I used to do this at the Malibu farmer’s market every once in awhile.

Go to every stand, ask the farmer what’s best today, and then buy that item. If your market is huge, you don’t need to buy from every single stand. Try to stick to a dozen stands or so just to keep things manageable.

Be reasonable with the quantities. Otherwise it’ll add up fast. If, say, the farmer recommends the leeks, buy a couple leeks. If it’s cauliflower, buy a head. If it’s strawberries, buy a basket.

Go home and create a meal together using only the things you purchased from the market. Use things like oil/cooking fat, salt, pepper, and spices from home (unless you bought them at the market, in which case you get extra points). If your market doesn’t offer any meat, feel free to incorporate store-bought meat. But do your best to use only things from the market.

Prep and cook it together. There you go, that’s your date.

6) Ten-Mile Date

Walk ten miles, at least. It can be through the city, the suburbs, or the forest. You can stop at stores, cafes, museums along the way—it doesn’t have to be ten miles straight without stopping. But get those ten miles in however you can.

7) Roughhouse

Roughhousing is universal. It’s also great fun. You roughhouse. You wrestle, jostle, poke, prod, but you don’t (ever) hurt each other. You keep things light, engaged, dancing on the edge of intensity. I really like Rafe Kelley’s approach. Check out the one where he and his partner act like their wrists are glued together as they move around, roll, push, and pull. Or where they stand on a large log, clasp hands, and try to pull each other off balance. That stuff is really fun. I’d try any of the videos from that link.

Another is one-legged tug of war. You each stand on one leg, clasp the other’s hand, and attempt to pull the other off balance. If there’s a big weight or strength disparity, have the stronger person stay on one foot and the weaker person use both. Put pillows and other soft landing spaces around your perimeter.

If you’re a man and she’s a woman, there will probably be some strength disparities. Use your better judgement. Keep things fair and competitive and fun.

8) Picnic and a Hike

Think back to all the hikes you’ve done, all the wilderness areas you’ve explored. Were there any perfect picnic spots that jumped out at you? Maybe a dry pebbly shore next to a gurgling creek. Maybe a ring of redwoods. Maybe a grassy meadow. Maybe a beach that only locals know about. If nothing comes to mind, Google one.

Then pack a lunch and get moving.

9) Stand-Up Paddling

I’m extremely biased. Stand-up paddling is probably my favorite activity. It’s training, meditation, adventure, and a fantastic core and rear delt/lat workout all in one. I’ve seen dolphins, manatees, whales, and any number of marine life on my board. I’ve hit the flow state on my board. I’ve finally figured out meditation being on my board. I’ve woken up with some of the most intense DOMS after a long day on my board. My transverse abdominals and obliques have never been stronger. It’s an all-around great time—and it makes a great date. We’re no longer youngsters in love, but Carrie and I have had a lot of good times when I can get her out on a board.

Not everyone has access to a paddle-worthy body of water, although more than you’d think—rivers, lakes, and reservoirs all work with a paddle board, not just the ocean. If you can’t paddle, something similar like kayaking or even cross-country skiing will work well.

10) Lecture Your Date At Dinner

Make sure your date knows exactly how unhealthy everything he or she is putting in her mouth.

When he orders pasta, make a face.

When she fails to confirm that the salad dressing was made with extra virgin olive oil, pull the waiter aside and do it for her.

When he orders the fish, let him know the Monterey Bay rating.

If she gets anything deep-fried, tell her all about how restaurants reuse cooking oil, which (by the way) is most likely very high in unstable polyunsaturated fats.

This will ensure a second date.

That’s it for today, folks. If you try any of these date ideas, let me know how it goes. If you have any other ideas, write them in down below!

Take care.

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Over the years, I’ve gotten a lot of questions from Mark’s Daily Apple readers about how I do my day. What do I eat each day? What are my favorite snacks? What do I do for exercise? How do I work out when I’m on the road? What supplements do I take (and how often)? Even what personal products I use… I feel like I’ve covered about everything there is, but then I’ll get something new. In this case, some readers over the last year have asked me about my bedtime. Do I have a routine? Just what do I do to get a good night sleep?

Quality sleep isn’t in any way optional for good health. In fact, it’s a Primal Blueprint Law. That means I consider the hour or two leading up to bedtime as important as my workout time.

Here’s my nightly ritual rundown. As you’ll see in the video, it takes advantage of the relaxing effect of heat along with the Grok Tip of finishing cold—a theme I continue with attention to the ambient temperature of my room. Check out how I wind down my day (and even what I’m reading before bed) below.

Thanks for stopping in today, everybody. Do you have a question for me to answer in a future video? Shoot me a line below. Otherwise, be sure to share your favorite tips for enjoying a great night sleep. Have a great week, everyone.

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The post My Evening Routine: How I Manufacture a Great Night Sleep appeared first on Mark’s Daily Apple.

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This is a surprisingly common question.

To get it out of the way: Yes, it does. Bone broth contains calories, and true fasts do not allow calorie consumption. You eat calories, you break the fast.

However, most people aren’t fasting to be able to brag about eating no calories for X number of days. They fast for shorter (often intermittent) periods of time for specific health benefits. It’s entirely possible that bone broth “breaks a fast” but allows many of the benefits we associate with fasting to occur.

As is the problem with so many of these specific requests, there aren’t any studies addressing the specific question. The scientific community hasn’t caught up to the current trends sweeping the alternative health community. But we can isolate the most common benefits of fasting and see how bone broth—and the components therein—interact.

Common Benefits of Fasting: Does Bone Broth Help or Hinder?

Ketosis

Fasting is a quick and easy (or simple) way to get into ketosis. You have little choice in the matter. Since you’re not eating anything, and your body requires energy, you break down body fat for energy. And because you’ve only got fat “coming in,” you’ll quickly start generating ketone bodies. If bone broth stops ketosis, it’s probably breaking the fast.

Bone broth doesn’t contain any digestible carbohydrates. Common additions like tomato paste and carrots might add a few tenths of a gram of carbohydrate to your cup of broth, but not enough to throw you out of ketosis.

Bone broth is quite high in protein, especially if you make it right or buy the right kind, but if it’s the only thing you’re consuming during your fast, the overall caloric load won’t be enough for the protein in broth to stop ketosis.

I can’t point to a paper. I know for a fact that I’ve consumed bone broth without affecting my ketones.

Fat Burning

Fat-burning is another important aspect of fasting. Since bone broth contains calories, you’ll probably burn slightly less fat drinking broth during a fast. But the calories come from protein, the macronutrient least associated with fat gain and most supportive of lean mass retention. And at any rate, your total calorie intake on a fasting+broth day will be under 100 calories—plenty low enough to promote fat loss.

Insulin Sensitivity

Over the long term, fasting is an effective way to improve insulin sensitivity and glucose tolerance. Most things that make you better at burning fat and expending, rather than storing, energy—like exercise, low-carb diets, weight loss in general—tend to improve insulin sensitivity over time. But the sometimes counterintuitive piece to all this is that in the short term, fasting can reduce insulin sensitivity. This is a physiological measure the body takes to preserve what little glucose remains for the brain. All the other tissues become insulin resistant so that the parts of the brain that can’t run on ketones and require glucose get enough of the latter to function.

There’s also the matter of sleep, fasting, and insulin sensitivity to consider. Some people report sleep disturbances during fasts, especially longer fasts. This is common. If the body perceives the fast as stressful, or if you aren’t quite adapted to burning fat, you may interpret the depleted liver glycogen as dangerous and be woken up to refuel in the middle of the night. Some people just have trouble sleeping on low-calorie intakes in general, and a fast is about as low as you can get. If that’s you, and your fasting is hurting your sleep, it’s most likely also impairing your insulin sensitivity because a bad night’s sleep is one of the most reliable ways to induce a state of insulin resistance. There’s some indication that total sleep deprivation creates transient type 2 diabetes.

That’s where bone broth comes in. A big mug of broth is one of my favorite ways to ensure a good night’s sleep. It’s a great source of glycine, an amino acid that has been shown in several studies to improve sleep quality and reduce the time it takes to fall asleep. It may “break” the fast by introducing calories, but a broken fast is preferable to bad sleep and the hit to insulin sensitivity that results from it.

Autophagy

Things fall apart. Cars, tools, buildings, toy trucks, civilizations. That’s entropy, which dictates that all things are constantly heading toward disorder. And people aren’t exempt. Our cells and tissues are subject to entropy, too, only we can resist it. One of the ways our bodies resist entropy is through a process of cellular pruning and cleanup called autophagy.  There’s always a bit of back and forth between autophagy and our cellular detritus, but it occurs most powerfully in periods of caloric restriction. Fasting enhances autophagy like nothing else because it’s a period of total caloric restriction.  If bone broth destroys autophagy, that’d be a big mark against drinking it during a fast.

Amino acids tend to be anti-autophagy signaling agents. When we eat protein, or even consume certain isolated amino acids, autophagy slows. Bone broth is pure protein. It’s almost nothing but amino acids. The key is: Which amino acids are in bone broth, and have they been shown to impede autophagy?

The primary amino acids that make up the gelatin in bone broth are alanine, glycine, proline, hydroxyproline, and glutamine.

Let’s say you’re drinking a mug of strong, really gelatinous bone broth with 15 grams of gelatin protein. How do those amino acids break down?

So it’s a mixed bag. The most prominent amino acid in bone broth—glycine—seems to allow autophagy, but the less proinent amino acids may not. It’s unclear just how much of each amino acid it takes to affect autophagy either way. The absolute amounts found in bone broth are low enough that I’m not too concerned.

What Else To Know…

Okay, so while bone broth technically “breaks” the fast, it may preserve some of the most important benefits. Is there anything else related to bone broth and fasting that deserve mention?

If you’re the type to train in a fasted state and eat right after, you might consider incorporating some bone broth right before the workout. Just like my pre-workout collagen smoothie does, bone broth (plus a little vitamin C to aid the effect) right before a workout improves the adaptations of our connective tissue to the training by increasing collagen deposition in the tendons, ligaments, and cartilage. You’ve already done most of the fast honestly. What’s shaving off a half hour of fasting time by drinking some broth or collagen, especially if you stand to improve your connective tissue in the process? Ask any older athlete and they’ll say they wish they could.

Some spices and herbs that are often added to bone broth can have effects similar to fasting. Take curcumin, found in turmeric. Research shows that it’s an independent activator of mTOR, which in turn can activate autophagy. Ginger and green tea (what, you haven’t tried steeping green tea in bone broth?) are other ones to try. Bone broth with turmeric, green tea, and ginger might actually combine to form a decent autophagy-preserving drink during a fast. Only one way to find out!

That’s about it for bone broth and fasting. If you have any further questions, don’t hesitate to ask down below.

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References:

Xu X, Wang X, Wu H, et al. Glycine Relieves Intestinal Injury by Maintaining mTOR Signaling and Suppressing AMPK, TLR4, and NOD Signaling in Weaned Piglets after Lipopolysaccharide Challenge. Int J Mol Sci. 2018;19(7)

De urbina JJO, San-miguel B, Vidal-casariego A, et al. Effects Of Oral Glutamine on Inflammatory and Autophagy Responses in Cancer Patients Treated With Abdominal Radiotherapy: A Pilot Randomized Trial. Int J Med Sci. 2017;14(11):1065-1071.

Shaw G, Lee-barthel A, Ross ML, Wang B, Baar K. Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis. Am J Clin Nutr. 2017;105(1):136-143.

Zhao G, Han X, Zheng S, et al. Curcumin induces autophagy, inhibits proliferation and invasion by downregulating AKT/mTOR signaling pathway in human melanoma cells. Oncol Rep. 2016;35(2):1065-74.

Hung JY, Hsu YL, Li CT, et al. 6-Shogaol, an active constituent of dietary ginger, induces autophagy by inhibiting the AKT/mTOR pathway in human non-small cell lung cancer A549 cells. J Agric Food Chem. 2009;57(20):9809-16.

Zhou J, Farah BL, Sinha RA, et al. Epigallocatechin-3-gallate (EGCG), a green tea polyphenol, stimulates hepatic autophagy and lipid clearance. PLoS ONE. 2014;9(1):e87161.

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Fasted workouts are a controversial topic in the fitness world. To some, the idea of working out without “carbing up” or doing the pre-workout protein shake is unthinkable. Won’t my performance suffer? Won’t my muscles shrink? Won’t my body think I’m in the middle of some horrible famine and go into starvation mode?

To others, fasted workouts are sacred tools, the perfect antidote to modern decrepitude. When I train in a fasted state, I can will my adipocytes to release fatty acids and feel the heat as they burn, hear the barely audible *pop* of muscle satellite cells replicating and proliferating, and see visions of my future physique through my gaping third eye. 

Where does the truth lie? Let’s look….

To begin with, the evolutionary argument—the Grok logic—for fasted workouts is extremely appealing and intuitive.

Humans did not evolve with access to 24-7 fast food restaurants, grocery stores containing hundreds of millions of calories, and food supplies so ample that we often throw out half of it before we’re able to eat it. If paleolithic humans wanted to eat, they had to hunt or gather something—both of which require the expenditure of caloric energy—often on an empty stomach. In fact, these “workouts” for hunter-gatherers probably occurred more often than not in a fasted state.

This doesn’t mean that fasted workouts are ideal or optimal for health, performance, and fat loss. It does suggest that humans have the capacity for working out in a fasted state without falling apart or losing all the benefits normally associated with exercise. The question is if fasted workouts offer any special advantages.

Today, I’m going to dig into the literature to explore the most frequent questions and claims about fasted workouts and arrive as close to the truth as we can.

Are Fasted Workouts Good or Bad for Muscle Gain?

Let’s take a look.

One common argument is that since you’re not eating, which already “stresses” the muscles and deprives them of structural substrate, stressing the muscle with exercise causes it to “melt away.” This is overly simplistic, if attractive.

For one, that first bit is wrong. Reasonable durations of fasting don’t cause muscle loss. In fact, you can do a few days of fasting without incurring any significant muscle loss. The ketones generated during the fast have protein-sparing effects, and the fasting-induced spike in growth hormone also spares muscle from breakdown. There was even a study where blocking growth hormone with a GH blocker caused fasting people to lose 50% more muscle than fasters who didn’t get the blocker.

For two, strength training itself is a powerful signal to your body that your muscles are essential tissues vital to your survival. Your body generally tries to avoid burning through essential tissues. Lifting also increases growth hormone. Paired with the fasting-induced GH boost, your muscles will be in good standing.

Okay, so fasted workouts don’t appear to be bad for gains. Are they good?

Fasted training augments the anabolic response—the ability of muscles to take up protein and get bigger and stronger. A 2009 study found that, compared to athletes who lifted weights after breakfast, athletes who lifted weights in the morning before eating had an augmented anabolic response to a post-workout protein-and-carb shake.

Are Fasted Workouts Good for Fat Loss?

This one makes sense, doesn’t it? When you don’t have exogenous calories coming in, and you go for a run or walk or bike ride, your body should burn more body fat since it’s the only energy source available. But does it actually happen?

Well, short term studies find that fasted cardio increases fat oxidation in the body. People who go for a run in a fasted state have a lower respiratory quotient, an indication of greater fat burning versus glucose burning. One study found that a morning fasted cardio session increased 24-hour fat oxidation by 50% in young men.

An increase in 24-hour fat oxidation doesn’t say much about long term fat loss, however.

Another study followed a group of healthy women for four weeks, placing them on a morning fasted cardio routine. Three mornings a week, the subjects would perform 50 minutes of treadmill cardio at 70% of their max heart rate in a fasted state. Both the fasted group and the control group (who performed the same cardio, just not fasted) maintained a daily 500 calorie deficit. What happened?

There were no differences in fat loss between groups. Both groups lost weight and lost body fat, but fasted morning cardio did not accelerate the loss. A recent analysis of the available research came to the same conclusion: no difference in fat loss or weight loss between fasted workouts and fed workouts.

I’d like to see a similar four-week study done with men, who in my experience and from reading the fasting literature tend to have a more favorable response to extremes in caloric restriction.

This isn’t a perfect fasted workout study, but it’s better than nothing. A group of triathletes was placed on a “sleep-low” program: instead of eating a ton of carbs after their afternoon workouts, they ate none at all. They depleted their glycogen with the workout, ate a very low-carb dinner, and went to sleep. Then they woke up and did low-intensity cardio in a fasted state, which is the equivalent of a normal person going for a walk. The study was interested in performance, not fat loss, but the group who did their cardio in a glycogen-depleted, fasted state lost more fat than the control group.

An old bodybuilding classic for shedding fat is the fasted morning walk. Wake up, consume no calories, and go for a brisk 20-30 minute walk. In those who are already pretty lean but want to get very lean (like bodybuilders preparing for competition), fasted low-level cardio can be very effective. This is the hardest body comp transition—from lean to very lean. Lean is what the body “wants,” and going lower requires getting over the natural tendency to hold on to diminished body fat stores. A fasted walk, jog, or cycling session performed in the aerobic zone almost forces the body fat to release into circulation. Insulin is low. Sensitivity is high. The stage is perfect, in theory.

Are Fasted Workouts Good for Performance?

Yes and no.

To answer this question, we must note the distinction between training and competing. You might perform worse in a given workout if you’re fasting. You’ll probably perform better if you’ve eaten. But if you’ve consistently trained in a fasted state, the metabolic and muscle adaptations you’ll acquire will boost performance when you compete in a fed state. And that’s everything, isn’t it? While it’s fun to go hard in a workout, test your PR, and treat your training session like the world championship, the real reason we train is to adapt to the training and get better, fitter, and faster—whether for a legit competition or to simply get healthier. A fasted workout trains you to perform under difficult physiological conditions of low fuel availability, and that comes in handy. You probably wouldn’t enter a race or powerlifting match in a fasted state, but the fasted workouts you did in the months leading up to competition make you more likely to win.

The two are complementary. Train fasted, race fed.

Sprinting performance appears to suffer. In one study, sprinting athletes who had fasted had impaired speed and power thanks to less springiness. In another, fasted sprinting led to slower reaction times. Again—the question is, do the training adaptations you get from sprinting in a fasted state make up for the acute losses in performance?

Ramadan fasters (no food or drink during daylight hours) who engage in sprint training improve their soccer-specific endurance performance. They may suffer during the training, but they get good training effects.

As for strength training, there isn’t much solid scientific evidence that the fasted state improves or harms performance. One thing I’ve noticed—and have also heard from dozens of anecdotal reports—is that fasted workouts fill me with a special sort of energy. For lack of a better term, it feels more “Primal,” like you’re actually on the razor’s edge of desperation and performance, where your entire being is focused on lifting the weight, sprinting the hill, or spearing the deer that represents the difference between food for a week and total starvation. It’s pretty cool.

Some people report the opposite. Some people seriously lag if they haven’t eaten. They need something in their bellies to have a good workout. This is a subjective thing, and you’ll probably find that it changes from workout to workout. For example, strength workouts and low level aerobic activity (hiking, walking, paddling) go well for me on an empty stomach, while I prefer to have something light to eat before really intense Ultimate Frisbee matches. Figure out what works for yourself.

Implications for Certain Populations and Conditions…

Type 2 Diabetes

Fasted training improves several physiological markers that are especially relevant to people with type 2 diabetes. For one, it improves insulin sensitivity. The basic definition of type 2 diabetes is “extreme insulin resistance”; fasted workouts counter that insulin resistance. It also improves fat burning, another deficiency common in type 2 diabetes.

Keto Dieters

Keto dieters and fat-adapted folks on low-carb, high-fat programs seem to do better in the fasted state. If you’re already adept at burning your own body fat and training in a low-carbohydrate state, training in the lowest-carbohydrate state—a fasted one—isn’t a big leap.

Gender

As I’ve written before, women tend to react more poorly to intermittent fasting, especially fasts exceeding 14 hours. They are simply more sensitive to caloric restriction, seeing as how their biological “programming” prefers they have a steady source of calories in place for growing, feeding, and nursing babies. Whether you have kids or not, that’s what a significant portion of your DNA is geared toward.

That’s not to say fasted training doesn’t work for women. It just might not do anything special compared to fed training. For instance, this study found that whether overweight women did high intensity interval training in a fasted or fed state had no effect on the benefits. Both types of training worked equally well, improving body composition and the ability of the muscles to burn fat.

Other research finds that women can benefit from fasted training, though men may derive unique benefits. In another study, men and women performed fed and fasted endurance training. Both men and women saw better VO2max increases when fasted, but fasted men saw bigger boosts to muscle oxidative capacity. Fasting helped both in this case. It just helped men a little more.

How I Use Fasted Training

These days, most of my workouts are performed in the fasted state. Anything resembling lower level “cardio,” like walking, hiking, standup paddling, and bike rides are all done totally fasted.

Before heavy lifting or HIIT sessions, however, I’ll drink 20 grams of collagen peptides with some ketone salts and often creatine monohydrate. This isn’t to “fuel” me. The collagen provides the raw material my connective tissue (tendons, ligaments, cartilage) needs to adapt to the training stress, the creatine provides the substrate for quick ATP generation for short bursts, and—this is speculative, mostly—the ketones provide brain fuel to prevent “bonking” and act as an epigenetic signal for muscle preservation. This drink doesn’t contain many calories, nor does it provoke a huge insulin response. I’m technically breaking the fast, but I’m retaining most of the benefits.

I always continue the fast after my workouts. Going a few more hours without eating enhances the HGH response, which helps spare muscle burning and augments the adaptive responses. The ability to comfortably fast after a training session is a good sign that you’re fat-adapted. If I were trying to maintain some elite athletic schedule, I’d refill my glycogen stores, but I’m not chasing performance anymore. It just doesn’t make sense to burn through them and eat a bunch of carbs only to go do it again.

I don’t train in a fasted state for magical effects. I’m not expecting any miracles and neither should you. But I do think every healthy human should be able to complete a fasted workout without falling apart or losing more than a step.

I can. How about you? Ever try fasted workouts? How do you use fasting to augment your training?

Thanks for reading, everyone.

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References:

Deldicque L, De bock K, Maris M, et al. Increased p70s6k phosphorylation during intake of a protein-carbohydrate drink following resistance exercise in the fasted state. Eur J Appl Physiol. 2010;108(4):791-800.

Marquet LA, Brisswalter J, Louis J, et al. Enhanced Endurance Performance by Periodization of Carbohydrate Intake: “Sleep Low” Strategy. Med Sci Sports Exerc. 2016;48(4):663-72.

Iwayama K, Kurihara R, Nabekura Y, et al. Exercise Increases 24-h Fat Oxidation Only When It Is Performed Before Breakfast. EBioMedicine. 2015;2(12):2003-9.

Schoenfeld BJ, Aragon AA, Wilborn CD, Krieger JW, Sonmez GT. Body composition changes associated with fasted versus non-fasted aerobic exercise. J Int Soc Sports Nutr. 2014;11(1):54.

Aird TP, Davies RW, Carson BP. Effects of fasted vs fed-state exercise on performance and post-exercise metabolism: A systematic review and meta-analysis. Scand J Med Sci Sports. 2018;28(5):1476-1493.

Cherif A, Meeusen R, Farooq A, et al. Three Days of Intermittent Fasting: Repeated-Sprint Performance Decreased by Vertical-Stiffness Impairment. Int J Sports Physiol Perform. 2017;12(3):287-294.

Cherif A, Meeusen R, Farooq A, et al. Repeated Sprints in Fasted State Impair Reaction Time Performance. J Am Coll Nutr. 2017;36(3):210-217.

Aloui A, Driss T, Baklouti H, et al. Repeated-sprint training in the fasted state during Ramadan: morning or evening training?. J Sports Med Phys Fitness. 2018;58(7-8):990-997.

The post Fasted Workouts: When They’re More Effective (and How I Incorporate Them) appeared first on Mark’s Daily Apple.

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For many women, menopause can introduce new health challenges. In addition to the symptoms that perturb basic quality of life like hot flashes, headaches, night sweats, and irritability, menopause is also associated with higher risk for serious health concerns like osteoporosis, cognitive decline, and metabolic syndrome. This has made the standard treatment for menopause—hormone replacement therapy, or HRT—a multi-billion dollar business.

A few weeks ago, I explored the benefits and risks of HRT. It has its merits certainly, but it’s not for everyone. Today’s post is for those people. Say you’ve waded through the morass of HRT research and would prefer a different route. Or maybe you’ve actually tried conventional or bioidentical HRT and found it just didn’t work for you. Whatever the reason, you’re probably interested in using “natural” products if you can swing it and if it’ll actually help.

Are there herbal alternatives to HRT that actually work?

As a matter of fact, there are.

Black Cohosh

A medicinal herb native to North America, black cohosh was traditionally used to treat a wide variety of conditions, including rheumatism and other arthritic conditions, colds, fevers, constipation, hives, fatigue, and backache. They used it to help babies get to sleep and soothe kidney troubles. In the mid 20th century, it gained popularity in Europe as a treatment for women’s hormonal issues. Modern clinical research bears out its relevance for menopause:

It’s effective against hot flashes, reducing both severity and frequency.

It improves objective markers of sleep quality (the reduction in hot flashes certainly can’t hurt).

It improves insulin sensitivity, which often degrades during menopause.

It improves early post-menopausal symptoms across the board, leading to a 12.9 point reduction in the Green climacteric score (a basic measure of menopause symptom severity).

In one study, black cohosh was comparable to conventional HRT for reducing most menopausal symptoms and better at reducing anxiety, vaginal bleeding, and breast tenderness.

Here’s a great black cohosh product.

Maca

In its native Peru, maca root was traditionally used as a root vegetable (like a turnip or radish), as well as for its pharmacological properties as an aphrodisiac and subtle stimulant. Incan warriors reportedly used it as a preworkout booster before battles. Today, we know it as an adaptogen—a substance that helps your endocrine system adapt to stress, rather than force it in one direction or another.

A 2011 review of the admittedly limited evidence found that maca shows efficacy against menopause. More recently, maca displayed the ability to lower depression and blood pressure in menopausal women. And earlier, maca helped perimenopausal women resist weight gain and menopausal women regain their sexual function and reduce depression and anxiety.

What’s going on here? According to a 2005 study, maca actually lowers follicle-stimulating hormone and increases luteinizing hormone in postmenopausal women, thereby increasing estrogen and progesterone production.

Make sure you buy gelatinized (cooked) maca, as that’s what the studies use.

Red Clover

The red clover blossom is a rich source of isoflavones, estrogen-like compounds that interact with receptors in our bodies and relieve many symptoms of menopause.

Twelve weeks of red clover cuts the Menopause rating score in half (a good thing!).

Twelve weeks greatly reduces the intensity and frequency of hot flashes and night sweats. Including some probiotics has a similar effect.

Red clover also improves vaginal cellular structure and function while (again) improving menopause symptoms and reducing triglycerides.

More exciting, there’s reason to believe that red clover may reduce the risk of breast cancer and improve bone mineral density in menopausal women.

Here’s a potent red clover supplement.

And then there are those herbs and plants with more limited scopes.

Ginseng

Ginseng has limited application in menopause. It improves sexual function, and Korean red ginseng appears to help libido and reduce the total hot flash score, but neither type of ginseng reduces oxidative stress, improves endometrial thickness, or reduces hot flash frequency.

Here’s some Korean red ginseng. Here’s some concentrated ginseng.

Evening Primrose

It’s good for hot flashes, and that tends to improve other things like socializing and sex, but that’s about it.

Here’s some cold-pressed primrose oil.

St. John’s Wort

You might remember St. John’s Wort as an herbal treatment for such conditions as depression and anxiety, but it’s also quite effective against certain symptoms of menopause.

In one study, 3 months of daily St. John’s Wort supplementation helped perimenopausal women go from three hot flashes to one hot flash a day, get better sleep, and have a better quality of life. In another, it took 8 weeks of St. John’s Wort for both perimenopausal and postmenopausal women to reduce the frequency and severity of their hot flashes. Researchers also combined it with black cohosh to successfully treat hot flash-related moodiness.

This is a pretty good product.

Wild Yam

The yam has been used for hundreds of years for menopause treatment. These days, we know it contains estrogen mimetics known as phytosterols with clinical efficacy in menopausal women.

Try this one.

Before you go fill your Amazon cart with supplements and start chowing down on powders and pills, however, make sure you’re making the right move.

Talk to your doctor about the herbal alternatives mentioned today. Discuss and research potential interactions with medications and even supplements you’re already taking. Be sure to cite the relevant references.

Minimize the variables. Don’t start taking everything from this article. Start with one and evaluate.

Don’t underestimate the power of plants. Just because something is “herbal” or “botanical” doesn’t mean it’s completely benign at all doses.

That’s it for today, folks. Take care, and be sure to write in down below.

Have you ever used any herbs or botanicals to treat menopause symptoms? If so, what worked? What didn’t?

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References:

Mehrpooya M, Rabiee S, Larki-harchegani A, et al. A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. J Educ Health Promot. 2018;7:36.

Jiang K, Jin Y, Huang L, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-67.

Mohammad-alizadeh-charandabi S, Shahnazi M, Nahaee J, Bayatipayan S. Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. Chin Med. 2013;8(1):20.

Zheng TP, Sun AJ, Xue W, et al. Efficacy and safety of Cimicifuga foetida extract on menopausal syndrome in Chinese women. Chin Med J. 2013;126(11):2034-8.

Lee HW, Choi J, Lee Y, Kil KJ, Lee MS. Ginseng for managing menopausal woman’s health: A systematic review of double-blind, randomized, placebo-controlled trials. Medicine (Baltimore). 2016;95(38):e4914.

Lee MS, Shin BC, Yang EJ, Lim HJ, Ernst E. Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas. 2011;70(3):227-33.

Stojanovska L, Law C, Lai B, et al. Maca reduces blood pressure and depression, in a pilot study in postmenopausal women. Climacteric. 2015;18(1):69-78.

Brooks NA, Wilcox G, Walker KZ, Ashton JF, Cox MB, Stojanovska L. Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content. Menopause. 2008;15(6):1157-62.

Shakeri F, Taavoni S, Goushegir A, Haghani H. Effectiveness of red clover in alleviating menopausal symptoms: a 12-week randomized, controlled trial. Climacteric. 2015;18(4):568-73.

Lipovac M, Chedraui P, Gruenhut C, et al. The effect of red clover isoflavone supplementation over vasomotor and menopausal symptoms in postmenopausal women. Gynecol Endocrinol. 2012;28(3):203-7.

Hidalgo LA, Chedraui PA, Morocho N, Ross S, San miguel G. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005;21(5):257-64.

Lambert MNT, Thorup AC, Hansen ESS, Jeppesen PB. Combined Red Clover isoflavones and probiotics potently reduce menopausal vasomotor symptoms. PLoS ONE. 2017;12(6):e0176590.

Beck V, Rohr U, Jungbauer A. Phytoestrogens derived from red clover: an alternative to estrogen replacement therapy?. J Steroid Biochem Mol Biol. 2005;94(5):499-518.

Abdali K, Khajehei M, Tabatabaee HR. Effect of St John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause. 2010;17(2):326-31.

Briese V, Stammwitz U, Friede M, Henneicke-von zepelin HH. Black cohosh with or without St. John’s wort for symptom-specific climacteric treatment–results of a large-scale, controlled, observational study. Maturitas. 2007;57(4):405-14.

The post 7 Herbal Alternatives to HRT appeared first on Mark’s Daily Apple.

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Most people chalk urinary incontinence and excessive urgency up to age. We get old, stuff stops working, we wake up to wet sheets. Cue jokes about adult diapers and investing in “Depends” futures. It’s not entirely out of line. Aging matters. There’s just more to it. Like other aspects of “aging,” incontinence and unreasonable urgency don’t just “happen.” Aging may hasten or accompany the decline, but it’s by no means inevitable, unavoidable, or unmitigated.

There are surgical treatments available, many of which involve the implantation of balloons and slings and rings and hammocks. Those are beyond the scope of this post, which will focus on exercises and other less invasive interventions and preventive measures.

What’s the Deal With Urinary Incontinence?

The most well-known type is stress incontinence. When you do anything intense enough to create pressure, such as a sneeze, a particularly boisterous laugh, a trampoline session, a power clean, or a box jump, the pressure escapes through the weakest point of your body—your slack pelvic floor muscles which support and enable bladder function. The result is inadvertent leakage.

The most common type is urgency incontinence. That’s when you can control your bladder well enough, but you feel like you have to go more frequently than you’d like. This can disrupt sleep and place you in uncomfortable situations.

There’s also prostate-related urinary incontinence. If men have incontinence, it’s usually because of prostate issues or prostate surgery altering the normal flow and function of their urinary tract. Today’s post won’t deal with this explicitly, although many of the exercises I’ll discuss that help women treat incontinence can also help men treat prostate-related incontinence. For more info on this, revisit my post on prostate health from a few weeks back.

Both stress incontinence and urgency incontinence usually have the same cause: pelvic floor dysfunction. The pelvic floor acts as a taut, supple sling of muscle and connective tissue running between the pelvis and the sacrum that supports the pelvic apparatus, including organs, joints, sex organs, bladders, bowels, and various sphincters. We use it to control our urination, our bowel movements, even our sexual functions. It’s very important.

What Goes Wrong?

It gets weak and tight and pulls the sacrum inward (the tail gets pulled toward the front of the body), interfering with urination and urinary control.

What causes pelvic floor dysfunction?

Childbirth is one potential cause, but it’s not a foregone conclusion. Women who have vaginal deliveries are more likely to display more pelvic floor dysfunction than women who have cesareans, while a more recent study found that tool-assisted vaginal delivery and episiotomy were the biggest risk factors for vaginal delivery-associated incontinence, not vaginal delivery alone. Allowing passive descent in the second stage of labor, rather than active pushing from the get-go, might also reduce the association.

Muscular atrophy of the pelvic floor muscles. The pelvis is where the magic happens. It’s where we generate power, walk, run, procreate, dance, and move. To keep it happy, healthy, and strong, we have to move. And then keep moving. Through all the various ranges of space and time and possible permutations of limbs and joints. That’s what all our muscles expect from the environment. It’s what they need. When that doesn’t happen, they atrophy—just like the other muscles.

Who Develops Incontinence?

Stress incontinence is more common among women than men. And most women with stress incontinence are older, although childbirth can increase the incidence.

Signs of Poor Pelvic Floor Function

Besides urinary incontinence and urgency incontinence—which are pretty tough to miss—what are some warning signs of poor pelvic floor function?

Low-to-no glute activity when walking. According to expert Katy Bowman, the glutes play a crucial role in pelvic floor function and incontinence prevention.

Lack of lower back curvature. This suggests your pelvis is being pulled inward due to poor glute activity and/or overly tight pelvic floor musculature.

Muscle atrophy elsewhere. If the muscle’s disappearing from your arms and legs, what do you think is happening in other areas?

What Can You Do?

Work On Your Squat

If you can’t sit in a full squat, with shins fairly vertical and heels down on the ground, you need to work on your form.

I suggest reading this old post by Kelly Starrett describing optimal squat form. He focuses on performance and strength training, but the technique applies equally to basic bodyweight squatting for pelvic floor health.

One thing to emphasize: go as low as you can without reaching “butt wink” threshold. The butt wink is when the pelvis begins rotating backward underneath the body. If you’re butt winking all over the place, you’re shortchanging your glutes and preventing them from balancing out the pelvic floor situation. Stop short of the butt wink.

Squat a Lot

You don’t have to load up the bar, although that’s a great way to build glute strength. In fact, I’d refrain from heavy squatting if you’re currently suffering from urinary incontinence, as the stress placed on that region of the body during a heavy squat can make the problem worse and cause, well, leakage.

I’m mainly talking about everyday squatting: while playing with the kids, picking up dog poop, unloading the dishwasher, brushing your teeth, cleaning the house, gardening. If you can incorporate squatting while using the bathroom, perhaps with a Squatty Potty or similar product, that’s even better. Katy Bowman recommends women squat to pee in the shower as an integral part of her therapy for pelvic floor disorder.

Squat To Use the Toilet (or At Least Get Your Feet Up)

I wrote an entire post almost ten years ago exploring the virtues of squatting to poop. Not only does it improve symptoms in hemorrhoid sufferers, reduce straining, and alleviate constipation, but squatting to poop turns out to relieve a lot of excessive pressure on the pelvic floor musculature.

Not everyone’s going to hoist themselves up over the toilet standing on a stack of thick books, or go all out and build a Southeast Asian-style squat toilet in their bathroom, or even get the Squatty Potty. It’s probably the best way to do it—and it’s certainly the most evolutionarily concordant way to poop—but it’s not totally necessary. What matters most is getting those feet up and those knees above your hips. If you can achieve this by placing your feet on a stool (not that kind of stool) as you sit on the toilet, it should do the trick.

Take a Walk and Feel Yourself Up

Next time you walk, rest your palms on the upper swell of your butt cheeks. Every time you step through, you should feel your glutes contract. If they contract, awesome. You’re unconsciously using your glutes to propel yourself forward. If they don’t, you’ll have to train them to contract when you walk.

Do this by going for a ten minute walk (minimum) every single day while feeling your glutes. Consciously contract them enough and feel yourself up enough and the resultant biofeedback will make glute activation a passive behavior, like breathing. Eventually you’ll start doing it without thinking. That’s the goal.

Do Kegels—Differently

The classic therapy for pelvic floor disorder is to train the pelvic floor muscles directly using kegels. This is the muscle you contract to stop yourself from peeing midstream. “Doing kegels” means contracting and releasing that muscle for sets and reps. A common recommendation is to hold for ten seconds, release for ten seconds, repeated throughout the day. Waiting in line? Kegels. Eating dinner? Do some kegels. Remember that man at the DMV last week who would randomly tense up and start sweating as you both waited for your number? He was probably doing kegels.

It’s definitely part of the story—studies show kegels work in men, women, and seniors—but it’s not enough.

Consider  Katy Bowman’s take on the subject. She thinks kegels by themselves make the problem worse by creating a tight but ultimately weakened pelvic floor muscle that pulls the sacrum further inward. Combine that with weak or underactive glutes that should be balancing the anterior pull on the sacrum but don’t and you end up with rising pelvic floor dysfunction and incontinence.  She recommends doing kegels while in the squat position to ensure that the glutes are engaged and all the other contributing muscles are in balance.

Do More Than Kegels

The bad news is that we don’t have controlled trials of Katy Bowman’s protocols with deep squats and frequent daily movement and going barefoot over varied surfaces and squat toilets. We mostly just have basic “pelvic floor exercises,” which usually just mean “kegels.” The good news is that even these suboptimal exercise therapies seem to work on anyone with incontinence, whether they’re just coming off a pregnancy, a 70th birthday, or a prostate procedure. Young, old, middle-aged, male, female—exercise works.

Actually, we do have one small study that suggests kegels will work much better if you balance them out with exercises that target the glutes and hips. In the study, women suffering from urinary incontinence were split into two treatment groups. One group did pelvic floor muscle exercises (kegels). The other group did pelvic floor muscle exercises, plus exercises to strengthen the hip adductors, the glute medius, and glute maximus. Both groups improved symptoms, but the group that did the combo exercises had better results.

For hip adduction, you can use that hip adduction machine where you straddle the chair with legs spread and bring your knees together against resistance. Another option is to use resistance bands. Attach one end of the band to a secure structure and the other to your ankle. Stand with legs spread, then bring the banded leg inward toward the unbanded leg; you should feel it in your inner thigh. Do this for both legs.

For glutes, you have many options. Glute bridges, hip thrusts, squats, deadlifts, lunges, resistance band glute kickbacks.

If you want to get deep into this subject and really learn the optimal exercises for pelvic floor dysfunction, I’d pick up a copy of Katy’s Down There For Women.

Get Strong and Stay Strong

One of the strongest predictors of urinary incontinence is physical frailty. The more frail—weak, fragile, prone to falling, unable to handle stairs, unsteady on one’s feet—the man or woman, the more likely they are to suffer from urinary incontinence. This mostly comes down to muscle atrophy; the frail tend to have low muscle mass all over, including the pelvic floor.

Studies show that strength training improves urinary control in both men coming off prostate procedures and women.

The best option is to never get frail in the first place. If you’re younger and in shape, keep training and moving. Don’t lose it. If you’re younger and trending frail, get training and moving. Don’t squander the time you have. It goes quickly. If you’re older and frail, you have to start today. Fixing this doesn’t happen overnight. Being frail makes it harder to do the things necessary to get strong, but that doesn’t absolve you of the responsibility.

The Bottom Line

None of this stuff is a guarantee against incontinence. Guarantees don’t really exist in life. But I’d definitely argue that anyone who employs all the tips and advice mentioned in today’s post will have a better shot at maintaining bladder control than their doppelganger in some parallel universe who never tries anything—the earlier the better.

If you have any experience with urinary incontinence, let us know in the comments down below. What worked? What didn’t? What worked for a while, then stopped?

Thanks for reading—and sharing here. Happy Halloween, everybody.

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References:

Bernstein IT. The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies. Neurourol Urodyn. 1997;16(4):237-75.

De araujo CC, Coelho SA, Stahlschmidt P, Juliato CRT. Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review. Int Urogynecol J. 2018;29(5):639-645.

Kokabi R, Yazdanpanah D. Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: A prospective cohort study. J Chin Med Assoc. 2017;

Handa VL, Harris TA, Ostergard DR. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynecol. 1996;88(3):470-8.

Dokuzlar O, Soysal P, Isik AT. Association between serum vitamin B12 level and frailty in older adults. North Clin Istanb. 2017;4(1):22-28.

The post Urinary Urgency and Incontinence: Why It’s Not Just Age appeared first on Mark’s Daily Apple.

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Many of you have asked about prostate health in a Primal context. Men are interested because they know men have a decent chance of getting prostate cancer. Women are interested because they’re worried about the men in their lives getting prostate cancer. Today, I’m going to delve deep into the topic, exploring the utility (or lack thereof) of standard testing, the common types of treatment and their potential efficacy, as well as preventive and unconventional ways of reducing your risk and mitigating the danger of prostate cancer.

Let’s go.

First, what does the prostate do, anyway? Most people only think about it in terms of prostate cancer.

It’s a gland about the size of a small apricot that manufactures a fluid called prostatic fluid that combines with sperm cells and other compounds to form semen. Prostatic fluid protects sperm against degradation, improves sperm motility, and preserves sperm genetic stability.

What Goes Wrong With the Prostate?

There are a few things that can happen.

Prostatitis

Inflammation of the prostate, usually chronic and non-bacterial. A history of prostatitis is a risk factor for prostate cancer.

Benign Prostatic Hyperplasia

Non-cancerous enlargement of the prostate. As men age, the prostate usually grows in size. This isn’t always cancer but can cause similar symptoms.

Prostate Cancer

What most of us are interested in when we talk about prostate health… After skin cancer, prostate cancer is the most common cancer among men and the sixth most common cause of cancer death among men worldwide. Yet, most men diagnosed with prostate cancer do not die from it; they die with it. The 5-year survival rate in the US is 98%.

That said, there is no monolithic “prostate cancer.” Like all other cancers, there are different grades and stages of prostate cancer. Each grade and stage has a different mortality risk:

  • Low-grade prostate cancer grows more slowly and is less likely to spread to other tissues.
  • High-grade prostate cancer grows more quickly and is more likely to spread to other tissues.
  • Local prostate cancer is confined to the prostate. The 5-year relative survival rate (survival compared to men without prostate cancer) for local prostate cancer is almost 100%.
  • Regional prostate cancer has spread to nearby tissues. The 5-year relative survival rate for regional prostate cancer is almost 100%.
  • Distant prostate cancer has spread to tissues throughout the body. The 5-year relative survival rate for distant prostate is 29%. Distant prostate cancer explains most of the prostate-related mortality.

What Are Symptoms of Prostate Cancer?

The primary symptom is problems with urination. When the prostate gland grows, it has the potential to obstruct the flow of urine out of the bladder, causing difficulty urinating, weak urine flow, painful urination, or frequent urination. This can also be caused by benign prostatic hyperplasia, a non-cancerous enlargement of the prostate.

What Causes Prostate Cancer?

A big chunk is genetic. People with “knockout” alleles for BRCA, which codes for tumor suppression, have an elevated risk of some forms of prostate cancer. That’s the same one that confers added risks for breast cancer.

Ethnicity matters, too. Men of Sub-Saharan African descent, whether African-Americans in the U.S. or Caribbean men in the U.K., have the highest risk in the world for prostate cancer—about 60% greater than other ethnic groups. White men have moderate risks; South Asian, East Asian, and Pacific Islander men have lower risks.

Testosterone has a confusing relationship with prostate cancer. Conventional wisdom tends to hold that testosterone stimulates prostate cancer growth, and there’s certainly some evidence of a relationship, but it’s not that simple.

In one study, men with low free testosterone levels were less likely to have low-grade (less risk of spreading) prostate cancer but more likely to have high-grade (higher risk of spreading) prostate cancer.

In another, testosterone deficiency predicted higher aggressiveness in localized prostate cancers.

In Chinese men, those who went into treatment with low testosterone were more likely to present with higher-grade localized prostate cancers.

Other studies have arrived at similar results, finding that “hypogonadism represents bad prognosis in prostate cancer.”

Many prostate cancer treatments involve testosterone deprivation, a hormonal reduction of testosterone synthesis. This can reduce symptoms and slow growth of prostate tumors during the metastatic phase, but prostate cancer tends to be highly plastic, with the ability to adapt to changing hormonal environments. These patients often see the cancer return in a form that doesn’t require testosterone to progress.

What About Testing?

If you have a prostate, should you get tested starting at age 40?

Not necessarily. The value of early testing hasn’t been established. Some researchers even question whether early testing is more harmful than ignoring it, and most of the research finds middling to nonexistent evidence in favor of broad testing for everyone. Early testing has a small effect on mortality from prostate cancer, but no effect on all-cause mortality.

PSA testing can also be inaccurate. PSA is prostate specific antigen, a protein produced by the prostate. It’s normal to have low levels of PSA present in the body, and while high levels of PSA are a good sign of prostate cancer—even years before it shows up in imaging or digital probes—they can also represent a false positive. Those two other common yet relatively benign prostate issues—benign hyperplasia and prostatitis—can also raise PSA levels well past the “cancer threshold.”

Other causes of high levels of PSA include:

  • Urinary tract infections
  • Recent sex or ejaculation
  • Recent, vigorous exercise
  • Certain medications.

In fact, if you have a PSA reading of 4 (the usual threshold), there’s still just a 30% chance it actually indicates cancer.

What About Treatment?

Let’s say you do have prostate cancer, confirmed by PSA and a biopsy (or two, or three, as needle biopsies often miss cancers). What next? Should you definitely treat it?

It’s unclear whether treatment improves survival outcomes. One study took men aged 50-69 with prostate cancer diagnosed via PSA testing, divided them among three treatment groups, and followed them for ten years. One group got active monitoring—they continued to test and monitor the status of the cancer. One group received radiotherapy—radiation therapy to destroy the tumor. And the last group had the cancer surgically removed.  After ten years, there was no difference among the groups for all-cause mortality, even though the active-monitoring group saw higher rates of prostate cancer-specific deaths (8 deaths—in a group of 535 men— vs 5 in the surgery group and 4 in the radiotherapy group), cancer progression, and metastasis.

In another study of men with localized prostate cancer, removing the prostate only improved all-cause mortality rates among men with very high PSAs (more than 10). In men with lower PSAs, “waiting and seeing” produced similar outcomes as surgery.

Prostate removal also carries many unwanted side effects, like incontinence and sexual dysfunction. No one wants prostate cancer, but it’s no small thing to have problems with urination and sex for the rest of your life. Those are major aspects of anyone’s quality of life.

Before you make any decisions, talk to your doctor about your options, the relative mortality risk of your particular cancer’s stage and grade, and how the treatments might affect your quality of life.

How Can You Reduce the Risk of Prostate Cancer?

1. Inflammation is definitely an issue.

For one, there’s the relationship between prostatitis, or inflammation of the prostate, and prostate cancer that I already mentioned above.

Two, there’s the string of evidence linking anti-inflammatory compounds to reductions in prostate cancer incidence. For example, aspirin cuts prostate cancer risk. Low-dose aspirin (under 100 mg) reduces both the incidence of regular old prostate cancer and the risk of metastatic prostate cancer. It’s also associated with longer survival in patients with prostate cancer; other non-steroidal anti-inflammatories are not.

Third, anti-inflammatory omega-3 fatty acids (found in seafood and fish oil) are generally linked to lower rates of prostatic inflammation and a less carcinogenic environment; omega-6 fatty acids can trigger disease progression. A 2001 study of over 6,000 Swedish men found that the folks eating the most fish had drastically lower rates of prostate cancer than those eating the least. Another study from New Zealand found that men with the highest DHA (an omega-3 found in fish) markers slashed their prostate cancer risk by 38% compared to the men with the lowest DHA levels.

2. The phytonutrients you consume make a difference.

A series of studies on phytonutrient intake and prostate cancer incidence in Sicilian men gives a nice glimpse into the potential relationships:

The more polyphenols they ate, the less prostate cancer they got.

The more phytoestrogens they ate, the more prostate cancer they got. Except for genistein, an isoflavone found in soy and fava beans, which was linked to lower rates of prostate cancer. The Sicilians are eating more fava than soy, I’d imagine.

How about coffee, the richest source of polyphenols in many people’s daily diets? It doesn’t appear to reduce the incidence of prostate cancer, but it does predict a lower rate of fatal prostate cancer.

3. Your circadian rhythm and your sleep are important.

Like everything else in life, tumor suppression follows a circadian pattern. Nighttime melatonin—which is suppressed if your sleep hygiene is bad and optimal if your sleep hygiene is great—inhibits the growth of prostate cancer cells and reduces their ability to utilize glucose. One way to enhance nighttime melatonin is by getting plenty of natural, blue light during the day; this actually makes nighttime melatonin more effective at prostate cancer inhibition. On the other hand, getting that blue light at night is a major risk factor for prostate cancer.

4. Get a handle on your fasting blood sugar and insulin.

In one study, having untreated diabetic-level fasting blood sugar was a strong risk factor for prostate cancer. Another study found that insulin-lowering metformin reduced the risk, while an anti-diabetic drug that raised insulin increased the risk of prostate cancer. Metformin actually lowers PSA levels, which, taken together with the previous study, indicates a causal effect.

5. Keep moving, keep playing, keep lifting.

This has a number of pro-prostate effects:

It keeps you insulin sensitive, so neither fasting insulin, nor fasting glucose get into the danger zone.

If you’re doing testosterone suppression treatment, exercise can maintain (and even increase) your muscle mass, improve your quality of life, and increase your bone mineral density.

Oh, and do some deadlifts. Men with prostate cancer who trained post-surgery had better control over their bodily functions, as long as they improved their hip extensor strength. If you don’t know, hip extension is the act of standing up straight, of moving from hip flexion (hip hinging, bending over) to standing tall. It involves hamstrings, glutes, and the entire posterior chain. Deadlifts are the best way to train that movement pattern.

The prostate cancer issue is frightening because it’s so common. Almost all of us probably know someone who has or had it, even unknowingly. But the good news is that most prostate cancers aren’t rapidly lethal. Many aren’t lethal at all. So whatever you do, don’t rush into serious treatments or procedures without discussing the full range of options in a frank, honest discussion with your doctor.

That’s it for today, folks. Thanks for reading. If you have any questions, comments, or concerns about prostate cancer, feel free to chime in down below. I’d love to hear from you.

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References:

Perletti G, Monti E, Magri V, et al. The association between prostatitis and prostate cancer. Systematic review and meta-analysis. Arch Ital Urol Androl. 2017;89(4):259-265.

Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018;362:k3519.

Brawer MK, Chetner MP, Beatie J, Buchner DM, Vessella RL, Lange PH. Screening for prostatic carcinoma with prostate specific antigen. J Urol. 1992;147(3 Pt 2):841-5.

Castro E, Eeles R. The role of BRCA1 and BRCA2 in prostate cancer. Asian J Androl. 2012;14(3):409-14.

Watts EL, Appleby PN, Perez-cornago A, et al. Low Free Testosterone and Prostate Cancer Risk: A Collaborative Analysis of 20 Prospective Studies. Eur Urol. 2018;

Neuzillet Y, Raynaud JP, Dreyfus JF, et al. Aggressiveness of Localized Prostate Cancer: the Key Value of Testosterone Deficiency Evaluated by Both Total and Bioavailable Testosterone: AndroCan Study Results. Horm Cancer. 2018;

Dai B, Qu Y, Kong Y, et al. Low pretreatment serum total testosterone is associated with a high incidence of Gleason score 8-10 disease in prostatectomy specimens: data from ethnic Chinese patients with localized prostate cancer. BJU Int. 2012;110(11 Pt B):E667-72.

Teloken C, Da ros CT, Caraver F, Weber FA, Cavalheiro AP, Graziottin TM. Low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy: hypogonadism represents bad prognosis in prostate cancer. J Urol. 2005;174(6):2178-80.

Banerjee PP, Banerjee S, Brown TR, Zirkin BR. Androgen action in prostate function and disease. Am J Clin Exp Urol. 2018;6(2):62-77.

Zhou CK, Daugherty SE, Liao LM, et al. Do Aspirin and Other NSAIDs Confer a Survival Benefit in Men Diagnosed with Prostate Cancer? A Pooled Analysis of NIH-AARP and PLCO Cohorts. Cancer Prev Res (Phila). 2017;10(7):410-420.

Russo GI, Campisi D, Di mauro M, et al. Dietary Consumption of Phenolic Acids and Prostate Cancer: A Case-Control Study in Sicily, Southern Italy. Molecules. 2017;22(12)

Russo GI, Di mauro M, Regis F, et al. Association between dietary phytoestrogens intakes and prostate cancer risk in Sicily. Aging Male. 2018;21(1):48-54.

Discacciati A, Orsini N, Wolk A. Coffee consumption and risk of nonaggressive, aggressive and fatal prostate cancer–a dose-response meta-analysis. Ann Oncol. 2014;25(3):584-91.

Dauchy RT, Hoffman AE, Wren-dail MA, et al. Daytime Blue Light Enhances the Nighttime Circadian Melatonin Inhibition of Human Prostate Cancer Growth. Comp Med. 2015;65(6):473-85.

Kim KY, Lee E, Kim YJ, Kim J. The association between artificial light at night and prostate cancer in Gwangju City and South Jeolla Province of South Korea. Chronobiol Int. 2017;34(2):203-211.

Murtola TJ, Vihervuori VJ, Lahtela J, et al. Fasting blood glucose, glycaemic control and prostate cancer risk in the Finnish Randomized Study of Screening for Prostate Cancer. Br J Cancer. 2018;118(9):1248-1254.

Haring A, Murtola TJ, Talala K, Taari K, Tammela TL, Auvinen A. Antidiabetic drug use and prostate cancer risk in the Finnish Randomized Study of Screening for Prostate Cancer. Scand J Urol. 2017;51(1):5-12.

Park JS, Lee KS, Ham WS, Chung BH, Koo KC. Impact of metformin on serum prostate-specific antigen levels: Data from the national health and nutrition examination survey 2007 to 2008. Medicine (Baltimore). 2017;96(51):e9427.

Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28(2):340-7.

Ying M, Zhao R, Jiang D, Gu S, Li M. Lifestyle interventions to alleviate side effects on prostate cancer patients receiving androgen deprivation therapy: a meta-analysis. Jpn J Clin Oncol. 2018;48(9):827-834.

Uth J, Fristrup B, Haahr RD, et al. Football training over 5 years is associated with preserved femoral bone mineral density in men with prostate cancer. Scand J Med Sci Sports. 2018;28 Suppl 1:61-73.

Park J, Yoon DH, Yoo S, et al. Effects of Progressive Resistance Training on Post-Surgery Incontinence in Men with Prostate Cancer. J Clin Med. 2018;7(9)

The post A Primal Guide to Prostate Health appeared first on Mark’s Daily Apple.

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A Primal woman’s first reaction to the prospect of taking synthetic hormone replacements for menopause? Probably a healthy dose of skepticism. We in the ancestral health community, after all, tend to view pharmaceuticals as a last resort—interventions that are overprescribed by vested interests, create their own set of side effects, and may even do more harm than good. To suggest that we “need” this or that prescription raises our hackles.

Besides, it’s not like menopause is a product of modernity or an aberration our ancestors never experienced; it’s a physiological stage that evolution has protected and selected in humans. It’s perfectly natural. Rather than the debilitating, miserable experience many women report having, menopause should be easier. Graceful, even. But it often isn’t.

And nature unfortunately doesn’t care about that. Menopause is nature’s way of preventing undue discomfort and reducing genetic damage to the group. Your average 50-year-old woman has a lot to offer the tribe in terms of wisdom, child care, and general know-how, but natural selection has also determined that it’s better for everyone if middle-aged women don’t easily get pregnant. Menopause achieves this by down-regulating the hormones and weakening the tissues necessary for conception. The problem is that these same hormones and tissues also figure prominently in a woman’s enjoyment of life and overall health.

What can happen when Mother Nature decides to step in?

  • Anxiety
  • Irritability
  • Loss of libido, vaginal atrophy
  • Night sweats
  • Hot flashes
  • Weight gain
  • Forgetfulness

Longer-term, menopause increases the risk of serious diseases like osteoporosis, heart disease, and breast cancer.

Those aren’t mere inconveniences. They can mar the beauty of what should be an enjoyable part of a woman’s life, interfering with her relationships, her productivity, her cognitive function, her sleep, and her basic ability to enjoy living.

Mother Grok didn’t take pharmaceutical hormone replacements, you might counter. She didn’t hit up the shaman for a compound blend of hormones, so why should you?

First of all, maybe she did. Pre-scientific peoples have been known to develop folk cures that seem primitive but end up getting scientific validation. Think of the medieval garlic-based concoction that we just found out can eliminate medication-resistant staph infections. Or the indigenous Amazonian tribes who somehow figured out if you brewed a certain vine with a certain leaf and drank the finished product you’d visit the spirit world, all without knowing the vine contained DMT and the leaf contained an MAO-inhibitor that made the DMT orally active. Or, to bring it back to menopause, the yam, which cultures have used for hundreds of years for menopause treatment without actually knowing it contains an estrogen mimetic with clinical efficacy.

Second of all, the basic Primal stance on pharmaceutical interventions is that they are useful and suitable when correcting a deficiency, a genetic proclivity, or an evolutionary mismatch—particularly when dietary and lifestyle interventions aren’t cutting it. If they can help us treat a condition that seriously impedes our life or pursuit of health, we should avail ourselves of the fruits of modern science. Hormone replacement therapy may very well qualify.

Philosophical qualms aside—does hormone replacement therapy (HRT) work? What factors play into its effectiveness—and safety?

First, Is It Safe?

This might just be the most contentious topic in medicine.

For decades, HRT was the standard treatment for postmenopausal women. Not only was it given to treat the symptoms of menopause, it was billed as an antidote to many of the chronic diseases that increased in frequency after menopause like breast cancer, osteoporosis, and heart disease. Most of this was based on observational data and small pilot studies. That changed with the Women’s Health Initiative (WHI), a massive series of randomized controlled trials involving tens of thousands of postmenopausal women. Finally, the establishment would get the solid backing they needed to continue prescribing HRT to millions of women for prevention of chronic disease.

Except it didn’t turn out so well. Midway through, they stopped the trial because they weren’t getting the desired results.

There were two different HRT study groups. In one study, women without uteruses either got placebo or estrogen alone. In the other, women with uteruses got a combo of estrogen and progestin (a progesterone analogue) or placebo. The estrogen was Premarin, a conjugated estrogen. The progestin was Prempro, or medroxyprogesterone acetate.

The E/P combo increased the risk of heart disease, breast cancer, pulmonary embolism, and stroke, and reduced the risk of colorectal cancer and fractures (but not enough to offset the increased risks).

The estrogen alone had no effect on heart disease (contrary to their hypotheses), but it did appear to increase the risk of stroke while decreasing the risk of breast cancer and fractures.

Following the publication and wide dissemination of the WHI results, HRT use plummeted among women. Breast cancer cases subsequently dropped by 15-20,000 per year. Hormone replacement therapy developed a bad rap that it has yet to shake.

Is it deserved? Yes and no.

While the WHI results highlight some very real risks associated with HRT, they don’t tell the whole story. There are other variables to consider when deciding on HRT.

How Early You Start Taking HRT Matters

Most of the women in the WHI study began HRT when they were very post-menopause: older, in their 60s and upward. They got worse results.

A much smaller proportion of the women in the study were under 60 when they started HRT. They had better results. In fact, among those women who initiated HRT before age 60, total mortality actually dropped by 30%.

Another analysis of the Women’s Health Initiative data found that women who started taking HRT during early pre-menopause were less likely to see the negative effects, like increased breast cancer and heart disease.

Another study found that older post-menopausal women taking estrogen took hits to their working memory that remained after therapy cessation, while younger post-menopausal women had no such reaction.

Women who took oral estradiol 6 years after menopause saw their subclinical atherosclerosis slow down. Those who took it later (10 years after) did not.

A recent large Cochrane meta-analysis found that while in general postmenopausal women taking HRT had a moderately increased risk of heart disease, breast cancer, and other diseases, a subgroup of healthy, 50-59 year old (so, younger) HRT users only had a slightly increased risk of venous thromboembolism.

The longer you wait to initiate HRT after menopause, the more adverse effects occur. Start earlier, if you do start

How You Administer the HRT Matters

Oral hormones have different metabolic fates than transdermal hormones. When you swallow a hormone, it goes to the liver for processing. This creates various metabolites with different bioactivity. One example is oral estrogen. When you take estrogen orally, you raise CRP, a marker of inflammation. Transdermal estrogen has no effect on CRP.

Oral HRT has been shown across multiple studies to increase the risk of venous thromboembolism, while transdermal HRT does not. This is because oral HRT increases thrombin generation and clotting, while transdermal HRT does not.

In the Women’s Health Initiative that found negative effects, the HRT given to the subjects was oral. Perhaps this was the issue.

For local vaginal symptoms, local application is probably ideal, while oral application is suboptimal. In one study, vaginal estriol was far more bioactive than oral estriol, despite the latter resulting in higher serum levels of the hormone.

However, topical isn’t always best. In one study, sublingual users of bioidentical hormones saw relief from night sweats, irritability, hot flashes, anxiety, emotional lability, sleep, libido, fatigue, and memory loss, while topical users only saw relief from night sweats, emotional lability, and irritability.

The Type Of Hormone You Take Matters

Another factor the WHI failed to address was the composition of the medication itself. They used synthetic hormones—conjugated estradiol and medroxyprogesterone acetate. Could bioidentical hormones, exact replicas of endogenous hormones which exploded in popularity following the WHI, have a different effect?

The amount of research into conventional HRT dwarfs bioidentical hormone therapy (BHT) research, but what we have looks pretty compelling.

Breast cancer is a major concern for HRT users. Most breast cancers respond to estrogen, just over half respond to progesterone, and traditional HRT seems to increase their risk. Yet, at least in healthy postmenopausal women, a combination percutaneous estradiol gel (inserted into the skin) and oral micronized progesterone—both bioidentical to their endogenous counterparts—had no effect on epithelial proliferation of the breast tissue, while reducing activity of a protein that protects cancer from cell death. The conventional HRT had the opposite effect, increasing epithelial proliferation and breast volume (a risk factor for breast cancer). This wasn’t about cancer, but it’s suggestive.

In another study, postmenopausal women on BHT (which included estriol, estradiol, progesterone, testosterone, and DHEA) saw improvements across all measured cardiovascular, inflammatory, immune, and glucoregulatory biomarkers despite being exposed to high levels of life stress.

Then again, in a recent study, bioidentical hormones performed poorly compared to the pharmaceuticals equine estrogen and medroxyprogesterone acetate. The pharmaceutical hormones resulted in a lower risk of breast cancer, although the bioidentical hormones still reduced the risk compared to placebo.

Which Hormones You Take Matters

The vast majority of postmenopausal women take estrogen, progesterone, or some combination of the two. But there’s another hormone that, despite plummeting during menopause, gets ignored—testosterone.

Although testosterone is the “male hormone,” it also plays a vital role in female physiology, especially sexual function. Menopause reduces testosterone by about half, and studies indicate that topical testosterone replacement therapy can improve sexual function and desire (combined with estrogen) as well as musculoskeletal health and cognitive performance in postmenopausal women. More importantly, topical testosterone improves sexual function without causing any of the adverse effects commonly associated with testosterone usage in women, like hair loss, voice deepening, body hair growth, facial hair growth, breast pain or tenderness, or headaches.

Adding low-dose testosterone to a low-dose estrogen regimen may even be better at reducing somatic symptoms of menopause (sleep disturbances, hot flashes, and other physical symptoms) than a higher dose of estrogen alone.

Your Expectations Matter

Our big mistake was treating HRT as a panacea for the chronic conditions of aging. It’s not that smart hormone replacement can’t or won’t reduce the risk of certain diseases, like osteoporosis or heart disease. It’s that we’re still figuring it out.

A better, safer move is to focus on what we know HRT can treat: the symptoms of menopause.

Want to reduce hot flashes and get more sleep? HRT works.

Want to reduce anxiety? HRT works.

Want to improve cognitive function and your sense of smell? HRT works.

The use of bioidentical hormones may be safer or more effective against the bigger stuff. It remains to be seen. Until then, treat symptoms, not chronic disease—but keep in mind your overall risks and discern whether treating the symptoms is worth any additional risk for that bigger stuff.

Your Personal Context Matters

Women with a history of estrogen-responsive breast cancer (80% of breast cancers) should exhibit caution and check with their oncologist before taking any kind of HRT.

ApoE4 carriers should seriously look into taking HRT. In one recent study, postmenopausal ApoE4 carriers exhibited rapid cellular aging—except if they were taking HRT.

Whatever You Decide…

Don’t feel guilty if you decide to take some form of it. I myself take a small dose of testosterone to get my levels up to where they should be. My wife, Carrie, has taken bioidentical hormones in the past (a modest compound blend of estrogen, progesterone, and testosterone) to deal with the symptoms of menopause, including persistent brain fog that didn’t respond to any other herbal or alternative measure in her case. There’s no shame. This is restoration of what’s healthy and supportive of a good life. 

Heck, I know women who are both aware of the potential long term risks—heart disease, breast cancer, and the like—and enthusiastic about the shorter-term, more immediate quality-of-life benefits they currently enjoy. They prefer the definite benefits over the small and uncertain absolute risk increases. Some have even said that feeling better day-to-day gives them the energy to continue living a healthy life in other ways.

I also know women who do the opposite, who either are lucky enough to not experience any profound symptoms in their transition or who prefer to use other methods and interventions to deal with their symptoms in order to avoid any increased long-term complications. (I’ll delve more into this in the future if there’s interest.) Regardless, it’s all a choice.

Hopefully after today you feel better equipped to make an informed one.

What about you, folks? I know I have thousands of readers who are facing this very question—or who have already faced it. What did you choose? How did you handle the HRT question?

Thanks for reading. Take care!

References:

Wu WH, Liu LY, Chung CJ, Jou HJ, Wang TA. Estrogenic effect of yam ingestion in healthy postmenopausal women. J Am Coll Nutr. 2005;24(4):235-43.

Murkes D, Lalitkumar PG, Leifland K, Lundström E, Söderqvist G. Percutaneous estradiol/oral micronized progesterone has less-adverse effects and different gene regulations than oral conjugated equine estrogens/medroxyprogesterone acetate in the breasts of healthy women in vivo. Gynecol Endocrinol. 2012;28 Suppl 2:12-5.

Ruiz AD, Daniels KR. The effectiveness of sublingual and topical compounded bioidentical hormone replacement therapy in postmenopausal women: an observational cohort study. Int J Pharm Compd. 2014;18(1):70-7.

Stephenson K, Neuenschwander PF, Kurdowska AK. The effects of compounded bioidentical transdermal hormone therapy on hemostatic, inflammatory, immune factors; cardiovascular biomarkers; quality-of-life measures; and health outcomes in perimenopausal and postmenopausal women. Int J Pharm Compd. 2013;17(1):74-85.

Zeng Z, Jiang X, Li X, Wells A, Luo Y, Neapolitan R. Conjugated equine estrogen and medroxyprogesterone acetate are associated with decreased risk of breast cancer relative to bioidentical hormone therapy and controls. PLoS ONE. 2018;13(5):e0197064.

Schiff I, Tulchinsky D, Ryan KJ, Kadner S, Levitz M. Plasma estriol and its conjugates following oral and vaginal administration of estriol to postmenopausal women: correlations with gonadotropin levels. Am J Obstet Gynecol. 1980;138(8):1137-41.

Scarabin PY. Hormone therapy and venous thromboembolism among postmenopausal women. Front Horm Res. 2014;43:21-32.

Espeland MA, Rapp SR, Manson JE, et al. Long-term Effects on Cognitive Trajectories of Postmenopausal Hormone Therapy in Two Age Groups. J Gerontol A Biol Sci Med Sci. 2017;72(6):838-845.

Hodis HN, Mack WJ, Henderson VW, et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 2016;374(13):1221-31.

Santoro N, Allshouse A, Neal-perry G, et al. Longitudinal changes in menopausal symptoms comparing women randomized to low-dose oral conjugated estrogens or transdermal estradiol plus micronized progesterone versus placebo: the Kronos Early Estrogen Prevention Study. Menopause. 2017;24(3):238-246.

Yazici K, Pata O, Yazici A, Akta? A, Tot S, Kanik A. [The effects of hormone replacement therapy in menopause on symptoms of anxiety and depression]. Turk Psikiyatri Derg. 2003;14(2):101-5.

Doty RL, Tourbier I, Ng V, et al. Influences of hormone replacement therapy on olfactory and cognitive function in postmenopausal women. Neurobiol Aging. 2015;36(6):2053-9.

Jacobs EG, Kroenke C, Lin J, et al. Accelerated cell aging in female APOE-?4 carriers: implications for hormone therapy use. PLoS ONE. 2013;8(2):e54713.

Kingsberg S. Testosterone treatment for hypoactive sexual desire disorder in postmenopausal women. J Sex Med. 2007;4 Suppl 3:227-34.

Davis SR, Wahlin-jacobsen S. Testosterone in women–the clinical significance. Lancet Diabetes Endocrinol. 2015;3(12):980-92.

Achilli C, Pundir J, Ramanathan P, Sabatini L, Hamoda H, Panay N. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis. Fertil Steril. 2017;107(2):475-482.e15.

Simon J, Klaiber E, Wiita B, Bowen A, Yang HM. Differential effects of estrogen-androgen and estrogen-only therapy on vasomotor symptoms, gonadotropin secretion, and endogenous androgen bioavailability in postmenopausal women. Menopause. 1999;6(2):138-46.

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The post The Pros & Cons of Hormone Replacement Therapy for Primal Women appeared first on Mark’s Daily Apple.

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As we move toward September, we might be thinking of Labor Day parties or fall tailgating weekends—events perfect for a barbecue spread. But when you’re eating Primal, keto or otherwise low-carb, traditional barbecue fare isn’t always the ideal choice. Even when you’re throwing a party centered on grilled meat, it’s all too easy for carbs to sneak into the mix. Buns, pasta salads, chips, cheese and crackers, beer, sweet tea, sodas and desserts often make up the bulk of a typical buffet. So, what’s a Primal type to do (or serve)? Here’s how to throw a low-carb barbecue feast everyone will love.

Drinks

Avoid high sugar drinks like juice, soda and tonic, and keep the ice chest filled with refreshing, sugar-free or low-sugar beverages.

Appetizers

Skip the chip and cracker aisle when shopping for a low-carb barbecue party. Instead, serve platters of cheese and nuts, raw vegetables with dip, and protein-rich appetizers.

Spicy Chorizo Keto Stuffed Jalapeños
Marinated Olives and Nuts 
Chipotle Lime Avocado Bacon Dip
Almost Deviled Eggs
Bacon Wrapped Hot Dog Bites

Side Dishes

Side dishes at a barbecue can be carb-loaded landmines. Instead of standard barbecue fare like pasta salad, potato salad, fruit salad and corn, load up the buffet up with crunchy coleslaw, colorful green salads and grilled or roasted vegetables.

Don’t ruin healthy low-carb salads with salad dressing or mayonnaise made from unhealthy industrial seed oils and sugar. Instead, whisk together homemade salad dressings. Better yet, make low-carb life easier by keeping Primal Kitchen® dressings and marinades and Mayo varieties on hand.

Keto Cole Slaw
Sausage and Veggie Skewers
Roasted Vegetable Salad
Baby Kale Rainbow Salad
Grilled Kale
Sesame Ginger Slaw

Meats

The most obvious way to avoid carbs at a barbecue is to serve hamburgers and sausages without buns. Even better, serve grilled meat that doesn’t need a bun, like steak, ribs or pork roast.

But beware of carbs lurking in the rubs, marinades and sauces that flavor meat. Sugar is usually the culprit. Read labels to avoid store bought rubs and marinades with sweeteners, or make your own rubs and marinades at home (or use any of the Primal Kitchen® Marinades).

Lime and Basil Marinaded Beef Kebabs
Low Carb BBQ Ribs
Coconut Marinated Short Ribs
Charcoal Roasted Pork Loin
5 Steps to the Perfect Steak

Condiments

Just try hosting a barbecue without ketchup, and wait for the outcry. Luckily, now there’s Primal Kitchen® Unsweetened Ketchup, Spicy Brown Mustard and Mayo to the rescue. Condiments that pack tons of flavor with very few carbs, like pickles, sauerkraut, and hot sauce, are also a must.

Desserts

A bowl of brightly colored berries (perhaps with unsweetened whipped cream on the side?) is an easy summer treat. If you’re willing to put in a little more work, then serve a decadent low-carb dessert.

Keto Coffee Popsicles
Keto Cheesecake Parfait
Avocado Matcha Dairy Free Ice Cream

Feeling inspired yet? Share your favorite barbecue fare below.

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The post How to Throw a Low-Carb Barbecue Party—With 20 Recipes appeared first on Mark’s Daily Apple.

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A few months ago, I explored the benefits and applications of cold therapy. Today, I’m going to talk about the benefits and applications of heat therapy—one of the most ubiquitous and ancestral therapies in the history of humankind. You name a culture and—as long as they didn’t live in perpetual tropical heat—they probably had some form of heat therapy. Native Americans had the sweat lodge, those of Central America the temazcal. The Romans had the thermae, which they picked up and refined from the Greeks. Other famous traditions include Finnish saunas, Russian banyas, Turkish hammams, Japanese sentó (or the natural spring-fed onsen), and the Korean jjimjilbang. People really like the heat.

Right off the bat, that’s one major benefit to heat therapy compared to cold: It’s an easy sell. “You can luxuriate in a sauna for half an hour or lower your naked body, genitals first, into a bathtub filled with ice water. Your choice.” People are far more likely to sit in the hot room for 20 minutes than they are to sit in an ice bath for 3 minutes or even take a cold shower. Short-term heat exposure is generally regarded as pleasant. Cold exposure is generally regarded as torture. If heat therapy offers legit health benefits, this is a major point in its favor. So, does it?

Oh, yes.

In a recent review of the available observational studies, controlled trials, and interventions, researchers found evidence that sauna usage has an impressive array of beneficial effects on health and wellness:

  • Increased lifespan and decreased early mortality.
  • Reduced cardiovascular disease.
  • Lowered blood pressure.
  • Improved cognitive function and reduced the risk of neurodegenerative disease.
  • Improved arthritis symptoms.

What’s going on here? How could sitting in a hot room do so many good things?

Stress, in a word. One of the coolest things about us is that encountering, facing down, and then growing resistance to one type of stress tends to make us better at dealing with stress from other sources. A 30-minute sauna session at 174 ºF/80 ºC raises body temperature by almost 1 degree C, spikes your flight-or-flight hormones, raises cortisol, and triggers a powerful hormetic response by the rest of your body. That’s a stressor. After such a session, subjects report feeling “calm” and “pleasant.” This isn’t a surprise. Intense exercise also raises cortisol in the short term. And like regular exercise, longer term sauna usage (daily for four weeks in one study) actually reduces stress hormones.  It’s a classic hormetic response, where acute doses of the stressor increase oxidative stress enough to provoke a compensatory adaptation by the organism.

What does this sauna-induced hormetic stress do for us?

Benefits of Heat Therapy

It reduces oxidative stress. Short term, it increases stress (that’s why we see the transient spike in cortisol and other stress hormones). Long term, it reduces oxidative stress. Long-term sauna use has an inverse association with levels of C-reactive protein (CRP), a “catch-all” biomarker for oxidative stress and inflammation. The more often you use the sauna, the lower your CRP.

It may reduce mortality. The more frequently a person visits the sauna, the lower his risk of premature death from heart attack and all causes. There is a dose-response relationship happening here, which has me leaning toward “causal.” Those using the sauna two to three times a week had a 23% lower risk of fatal heart attack compared to men who used it just once a week. Men who used the sauna four to seven times a week had a 48% reduced risk of fatal heart attack compared to once-a-weekers. The more frequently men used the sauna, the greater the protection (for other causes of mortality, too).

It improves vascular function. A single bout of sauna (or exercise, for that matter) reduces vascular resistance—the amount your blood vessels “resist” blood flow—in hypertensive patients for up to two hours.

It’s good against type 2 diabetes. Sauna use has been shown to improve almost every marker related to type 2 diabetes, including insulin sensitivity, fasting blood sugar, glycated hemoglobin, and body fat levels.

It can improve depression scores. Patients with depression who underwent heat therapy saw improvements in their Hamilton Depression Rating.

If you’re an athlete, or exercise at all, you should try the sauna. Training magnifies the benefits of the sauna.

Finally, pairing exercise and heat therapy together is a boon for cardiovascular health. For instance, people who frequent the sauna and the gym have a drastically lower risk of heart attack death than people who do either alone. That combo also reduces 24-hour blood pressure in hypertensive patients and confers special protection against all-cause mortality above and beyond either variable alone.

Post-Workout Benefits

Post-workout sauna sessions improve endurance performance in runners: For three weeks, endurance runners sat in 89° C (+/- 2° C) humid saunas for 31 minutes following training sessions. This amounted to an average of 12.7 sauna sessions per runner. Relative to control (no sauna), sauna use increased time to exhaustion by 32%, plasma cell volume by 7.1%, and red cell volume by 3.2% (both plasma cell and red cell volume are markers of increased endurance performance).

Post-workout sauna use increases plasma volume in male cyclists: Following training sessions, cyclists sat in 87° C, 11% humidity saunas for 30 minutes. Just four sessions were sufficient to expand plasma volume. This is important because increasing plasma volume improves heat dissipation, thermoregulation, heart rate, and cardiac stroke volume during exercise.

Post-workout sauna—either dry or steam—can also alleviate muscle fatigue.

How About Pre-Workout?

The effects are more mixed. In one study, pre-workout sauna reduced strength endurance and 1 rep max leg press, had no effect on 1 rep max bench press, and improved maximum power (vertical leap). Another study found that in female athletes but not in males, maximum power decreases after sauna use. It’s possible that these performance disturbances are caused by dehydration rather than the heat itself, so make sure you rehydrate if you’re planning on training after a sauna session.

If you want to apply heat pre-workout without overdoing it, I’ve always liked a nice hot bath to help limber up, mobilize my joints, and clear out any stiffness for the coming workout session.

Oh, and It Can Help You Detox

I was going to write the full word “detoxification,” but I figured I’d write “detox” just to trigger the hardcore skeptics reading this…. Heat exposure can augment your natural detoxification capacities by at least two mechanisms.

First, exposure to extreme heat increases something called heat shock proteins, or HSPs. HSPs are responsible for many of the benefits of heat therapy, including enacting beneficial hormetic effects on our detoxification capacity. They trigger compensatory adaptations and activate antioxidant defenses in the blood of healthy volunteers. They even increase regeneration of the body’s main detoxifying organ—the liver—after it’s been damaged.

Second, contrary to popular belief, sweating can aid detoxification. Sweat itself contains bioaccumulated toxins, including BPA—even when it doesn’t show up in the blood or urine. Sweat also contains certain phthalate compounds and their metabolites, none of which we want. Sweat also contains arsenic and lead in people exposed to high levels of the metals. Sweating may even improve the function of another important detoxification organ—the kidney—by restoring nitrogen excretion in people with kidney disease. In one study, police officers with chronic illnesses caused by exposure to high levels of meth lab chemicals experienced major improvements after sauna therapy.

What If You Don’t Have Access To a Sauna?

There are other options.

Steam rooms work. Only problem with them is it’s difficult to remain in one long enough to trigger the necessary stress response. Saunas, with their dry heat, are easier to stick with. Steam rooms feel different enough that I wonder if there’s something unique about them. Not enough evidence to go on, unfortunately. Perhaps I can revisit this later.

Jacuzzis and hot baths work. A recent paper found that taking regular hot baths at home improved insulin sensitivity and increased nitric oxide synthase activity about as much as working out. Another found that, compared to showering, bathing improved mood, perceived stress, blood flow, and accumulation of metabolic waste products.

You could probably sit in a black car on a hot day with the windows rolled up and get an effect.

Just get hot, as hot as you can stand. Then stay a little longer. (As always, be sure to talk to your doctor. Certain conditions and scenarios, like pregnancy, require extra caution with saunas or other forms of heat therapy.)

Have you used the sauna? Are you a regular attendee? Or do you use other means of heat therapy? I’m curious to hear your experiences, tips, and stories below.

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References:

Laukkanen JA, Laukkanen T, Kunutsor SK. Cardiovascular and Other Health Benefits of Sauna Bathing: A Review of the Evidence. Mayo Clin Proc. 2018;93(8):1111-1121.

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