In this week’s edition of Ask a Health Coach, Erin answers more of your questions from the Mark’s Daily Apple Facebook group. She’ll be discussing strategies on the best way to go Primal, the real reasons we crave sugar (and what to do about it), and what happens when we all go back to work and have to wear real clothes. Got more questions? Keep them coming on the MDA Facebook page or in the comments below.

ask a health coachMichael asked:

“I’m planning on starting the Primal Blueprint next week. Better to dive in 100% or do it more gradually?”

As you might have guessed, some people do great diving right in, while others find it too overwhelming and have more success with a gradual approach. I think the bigger question we need to ask here is: what will make you stick with it for the long term?

For the record, the Primal Blueprint isn’t a diet or a workout routine — two things that have “short-term” written all over them. It’s not an all-or-nothing approach either. The Primal Blueprint is based on an 80/20 principle that allows you to abide by the theories of ancestral living without worrying about a French fry here or a glass of red wine there.

The key is to know yourself well enough to understand what works best for you. Do you have proof that you’re better going cold turkey rather than dipping your toe in? Or maybe you’ve always been more successful taking baby steps. Look at all the areas of your life — all the times you thrived when there was zero room for negotiating versus not wanting the pressure of everything needing to be perfect 100% of the time.

There’s not a ton of research out there about which is better, but this study‘>2 contradicts that finding, saying that going all out in the beginning can influence how well you do in the long-term.

For some, the immediate reward of dropping a bunch of water weight with an all-in approach can be really gratifying. For others, starting gradually can feel less scary and more comfortable.

No matter which way you decide to pursue it, it’s important to be 100% committed to the changes you’re making, knowing that 80/20 doesn’t mean you have a free pass to binge on ice cream or stay out late 20% of the time. And if you’re not totally committed, you might be better off taking a step back to figure out why this change is important to you in the first place.

Suzanne asked:

“I know sugar is bad for me, but why do I crave it so much?”

Since you’re already aware of sugar’s health-degrading properties, I’ll save you the lecture and the research. But you bring up an interesting question. Why do we crave it so damn much?

Any kind of emotional or psychological dependence on sugary foods, or even foods that convert to sugar in the body is classified as a sugar addiction. So, we’re on a similar playing field to other addictions like cigarettes, drugs, and alcohol.

Sugar provides a quick fix‘>4 or going for a walk outside before choosing to rip through a bag of M&Ms.

  • Sleep. Skimping on sleep can send you looking for a hit of energy‘>9 In countries where squatting and other forms of floor living are seamlessly weaved into everyday life, people still retain the mobility to do all that stuff into old age. I’ve got a buddy from Thailand who moved over to Hollywood as a teenager in the late sixties and still retains the ability to sit in a full squat, painlessly and effortlessly. This guy is an avid user of chairs and everything Western. He’s not a gymgoer at all, and he’s never even heard of a foam roller or Mobility WOD, but because he got the right floor living experience during the formative years, he can still squat and move around on the floor. Unfortunately, for many of us in Western countries who stopped floor living right around age four or five, we may never quite get there – but we can certainly do a lot better than we are now.

    Now that you have some idea of what to do when you’re on the ground, I’d like you to spend the next week doing as much floor living as possible. I don’t expect you to ditch the office chair and roll around the ground while at work, but I do expect you to get in some quality floor time when you’re at home.

    Let’s hear from you guys. How do you handle yourselves on the floor? What’s your favorite go-to position?


    The post Floor Sitting: Do You Spend Enough Time on the Ground? appeared first on Mark’s Daily Apple.

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    Research of the Week

    Blue-blocking glasses improve mania patients’ sleep quality.

    The human landscape of ancient Africa looked a lot different 3000 years ago.

    Without changing caloric intake, time-restricted eating improves metabolic health.

    Ramadan-style fasting (30 days of 14-hour fasts, from dawn to sunset) activates proteins related to cancer protection, glucose regulation, fat burning, cognitive function, and immune function.

    In Danes, taking fish oil was associated with larger testicles and better sperm parameters.

    Women who take the birth control pill tend to have smaller hypothalamuses.

    Grass-fed beef is darker, firmer, and less acidic than grain-fed beef.

    New Primal Blueprint Podcasts

    primal blueprint podcast

    Episode 400: Dr. Corey Riser: Host Elle Russ chats with Chiropractor and Certified Functional Medicine Practitioner Dr. Corey Riser.

    primal health coach institute podcast

    Primal Health Coach Radio, Episode 44: Laura and Erin chat with Anya Perry and Deanna Wilcox, founders of Plan to Succeed.

    Each week, select Mark’s Daily Apple blog posts are prepared as Primal Blueprint Podcasts. Need to catch up on reading, but don’t have the time? Prefer to listen to articles while on the go? Check out the new blog post podcasts, and subscribe to the Primal Blueprint Podcast here so you never miss an episode.

    Media, Schmedia

    California may call Tylenol a carcinogen.

    American Southerners in particular are inactive (but everyone’s pretty bad).

    Interesting Blog Posts

    Fat from your last meal sets the metabolic table.

    Dr. Danenberg goes carnivore for his cancer.

    The glucose-lowering effect of ketones.

    Social Notes

    Amy Remondi explains how she learned the science of Primal health and fitness while building her business.

    Play a little. Or a lot.

    Everything Else

    What the smartphone has done to our concept of “space.”

    Talk like an Egyptian.

    More calls to look into the ethics of Harvard’s meat science research.

    Things I’m Up to and Interested In

    Interesting stat: When trying to lose weight, female doctors tend to personally use intermittent fasting, ketogenic diets, and low-carb diets.

    Question I found interesting: What’s driving people to seek out and relish objectively painful and uncomfortable stimuli like cold water swimming?

    I agree with this principle: Happiness (and love) is what matters.

    Why not both?: Exercise as a caffeine alternative.

    One of many: The forgotten art of squatting.

    Question I’m Asking

    Are you worried about the coronavirus?

    Recipe Corner

    Time Capsule

    One year ago (Jan 18– Jan 24)

    Comment of the Week

    “Years ago my brother was placed on a drug for high blood pressure. Within two weeks he had a heated disagreement with his neighbor and code enforcement at his home that led to a SWAT team being called. Fortunately one of his neighbors was a cop in the same city; he was able to de-escalate the situation and no one was harmed. The next day my brother realized his outrage about many things had begun after taking the drug. He discontinued it. Three years later his wife was put on the same drug; due to constant arguing, they ended up divorced. They had been high school sweethearts.”

    – That’s a sad, alarming story, Lisa.


    The post Weekly Link Love – Edition 65 appeared first on Mark’s Daily Apple.

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    Successful Habit ChangeWe all know the grim stats about how many New Year’s resolutions fail. It’s not because making resolutions is hokey or people are inherently lazy. It’s because most resolutions come down to one of two things: adopting new (good) habits or breaking old (bad) habits, and habit change is hard.

    People struggle at every step, from picking the right goals—ones that are motivating and achievable—through the implementation process.

    The trick is to be strategic and intentional about changing your habits. Rather than relying on willpower and wishes, get good systems in place. As James Clear, author of Atomic Habits, says, “You do not rise to the level of your goals. You fall to the level of your systems.”

    What Are Habits, and How Do You Change Them?

    Successful habit change is the process of taking a behavior that currently requires cognitive effort and making it automatic. 

    “Automatic” is a word psychologists use to describe behaviors that don’t require a lot of cognitive attention or processing. Habits are any behaviors that have become automatic: walking past the cereal aisle at the store instead of turning down it, swinging your legs out of bed when your alarm goes off, going to yoga class on your lunch break.

    Adopting new habits might feel difficult at first, but with enough repetition they feel easy, like you’re not even thinking about them. That’s sort of true. Effortful behavior relies on the prefrontal cortex, the higher-level thinking and planning part of your brain. Habitual behavior is governed by a different structure called the basal ganglia.

    From a cognitive perspective, this is highly advantageous. The brain has a massive number of inputs to deal with each day. The more behaviors we don’t have to think much about, the better.

    So if building habits is so desirable for the brain, why isn’t it easier?

    How Habit Change Works

    On a basic level, all behavior works like this:

    Cue (trigger) –> Response (behavior, action) –> Feedback (consequences)

    To make a behavior a habit, the feedback has to be rewarding. You also have to repeat the behavior over and over to reinforce the relationship between cue and response:

    Cue (trigger) –> Response (behavior, action) –> Reward –> Repeat

    It’s elegantly simple but obviously not easy. The process can break down at any point along the way. The good news is you can improve your odds of success by beefing up any part of the system—the cue, the reward, or the “in-between stuff” represented by the arrows.

    You don’t necessarily need to do all of these for each new habit you’re trying to build. One might be enough. On the other hand, this is often a more-is-better situation.

    Target #1: Strengthen the Cue

    A cue can be a time of day (first thing in the morning), something you see or do in your environment (opening the fridge, watching a TV commercial), or a feeling (tension in your neck, boredom).

    In order to build a reliable habit, number one: make the cue stronger. In the language of Atomic Habits, make it obvious.

    Targets #2, 3, and 4: Mind the Gap

    A lot happens in the space between noticing the cue and initiating the behavior. According to Dr. Steve Wendel’s behavior funnel, this includes:

    • Gut reaction – your initial “yay” or “ick” feeling about the behavior that’s being cued
    • Evaluation – your more thoughtful evaluation of the cost and benefits of doing the behavior
    • Ability and timing checks – deciding whether you have the resources to follow through and whether there is any sense of urgency

    Thus, to increase the likelihood of making it to the response phase, you can:

    • Number two: Make it more appealing (“Make it attractive,” says James Clear.)
    • Number three: Make it feel more feasible (increase your ability)
    • Number four: Make it urgent

    Target #5: Make It Rewarding

    While developing better habits can be rewarding in and of itself, you can speed the process along by building in positive reinforcement. Especially if your goal is long-term (weight loss, training for a marathon), more immediate rewards can be helpful.

    Target #6: Rinse, Repeat

    To really ingrain the habit, you have to do the behavior over and over. The more you do, the stronger the cognitive association between the cue and the behavior and, over time, the more automatic it becomes.

    The Process in Action

    Let’s say you’ve decided to start going to the gym after work twice per week to lift weights. Here are 20 things you can do to increase your chances of success.

    Strengthen the Cue

    1. Leave yourself reminders.

    • Put post-it notes on your bathroom mirror, fridge, or laptop.
    • Set alarms on your phone.

    2. Arrange your environment.

    • Keep your gym bag on your front seat.
    • Put your exercise tracking app on the home screen of your phone.

    3. Use implementation intentions. This a fancy way of saying “make a plan.” Be specific. Use if/then statements. Research has shown that implementation intentions are incredibly powerful tools for instilling new habits.

    • “I will go to the gym on Mondays and Thursdays at 5:30 p.m.”
    • “When I leave the office, I will head straight to the gym.”
    • “If the gym is crowded when I get there, I will adjust my workout instead of leaving.”

    4. Use habit stacking, a specific type of implementation intention. Pair your new desired behavior with something you already do habitually. (This is the same as the anchoring principle in B.J. Fogg’s Tiny Habits protocol.)

    • “When I shut off my computer at work, I will immediately change into my gym clothes.”
    • “When I fold my laundry, I will set out two gym outfits.”

    Make It More Attractive

    5. Arrange to meet friends at the gym (also creates pressure to show up at a certain time).

    6. Invest in nice workout clothes that make you feel more comfortable.

    7. Designate podcasts or audiobooks you only listen to at the gym.

    8. Use positive language to describe your habit, for example, “I get to go to the gym today” instead of “I have to go to the gym today.”

    Make It Seem More Feasible

    9. Invest in a few sessions with a personal trainer or watch YouTube videos to learn good form.

    10. Download a fitness app that programs workouts for you.

    11. Break big goals into smaller, more achievable interim goals.

    12. Remove obvious obstacles.

    • Hire a babysitter.
    • Block off gym time on your work calendar so nobody schedules you for meetings.

    13. Join the gym between your home and office, even if the one on the other side of town is fancier. Or, buy workout equipment for your home so you don’t have to go anywhere.

    Increase Urgency

    14. Tell people about your plan so you’ll be motivated to follow through and save face.

    15. Hire a coach or trainer so someone who is counting on you to show up.

    16. Have a deadline.

    • Register for an upcoming strength competition or obstacle course race.
    • Join a 30-day challenge.

    17. Put your money where your mouth is. Use a service where you can bet on yourself following through on your plan. If you fail, you lose the money. If you’re successful, you get your money back. (Note: Spending money on your goal can increase urgency, but it has to be enough that you’ll feel bad wasting it. For some people that’s $10. For others it’s $10,000.)

    Make it Rewarding

    18. Use a tracking app or journal to record your sessions, or check off days on your calendar. Seeing your work accumulate is the grown-up version of getting gold stars on the good behavior chart in elementary school.

    19. Post your progress on social media. I know, I know, but it’s more than just bragging! Getting likes and positive comments is actually quite reinforcing.

    20. Structure rewards for yourself to celebrate milestones. For example, every time you increase a lift by 10%, put money aside for those expensive gym shoes you’re eyeing.

    Different Goals, Same Framework

    No matter what your specific goal, you can still use these same practices. If your goal is to get back into cross-stitch:

    • Leave your materials on the table where you’ll see them every afternoon. (Obvious)
    • Make yourself a cup of tea and put on relaxing music. (Attractive)
    • Start with two minutes per day. (Feasible)
    • Join a “pattern-a-day” challenge. (Urgent)
    • Turn your creations into gifts for friends. (Rewarding)
    • Try to cross-stitch every day. (Repeating)

    See? And most importantly, no matter what your goal, stick with it. Don’t get derailed by minor setbacks. Habits take weeks or months to lock in. Be patient.

    What say you? I’m a huge fan of habit stacking, but what techniques have you used successfully to build new habits?


    The post 6 Concrete Ways to Rewire Your Brain for Successful Habit Change appeared first on Mark’s Daily Apple.

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    intermittent fastingIt’s curious how not eating can spark so many questions and debates. A practice born out of necessity for our ancestors, fasting for long stretches happened when weather or circumstance hampered hunting and gathering, or for shorter periods while on the hunt or foraging.

    As food has become readily available and abundant in many countries, our near-constant state of food arousal can dull the hormonal drivers that regulate appetite and, ironically, lead us to want to counteract the overabundance with some restriction. When we eat too much too often, we get the natural inclination to push back from the table and vow not to consume another bite for a (possibly long) while.

    Fasting, particularly intermittent fasting, is gaining popularity now as a weight loss and weight management tool. As some celebrities proclaim that intermittent fasting is one of their “secrets” to their hard Hollywood-worthy bods, more and more people will be keen to latch on. We compiled a list of our greatest hits on fasting and intermittent fasting to provide education and context around how intermittent fasting works, reasons you may want to try it, reasons you may not want to try it, and considerations for athletes who want to fast.

    First, let’s start with the basics. Before making any changes to your eating (or non-eating) habits, it’s important to understand:

    • what it means to fast
    • why people fast
    • how long to fast
    • what benefits or downfalls there could be to fasting
    • whether all of the above can or should apply to you individually

    Do the effects of fasting differ for men and women? What are the most common things people get wrong about fasting? Is fasting an effective tool for weight loss? We answer those questions, and more, in the following articles.

    Fasting How to

    How to Lose Weight with Intermittent Fasting

    Fasting can be really beneficial to those who are trying to lose fat. Yes, that’s fat and not weight. Unlike some other kinds of weight-loss methods, which result in loss of water weight or muscle mass, fasting can effectively get rid of fat.

    Read more

    How to: Intermittent Fasting

    There is no one way to do IF. The only real guideline is that, as always, the food you eat should be healthy. (It’s pretty clear how we choose to characterize that.) In addition to the substantial health benefits, the simplicity and flexibility are what draw people to IF.

    Read more

    Dry Fasting

    Dry fasting is going without both food and fluid. That means no coffee, no tea, no broth, and no water or liquid of any kind (except the saliva you manage to produce). It’s an extreme type of fast whose fans and practitioners are adamant that it can resolve serious health issues. But does it? Is it safe? And what kind of research is available on it?

    Read more

    Fasting vs. Carb Restriction

    Both fasting and carb-restriction appear to operate along similar physiological pathways. Both lower carbs. Both increase fat-adaptation. Both have the potential to get you into ketosis. Both lower insulin and blood sugar. But is one better than the other?

    Read more

    Top 10 Fasting Mistakes

    If you’re making fasting mistakes, you might never accomplish the benefits you were hoping for. Before you throw in the towel, I want to help you identify some possible fasting pitfalls you might not be aware of and also help you avoid them.

    Read more

    The Pros and Cons of Fasting

    The Health Benefits of Intermittent Fasting

    Fasting is one way to have your cake and eat it too. Beyond the already proven benefits of a Primal Blueprint low-carb lifestyle, fasting once in a while seems to offer many of the same benefits of calorie restriction—you know, stuff like increased longevity, neuroprotection, increased insulin sensitivity, stronger resistance to stress, some cool effects on endogenous hormone production, increased mental clarity, plus more—but without the active, agonizing restriction.

    Read more

    Intermittent Fasting for Women

    With fasting, perhaps the most important variable to consider is your biological sex. This really does make intuitive sense. Biology cares most about your fertility. Can you reproduce? Can you produce healthy offspring that survive to do the same? These things come first. And from that perspective, a woman’s situation is more precarious than a man’s.

    Read more

    Should You Try Fasting?

    Primal folks who are losing weight or looking to lose a bit more, and getting the right lifestyle changes enacted (sleep, exercise, sex, leisure, rest, relaxation, mental stimulation) should definitely try fasting. They will likely flourish.

    Read more

    When Does Fasting Cross the Line?

    How do you know if your fasting regimen may be slipping into the grey area of potential orthorexia or disordered eating? We can’t diagnose anyone in an article, of course, but there are signs to watch out for if you have personal concerns or worries about others.

    Read more

    14 Reasons to Fast

    Anytime you attempt a “radical” health practice like not eating, it helps to have a good reason to do it. That will not only give you something to aim for, but it will ensure you actually have a physiological justification for your experiment. Never go in blind. What are some of the specific scenarios and conditions where fasting makes the most sense?

    Read more

    Long Fasts: Worth the Risk?

    If fasting for more than three days sounds riskier than just skipping breakfast, you’re right. Long fasts can get you into trouble. They’re a big commitment. You shouldn’t just stumble into one because it sounds interesting or some guy on your Twitter feed wrote about it.

    Read more

    What Breaks a Fast?


    It’s the nature of many beings—particularly those with weight-loss goals, it seems—to want to know what the “rules” are so they can look for the loopholes to bend them. It’s no surprise that the top-performing article last year on Mark’s Daily Apple was “Does Coffee Break a Fast?” Consequently, we followed up with an article about whether bone broth breaks a fast because we received additional questions. Then people wanted to know about supplements—should they be taken while fasting? We then created a definitive guide to what breaks a fast. If there’s any other liquid, leaf, pill, stone, or twig we neglected to examine, let us know in the comments section.

    Does Bone Broth Break a Fast?

    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.

    Read more

    Does Coffee Break a Fast?

    Does black coffee break a fast? Put another way… Does coffee interfere with the benefits we’re seeking from a fast? Depends on the benefits you’re seeking (and what you put in the coffee).
    Let’s look at some of the most common benefits first and if/how coffee affects them.

    Read more

    Do Supplements Break a Fast?

    Does fish oil break a fast? What about my multivitamin, protein powder, collagen, or melatonin? Mark delves into the research to provide definitive answers.

    Read more

    Definitive Guide to What Breaks a Fast

    One of the most common questions I get is “Does [x] break a fast?”
    What they’re really inquiring about is: “Does this interfere with, negate, or nullify the benefits of fasting?” Let’s go through the most popular queries one by one and figure out how each one affects an intermittent fast.

    Read more

    Does Intermittent Fasting Work for Athletes?

    Does fasting before and during workouts confer any performance perks or additional fat-burning benefits? Should athletes fast before every session, or only specific types of workouts? What are the potential drawbacks to fasting for athletes? Let’s go.

    Intermittent Fasting Tips for Athletes

    What are my specific recommendations for athletes who wish to explore intermittent fasting? I’ve got 12… plus some details about my own fasting and workout routine.

    Read more

    Benefits & Concerns Fasting for Athletes

    Sometimes, high stress is exactly what we need to progress—a few heavy sets of squats, some rounds on the Airdyne, a killer CrossFit workout—as long as you can recover from it. A major modulator of our stress is the amount of food we have coming in. At least in theory, exercising in a fasted state could provoke a powerful adaptive response that athletes would find helpful. So, does it stack up? What exactly can intermittent fasting offer athletes?

    Read more

    Fasted Workouts

    To some, the idea of working out without “carbing up” or doing the pre-workout protein shake is unthinkable. To others, fasted workouts are sacred tools, the perfect antidote to modern decrepitude. Where does the truth lie?

    Read more

    That’s it for today, folks. Thanks for reading, take care, and leave a comment below if there are more questions you have about IF!


    The post Intermittent Fasting: How It Works, Reasons to Try It & Considerations for Athletes appeared first on Mark’s Daily Apple.

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    Goal SettingThis is the time of year where we audit what we can change, improve, and do away with in our lives.

    What goals can we crush this year?

    If there was a phrase that could be done away with it, this would be it for me: “CRUSH YOUR GOALS.” It sounds exhausting, and a little angry.

    Here, instead, are a few nice promises that you can make for yourself. These five promises are all about loving kindness—the gentleness you need to thrive and survive in a world gone mad with goal-crushing.

    5 Promises to Keep:

    1. Enable Your Environment
    2. Trust the Progression of Progress
    3. Offer Yourself Kindness
    4. Have the Full Experience
    5. Ask for Help

    1. Enable Your Environment

    We are what we surround ourselves with, and if you’re trying to make any improvement in your life, you’ll be more successful if your environment is set up to support you.
    Trying to stick to a budget, diet, or fitness routine? Keep near you things that support those endeavors, and ruthlessly purge anything that gets in the way.

    Let’s say you’re trying to curtail your alcohol consumption this year. Simply not bringing adult beverages into the home is the obvious first step to setting up your environment for success.

    But go deeper than that. Rearrange your cupboards so the wine glasses or highball glasses are hidden away. Acknowledge what other rituals go alongside your cocktail routine. For example, is it how you wind down in front of the TV each night? If so, consider treating yourself to a great book, a true crime podcast series, or an indulgent epsom salt bath, so you have something to do besides TV, the activity in which your alcohol habit is tethered.

    If your friends, loved ones, or life partners seem to influence whether or not you have a drink, speak up: Let it be known that you are changing your habits, and that a friendly internet stranger told you that setting up your environment is the first step. If they love you, they’ll be on board and won’t pressure you. If they do pressure you… it might be time to have a meaningful conversation about how you need your loved one to show up for you with support and love.

    This is why many diet programs—including Mark’s 21-Day Primal Reset—begin with the Pantry Purge as step one. The willpower required to stick to a lifestyle change works better in the context of an environment that’s set up to remove the struggles and barriers. It’s a nice thing to do for yourself when you’re trying to change, grow, and improve.

    2. Trust the Progression of Progress

    You will not knock your goals out of the park on the first try. I repeat: YOU WILL NOT.

    Simply acknowledging this already takes the pressure off.

    In the world of coaching, we use a body of knowledge called the Transtheoretical Model, or the Stages of Change (which is much easier to remember, and to spell). Developed by behavioral psychologists, the Transtheoretical Model factors in six different stages of change:

    • Pre-Contemplation: You don’t even know you want or need to change. Given that you’re here, reading Mark’s Daily Apple, that’s probably not you.
    • Contemplation: You have begun to think about changing, though you haven’t yet taken action. This might ring familiar to you if you have a list of New Year’s Resolutions staring you in the face that you’ve not yet embarked on. There’s no shame in that—you should be proud of yourself for even contemplating change. Many never do.
    • Preparation: You’re ready to take action! You begin to make small steps toward your end goal. This is a big deal, and should be an exciting and celebratory time.

    Think of a staircase with your ultimate goal at the top, and every necessary micro-step in between, leading you deliberately up to your final destination. At this stage, you’ve begun to take those tentative first steps.

    This is the stage where folks tend to feel as though they’re falling off the wagon; failing at achieving their goals, just because their forward momentum up the staircase has slowed, stopped, or temporarily regressed backward. You aren’t failing. It’s impossible to leap from the bottom step to the top one in a single bound. You may take a step back down on the staircase, but the steps are small, so no harm is done. And that next upward step is always within your reach.

    In the interest of closing the loop, the final three stages of the Transtheoretical Model include: Action (you’ve officially changed a behavior and are confident and comfortable moving forward with it); Maintenance (the change no longer feels like a “change;” it has integrated into your life!); and, Termination (you’ve effectively exited the change interstate, and are now a different person).

    It’s the earliest first few steps of change where we’re hardest on ourselves, though. Understand that steps backward are allowed, and be kind to yourself when they inevitably occur.

    Speaking of which…

    3. Offer Yourself Kindness

    This is why I don’t like language around sacrifice or deprivation when one is embarking on a change, and it’s why the phrase “crush your goals” feels like nails down a chalkboard for me. This hard language forgets one important thing: Your inner and outer worlds are unpredictable, and if you hang your hat on drive and discipline, what happens when you’re inevitably thrown a curve ball that you can’t program your way out of?

    Often I’ll work with people who identify, proudly, as: “being very black and white.”

    “I need to be absolutely ON, otherwise I’m OFF,” they’ll say.

    While I admire the boldness of this statement, it simply can’t and won’t work for most people, for a lifetime.

    Life is not black and white. And the sooner you can get comfortable hanging out in the grey between Winning and Losing, the more at peace you’ll be as you navigate the inevitable ups and downs of personal growth. Heck, of life.

    So be kind to yourself. Feel proud when goals are “crushed,” absolutely. And when they aren’t? That’s okay too. Sit with it; observe it, journal it, declare out loud why you experienced your struggle or slip up. Recognize it. Give it a face, a name. Take the power back. And then dust off and move on.

    I want you to achieve your goals. And I want the entire process of that journey to feel good in your heart and mind, even the screw-ups.

    When you can flip the switch from driven discipline to loving kindness, the process of navigating change feels friendlier.

    4. Have The Full Experience

    This is one of those ideas that I thought I had invented… and then I heard Mark describe it perfectly on a podcast.

    His example was cheesecake, a dessert he loves… and one that is not particularly Primal!

    When he orders the cheesecake, the very act of that decision comes from a place of excitement and happiness. He wants the cheesecake, and doesn’t hesitate to order it. The entire experience of ordering the cheesecake is considered: how exciting it is to see it on the menu, to make the decision to order it, ask the waiter to bring it, patiently await its arrival while chatting and laughing with loved ones at an amazing restaurant.

    When the cheesecake arrives, how does it look? How does it smell? How does your body respond when it’s put down in front of you: Joy, delight? Anxiety, disappointment? There is never a wrong answer, only a necessary observation.

    Take the first bite. On a scale of 1-10, it’s a 10. Second bite: about an eight. Third bite: solid five. Fourth bite… four…

    And so on and so forth, stopping when the awesomeness of the cheesecake experience has been fully enjoyed, and before you’re just still eating it for the sake of eating it. Once the joy has faded, it’s time to put the fork down, and bask in the memories of those first few epic bites.

    With my clients, I take it further. What happens after the cheesecake? How does your body feel: Tired? Foggy? Do you have a stomach ache? Or do you feel fine?

    And then we keep going: the “after” after. The next day, has the cheesecake awakened the sugar monkey that lives on your back? Are your sugar and refined carb cravings awake and alive? How do you feel having indulged your cheesecake craving: satisfied and happy? Or have you descended into guilt and shame? Were you able to return to your regularly scheduled programming with no hiccups?

    Was it, ultimately, worth it?

    This is an incredible teaching moment.

    You may know this as “mindfulness.” I wanted to give it a more descriptive title since I think the concept of mindfulness has been too vague for too long, and though folks think they know they “need to be more mindful,” not too many can put their arms around what it really means.

    So have the full experience any time you make a choice that supports your goals—or doesn’t. If it was worth it, hooray! If it wasn’t, what can you learn from it?

    5. Ask For Help

    This is a hard one for anyone who prides themselves as being proud, stoic, or strong. Whether we don’t want to bother people with our struggles and strife, or we don’t feel comfortable declaring our goals and challenges out loud, one of the best promises you can keep to yourself is to ask unapologetically for help when you need it.

    I can tell you from experience that big change and growth only happens when you stretch yourself out of your comfort zone. So get comfortable with discomfort, and don’t be shy to seek a mentor who specializes in what you want help with. Finances? Hire a money coach. Health? Hire a health coach. Love? Get thee a relationship coach. Confidence? Yes, there are even confidence coaches out there.

    If you knew that there was a trusted expert out there who could help solve your specific problem, imagine how liberating and transformational it would be to form a partnership with that coach. I promise you, it’s a life-changer.

    Let’s make this the year we kindly and lovingly make and keep promises to ourselves.

    I’m Erin, the coaching director for Mark’s Primal Health Coach Institute. And if this little missive can help you start this year off feeling extremely pumped up, optimistic, happy, and empowered about the exciting opportunity for change ahead of you, then I’ve done my job.

    If you need any help along the way, we have thousands of Primal Health Coaches with vast specialities who are trained to help you mentor you toward your health and happiness goals for 2020 and beyond.


    Erin Power Erin Power is the coaching and curriculum director for Primal Health Coach Institute. She also helps her clients regain a loving and trusting relationship with their bodies—while restoring their metabolic health, so they can lose fat and gain energy—via her own private health coaching practice, eat.simple.

    The post 5 Easy Promises to Make and Keep This Year appeared first on Mark’s Daily Apple.

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    A big problem with New Year’s resolutions is not something intrinsic to the practice of resolving to make positive changes in the coming year—these can be beneficial forces in a person’s life—but with the way we word our resolutions. Word choice determines everything. Words mean things. The words we use determine everything that follows. With just slight modifications to the wording and by being more specific, these resolutions can become more powerful, more effective, and more true to our nature and our actual desires.

    How would I rewrite eight common New Year’s resolutions?

    “I’m going to lose 50 pounds.”

    This might be the most common goal. The world has a growing obesity problem, and the vast majority of people implicitly understand that this is indeed a problem to be solved. But “I’m going to lose 50 pounds” doesn’t give you a roadmap. It doesn’t even give a specific destination. Are you going to lose 20 pounds of fat and 30 pounds of muscle? Are you going to count calories? How many do you plan to burn and consume? What are those calories going to consist of?

    This is better: “I’m going to lose body fat and gain or retain lean mass by eating foods that naturally increase satiety and inadvertently cause a reduction in calories.”

    “I’m going to focus on my relationships.”

    A noble goal, to be sure, but what does it mean? Which relationships? How are you going to “focus” on them? Determine which relationships you’re most concerned with and identify what they lack and require most. Then, resolve to provide what they’re missing.

    Better options: “I’m going to find a reliable babysitter and plan a date night every Wednesday with my wife/husband.” Or: “I’m going to read to my kids every night.” Or: “I’m going to get together every Sunday morning with my friends to hike/grab coffee/work out.”

    “I’m gonna exercise more.”

    This is a popular resolution, and, at least for a couple of weeks, people stick with it. But around mid-January, the gym depopulates. The newcomers all migrate elsewhere. They don’t stick with it, despite quite honestly wanting to work out more often. What goes wrong?

    They’re not specific. They don’t make concrete plans or set a schedule. It’s one thing for someone with a lot of gym and training experience to practice “intuitive training,” where they just do what feels right and interesting. That’s pretty much how I train, but I’ve been doing fitness for most of my life. The total beginner will flounder if they try to go to the gym without any experience or any plans.

    Better options: “I’m going to lift heavy things twice a week, go for a 30-minute walk every day, and do some intense anaerobic activity like sprints or rowing.”

    “I’m going to meditate.”

    I see it all the time. Someone listens to a podcast with a business guru who swears meditating got him where he is today, and that it’s the single most important thing anyone can do. They try meditating, and it just doesn’t work. They can’t stick with it. So New Year’s rolls around, and they resolve to finally make it happen.

    Maybe meditation will work. Some say that it’s those who have the most trouble meditating who need it the most. Perhaps. But as someone who’s dedicated to improving myself and never has trouble doing hard things like lifting or pursuing business ideas or taking risks, meditating simply didn’t work. What did work?

    Going for walks in nature.

    Going paddle boarding.

    Even guided meditations worked better for me.

    In essence, “finding the flow” is what worked. Finding that activity that allowed me to turn off my mind and just be.

    Better options: Find the thing that allows you to reach that Primal state of flow. “I’m going to go for a quiet walk without any stimulus in nature every single day.” Or: “I’m going to go surfing/rock climbing/play music.”

    “I will live life to the fullest.”

    Too often this translates as, “I will stay up late getting black-out drunk as often as possible.” Maybe that’s someone’s “full life,” but I don’t recommend it. That doesn’t take “resolve” to do. That’s the kind of thing that people revert to when their better inhibitions fail. It’s the opposite of what a good resolution looks like.

    Better: “I will embrace looking stupid and try new things that I’ve always wanted to do but have felt nervous about being bad at.” Or: “I will pick something new and novel to do at least once a week (with an allowance for repeating if the new activity sticks).”

    “I’m going to learn a new skill/language.”

    Be more specific. What are you going to learn? What is the thing that keeps surfacing in your mind as you drift to sleep? What do you dream about? What do you keep noticing in your everyday life?

    Better: “I’m going to learn how to change my brake pads.” Or: “I’m going to learn German.” Or: “I’m going to take judo classes.”

    “I’m going to stop drinking.”

    This is a noble resolution, but it may not be effective by itself. When someone’s alcohol intake becomes a problem, it’s usually masking a deeper issue. People don’t drink to excess because they’re celebrating real life too much or living a totally fulfilled life when sober. Drinking becomes a problem because you’re covering something up.

    Instead of just “not drinking,” plumb the depths of your soul to determine the true cause of your over-indulgence in alcohol. Figure that out, come to peace with it, and figure out a resolution to address it. In doing so, you will have a better chance at fixing the drinking.

    A better option: “I’m going to figure out and overcome the reasons I’m drawn to drink so much alcohol.”

    “I’m going to read more.”

    I’m a bibliophile. I understand the joy of reading books and the frustration that comes when the end of the year rolls around and I realize I haven’t read as many books as I would have liked. There are so many to read, so little time, and time squandered is reading time you won’t get back.

    “Books” is such a general category to be useless. Get more specific about what kind of book you want to read. Read only what you truly enjoy. Don’t feel guilty about stopping a book after 30 pages if it hasn’t grabbed you (it’s just an inanimate object, it won’t feel anything). Go to the library (having a time limit forces your hand; sometimes owning a book means you shelve it and forget it).

    Better: “I’m going to read books I enjoy and quit books I don’t without feeling guilty.” Or: “I’m going to get a library card and start checking books out.” Or: “I’m going to read more fiction.” Or: “I’m going to flip through books and read what I want without worrying about reading the whole thing.”

    The hardest resolution is the one we can sense but can’t articulate. In my experience, almost everyone in this modern age is missing something, is searching and yearning for something that they can’t quite pin down. If it exists in some immaterial dimension of potentiality outside of language, the resolutions we write down won’t capture it. That, I suspect, is a major reason the resolutions we choose do not complete us.

    How do we fix that one? How do we find it? Maybe by moving through the world, by throwing ourself into meaningful pursuits that resonate in the moment, by taking long walks and letting the mind and body wander where they will, by letting go of our need for constant stimulation and embracing boredom.

    What are you resolutions this year? If you could rewrite them, what would you say?

    Have a great New Year, folks. Take care!


    The post Common New Year’s Resolutions (and How I’d Rewrite Them) appeared first on Mark’s Daily Apple.

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    Many people get to age 60 or so and, if they haven’t lived a healthy, active life up to that point, assume it’s too late for them. After all, things only get harder the older you get. You’ve got aches and pains. Your doc is always reminding you about your weight. Things creak and crack. You look wistfully at the gym you pass by every day, thinking to yourself, “It would never work.”

    At least, that’s how most people deal with getting old: they lament their “inability” to do anything about it as oblivion approaches and overtakes them.

    Forget all that. While you can’t turn back the chronological clock, you can “de-age” yourself by engaging in the right diet, exercise, and lifestyle modifications. So—how?

    Realize That It’s Never Too Late

    The scientific literature is rife with examples of older individuals making changes to their lifestyle, diet, and exercise and seeing great results.

    How about 68-year-olds still getting gains from strength training?

    Older women switching to high-fatty-meat or high-cheese diets and enjoying better heart health.

    Verifiable examples (or “anecdotes”) from people online are also available. Like PD Mangan, who went from this to this. That’s not impossible, or even difficult to achieve. What you need is the will and means and know-how—all freely available.

    Know that it’s possible. Know that it’s probable. Know that your efforts will not be in vain.

    Realize That It’s Your Fault—And Even If It’s Not, It’s Your Responsibility

    I don’t care where you fall on the belief spectrum. It could be that “your body is a temple ordained by God and you’d be remiss to let it fall to ruin and in doing so fail your creator.” It could be that “your body was the work of hundreds of generations of ancestors who fought and suffered and scrounged and died to ensure you’d make it and to fail to maintain your health is a huge insult to their sacrifices.” It could be that “your body is the product of millions and billions of years of evolution through natural selection, a chance byproduct of a process that probability says shouldn’t have even happened, and you’re going to waste it?”

    However you approach it, what matters is that you have a remarkable body (and mind) that deserves your attention, care, maintenance and nourishment. Only you can do anything about it. Maybe you were fed bad food as a kid and bad info as an adult (this is most people). Doesn’t matter. You still have to own it and take the steps necessary to improve your condition. Responsibility means ability to respond. Claim it.

    Eat More Protein

    If you’re over 50, you need more protein than you think.

    If you’re over 50, your ability to utilize protein isn’t as good as it used to be.

    If you’re over 50, you need more protein to do the same job as a person 25 years younger.

    If you’re over 65, the supposed negative relationship between meat and mortality the “experts” are always crowing about reverses, magically becoming a positive relationship.

    And if one of your issues is trouble losing body fat, more protein will also help you beat back exaggerated hunger and keep food intake low enough to lose weight. Many people in the ancestral community don’t like acknowledging this, but it’s true for a great many people: protein is the most satiating macronutrient.

    Moreover, protein will help you lose body fat and retain (and even gain) the all-important lean muscle mass. Losing muscle when you’re over 50 is harder and harder to recover from.

    The only catch is that if one of your “aging-related maladies” is kidney failure, you may have to slow things down and keep your protein intake low to moderate. Emphasis on “may.” Check with your doctor if that’s the case.

    Get As Insulin Sensitive As You Can

    The relationship between insulin signaling and aging is a bit unclear. What we know is that people with higher insulin sensitivity live longer and healthier lives. We know that insulin resistance is strongly linked to most degenerative diseases, like cancer, diabetes, sarcopenia, and osteoporosis (to name only a few). But researchers are always oscillating between “cause” and “effect.” Is insulin resistance a cause or a sign of aging? Are insulin sensitive people healthier into old age because they’re insulin sensitive, or are they insulin sensitive because they’re healthier?

    I’m not sure it really matters. Either way, to become more insulin sensitive you have to do a bunch of things that will also make you healthier and age better like lifting weights, quitting overeating, taking more walks, doing more low level aerobic work, and regulating your carb intake.

    I’ve always said that you should burn as little glucose as possible. The more you can rely on stored body fat for energy and daily maintenance, the better. Well, the more insulin sensitive you are, the less insulin you’ll have blunting your ability to liberate stored body fat, the more fat you’ll burn and the better you’ll age.

    Walk Every Day

    One of my favorite predictors of mortality in older people is walking speed: they ask people to walk at their normal speed and then track how fast they go. The slower the walk, the higher their risk of dying earlier. It’s my favorite because it’s so elegant. And no, actively forcing yourself to walk more briskly when you get tested won’t increase your longevity. But if you get up and walk every single day, walking will be second nature. Your walking speed will increase naturally, and it’s the natural increase in walking speed that presages a longer, healthier life.

    Walking will also force you to get out and see and experience the world. It’ll lower your fasting blood glucose and postprandial blood glucose (hint: walk after meals). It will introduce novelty to your life and in doing so extend your time horizon.

    Eat Tons Of Collagen

    Collagen improves skin health, elasticity, and reduces wrinkling. This might sound superficial, but altering those “surface level” signs of aging indicates that you’re also modifying the internal aging markers.

    Another reason to up your collagen intake is to balance out the meat you’re eating. As an older person, you’ll need to eat more meat to counter your suboptimal protein utilization. That means you need to process more methionine, which requires more glycine, which comes from collagen.

    The easiest way to get collagen and hit a few birds with one stone is to eat lots of collagenous meats—shanks, skin, knuckles, oxtails, ears, snouts, feet, tendons. That way you get your muscle meat protein and collagen protein. Collagen protein powder is another option.

    Lift Heavy Things To Build Your Musculoskeletal System

    Exercise isn’t just good for your muscles and your heart. It’s also the only reliable way to build and maintain bone mineral density. But in order for exercise to improve bone mineral density, it must satisfy several requirements. It should be dynamic, not static. It needs to challenge you. It needs to challenge your muscles. In other words, you need to lift (relatively) heavy things. You need to progress in weight, intensity, and duration. It should be “relatively brief but intermittent.” No long drawn-out sessions that do nothing but overwork and overtrain you. Keep it short and intense. Also, the exercise should place an unusual loading pattern on the bones. That could be different movements, or increased resistance, as long as you’re introducing something “new” to the body; don’t just do the same old weights forever. Finally, for exercise to improve bone mineral density it must be supported by sufficient nutrition, especially calcium, vitamin D, sufficient protein, and vitamin K2.

    Develop Your Balance Yesterday

    The number one cause of death and degeneration after age 70 is falling and breaking something. You step out of the shower, slip, and break a hip, then never recover. You step off a curb and fall on your knee, breaking your femur, and never recover. Avoid this at all costs. Improve your balance as soon as possible.

    Get a slackline: Keep it low to the ground, have a partner to help, or use something like a walking stick to support you. Focus on simply balancing rather than trying to walk.

    Try standup paddling: Not only is it a great workout and a great time, paddling forces you to balance—constantly. And as long as you can swim, falling is totally safe.

    Walk on uneven surfaces (carefully): Go for hikes, walk in the sand or in the grass, walk along cobblestone streets, walk on slopes.

    Walk along curbs (very carefully).

    Wear footwear that is as minimalist as you can handle (or just go barefoot if you’re up for it): The bottom of the foot is loaded with nerve endings that inform you and guide your balance as you make your way through the world. They help you subconsciously make those micro-adjustments to your posture and body position that make up “good balance.” A big clunky rubber sole blocks that out and cuts you off from your body.

    Play Every Day

    They say that when you stop moving, you start dying. I say when you stop playing, you start dying. We see this in dogs; once a dog no longer wants to play, chase the ball, roughhouse, or do the things he or she used to love doing, they’re on the way out. I firmly believe the same is true for people—just spread out across a longer timeline.

    So have fun. Play sports. Try Ultimate Frisbee (my favorite).

    Don’t forget about the mental games. Game nights. Crosswords in the morning (that’s what I do). Play cards. Do a weekly poker night with friends and make it a potluck.

    What I’m not saying is that doing the crossword will stave off Alzheimer’s or make you smarter. What it will do is send the message to your brain and body that “this person hasn’t given up.” Ideally, your physical play will train your muscles, bones, and balance—that way you can satisfy all those requirements and have fun doing it.

    Don’t Do It Alone

    If you’re an older person reading this and actually preparing to make the changes necessary to be healthy and vigorous, you are a rare bird. Most of your peers have given up. Most have resigned themselves to being less healthy and less vigorous with every passing day. Don’t let that happen. Enlist a friend, a loved one, a peer. Not only will it give you another person to play, train, and walk with, but it will help you stay the course and enjoy doing it. It will also save another person—or at least give them the best chance they’ve got.

    Those are the big tips. There are others, though. And for anyone interested in better health and longevity and more life in the years you have, Keto for Life, offers more information than I could fit here. All the points I covered today and many more are fleshed out and expanded upon twenty-fold.

    But if you just focused on these 10 tips, you’d be pretty far along on your way to health (no matter what age you are).

    That’s it for today, folks. Take care, drop your own tips down below, and have a great Thanksgiving!


    The post Late To the Healthy Living Game? 10 Essential Tips Making the Transition to Better Health appeared first on Mark’s Daily Apple.

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    As we covered in Parts I and II of this series, during perimenopause and menopause women can experience a complex web of physical, psychological, and social symptoms.

    The treatment usually prescribed by doctors, hormone therapy (HT), is controversial and not appropriate for some women. I won’t get into the HT debate here—Mark did a great job covering the pros and cons recently. Suffice it to say that HT isn’t the answer for everyone, and it’s not a panacea by any means.

    Whether or not they choose to go the HT route, many women desire additional support during perimenopause and beyond. For the sake of keeping this post from becoming a novella, I’m going to focus on mind-body therapies today.

    This is not meant to be an exhaustive list of nonhormonal options, nor is it meant to try to dissuade you from trying HT. That’s a decision you have to make for yourself with your doctor. The approaches below can be used alone or in combination with other modalities, including HT.

    As with any medical-adjacent tools, if you are considering any of the options here, take the time to educate yourself, talk to your doctor, and find qualified practitioners to help you implement these practices.

    A Note Regarding Research Evidence…

    Because so many women are interested in complementary or alternative approaches, there’s a fair amount of research into nonhormonal treatments. There are also important limitations.

    A lot of the randomized control trials—experiments that are best for establishing causal effects—are small. There is considerable variability in research design, so it’s difficult to generalize across studies.

    Participants in these studies tend to be white and well-educated. Since there are cross-cultural differences in the experience of menopause, we shouldn’t assume that the findings apply to all women. Likewise, a lot of the research focuses on women with a history of breast cancer because HT is generally contraindicated in this population. While the results of these studies probably generalize to other women, it would be great to have more data.

    Finally, vasomotor symptoms—hot flushes and night sweats—are studied more than other types of symptoms. Though they are the most common complaint, many women do not experience debilitating vasomotor symptoms. They might, however, experience mood fluctuations, depression, sexual issues, memory problems, and more. We know less about how these approaches might help those women.

    Nevertheless, I’ll highlight some of the potentially fruitful avenues you might explore. When possible, I’ll focus on systematic reviews and meta-analyses. They pool the results of multiple smaller studies to help a more reliable picture emerge.

    Cognitive Behavioral Therapy (CBT)

    In CBT, individuals are encouraged to explore how their thoughts (cognitions) affect feelings, behaviors, and physical symptoms. With help, they change their thoughts or beliefs about a situation to help manage their responses and improve coping skills.

    Although there isn’t a ton of research on CBT for menopause, available studies are very promising. Whether or not CBT reduces the actual number of hot flushes—and the data here are mixed—CBT should work by changing women’s perceptions of their hot flushes. Multiple studies do find that after CBT women view their hot flushes as interfering less with daily life. As expected, they are also less bothered by them.

    Women who see themselves as having less control over their hot flushes also tend to experience more distress. Changing their perceived control could be an effective intervention for improving quality of life. Indeed, in one study, 95 women received either group-based or self-help CBT. After therapy they reported feeling greater control over hot flushes and having better coping skills compared to women in a no-CBT control condition. Further analyses showed that women’s beliefs about control and coping predicted how problematic they found their hot flushes to be. (Having more positive beliefs about how hot flushes affect sleep also helped.)

    Women who participated in CBT also experienced fewer sleep issues and insomnia as well as fewer depressive symptoms and sexual concerns.  They also noticed less impairment at work. Positive results were found with in-person therapy, self-help programs, and telephone-based therapy. When studies included a follow-up assessment, the beneficial effects of CBT persisted for at least six months.

    Mindfulness, Meditation and Relaxation Training

    A cross-sectional study of 1744 women found that women with higher scores on a mindfulness assessment tended to report less severe menopausal symptoms. For women with higher life stress, this association was especially strong. The idea here is that when women are able to be present-focused and observe their symptoms without judgment, they are protected against some of the distress, and possibly the physical symptoms, associated with menopause.

    Although some of the women in that survey are probably mindful by nature—lucky them—mindfulness is also a skill that can be learned and cultivated. Among the many reasons to do so, mindfulness and meditation training can apparently lessen menopausal symptoms.

    For example, researchers assigned 110 women to either an intensive eight-week mindfulness-based stress reduction program or a control group. The women who received mindfulness training reported having less bothersome hot flushes, better sleep quality, less anxiety and stress, and greater overall quality of life compared to the control group. When the researchers followed participants over the next 11 weeks, these results persisted or became even stronger.

    A few other studies found that women who receive mindfulness or meditation training report fewer and less bothersome hot flushes, improved sleep, and better psychological functioning, though the results have not consistently endured over time. However, when looking at more general relaxation training and paced breathing techniques, effects are minimal, at least for hot flushes.


    An ethnographic study of nine female yogi masters concluded that they tend to skate fairly easily through menopause. The authors concluded that menopausal women should be encouraged to practice yoga. Of course, in addition to yoga, these yogi masters’ lifestyles included “healthy food habits, adequate sleep, and the use of nature cure techniques (i.e., fasting, detoxification, selection of suitable food products, and living in well-ventilated houses) that facilitated the art of living in tune with nature.” This sounds pretty great, but can we give really yoga all the credit here?

    Probably not. However, two recent meta-analyses did conclude that yoga offers small but significant relief from symptoms of all types: vasomotor, psychological (including depression), somatic (including fatigue and sleep disturbances), and urogenital. Women also report better overall well-being and quality of life after receiving yoga training.

    In one study, a group of breast cancer survivors received twelve weeks of yoga and meditation instruction, and they were encouraged to practice daily at home. Compared to women in a control group (no instruction), they reported fewer symptoms and improved quality of life at the end of the twelve weeks and again when asked three months later. A later analysis found that many of the effects were mediated by improved self-esteem in the yoga group.

    Note that most of the individual studies are small, and they employ different types of yoga practices. This might be considered a strength insofar as different practices have been shown to work, or a weakness in that it’s not clear if one approach is particularly effective.


    Cross-cultural surveys find that women who are more active tend to have an easier time with menopause. For example, two large surveys of Swedish women found that women who exercised at least once per week reported less intrusive symptoms than women who never exercised, and women who exercised more than three hours per week were significantly less likely to experience severe symptoms than their less active counterparts. Sedentary women in this Finnish study experienced more vasomotor, psychological, and somatic/pain symptoms than women who were at least somewhat active.

    While promising, experimental studies have not yielded such favorable results. When women were assigned to “physical activity” conditions (often walking), some studies report improvements, but others find no improvements or even worsening symptoms (perhaps depending on women’s baseline fitness). Multiple reviews have concluded that there is no systematic effect of exercise, particularly not for vasomotor symptoms.

    Does that mean menopausal women shouldn’t exercise? Obviously no. It’s clear that being active—or at least not being sedentary—is important for overall health, and it probably helps menopausal women through the transition. However, there isn’t enough research to know what types of exercise are most effective and when. Do the types of movement you enjoy and that make your body feel good.


    A recent review concluded that acupuncture is effective for reducing vasomotor symptoms, both frequency and severity, as well as for improving quality of life. However, the reviewers also found that acupuncture was not reliably better than sham acupuncture where needles are inserted at points other than the prescribed pressure points and at a shallower depth—a placebo condition.


    A handful of studies have shown that clinical hypnosis can reduce hot flush frequency and distress among breast cancer patients. Another study of 187 women without breast cancer found that women who received hypnotherapy had fewer, less severe, and less bothersome hot flashes, as well as improved sleep. These results were evident at the end of the five-week treatment protocol, and they remained or got stronger in the six-week follow-up period.

    The Experts Weigh In…

    In 2015, the North American Menopause Society released a position statement on nonhormonal management of vasomotor symptoms. Of the approaches discussed here, the only ones NAMS recommended based on the strength of the available evidence were CBT and hypnosis. Mindfulness-based stress reduction earned a “recommend with caution,” which means, “We think it might work, but the evidence isn’t conclusive.”

    The others—yoga, exercise, relaxation and paced breathing techniques, and acupuncture—were not recommended. This does not mean they are not worth trying! It simply means that based on their standards, the evidence was not strong enough for the committee to conclude that they are likely to be effective treatments for vasomotor symptoms specifically. This says nothing about other types of symptoms, nor about general well-being or quality of life.

    Mind-Body Therapy Pros and Cons

    So where does this leave us? Each of these therapies shows promise for alleviating at least some symptoms of menopause. Moreover, all these therapies have the potential to improve overall quality of life, sleep, stress, and general health. While reading these studies, I did wonder whether some of the women felt better simply because they were investing time and energy in taking care of themselves. If so, is that a problem? I don’t think so. They are low-risk interventions with a lot of potential upside.

    That said, these aren’t quick solutions. The effective mindfulness/mediation trainings included six to eight weeks of classes and multiple hours per week. Women practiced yoga for two to four months during the study periods. Hypnotherapy was five weeks or longer. It’s not clear what the minimum time frame is for each of these therapies to be useful, but they’ll certainly involve a time commitment that might not be practical for all women. However, yoga, mindfulness/meditation, exercise, and even CBT can all be practiced at home once you know the proper technique.

    As I said at the beginning, this is not an exhaustive list of nonhormonal therapies. There are also various supplements that might help, as well as lifestyle modifications that most of you Primal-savvy readers are probably already implementing: eating a variety of nutrient-dense foods, getting plenty of sunlight, practicing good sleep hygiene, and nurturing social connections.

    Whatever you choose, be patient. Don’t just focus on one symptom; focus on the big picture. Pay attention to how you’re feeling more globally. Consider that while an intervention might not hit its desired mark, it might help you in ways you didn’t expect.

    Have you used mind-body techniques (these or others)? What’s been your experience? Share your insights and questions below, and have a great week, everyone.



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    Goldstein KM, et al. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric. 2017 Apr;20(2):178-182.

    McMillan TL, Mark S. Complementary and alternative medicine and physical activity for menopausal symptoms. J Am Med Womens Assoc (1972). 2004 Fall;59(4):270-7.

    Molefi-Youri W. Is there a role for mindfulness-based interventions (here defined as MBCT and MBSR) in facilitating optimal psychological adjustment in the menopause? Post Reprod Health. 2019 Sep;25(3):143-149

    Moore TR, Franks RB, Fox C. Review of Efficacy of Complementary and Alternative Medicine Treatments for Menopausal Symptoms. J Midwifery Womens Health. 2017 May;62(3):286-297.

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    The post 6 Mind-Body Approaches for Menopause appeared first on Mark’s Daily Apple.

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    For today’s edition of Dear Mark, I’m answering a bunch of questions from readers. The first one concerns another inflammatory marker, homocysteine. How could CRP be low but homocysteine be high? What could cause that? Next, I answer a barrage of kefir questions, including ones on kefir carb counts, pasteurized kefir, and water and coconut kefir. Finally, I address the elephant in the room: stressing out about your diet.

    Let’s go:

    How do Homocysteine levels figure in this equation? I have C-reactive protein under 1, but Homocysteine levels of 15, slightly high. Seems odd one so low and one a bit high.

    Both indicate elevated inflammation, but they can have different causes. There are many nutrient deficiencies and interactions that go into elevated homocysteine levels—that’s why they indicate inflammation. What are they?

    It all comes down to methionine. That’s the essential amino acid most abundant in muscle meats, the one most of you are getting a ton of if you’re eating a standard Primal, keto, or carnivore diet. We use it to perform cellular communication, regulate gene expression, repair cells, and build new tissue. It does some really important stuff, but it needs several different co-factors to work properly.

    B12 and Folate—Vitamin B12 is a major one. So is folate. In fact, I lumped them together in one section because they are co-dependents. Vitamin B12 requires folate to do its job. Folate requires vitamin B12 to do its job. Both vitamins are necessary co-factors for methionine to do its important cellular work. Without either one, methionine builds up and contributes to homocysteine.

    They even tested this in a controlled human trial. Giving a big dose of methionine without increasing B12 or folate increased homocysteine levels. Supplementing with B12 and folate protected against the methionine-induced increase in homocysteine.

    Riboflavin—Some groups may need extra riboflavin to deal with homocysteine levels.

    Glycine—After teaming up with the B-vitamins to do the gene expression and cellular repair/buildup, any excess methionine combines with glycine to form glutathione. That’s the body’s main antioxidant, and it’s very helpful to have. If you have low glycine levels/intake, then any leftover methionine goes into the homocysteine cycle.

    B6—Vitamin B6 is also used to mop up and convert into glutathione any excess methionine after methylation.

    Betaine—Similar to glycine, betaine acts as a buffer for excess methionine. In fact, high intakes of methionine deplete the body of betaine, while supplementing with betaine reduces homocysteine levels.

    Choline—Choline is another methionine buffer. High methionine increases the need for choline, while adequate choline or supplementation reduces homocysteine.

    If you’re missing those co-factors, methionine fails to assist with cellular communication, gene expression, cellular repair, or new tissue formation. Instead, it generates homocysteine.

    For a primer on obtaining adequate B-vitamins, read this post. Meat of all kinds, eggs, organ meats, seafood, dairy, green vegetables, and even legumes are ways to obtain them.

    For a primer on obtaining adequate glycine, read this post. You can get it through collagen, gelatin, bone broth, or bone-in, skin-on meats with a lot of gelatinous connective tissue.

    To get enough betaine, include some beets and/or spinach in your diet. Wheat germ is the best source, but most of you aren’t eating wheat germ (nor would I recommend you start).

    To get choline, eat egg yolks. That’s the single best source. If you’re not going to eat betaine-rich foods (beets, spinach, wheat), eat extra choline; you can make betaine from choline.

    Isn’t there a relatively large amount of carbs in kefir, when consumed in quantity?

    The fermentation process digests most of the lactose present in milk. The sourer the product, the lower the residual lactose. The sweeter the product (or even just less sour), the higher the residual lactose. At any rate, I wouldn’t worry too much about the carb content of kefir. It’s assuredly lower than advertised, and probably low enough for even keto eaters to incorporate at least a little.

    There are even lactose-free kefirs that will be definitely near-zero in carbs. If that’s the case, it will be prominently displayed on the label.

    Mark, don’t they at least partially”clean up” kefir? Does it really contain all that good stuff, or is pasteurized?

    Commercial kefir uses pasteurized dairy, but the fermentation takes places after pasteurization. This means the finished product is fermented with living bacteria (and yeast, in the case of kefir).

    I’ve never seen a commercial kefir that pasteurized after fermentation. If you’re worried, you can always get your own kefir grains and make your own kefir. It’s pretty easy and delicious.

    Kefir – I just did a test of dairy and it definitely gives me a reaction. I’d love to read your take on water kefir though I’m not pleased that the recipes use sugar. What about coconut milk kefir?

    Don’t worry about water kefir that uses sugar. All the sugar gets consumed by the kefir grains, leaving little to no residual sugar for you. You can tell by the taste (and I admit I’m no fan/expert of water kefir, only because I can tolerate dairy kefir). If it’s sweet, it contains sugar. If not, it doesn’t. Even if it has some sugar left, it’ll be far less than indicated on the label.

    Coconut milk kefir is a good option too. Again, I prefer the dairy kefir, but I see nothing wrong with coconut milk kefir. I even put up a coconut milk kefir recipe some time ago.

    Funny you mentioned to drink bone broth (for the glycine) to help with sleep. I have been keto-carnivore for 9 months and recently realized that the high level of histamines in bone broth was giving me insomnia. I can eat most foods that contain a moderate level of histamines, but canned fish and long-cooked bone broth have derailed my sleep on carnivore.

    If that’s the case, straight glycine can work. That’s what several studies actually used to improve sleep in humans—isolated glycine.

    Collagen may also work for you.

    Could all this be too much worry from being obsessed with checking if they are doing the keto diet “right” ?

    Ha! Yeah. That’s the issue with a certain subset of the Primal/keto crowd. Worrying about every little thing until it becomes a stressor. Ketone numbers running through the head as you lie awake. Waking up at 2 AM to test your urine. “Did I remember to Amazon Prime the MCT oil?” Wondering “Is the olive oil in my canned sardines truly the highest quality olive oil?”

    Then there’s the true classic: stressing out about the stress you’re inducing from worrying about your diet. Educate yourself, but don’t forget to enjoy life. There’s only so much diligence we can orchestrate without losing the forest through the trees.

    That’s it for today, everyone. Take care and be well, and make sure to leave any comments or questions down below.


    The post Dear Mark: Homocysteine, Some Kefir Questions, and the Stress of Worrying appeared first on Mark’s Daily Apple.

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