In our previous menopause post, I mused on some perspectives of menopause that are positive and affirming for women. However, I don’t want to downplay the fact that many women experience menopause as a difficult, frustrating, and even disempowering time. (Again, I am using “menopause” to include the perimenopausal period.)
As I mentioned in the last post, some researchers estimate as many as 75% of women experience some type of “menopausal distress,” and we don’t talk about it enough. Today I want to examine some of the psychological and emotional facets of menopause. In the final post of this series, we’ll look at self-care techniques and non-hormonal therapies that seem to be the most beneficial.
What Research Suggests About Emotional Well-being During Menopause
Obviously menopause is a major life transition—significant biological changes wrapped up in a complex web of personal and sociocultural beliefs, fears, stressors, and stories. It can be a time of great apprehension, confusion, even despair for some women. Others pass right through menopause with hardly a bat of an eye. Still, others welcome and embrace it.
It’s extremely understandable why this would be a challenging time for women. Menopause can be a perfect storm of physical discomfort and cognitive symptoms (brain fog, forgetfulness), sleep deprivation (thanks to those night sweats and hot flashes), and emotional fluctuations. Besides how they feel, these symptoms can affect women’s personal relationships, ability to perform their jobs, and sense of self-worth and self-confidence.
For many women, menopause also coincides with the dual stressors of aging parents and raising teenagers or having a newly empty nest. Plus, menopause is an unmistakable marker of aging, which can evoke complicated feelings as well.
Overall, stress, depression, and anxiety seem to be fairly common during menopause. Recent Guidelines for the Evaluation and Treatment of Perimenopausal Depression commissioned by the Board of Trustees for The North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers describe perimenopause as a “window of vulnerability for the development of both depressive symptoms and a diagnosis of major depressive disorder.”
It’s difficult to know exactly how many women are affected. Studies of depression and anxiety are usually conducted on women whose symptoms are severe enough to seek help from their doctors. Researchers estimate that up to 40% of women will experience depression at some point during menopause; it’s unclear how prevalent anxiety might be.
It’s easy to assume that some women become depressed and anxious during menopause because their symptoms are so gnarly. To some degree, that narrative is probably true. Studies do find that women who experience more severe symptoms such as frequent hot flashes also exhibit more depression and anxiety. This makes sense—being physically uncomfortable and unable to get a good night’s sleep can certainly set the stage for poor psychological outcomes.
On the other hand, it’s likely that for some women, depression and anxiety exacerbate the physical and emotional symptoms. That is, depression and anxiety might be a lens that magnifies how bad menopausal symptoms feel, so these women report having more severe symptoms.
In any case, there’s more to it than “menopause is rough, and it makes women depressed and anxious.” One of the biggest risk factors for depression and anxiety during menopause is prior episodes of depression and anxiety. Women who are also experiencing other life stressors, including relationship stress and socioeconomic stress, are also more likely to become depressed.
In other words, women who are otherwise vulnerable are more likely to experience poor psychological well-being when hit with the additional stress of the menopausal transition.
Along these lines, one study compared depressed and non-depressed perimenopausal women on a variety of quality of life measures, including life enjoyment and satisfaction; ability to function in work, social situations, and relationships; and perceived social support. The researchers also assessed the severity of the women’s hot flashes. The depressed women scored lower than the non-depressed women on all quality of life measures. Severity of hot flashes had no effect for either group.
The authors concluded that future studies “need to distinguish between those women with [perimenstrual depression] and non-depressed women to avoid attribution of decreased [quality of life] to the menopause transition alone.” In other words, don’t blame the hot flashes for what the depression wrought.
This is an important point: We assume that menopause interferes with women’s well-being and quality of life because the symptoms stink (and they definitely do for a lot of women). However, the degree to which menopause actually impacts a woman’s quality of life might depend, at least in part, on whether she experiences concurrent depression or anxiety.
This is not to say that if you’re having a hard time dealing with your symptoms, you’re definitely also depressed. Rather, consider whether depression and anxiety are contributing so that you can address them directly.
Likewise, don’t assume that depression and anxiety will resolve on their own once the physical symptoms subside. Treating the physical symptoms is important, but for many women it might not be enough.
What We Need to Be Saying (To Each Other) About It
At the risk of stating the obvious, a lot of distress is surely rooted in the fact that women don’t feel like they can talk openly and honestly about their experience of menopause, perhaps especially the mental and emotional aspects.
In Becoming a Menopause Goddess, author Lynette Sheppard asserts that all of her friends experienced sadness, if not full-blown depression, during menopause. All of them. More than anything, she says, they needed to hear that it was normal, that there was nothing inherently wrong with them.
Instead, the stigma surrounding mental health struggles and the taboo nature of talking about menopause keep many women suffering in silence. Of course, it’s not like we talk freely about the physical symptoms, either. Sure, we can kvetch about hot flashes with our friends. How many women feel free to discuss brain fog and sleep deprivation with their bosses, even if they have very real consequences in the workplace?
I understand that “just talk about it” is neither easy nor sufficient—I’m not trying to be trite. It’s not like posting your hot flashes on social media will do anything to stop them. Nor can I promise that your boss will be super understanding if you march into his/her office and announce that you can’t finish your project on time because you simply can’t focus.
However, let’s think about what we can do to open up the channels of communication with our friends and partners at least to start. It’s no secret that social support can be an important factor in warding off depression during times of stress.
We Need A Multi-Pronged Approach
Besides talking about it, what else can women do to cope with physical, psychological, and emotional symptoms during menopause? Hormone therapy (HT) is the predominant approach that doctors prescribe (of course). I won’t cover the pros and cons, nor the safety questions, since Mark did so recently. Definitely check out that post if you are considering HT for yourself. Mark’s wife, Carrie, has also written about her experience with menopause symptoms in previous posts (1, 2).
I will point out that most symptoms aren’t clearly caused by the hormonal changes that characterize menopause. Vasomotor symptoms (hot flashes, night sweats) are the most strongly linked to hormonal changes, but other symptoms seem to be more related to psychosocial factors. Even vasomotor symptoms don’t map perfectly onto hormone fluctuations. Women with the biggest drops in estrogen won’t necessarily experience the most hot flushes, for example.
That doesn’t mean you shouldn’t try HT if you and your doctor decide it’s right for you. It clearly has benefits, including that it seems to help some women with depressive symptoms and anxiety. It’s not clear whether this is because it alleviates physical symptoms or because the depression and anxiety are directly caused, at least for some women, by hormone fluctuations.
However, it’s a mistake to assume that if we “fix” the hormones, or get rid of the hot flashes for example, the rest will fall into place.
Thinking about the quality of life study I mentioned above, it’s important not to get wrapped up in the story that hormones plummet, hot flashes and night sweats ensue, and then women become grouchy and depressed as a result.
In reality, the hormone stuff, the physical stuff, the emotional stuff, the sleep stuff, the relationship stuff, and more stuff all get thrown into the mix, each potentially feeding into and off of the others.
What we need is a multi-pronged approach. (I feel like there’s a pun here about protecting the flanks—I’ll keep working on that one.) Besides treating underlying hormone fluctuations with HT or herbal remedies, women and their doctors should also separately address specific physical and cognitive symptoms, general health, and psychological and emotional well-being.
The aforementioned Guidelines for the Evaluation and Treatment of Perimenopausal Depression, for example, offer this recommendation, “Proven therapeutic options for depression (antidepressants, cognitive behavioral therapy and other psychotherapies) should remain as front-line antidepressive treatments for major depressive episodes during perimenopause.” In other words, take care of the depression on its own.
For women who want to be holistic in their approach, and who perhaps want to avoid or minimize HT, there are a number of non-hormonal, complementary practices that have been shown to help. In the next post in this series, I’ll highlight some of the ones that show the most promise for relieving menopausal symptoms specifically, as well as for stress reduction, emotion regulation, and coping more generally.
Now I want to hear from you. Do you feel free to talk about your experience of menopause with the people in your life? Have you had positive or negative experiences when you have talked about it in the past?
Deeks AA. Psychological aspects of menopause management. Best Pract Res Clin Endocrinol Metab. 2003 Mar;17(1):17-31.
Schneider M, Brotherton P. Physiological, psychological and situational stresses in depression during the climacteric. Maturitas. 1979 Feb;1(3):153-8.
Zhou B, Sun X, Zhang M, Deng Y, Hu J. The symptomatology of climacteric syndrome: whether associated with the physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety-depression disorder. Arch Gynecol Obstet. 2012;285(5):1345–1352.
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Disclaimer: I have not gone through menopause. I am, however, turning 40 this year. Statistically speaking, this is the decade in which I’m likely to enter perimenopause, so I have a vested interest in understanding what might be in store for me.
I’m all too familiar with the stereotype of the belligerent, out-of-control menopausal lady plagued by hot flashes and mood swings, bewildering her poor, beleaguered partner. [Note that for convenience I am going to use “menopause” to include the perimenopausal period as well.] Frankly, this narrative doesn’t suit me at all. I know very well that hot flashes and mood swings can be a part of menopause, but obviously there’s a lot more to it than that.
Of course, I want realistic view of what lies ahead so I might prepare mentally, emotionally, and physically. However, I also want the nuances. Plus, as an optimist I want to know the good, not just the bad and the ugly. To my mind, any major life transition is a chance at a reawakening of sorts, even if the road through it is rocky. My natural tendency is to find the silver lining and reframe situations as growth opportunities.
Menopause is much more than a collection of symptoms that need to be combatted. However, much of what’s written about menopause, from the scientific literature to the blogosphere, focuses on coping with and dealing with menopause. After a while, one wonders if the scientific and medical communities aren’t overeager to problematize and medicalize menopause by putting all the focus on the symptoms and, naturally, the treatments (they can make money off of). You have to dig deeper to find discussions about the meaning of menopause through the eyes of women who are living it.
Nevertheless, plenty of women and scientists (and women who are scientists!) are exploring how menopause fits into the flow of a woman’s life. I came away from my research seeing that menopause is, in fact, not terrible for many women. There’s tremendous variation in individual women’s experiences of menopause, not only in terms of the actual symptoms but also in the way she appraises them. Menopause is far more nuanced and idiosyncratic than sitcom stereotypes or medicalized portrayals would have us believe. It can be a time of tremendous growth and transformation, and a lot of women embrace that opportunity.
Moreover, although hormone therapy is by far the most loudly promoted remedy, it’s not the only game in town by far. There are actually a wide array of options that women might use to prepare for and alleviate the troublesome aspects of menopause. (Stay tuned for a future post on this topic.)
Why We Go through Menopause: The Value of Elder Women
One of the fun facts I came across in my deep dive into menopause is that scientists have so far identified four non-humans species whose females experience menopause: orcas, narwhals, belugas, and short-finned pilot whales. All toothed whales—fascinating! Other primates probably do not, although chimps and gorillas might (this is controversial, apparently). In other words, we’re pretty special!
While the biology of menopause—the when and what—are well understood, the why is still not totally clear. Human females might spend 40% or more of their lives in the post-menopausal phase. As the authors of this paper bluntly put it, “If the main purpose of women is to propagate the species (survival of the fittest), as postulated by Darwin for all species, then going through menopause many years before dying should be selected against unless there are distinct advantages to it.”
Ouch, but also fair. Scientists have come up with various theories about the nature of those advantages and how they came to evolve. The most compelling explanation is that our post-menopausal longevity directly contributes to the reproductive success of our offspring. Because humans mature slowly, not only do our children require a ton of resources and caretaking, but we also have additional children before our older children are anywhere near self-sufficient.
The Intergenerational Network of Caregiving
The “grandmother hypothesis” proposes that elder women enhance the survival of their lineage by caring for their biological grandchildren, but they also pass down their considerable knowledge and wisdom in and beyond the family itself. Post-menopausal female orcas assume leadership roles in their pods. They’re instrumental in helping other whales find food. Research has shown that their ability to lead others to fruitful fishing grounds is especially important in times of food shortage.
These older females possess skills and knowledge that enhance the survival of their offspring; and their offsprings’ mortality risk increases dramatically following their mothers’ death. The same is probably true for humans. Indeed, there is historical evidence from the 1700s and 1800s that women reproduced earlier and more often if their children’s grandmother was alive. The grandchildren’s odds of surviving to adulthood decreased if grandmothers were distant or deceased.
Competition versus Cooperation
A related theory to the grandmother hypothesis is that intergenerational conflict drove the evolution of menopause. In both human and cetaceans, daughters reach sexual maturity while the mothers are also still capable of reproducing. However, there are only so many resources (both material and energetic) to go around.
When female orcas continue to reproduce once their daughters have themselves started reproducing, the older females’ babies are less likely to survive than the younger females’ babies. The same might have been true for humans. According to this line of thinking, as we age, it’s better that we cease having children of our own and instead step into a supporting role for direct caretaking—and a more expansive role beyond caretaking itself.
Personally, I like the view of our roles changing through the lifespan, providing different types of value at different times. We have different gifts to offer in our post-reproductive years.
Different Women, Different Menopauses
In both the scientific literature and everyday conversation, people tend to talk about menopause as if it were one thing, a singular experience shared by all women. Nothing could be further from the truth.
Although some symptoms are common enough to be considered standard—hot flushes/flashes, night sweats, vaginal dryness, and mood alterations being at the top of the list—the range of possible symptoms is considerably greater than that. Not all women will experience even the most common ones. Among women who do, the severity of those symptoms can vary tremendously. Depending on whom you ask, anywhere from 20-75% of women experience symptoms severe enough to significantly impact their quality of life.
A huge number of factors influences any individual woman’s experience. To start, the onset and severity of symptoms can differ depending on what type of menopause she experiences: if it is premature (younger than 40-years-old) or early (between 40 and 45 years), or if it’s induced by surgical removal of the ovaries versus natural changes in hormone levels. Other factors shown to affect a woman’s symptomatology include her physical and mental health before starting menopause, activity level, lifestyle factors such as smoking, socioeconomic status, and perhaps even geography.
It’s also clear that women’s expectations about and attitudes toward menopause shape her experience. Part of the stereotype is that menopausal women complain and kvetch their way through menopause, periodically pausing to stick their heads in the freezer. (I hear this does help.) However, surveys show time and again that most women actually have neutral to somewhat positive attitudes about menopause.
Many at least hold a mix of positive and negative beliefs and expectations. Understandably, women tend to hold negative attitudes towards hot flashes, night sweats, and other unpleasant physical symptoms. On the other hand, most women are only too happy to stop having monthly periods, and many of them are ready to move past the need for contraception. However, this can be an emotionally fraught time for women who are not ready for their reproductive years to end.
There’s a complex interplay between physical symptoms, attitudes and beliefs about menopause, and psychological well-being. Studies show a bidirectional link between a woman’s attitudes and her subjective experiences. Women who experience disruptive symptoms such as frequent and severe hot flushes understandably have more negative attitudes. The reverse is also true. One prospective study also showed that premenopausal women who had more negative attitudes about menopause later reported experiencing more frequent and more severe symptoms. Another study found that women are less likely to be bothered by menopause if they have other more pressing issues in their lives. (“Pssht, menopause? I can’t be bothered worrying about that, I’m too busy dealing with this crisis over here.”)
Women’s attitudes about menopause are also shaped by her cultural milieu. This could help explain why women around the world have quite disparate experiences in menopause. Not only do women in different cultures report being more or less bothered by menopause overall, the specific symptoms they describe differ as well. The reasons for this are not well understood. It’s not clear whether cross-cultural differences are due to factors like diet, climate, and number of children a woman typically bears, or whether they reflect the varied beliefs and meanings that cultures ascribe to menopause. It’s probably all of the above and more.
Finally, women’s subjective experiences of menopause do not perfectly map onto objective markers such as hormone levels. Two women reporting the same number of hot flashes and sleep disturbances might also report very different levels of distress about those symptoms, for example. This might be due to differences in psychological and emotional well-being, as I will discuss in the next post. Women who have better coping mechanisms, more social support, or higher emotional intelligence are likely more resilient to the physical symptoms.
This all goes to show there is so much more to the menopause story than we’re typically presented with. It’s important that healthcare providers understand this and take the time to understand their patients’ unique situations. Likewise, women should know that there’s no right or wrong way to experience menopause.
“Second Adulthood”—A Lot to Look Forward To
“Menopause starts out as a horror movie, but then transitions into a coming of age story. The time after menopause can truly become the best part of our lives as we create a vibrant second half of life. … Second adulthood is the best!” — Lynette Sheppard, RN
Now for the really good news. As I said above, many women have positive attitudes toward menopause, even when they are in the thick of it. Lotte Hvas is a Danish doctor and author of the book, Menopause—Better Than Its Reputation. Her research shines light on the positive aspects of menopause. In one study, Hvas asked women to reflect in an open-ended manner on how they experienced menopause and how it affected their lives. About half of the 393 women in the study spontaneously offered positive assessments.
Not surprisingly, many women were happy to be done with PMS and monthly periods. (This is something I saw often while reading menopause blogs—”No more cramps, and I can finally wear white pants again!” White pants are apparently a big deal for a lot of ladies.) Others described it as a “wonderful” and peaceful phase in their lives. Still others celebrated the fact that now that their children were grown, they had the time and freedom to explore new areas of interest. Nine of Hvas’ respondents reported that menopause improved their sex lives.
Plenty of women celebrate menopause as the beginning of a new phase of their lives. Menopause coincides with coming into their own in a new way. They talk about exploring new creative channels, experiencing greater patience, and being more selfish in a good way.
As Margaret Mead once said, “There is no greater power in the world than the zest of a post-menopausal woman.” Once women walk through menopause, whether it’s an easy stroll or a walk through fire, they emerge on the other side more confident, with a renewed vigor, and a take-no-baloney attitude. These sentiments were echoed by participants in a study in which Dr. Hvas conducted in-depth interviews with 52- and 53-year-old women. The women perceived themselves as more experienced and more competent than their younger selves, and more assertive about speaking their minds.
As my own mother told me, “Once you get older, you stop giving a $%&! about what other people think.” This theme is echoed time and again by post-menopausal women who say they feel less constrained and more self-confident. Some researchers believe this is actually due to the hormonal changes of menopause, but there are probably psychosocial influences as well. Whatever the cause, a lot of women affirm this, and frankly it sounds pretty great.
A Shift in Perspective
At some point in my reading I came across the term “menostart” as an alternative to “menopause.” This seems apt for the many women who experience menopause as a turning point after which their interests, priorities, and attitudes change.
The psychological principle of socioemotional selectivity theory (SST) offers a lens through which we might understand some of these shifts. The central tenet of SST is that as we age, our future time perception changes. Whereas once we were young and time felt expansive, with aging comes a growing recognition that time is limited. This changes how we approach the world. According to the theory, when time seems expansive in our youth, we focus on future-oriented goals, seek novelty and knowledge, and invest in individual achievement. In contrast, older adults prioritize relational goals and positive emotional experiences.
Three decades of research into SST bears this out. Although SST is not a theory of menopause per se, it does postulate that older individuals facing important life transitions that signal an “ending,” such as retirement, will effortfully focus on positive aspects and downplay negative aspects. Menopause surely falls into this category as well. Older individuals also tend to be better at emotion regulation in everyday life and enjoy more stable positive emotions.
Consistent with this, Hvas relates, “Some women describe that they have used the menopause as a trigger to changing their lifestyles. To others it has meant that they have realised that life is not eternal and that it is important to, ‘use life while you have it’. The statements indicate that the phase has resulted in personal development.” Some of the women in her other study described themselves as more tolerant. “The women also experienced that they had become better at prioritising and at ignoring trifles and instead focus on the important things in life, viz. things that were crucial to themselves.”
I’m Starting Now
No, this isn’t my public announcement that I’m starting “the change.” (Ugh to that term.) I’m laying the foundation upon which I hope a healthy, meaningful “upper middle age” will be built when my husband and I will become empty nesters, and when we fully intend to be healthy, vibrant, active, and on the move.
I’ll talk in my next post about psychological and emotional considerations as well as non-hormonal approaches to easing one’s way through menopause. Hint: I bet you’re already using a few of them to improve overall well-being. I am, and now I see them in a new light.
Because attitude is clearly important, I’m cultivating a positive mindset about menopause. It’s necessary to be intentional about this in a world that often treats menopause like it’s the worst thing ever. One strategy is to gather positive role models of women who are celebrating this period of life. I’m starting with Oprah, who says, “So many women I’ve talked to see menopause as an ending. But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time and talent.” That sounds good to me.
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For today’s edition of Dear Mark, I’m answering a few questions from recent comment boards. First, with all the scary tick-related news coming out lately, are there any non-toxic tick repellents that actually work? Are there essential oils that repel and/or kill ticks? Is there a safer way to use insecticides? Next, were the people in the Mediterranean keto study actually eating a kilo of fish on their fish days? And is the wine an important part of the Mediterranean diet? Is the wine therapeutic or just for pleasure?
Let’s find out:
Non toxic effective tick repellents safe for children? Any suggestions? I live in NC so the tick thing scares the hell out of me. Found at parks in short grasses, like how am I supposed to avoid this???
If you want to avoid DEET and other pesticides, there are many essential oils that repel ticks. Let’s go through the various tick species.
The castor bean tick:
Repelled by Dorado azul, also known as pignut or bushmint and traditionally used as mosquito repellent. The terpene known as alpha-humulene was the most repellent terpene found in the oil; you can buy both the oil and the humelene.
Repelled by turmeric oil, even beating out DEET.
The cattle tick:
The deer tick:
Repelled by nootkatone (a grapefruit aromatic compound) and to a lesser degree ECOSMART organic insect repellent. Here’s a cool video showing ticks trying to climb a person’s finger that’s been dipped in nootkatone.
Nothing is 100% guaranteed to repel all ticks. In fact, many of these oils show 50-60% effectiveness in the field. But if you use a combination of relevant essential oils, frequent tick checking, smart clothing choices (long socks, shoes/boots, pants), and avoidance of tick-heavy landscapes (tall grass, oak leaves, etc, notwithstanding these new breeds that apparently love short grass), you’ll be in good hands—or at least better hands than the naked guy rolling around in piles of oak leaves.
And if you’re really worried, you could always tuck pants into your shoes, then spray the shoes and lower section of your pants with peremethrin, an insecticide that kills the ticks as they climb before they can reach your flesh. Use a dedicated pair of pants and shoes that you don’t use for anything else and reapply each time you go out. A light spray on the outside of reasonably-thick pants should provide tick protection without actually putting the pesticide into contact with your skin.
2.2 pounds of fish each day?!
I know, I was surprised to read that myself. But right there, according to the researchers:
We estimated during the first 4 weeks of this study that the average edible fish consumption per subject during the ‘‘fish block’’ day was approximately 1.12 0.41 kg=day.
So it wasn’t just an allowance of fish. They actually tracked their consumption and found they were eating over 2 pounds of fish on average on the days they ate fish.
The study said that they had “fish block” and “no fish block” days. With no mix of fish and other meats on the same day. What is the reason for this?
They offered no justification in the study write-up.
Maybe it was to increase variety.
Maybe it was to reduce their intake of omega-3s. I mean, a kilo of fish per day adds up to a lot of omega-3s, especially if you’re doing sardines and salmon. There is such a thing as too much a good thing, and excessive omega-3 can lead to blood thinning, excessive bleeding, and imbalanced omega-3:omega-6 ratios in the opposite direction.
Maybe it was to help people stick to the diet, to break up all that fish with some meat and chicken.
Great, but why the wine? Is it not a contradictory with ketosis? But is it for pleasure or is it for a therapeutic reason?
Wine is emphasized in Mediterranean diet studies (both keto and regular) because wine is considered an important part of the cuisines of most Mediterranean countries, at least on the European side. Italy, France, Spain, Portugal, and Greece all have an extensive history of wine production and consumption. Since researchers are casting a wide net to capture everything that might be contributing to the health effects, they’re including everything that appears in the “Mediterranean diet.”
It’s good to keep in mind that ketosis and alcohol detoxification do utilize some of the same physiological pathways. If you’re drinking an excessive amount, you’ll run the risk of inhibiting ketone production.
Still, wine does appear to have therapeutic effects, especially in people with metabolic syndrome—the subjects of this study.
Red wine is very high in polyphenols, due to both the polyphenols in grapes themselves and the unique polyphenols that form during fermentation. One study compared grape extract to red wine made with the same types of grapes, finding that red wine provided benefits the grape extract did not.
Drinking wine with a fast food meal can reduce postprandial oxidative stress and inflammatory gene expression; it can actually make an otherwise unhealthy meal full of refined, rancid fats less damaging (though still not advisable).
Blood pressure: In people with (but not without) a genetic propensity toward efficient or “fast” alcohol metabolism, drinking red wine at dinner seems to lower blood pressure.
Type 2 diabetics: Type 2 diabetics who initiate red wine drinking at dinner see reduced signs of metabolic syndrome, including moderately improved glycemic control and blood lipids.
Inflammation: A study found that non-drinkers who begin regularly drinking moderate amounts of Sicilian red wine enjoy reduced inflammatory markers and improved blood lipids.
I’d say the wine is a therapeutic addition to the Mediterranean keto diet. Don’t let that override your own experience, however. Wine might have therapeutic effects for many people, but not everyone feels better including it. It’s an option, but it’s hardly a necessary one for a healthy diet.
If you have any more questions, feel free to ask away down below. Thanks for reading, everyone.
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Di renzo L, Carraro A, Valente R, Iacopino L, Colica C, De lorenzo A. Intake of red wine in different meals modulates oxidized LDL level, oxidative and inflammatory gene expression in healthy people: a randomized crossover trial. Oxid Med Cell Longev. 2014;2014:681318.
Gepner Y, Henkin Y, Schwarzfuchs D, et al. Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes. Am J Hypertens. 2016;29(4):476-83.
Gepner Y, Golan R, Harman-boehm I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. 2015;163(8):569-79.
Avellone G, Di garbo V, Campisi D, et al. Effects of moderate Sicilian red wine consumption on inflammatory biomarkers of atherosclerosis. Eur J Clin Nutr. 2006;60(1):41-7.
The post Dear Mark: Safe Tick Repellent, Fish Intake on Mediterranean Diet, and Therapeutic Value of Wine appeared first on Mark’s Daily Apple.
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“Do not go gentle into that good night.” That’s one of my favorite lines in all of literature, and it informs my outlook on health, life, wellness, and longevity.
Live long, drop dead. Compression of morbidity. Vitality to the end. All that good stuff.
But I’m sorry to report that Dylan Thomas imploring you to assail life with boldness is becoming harder for the average person to fulfill and embody. People more than ever before are heading into middle age with a head-start on the degenerative changes to body composition and function that used to only hit older folks. They may want to go boldly into that good night, but their bodies probably won’t be cooperating.
Ignore the standouts for a moment. I’m not talking about that awesome granny you saw deadlifting her bodyweight on Instagram or the centenarian sprinter smoking the competition. I’m not talking about the celebrities with personal trainers and access to the latest and greatest medical technologies. I’m referring to the general trend in the greater population. All signs point to average men and women alike having more fragile bones, weaker muscles, and worse postures at a younger age than their counterparts from previous eras.
What Signs Point This Way?
Low Bone Density
These days, more men than ever before are developing the signs of osteoporosis at an earlier age. In fact, one recent study found that among 35-50 year olds, men were more likely than women to have osteopenia—lower bone mineral density—at the neck.
Osteoporosis used to be a “woman’s disease,” lower estrogen after menopause being the primary cause. That’s rather understandable; estrogen is a powerful modulator of bone metabolism in women, and a natural decline in estrogen will lead to a natural decline in bone density. Men’s bone density has a similar relationship with testosterone; as a man’s testosterone declined, so does his bone density. As long as a man or woman entered the decline with high bone density, the decline wouldn’t be as destructive.
But here’s the thing: these days, both men and women are starting the decline with lower bone density. In women and men, peak bone mass attainment occurs during puberty. In girls, that’s about ages 11-13. In boys, it’s later. Puberty sets up our hormonal environment to accumulate healthy amounts of bone mineral density—but we have to take advantage of that window.
One of the main determinants of bone density accumulation is physical activity. If you’re an 11-year-old girl or a 16-year-old boy and you’re not engaging in regular physical activity—running, jumping, throwing, lifting, playing—you will fail to send the appropriate signals to your body to begin amassing bone mass. And once that developmental window closes, and you didn’t spend it engaging in lots of varied movement, it’s really hard to make up for all the bone mineral density you didn’t get.
But you can certainly improve bone mineral density at any age. Even the elderly can make big gains by lifting weights, walking frequently, or even doing something a simple as regular hopping exercises. The problem is that physical activity is down across all ages.
Children are spending more time indoors using devices than outdoors playing. They aren’t walking to school or roaming around outdoors with friends getting into trouble. If they’re active, they’re more likely to be shuttled from soccer practice to ballet to music lessons. Their movement is prescribed rather than freely chosen. Hour-long chunks of “training” rather than hours and hours of unstructured movement…
Not just kids, either. Sedentary living is up in everyone.
So there are two big issues:
- Kids are squandering the developmental window where they should be making the biggest gains in bone density.
- Adults are leading sedentary lives, squandering the lifelong window we all have to increase bone density.
Another reason men are having newfound problems with low bone mineral density is that a generational drop in testosterone has been observed. Twenty years go, men of all ages had higher testosterone levels than their counterparts today, meaning an average 50-year-old guy in 1999 had higher testosterone than an average 50-year-old guy in 2019. Testosterone will decline with age. That’s unavoidable. But something other than aging is also lowering testosterone—and bone density—across the board.
Experts are now recommending that young men use night lights, avoid throw rugs on the floor, and do pre-emptive physical therapy—all to reduce the risk of tripping, falling, and breaking something. That is absolutely tragic. This shouldn’t be happening.
The smartphone is a great tool with incredible potential to transform lives, economies, and personal capacities. But it can wreck your posture if you’re not careful and mindful.
Try this. Pick up your phone and compose a text message. Do it without thinking. Now hold that position and go look at yourself in a mirror. What do you see?
Head jutting forward, tilted down.
Upper back rounded, almost hunched.
Shoulders internally rotated.
Now spend 6-8 hours a day in this position. Add a few more if you work on a computer. Add another 15-20 minutes if you take your phone into the bathroom with you. Add an hour if you’re the type to walk around staring at your phone.
It all starts to sound a little ridiculous, doesn’t it?
Not only are people spending their days sitting and standing with their spine contorted, they’re staring down at their phones while walking. This is particularly pernicious. They’re training their body to operate in motion with a suboptimal, subhuman spinal position. They’re making it the new normal, forcing the body to adapt. And it is subhuman. Humans are bipeds, hominids that tower over the grasslands, able to scan for miles in every direction, perceive oncoming threats, plot their approach, stand upright and hold the tools at the ready. What would a Pleistocene hunter-gatherer of 20,000 years ago make of the average 25-year-old hunchback shuffling along, nose pointed toward the ground? What would your grandfather make of it?
It used to be that the only person with a kyphotic, hunchback posture was pushing 70 or 80 years old. And even in that age group, it was relatively rare. Nowadays young adults, teens, and even kids have the posture.
Interest in effective fitness and healthy eating and CrossFit and paleo and keto and everything else we talk about is at an all-time high, and all your friends on Instagram seem to be drinking bone broth and doing squats, so you’d think that people are getting stronger and waking up from all the crazy conventional wisdom that society has foisted upon us over the years. They’re not, though. That’s the view from inside the Internet bubble. This explosion in ancestral health and fitness is a reaction to the physical ineptitude and torpor enveloping the modern world. A small but growing group of people are discovering the keys to true health and wellness because the world at large has become so backwards.
And no matter how many CrossFit gyms pop up or people you see walking around in yoga pants, the average adult today is weaker than the average adult from twenty years ago. That’s the real trend. It probably doesn’t apply to you, my regular reader, but it does apply to people you know, love, and work with. Here’s the reality:
Grip strength—one of the better predictors of mortality we have—of 20-34 year old men and women has declined since 1985, so much that they’re “updating the normative standards” for grip strength. Even 6-year-olds are weaker today.
New recruits in the military are weaker than recruits from previous eras. They’re even having trouble “throwing grenades.”
Everywhere you look—Lithuania, Portugal, Sweden, to name just a few—kids, teens, and adults of all ages are failing to hit the normative standards of strength and fitness established in older eras. People are getting weaker, softer, and less fit earlier than ever before.
Don’t let this happen to you. Don’t let it happen to the people you care about. You have the chance, the duty to your future self to go boldly into that good night, rather than wither and dwindle and fall apart. And it starts today, right now, right here. Do one thing today. What will it be?
How are you guys fighting the ravages of age and gravity? What are you going to do today to ensure you’ll go boldly into older age?
Bass MA, Sharma A, Nahar VK, et al. Bone Mineral Density Among Men and Women Aged 35 to 50 Years. J Am Osteopath Assoc. 2019;119(6):357-363.
Fain E, Weatherford C. Comparative study of millennials’ (age 20-34 years) grip and lateral pinch with the norms. J Hand Ther. 2016;29(4):483-488.
Larson CC, Ye Z. Development of an updated normative data table for hand grip and pinch strength: A pilot study. Comput Biol Med. 2017;86:40-46.
Venckunas T, Emeljanovas A, Mieziene B, Volbekiene V. Secular trends in physical fitness and body size in Lithuanian children and adolescents between 1992 and 2012. J Epidemiol Community Health. 2017;71(2):181-187.
Marques EA, Baptista F, Santos R, et al. Normative functional fitness standards and trends of Portuguese older adults: cross-cultural comparisons. J Aging Phys Act. 2014;22(1):126-37.
Ekblom B, Engström LM, Ekblom O. Secular trends of physical fitness in Swedish adults. Scand J Med Sci Sports. 2007;17(3):267-73.
The post Is 50 the New 70? How the Modern Lifestyle Is Remaking Middle Age appeared first on Mark’s Daily Apple.
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Today’s post is part two of a postpartum series inspired by a reader question. You can read part one here.
Diastasis recti (DR) is usually described shorthand as a separation of the ab muscles. More accurately, it’s a deformation of the linea alba, the line of connective tissue that runs down the front of your torso from your ribcage to your pelvis. The linea alba is basically where all the abdominal muscles meet in the middle; I think of it like the spine of a book. When the linea alba becomes deformed for reasons I’ll discuss in a moment, the rectus abdominis muscles, aka your “six-pack” muscles, pull apart. This is the (often visible) sign of DR.
More than a cosmetic issue, this compromises the integrity of your core and can be associated with a whole host of other problems if not corrected. Although it’s difficult to establish clear causal relationships, DR is often related to pelvic floor issues and incontinence, back pain, hernias and prolapses, and difficulty exercising. While some DR resolve on their own, often they require intervention—targeted exercises to bring the muscles back together or, in some extreme cases, surgery.
What Causes Diastasis Recti?
To understand DR, you have to understand that the abdominal cavity is always under pressure. Wedged as it is between the thoracic (chest) cavity and the pelvic cavity, the pressure in your abdomen is always shifting based on your breathing, movement, digestion, and so on. If the pressure isn’t too great, it’s no problem. However, when the pressure increases—say perhaps because you have a growing baby taking up more and more space in there—one of the ways that pressure can manifest is by pushing outward on the front of the belly. The linea alba stretches and weakens, and the rectus abdominis ends up abnormally separated.
I say “abnormally” because some separation can be classified as normal, especially during pregnancy, and can simply reflect individual structural differences. Estimates of the prevalence of DR among pregnant women range from 66%-100% of women experiencing some degree of DR by the end of pregnancy. Abdominal separation that does not resolve on its own soon after pregnancy, or DR not associated with pregnancy, needs to be addressed as soon as possible.
That’s right—men, children, and women who have never been pregnant can all have DR. Any conditions that increase intra-abdominal pressure and stretch and weaken the linea alba can lead to DR. These include things like overdoing traditional ab exercises like sit-ups, chronic coughing, and chronic constipation leading to straining. Injury to the linea alba, including from abdominal surgery, is another risk factor.
Renowned biomechanist Katy Bowman believes that alignment (how we hold our bodies throughout the day), movement, and even breathing all play a key role in preventing or developing DR. This isn’t to say that breathing incorrectly will make your abs split apart. Rather, the types of loads we place ourselves under can make us more or less susceptible to developing DR. On the flip side, by fostering proper alignment and movement patterns, you might be able to avoid DR even during and after pregnancy. More on this later.
How Do I Know If I Have Diastasis Recti?
Unfortunately, DR is often overlooked even in the antenatal and postpartum periods. However, it’s easy to test for yourself whether you have DR. The most obvious sign is if your stomach bulges when you do a traditional crunch (don’t do crunches if you think you have DR, or ever really—they aren’t a particularly safe or effective ab exercise), cough, or otherwise load your abs. This might look like a small football in your tummy, a loaf of bread, or just a mound. It is most likely to appear right around your navel, but it can also happen above or below your navel, or all of the above.
Even if it’s not visible, if you have pelvic floor weakness (no ladies, we shouldn’t be peeing when we run or jump rope), chronic back pain, hernias, or even digestive issues like constipation or bloating, you should check yourself for DR. Likewise if you feel like your abs are weak or aren’t holding you in, for lack of a better term, perform a self-test.
To do this, lower yourself carefully onto your back and lie flat with your feet on the floor and your knees bent. Lift up your shirt and slide your waistband down so you can feel your abs from your pubic bone to your sternum. Take two or three fingers and with your palm facing you, press down firmly at the top of your navel while you slowly lift your head off the floor like you’re beginning a crunch. You should feel your rectus abdominis muscles tense on either side of your fingers. Relax your head back to the floor. Repeat this test below your navel and above your navel up to your sternum. (Check out the video here if you need more guidance.)
You are feeling for two things:
- What is the gap between the ridges of your muscles? Anything greater than about two finger-widths is considered positive for DR. (The generally accepted medical standard is a gap of 2.7 centimeters.)
- How “squishy” is the linea alba? In other words, how far down do your fingers sink when you press? Ideally your linea alba would feel firm and resist being pressed down.
Don’t freak out if your fingers sink down in there! Now you know and can do something about it.
I Have a Diastasis… Now What?
If you believe that you have DR, it’s a good idea to get it checked by a doctor so you can get a referral to a physical therapist if needed. Look for a PT who specializes in DR and, if applicable, postpartum fitness. While surgery is sometimes recommended for serious cases of DR, it’s not to be taken lightly and might be avoidable with the help of a knowledgeable PT. Of course this is a decision that you must make with your doctor. Mild-to-moderate cases are often correctable with simple at-home techniques, but especially if you’re pregnant or have recently delivered your baby, I am still going to advise checking in with your doctor first.
Even if your doctor determines that you don’t meet the medical criteria for diagnosis, the exercises suggested to resolve DR will be helpful for anyone wishing to improve alignment and increase core strength and stability. That’s to say, even if you don’t have significant DR, you’ll likely still benefit from what I call the ABCDs of fixing DR. They are generally regarded as safe during pregnancy to help mitigate the damage of DR, but always talk to your doctor or midwife to be sure.
Katy Bowman reminds us that we can’t look at any one body part in isolation. While we might think of DR as a problem in the abdominals, in fact the pelvis, abdominal muscles, and ribs are all connected. Moving any other body part that also moves the pelvis or the ribs will therefore affect the abdominal muscles and connective tissue.
Katy’s book, Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation, is a great resource. She focuses on proper alignment as both a preventative and restorative practice, and then she walks readers through a series of whole-body exercises, starting small and progressing to larger movements, that can improve DR. Her alignment checklist is as follows:
- Straighten your feet
- Back your hips up
- Align your knee pits
- Adjust your pelvis
- Drop your ribs
- Relax your diaphragm
For help understanding what this looks like in practice, I recommend starting with this video. It’s designed for runners, but it demonstrates the same principles that are important here. Katy also provides tons of information and resources on her website, Nutritious Movement. (Start with her Under Pressure post.)
You can’t have proper alignment if you’re walking around in heels all day, unfortunately, so it’s time to embrace going barefoot and wearing minimalist shoes as often as possible. If you’re used to wearing heels or even just traditional shoes (which often have a heel lift that we don’t even notice), make sure you take care to transition to a minimalist/barefoot lifestyle safely.
The goal here is diaphragmatic breathing that engages the transverse abdominis (TA) muscles. Quick anatomy lesson: What we call “the abs” are not just the rectus abdominis muscles that make the six-pack. There are actually layers of muscles and connective tissue criss-crossing around in there. The TA are the innermost layer. They wrap all the way around the torso from the spine to the linea alba, and they are often described as looking like a corset.
In order to close a DR, we need to be able to recruit the TA, which means connecting to it and learning to activate it in the first place. This is where diaphragmatic breathing comes in. I find it easiest to feel my TA and understand what diaphragmatic breathing is supposed to feel like when lying on my back, but you can also do this kneeling. Place a hand on your belly and try to breathe into your hand, meaning you should feel a slight expansion of the belly as you breath. You aren’t forcing your belly out, but you want the motion as you inhale to be under your hand, not in your chest.
Next, place your fingers just above your hip bones on either side. Inhale through your belly, then exhale with some force, making a hissing noise. As you exhale, imagine tightening your core so your fingers move toward each other ever so slightly. This is not sucking in your belly, this is engaging that TA that wraps around from your back. Your belly should neither suck in nor pooch out, it should feel like it’s flattening (even if you can’t see it). Another cue my trainer sometimes uses is imagining zipping up the “corset” from the pelvis to the sternum.
Feeling the flexion underneath your fingers can be helpful for knowing you’re doing it right. If you’re having trouble understanding the technique, check out this video for a demonstration. Once you feel really connected to the TA, you can proceed to other strengthening exercises.
Core Exercises—but Only the Right Ones
I’m going to reiterate here that it’s important to consult with your doctor if you are concerned that you have limitations that might make any kind of exercise unsafe or inadvisable for you. In the case of DR, it’s a good idea to find a physical therapist and/or someone trained in DR or postpartum fitness who can help check that you’re doing the alignment and TA activation pieces correctly, and who can advise you on proper core exercises.
That said, there is widespread agreement about what not to do if you have DR, and that is any core exercise that increases intra-abdominal pressure. These include traditional crunches and sit-ups and, yes, planks. I know planks are one of the Primal Essential Movements, but they aren’t for you right now. Likewise experts advise avoiding twisting motions such as Russian twists and even certain yoga poses; high-impact exercises such running; and full-body exercises that require core activation like burpees, push-ups, and pullups (two more Essential Movements bite the dust) and heavy lifting.
Yes, that’s a lot, and it’s a bummer. That means you shouldn’t sign up for a 5k or get back to CrossFit until you take the time to address the DR. Bear in mind, though, that if you can’t properly engage your core during exercise, you’re at significant risk for injury and additional problems down the road. Although you likely have to back-burner some of your favorite activities in the short term, long term it is worth it to fix the DR first.
In order to do so, you need to work on gentle, appropriate exercises to strengthen the entire core. I’m not a PT or personal trainer, so I’m not going to give you specific exercises here. As I mentioned, Katy Bowman’s excellent Diastasis Recti book includes a whole series of progression exercises, and there are many resources and programs available online. You can also check out the movements here, here, and here for examples of the types of exercises that are generally regarded as safe and beneficial for DR. Did I mention you should check with your doctor first and consult a PT if you can? Good. I will also put some additional resources at the bottom of the post.
Because DR can be thought of as an injury to the connective tissue, you can support recovery by eating a nutrient-rich, anti-inflammatory diet that includes a variety of vegetables, sufficient protein, and essential fatty acids to promote healing. Since this just so happens to describe the Primal way of eating, hopefully you already have this box checked.
Also include plenty of collagen-rich bone broth. Use it in cooking or simply sit on a mug of broth during the day. You can jazz it up by blending in different herbs and spices. My favorite is using my immersion blender to blend 2 teaspoons butter or ghee, ¼ teaspoon turmeric (an anti-inflammatory powerhouse), and a pinch of black pepper into a mug of ghee to make a frothy golden “latte.”
To Splint or Not To Splint?
Experts disagree about whether it’s advisable to wear a splint or brace to support the abdominals while you work on closing your DR. Since there’s no consensus, this is another area where you should consult your doctor or PT about your specific needs.
But When Can I Start the Real Exercise?
If you’ve recently had a baby, you probably miss the physical activities you couldn’t do later in your pregnancy. It’s hard to be patient and do breathing exercises when you really want to be going for a run and hoisting a barbell over your head.
I implore you to be patient. It will pay off in the long run! And please, please don’t push your body too far too soon because you’re feeling pressure to get back to exercise ASAP so you can “get your pre-baby body back.” With proper care, a DR might start to resolve in a matter of weeks, but realistically it might be several months or longer before it is fully fixed.
Only after you have done the foundational work of the ABCDs should you move on to other exercise. Make sure you’re selecting safer movements that don’t put excess stress on the DR. You should ease slowly into more strenuous or vigorous exercise, paying attention to how your body responds. If you can, work with a qualified trainer or coach who can help you determine a safe progression back into your exercise modality of choice.
What If My Post-baby Belly Isn’t DR?
Even if you don’t pass the two finger test, you can benefit from working on alignment as Katy Bowman describes, as well as working on activating the TA, the foundation of a strong and healthy core and pelvic floor. Everyone should be doing these things, really.
If you’ve done all this and still feel like you look bloated or pregnant despite being well into the postpartum period, you might be experiencing bloating due to food sensitivities or gut issues such as imbalances in the microbiome. Talk to your doctor or find a functional medicine practitioner to help you dig into that more. If your issue is an accumulation of fat in the midsection, that can be related to stress and excess cortisol. You can work with your doctor to diagnose this, and/or start working on your own to manage stress.
At the end of the day, you might also have to accept that your body isn’t going to look exactly the same as it did before, and that’s ok. If you’re struggling with that, please check out my previous post on postpartum body image for support.
Find a professional to help diagnose and treat your DR:
- http://aptaapps.apta.org/findapt (Put in your search area, then select Women’s Health on the following page)
The following offer paid programs designed to fix DR. They are endorsed by a variety of individuals and professional organizations. We at Mark’s Daily Apple do not have personal experience with these programs.
Do you have experience with diastasis recti or resources related to treatment? Share your thoughts and questions below, and thanks for reading today.
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Last week, I linked to a story about a popular vegan blogger, author, and influencer who found herself going into menopause at the age of 37 despite doing “everything right.” She exercised, she ate raw, she avoided gluten and refined sugar, and, most importantly, she avoided all animal products. Now, this wasn’t a randomized controlled trial. This wasn’t even a case study. But it was a powerful anecdote from someone whose livelihood depended on her remaining a raw vegan. It wasn’t in her interest to make it up.
So, it got me wondering: How do diet and lifestyle influence the timing of menopause?
Now, before I begin, let’s just state the obvious: Menopause isn’t a problem to be avoided. It’s not something to be feared or maligned. It’s not “the end.” I wrote an entire series on menopause last year, and there will always be more to come on the subject because it’s an important time of life with its own questions and possibilities. While it’s a natural, evolutionarily-preserved part of being a woman, it also follows a natural cadence. Menopause at the right time in accordance with your genetics is normal, expected, and healthy. Menopause that occurs earlier than your genetics would direct suggests something is amiss. Sure enough, early or premature menopause—defined in most places as menopause before the age of 40—has a number of troubling links to poor health outcomes.
Early menopause is linked to:
- A shorter life and an increase in the risk of type 2 diabetes.
- Reduced physical function in later years.
- Lower cognitive function.
- Increased heart disease.
Not to mention that all the other things normally associated with menopause, like osteoporosis and changes in mood, also have the potential to occur, only earlier.
Okay, so early menopause can have some health consequences. Is veganism actually linked?
What Research Says About Diet and Menopause Timing
There was one study that found people who’d never been a vegetarian developed menopause at a later age, which is a roundabout way of saying that vegetarianism may increase the risk of early menopause.
Other lifestyle factors linked to later menopause included regular strenuous exercise, never smoking, midlife weight gain, and drinking alcohol. Strange mix of behaviors, both classically healthy and unhealthy.
But then another study in Han Chinese women found the opposite—that vegetarianism was associated with a lower risk of premature menopause.
Those are the only direct (if you can call it that) lines of evidence, and they conflict. No solid answers there. That said, there’s more indirect stuff pointing toward a link between exclusion of animal foods and earlier menopause:
- A high intake of vitamin D and calcium from dietary sources has been linked to a lower risk of premature menopause. Oddly enough, supplemental vitamin D and calcium were not linked to lower risks, suggesting that it’s the food—dairy primarily, but also bone-in small fatty fish like sardines—and not the nutrients alone. So a vegan might not be in the clear simply by supplementing with D and calcium.
- The amount of protein and carbs a woman eats throughout her life seems to predict the age at which menopause occurs. More protein, later menopause. More carbs, earlier menopause. Protein is harder and carbs are easier to come by on a plant-based diet—that’s for sure.
- Another fairly consistent finding is that polyunsaturated fat intake “accelerates” menopause. Women who eat the most PUFA tend to have menopause earlier. High PUFA intakes are pretty unavoidable when your diet is awash in seeds, nuts, and other plant-based fat sources.
Then there was a different connection in another study.
The Nurses Health Study found that women who ate the most plant protein were more likely to avoid premature menopause; animal protein intake had no effect. They even found beneficial links between specific foods and protection against early menopause, including dark bread, cold cereal, and pasta. Those are about as unPrimal as you can get.
How Can We Make Sense of Conflicting Research?
In addition to smoking (which we all know is trouble for almost all markers of health), one thing that keeps appearing in all these observational studies—and they’re all observational studies, unable to prove causation—is that underweight BMIs predict early menopause. In the Nurses Health Study, for example, BMIs under 18.5 were linked to a 30% greater risk of early menopause and BMIs between 25 and 29 were linked to a 30% lower risk. If that’s true, and if that’s actually a causal factor, then the most important thing a woman who wants to avoid early menopause can do is avoid being underweight. In that case, filling up on foods known to cause weight gain in susceptible people like bread, pasta, and cereal would be protective (at least for early menopause).
And that could really explain why the vegan blogger developed premature menopause. In her own words, she “had run out of fuel.”
A big downfall of many plant-based diets is that they starve you. They starve you of vital micronutrients you can really only get in animal foods, like B12, zinc, creatine, cholesterol, and others. They starve you of vital macronutrients, like protein and animal fat. And they starve you of calories. It’s hard to maintain your weight and physical robustness eating a diet of leaves, twigs, and seeds (unless you’re a gorilla). Oddly enough, I think vegans who eat grains and vegan “junk food” like fake burgers and weird nut cheeses are probably better off than the gluten-free ones who live off salads, simply because they’re getting more calories. It’s true that there are many ways to eat vegetarian and even vegan—and some are healthier than others (I’ve written about Primal recommendations for vegetarians and vegans in the past), but the more restrictive a person is with animal products, the trickier it will be to stay well-nourished.
If I had to make a bet, it’d be that any diet that provides sufficient nourishment in the form of micronutrients, macronutrients, and total calories will help stave off early menopause.
What about you? What’s your take on this? Has anyone out there experienced premature/early menopause that didn’t follow natural, familial patterns? What can you recall about the diet and lifestyle leading up to it?
Wang H, Chen H, Qin Y, et al. Risks associated with premature ovarian failure in Han Chinese women. Reprod Biomed Online. 2015;30(4):401-7.
Velez MP, Alvarado BE, Rosendaal N, et al. Age at natural menopause and physical functioning in postmenopausal women: the Canadian Longitudinal Study on Aging. Menopause. 2019;
Sujarwoto S, Tampubolon G. Premature natural menopause and cognitive function among older women in Indonesia. J Women Aging. 2019;:1-15.
Løkkegaard E, Jovanovic Z, Heitmann BL, Keiding N, Ottesen B, Pedersen AT. The association between early menopause and risk of ischaemic heart disease: influence of Hormone Therapy. Maturitas. 2006;53(2):226-33.
Purdue-smithe AC, Whitcomb BW, Szegda KL, et al. Vitamin D and calcium intake and risk of early menopause. Am J Clin Nutr. 2017;105(6):1493-1501.
Sapre S, Thakur R. Lifestyle and dietary factors determine age at natural menopause. J Midlife Health. 2014;5(1):3-5.
Boutot ME, Purdue-smithe A, Whitcomb BW, et al. Dietary Protein Intake and Early Menopause in the Nurses’ Health Study II. Am J Epidemiol. 2018;187(2):270-277.
Szegda KL, Whitcomb BW, Purdue-smithe AC, et al. Adult adiposity and risk of early menopause. Hum Reprod. 2017;32(12):2522-2531.
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One of the most common complaints people have as they age is poor quality sleep. They get less sleep than younger people, and, despite what you may have heard, their sleep requirements do not decline with age. A 70-year-old should still be getting 7-8 hours of sleep a night. The problem is that, for many different reasons, older people usually have issues getting the amount of sleep they need.
The popular approach is to accept poor sleep as an inevitable part of aging and find workarounds, ideally workarounds that require a lifelong prescription to a name-brand pharmaceutical. That’s not my way. I accept that the conventional approach may be warranted in certain cases, but it should be a last resort. A person should exhaust the diet, lifestyle, and exercise options before turning to the prescription pad.
What about that central position of the conventional wisdom: Declining sleep quality is a necessary function of age. Is that actually true?
Why Do We Equate Getting Older With Sleeping Poorly?
Age is a predictor of poor quality sleep, but it’s not a foregone conclusion. Not every older adult suffers from poor sleep, which means the passage of time alone cannot explain the loss of sleep quality. In fact, when you drill down deeper, you find that there are many health and lifestyle-related predictors of poor quality sleep among older adults.
- In older Taiwanese adults living in a retirement community, 42% reported sleep disturbances. The best predictors for low quality sleep were being sedentary, suffering from nighttime urination, using anti-hypertensive drugs, and having poor mental health.
- In older Korean adults, 60% reported sleep issues. The best predictors for low quality sleep in this group were depression, pain, and poor self-rated health scores.
- In older women, menopause can make getting good sleep harder. The night sweats and body temperature fluctuations (the body tends to drop its temperature in preparation for sleep, and heat flashes can interfere with this) are notorious sleep disruptors.
These are all modifiable risk factors. Even menopause. Menopause will happen, but the symptoms can be addressed and mitigated (though admittedly not easily). I actually wrote a post about this.
There is one specific cluster of neurons called the ventrolateral preoptic nucleus that acts as a “sleep switch”—releasing GABA and other inhibitory neurotransmitters that inhibit wakefulness. The ventrolateral preoptic nucleus has been shown to degrade with age, actually getting smaller over time; further research shows that the size of a person’s VPN correlates closely with their sleep quality. But there’s no indication that this is an inevitable consequence of aging. After all, the rate of VPN decline varies between individuals. Maybe some of that rate variation is genetic. Maybe some is environmental—based on how you live and eat and exercise. We do know that light and sun exposure during the day boosts serotonin levels, and serotonin is one of the precursors for VPN sleep activity. What if a lifetime of inadequate sun and daylight exposure causes the VPN to “atrophy”? There are many unanswered questions, but even if the VPN turns out to follow a strictly chronological decline, there are improvements to be made.
Other “inevitabilities” of aging are often a function of accruing compound interest on one’s failure to lead a healthy lifestyle. If we’ve neglected our health and wellness for our entire lives—often because we were following bad advice from the “experts” who were supposed to know better—that’s going to come to a head the older we get. The older we are, the worse our body will work. The more negative interest we’ll have accrued.
Okay, Sisson, that’s all well and good, but what if I’m already an older adult, I’ve already accrued a lifetime of suboptimal health, and my sleep is bad? What can I do?
5 Easy Ways To Improve Your Sleep (At ANY Age)
You can start addressing the issues right now, right today.
1. You can lift heavy things.
Resistance training has been shown to improve sleep quality in older adults. Three times a week, older adults lifted weights for 30 minutes in the morning and saw their sleep quality improve by 38%. It also works in older adults with poor sleep and depression.
2. You can walk.
A three-time weekly walking program for four weeks helped older Nepalese adults improve their sleep quality.
3. You can reduce your alcohol intake.
A few years ago, I noticed that my nightly glass or two of wine was messing with my sleep, so I gave it up and my sleep improved immediately. I’ve since re-introduced Dry Farm natural wine—lower in alcohol and sulfites, higher in antioxidants and complexity—and have no issues. If you drink on a regular basis and have trouble with sleep, try giving up alcohol for a month. It’s a potentially very easy fix.
4. You can avoid artificial light after dark.
This doesn’t just work in younger people. There is strong evidence that exposure to artificial light after dark is linked to insomnia in older adults. Wearing blue-blocking goggles or simply not using electronic devices after dark are easy fixes.
5. You can get more natural light in the morning and daytime.
In older adults, getting more natural light in the daytime hours has a direct effect of improving sleep quality.
Hey, it’s almost like everything in our lives is connected. Some people find this overwhelming and depressing—”how can I possibly fix everything?” I find it empowering. It fills me with optimism because addressing one piece of the chain can get everything else moving in the right direction. Just look at the study with depressed older adults who had trouble sleeping. All they had to do was start lifting heavy things a few times a week and all their major issues began resolving, or at least improving. That’s powerful.
Now imagine if you tried everything. Imagine if you started lifting weights, walking, reduced your alcohol intake. Imagine the changes you could see. Now imagine if you did this from early adulthood and never stopped. Imagine how you’d sleep. Oh, and don’t neglect the power of a consistent routine.
What I Do (and One Thing That’s Made the Biggest Difference)
Last year, I released a video of my nighttime routine. Now that I’m in Miami, the setup has changed but I still do the same basic stuff.
I live in a condo now that has a great spa. I do “fire and ice” before dinner almost every night”—usually 7-10 minutes sauna, 3-4 minutes cold plunge at 50 degrees, repeat a few times. So, no longer right before bed. But it has the effect of making me relaxed and sleep-ready a few hours after a light dinner.
But there’s one tool I began using a couple years ago that has probably made the most difference of any particular strategy: controlling the temperature of my bed.
Ambient temperature matters for sleep quality. My chiliPAD has become indispensable. (Disclosure: I became such a fan that I eventually invested in the company.) Carrie uses one, too. We have different ideal temperature ranges. Mine cools to 65 at bedtime, but with the app I can set it to rise to 68 at 3:00 A.M. (otherwise I get a little too much heat loss), 70 at 5:00 A.M. and then 75 at 6:45 to help me wake up. It makes a huge difference and has real evolutionary antecedence; humans spent many millennia sleeping on a cold surface (the ground) covered with animal skins. It’s what our genes still expect from us.
How’s your sleep, older (or not) readers? What’s worked, what hasn’t? If you have any questions about sleep, drop them down below and I’ll follow up!
Now For the Giveaway…
Whenever I find a product I truly love, I want to share it. Today it’s for two lucky winners.
The great folks at ChiliTechnology have offered two of their cooling systems for MDA readers (the two Carrie and I use): a chiliPAD system and their new OOLER system. Both offer the same fully programmable cooling technology to help you manufacture your best night’s sleep. Plus, I’m throwing in a Primal Essentials Kit (Damage Control, Primal Omegas, Primal Sun, Primal Probiotics and Adaptogenic Calm) because good health and great sleep go hand-in-hand.
One winner will nab the chiliPAD, plus Primal supplements package.
The second winner will enjoy the OOLER system, plus Primal supplements package.
To enter to win:
Open to US only. The winner will be announced and contacted via Instagram direct message on Thursday, May 30th.
Good luck, everybody!
Park JH, Yoo MS, Bae SH. Prevalence and predictors of poor sleep quality in Korean older adults. Int J Nurs Pract. 2013;19(2):116-23.
Ferris LT, Williams JS, Shen CL, O’keefe KA, Hale KB. Resistance training improves sleep quality in older adults a pilot study. J Sports Sci Med. 2005;4(3):354-60.
Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of the effect of exercise on sleep. Sleep. 1997;20(2):95-101.
The post Does Sleep Quality Really Decline With Age? (Plus, What I Do & a Giveaway) appeared first on Mark’s Daily Apple.
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Tennis elbow, Achilles tendinitis, osteoarthritis, and other connective tissue injuries are on the rise. Athletes have always gotten them, but it’s only in the past few decades that regular folks are getting them too. For some connective tissue injuries, non-athletes outnumber athletes. That shouldn’t happen if the conventional wisdom—injuries to tendons, ligaments, and cartilage occur only because of overuse or overloading during intense physical activity—were true.
Now, of course the way we train affects the health and function of our connective tissue. Acute injuries absolutely occur. Overuse injuries absolutely develop. But that’s to be expected. Athletes put their bodies through a lot, and there is going to be fallout from that. Where those injuries shouldn’t be happening is in regular, everyday folks who don’t train for a living or engage in intense physical competition on a regular basis. And yet that’s exactly how it’s going down in the world today. In one recent study, the majority of patients with Achilles tendon injuries couldn’t attribute their condition to working out or playing sports. In other words, they just got it.
Part of the problem is our nutrition. We eat too many of the inflammatory foods which contribute to connective tissue degradation and deconditioning, like grains and refined seed oils and sugar, and too few of the nutritive building blocks our bodies use to buttress and repair damaged connective tissue, like collagen. For over a decade, I’ve sought to address these deficiencies in the modern diet by laying out the Primal eating plan and creating non-inflammatory versions of existing products (like mayo and salad dressings) and products that replace some of the foods we’ve been missing. This is why I started selling collagen powder—because it’s the greatest source of gelatin, provides the necessary building blocks for collagen construction and repair, and provides the glycine that balances out the methionine in our meat-heavy diets and makes them less inflammatory.
This is all standard stuff at this point. It’s no surprise to most of you. Eat healthy, exercise, sleep, and most other things fall into place, including the health of your connective tissues. But it can’t explain everything. There’s more to it.
I’ve been suspicious of stretching in the past, especially static stretching. You don’t see Hadza tribes people doing the downward dog, hitting the couch stretch, or doing toe touches every morning. They simply move around a lot and avoid sitting in chairs for ten hours a day, and it’s enough. Right?
But over the past few months, I’ve become acquainted with Matt Wallden, the Global Head of Education for the Chek Institute. Like me, he’s obsessed with taking lessons from human evolution and applying them to humans living today to help them thrive. We really hit it off, so much that we collaborated on a pair of papers that appear in the April edition of the Journal of Bodywork and Movement Therapies that discuss the power of “Archetypal resting positions” (several positions depicted in the article) and the crisis (and solution) of “Modern disintegration and primal connectivity.”
In the papers, we posit that it’s not just our tendency to sit in chairs way too much that’s destroying our health, movement quality, and tissue quality. We’re also failing to utilize the archetypal resting positions that humans have been using for hundreds of thousands of years. Sitting in chairs isn’t ideal, but far worse is our neglect of the dozen or so permutations of ancestral floor positions.
- The full squat, with heels down.
- The high kneel.
- The low kneel.
- The side sit.
- The long sit.
- The cross-legged sit.
- In each of these positions, some tissues are lengthened (stretched) while others are compressed.
- The squat stretches the back, glutes, quads, and calves.
- The high kneel stretches the quads, Achilles’ tendon, and foot fascia.
- The low kneel stretches the feet and quads.
- The long sit stretches the hamstrings and wrist flexors.
- The cross-legged sit stretches the hip adductors and rotators.
- The side sit stretches the external and internal rotators of the hip.
If you alternate between all the positions, every limb will receive the stretch/compression treatment that has been shown to improve tissue healing and maintain tissue viability and function.
Many of these positions also restrict blood flow to specific areas of the body, a practice that has been shown to enhance connective tissue healing. You restrict the blood flow and then restore it, and the tissue gets a “rebound” effect.
Now imagine doing this all the time, whenever you’re at rest. Imagine not having any chairs at all. Imagine how you’d feel—and move, and perform, and recover—if instead of spending 10 hours a day hunched over in a chair you spent 2 hours a day exposing your body to these archetypal stretch/compression positions.
Not only that, but sitting in these archetypal resting positions may even improve glucose tolerance.
We cite research showing that a gentle passive stretching program (10 different stretching positions, 4 30-second “reps” each for a total of 20 minutes) lowers blood sugar in diabetics. That’s a possibility, but I’ve always found dedicated stretching or mobility routines to be the hardest to maintain. And I’m not alone—pretty much everyone hates stretching. A more evolutionarily-congruent method would be to integrate these resting positions into your daily life.
Hanging around at home or at the park or beach? Sure, getting down into these positions on the floor is cinch. You could easily make that work. But what about at work? What if you work in front of a computer? I’m picturing a floor-based workstation that enables the archetypal resting position as you work, sort of a low-lying modular “desk” that can be manipulated into various shapes to adhere to your particular resting position. That would be very cool and very interesting. We haven’t done the research on the cognitive effects of chair sitting vs archetypal resting positioning, but I wouldn’t be surprised if they offered some performance-enhancing effects for knowledge workers.
In the next couple weeks, Matt and I will be releasing a podcast discussing the archetypal resting positions and other topics in full.
For now, why don’t you make it a point to spend the next month doing at least one hour of archetypal floor sitting every day? See if you notice any improvements to your tissue function, and report back. I’d love to hear your results.
Thanks for reading, everyone. Take care!
De jonge S, Van den berg C, De vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45(13):1026-8.
Wallden M, Sisson M. Modern disintegration and primal connectivity. J Bodyw Mov Ther. 2019;23(2):359-365.
Wallden M, Sisson M. Biomechanical attractors – A paleolithic prescription for tendinopathy & glycemic control. J Bodyw Mov Ther. 2019;23(2):366-371.
Taheri N, Mohammadi HK, Ardakani GJ, Heshmatipour M. The effects of passive stretching on the blood glucose levels of patients with type 2 diabetes. J Bodyw Mov Ther. 2019;23(2):394-398.
The post Archetypal Resting Positions: How Sitting Like Your Ancestors Could Save Your Health appeared first on Mark’s Daily Apple.
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Anxiety is normal. It’s something we all have experience with—to one degree or another. Most people are anxious about something that hangs over them and follows them around like a personal rain cloud. Then there’s the deeper but still familiar anxiety many of us carry. The anxiety about our self-worth. The anxiety of performance, of social situations. This type can grip us in an uncomfortable, but hopefully not chronic, way.
But not all anxiety is run-of-the-mill—or manageable. People with Generalized Anxiety Disorder, for instance, might have trouble leaving the house, ordering a coffee from Starbucks, going to work. Anxious thoughts cycling through their brains often keep them up at night. When untreated, people with this level of anxiety can end up living in a state of perpetual fear.
The conventional approach is to take anti-anxiety meds, which can be genuinely life-saving for some people. Nonetheless, these can come with downsides that vary depending on an individual’s dosage and reactions—and the nature of the particular medication itself. Some meds result in few side effects, but others’ effects can be heavy. For instance, there are the benzodiazepines, highly-addictive tranquilizers with the potential for abuse. They make driving unsafe. They lower productivity. They sedate you. When necessary for the severity of the condition, these side effects may be worth it.
In other cases, a person might have more space to experiment and want to explore a different route.
In some cases, people choose to try natural anxiety aids. These are supplements, nutrients, and herbs that have been designed across millennia by nature (and maybe some input from green-thumbed healers). They might not always be enough for something as serious as a clinical anxiety disorder (please talk to your doctor before making any adjustment or addition to your medication), but at least some may be important complements to a prescribed regimen.
For those who want or need an alternative strategy for anxiety beyond meditative practices and general good health, these natural remedies may be worth a try.
First, the NUTRIENTS….
These are basic vitamins, minerals, and amino acids that your body needs to work. They are non-negotiable. You don’t have to get them through supplements—in fact, that should be a last resort after food—and I wouldn’t expect “drug-level” effects, but you do need to get them.
1. Long Chained Omega-3 Fatty Acids
Some human evolution experts maintain that the human brain wouldn’t be the human brain without steady and early access to coastal food resources—fish and shellfish rich in long chain omega-3s. If the long-chained omega-3s found in fatty fish and other sea creatures made our brains what they are today, it’s safe to assume that our brains work better when we eat them today. And if we’re talking about anxiety, that appears to be the case:
Studies in substance abusers find that supplementing with enough fish oil (and, yes, here’s what I use regularly) to raise serum levels of the long chain omega-3 fatty acid EPA reduces anxiety, while increases in DHA (the other long chain omega-3) reduce anger. Rising EPA levels after supplementation predicted the reduction in anxiety.
In healthy young medical students, omega-3 supplementation (2 grams EPA, 350 mg DHA) lowered inflammation and anxiety. Follow-up analyses revealed that reducing the serum omega-6:omega-3 ratio also reduced anxiety scores.
And in early pregnancy, high DHA levels predict low anxiety scores.
Magnesium deficiency is a risk factor for anxiety. The evidence, considered by some to be low quality, nonetheless suggests that supplementing with magnesium can reduce subjective anxiety. The mechanistic evidence is stronger, as magnesium is one of those minerals that plays a role in hundreds of very basic and essential physiological processes—including the generation of ATP, the body’s energy currency. Without adequate energy production, nothing works well. One’s mental health is no exception.
Magnesium supplementation reduces subjective anxiety (the only kind that matters) in the “mildly anxious” and in women with premenstrual syndrome.
Magnesium L-threonate, a form particularly good at getting into the brain, is worth trying for more immediate, noticeable effects.
Zinc deficiency is common in people with anxiety, including Chinese males and Americans. And although mainlining oyster smoothies probably won’t fix serious anxiety, a follow-up in the group of Americans with low zinc levels found that zinc supplementation did reduce anxiety levels.
4. Vitamin B6
Vitamin B6, or pyridoxine, helps regulate production of serotonin and GABA—two neurotransmitters that control depression and anxiety. In mice exposed to anxiety-producing situations, pyridoxine increases GABA, reduces glutamate, and reduces anxiety. In humans, correcting a magnesium deficiency with magnesium and vitamin B6 has a stronger effect on anxiety than magnesium alone. (Good to note: women on hormonal birth control may be depleted of vitamin B6 as well as other vitamins and minerals.)
The best sources of vitamin B6 are turkey, beef, liver, pistachios, and tuna.
Now, the NATURAL INTERVENTIONS….
These aren’t essential nutrients. Rather, they’re plant compounds with pharmacological effects and, in most cases, hundreds of years of traditional usage for dampening, inhibiting, or resolving anxiety.
Kanna comes from a succulent plant native to South Africa. The story goes that an anthropologist noticed elderly San Bushmen nibbling on a particular type of succulent plant while displaying incredible cognitive ability and remaining calm, cool, and collected. The fact that they weren’t dealing with daily commutes, traffic jams, annoying bosses, and mounting bills probably had something to do with it, but it turns out that the succulent plant wasn’t hurting the cause.
Kanna has been shown to dampen the subcortical threat response, which is normally heightened in anxious states. It also increased well-being and resistance to stress in health adults who took it in a safety study.
Theanine, an amino acid found in green tea and available as a supplement, isn’t going to obliterate your nerves before a big performance. One study showed that it (along with the benzodiazepine Xanax) reduced resting state anxiety but not experimentally-induced anxiety. Then again, neither did Xanax.
Theanine is instead a mild anxiolytic. If you get anxiety from caffeine, take 200 mg of theanine with your coffee. It will smooth out the experience, reduce/remove the anxiety, and leave the stimulation.
Kava is a plant native to the South Pacific. Traditionally, its roots were chewed fresh with the resultant liquid often spit into communal bowls for consumption, pounded to release the moisture, or sun-dried, ground, and steeped in water to make an intoxicating, relaxing mild sedative. Nowadays, the active kavalactones are also extracted and pressed into capsules.
I don’t use kava, but I have tried it a couple times in the past. For what it’s worth, I don’t have anxiety issues but it did seem to pair well with caffeine (similar to theanine).
8. Rhodiola Rosea
Rhodiola rosea is a longtime favorite adaptogen of mine. It hails from the barren wastes of Siberia, where for millennia people from all over the ancient world coveted it. There’s something about the harsh environment of the northern tundra that made rhodiola rosea incredibly resilient—and bestows upon those who consume it a similar type of mental resilience.
A 2015 study sought to determine the impact of rhodiola on self-reported anxiety, stress, cognition, and a host of other mental parameters. Eighty subjects were divided into either a twice-daily commercial formula (containing 200 mg rhodiola) group or a control group. Compared to the controls, the rhodiola group showed notable improvements in mood and significant reductions in anxiety, stress, anger, confusion and depression after 14 days.
There’s a great lavender farm on the island of Maui. One of the favorite memories from that trip is strolling through the fields of lavender, brushing against the leaves and flowers, just basking in the relaxing scent that permeated the entire property. A very low-stress environment, to be sure.
One study gave lavender oil capsules to major depressive disorder patients suffering from anxiety who were already taking antidepressants. Not only did adding the lavender reduce anxiety, it also improved sleep.
Perhaps the most impressive study is this one, where generalized anxiety disorder patients either received lavender oil or a benzodiazepine anti-anxiety drug. Patients receiving the lavender had the same beneficial effects as the benzo patients without the sedation.
Lavender oil aromatherapy also seems to reduce anxiety, at least in cancer patients. One weakness of aromatherapy research is the difficulty of giving a “placebo smell.” Essential oil scents are quite distinct.
10. CBD Oil
As I wrote a couple weeks ago, CBD is the non-psychoactive cannabinoid found in cannabis.
Most recently, a large case series (big bunch of case studies done at once) was performed giving CBD to anxiety patients who had trouble sleeping. Almost 80% had improvements in anxiety and 66% had improvements in sleep (although the sleep improvements fluctuated over time).
In a five-year-old girl with PTSD (a category of patient that just shouldn’t exist) in whom pharmaceutical anxiety medications did not work, CBD oil provided lasting relief from anxiety.
What do you folks like for anxiety? What’s worked? What hasn’t? What did I miss?
Thanks for reading, everyone. Take care.
Cunnane SC, Crawford MA. Energetic and nutritional constraints on infant brain development: implications for brain expansion during human evolution. J Hum Evol. 2014;77:88-98.
Boyle NB, Lawton CL, Dye L. The effects of magnesium supplementation on subjective anxiety. Magnes Res. 2016;29(3):120-125.
Mccarty MF. High-dose pyridoxine as an ‘anti-stress’ strategy. Med Hypotheses. 2000;54(5):803-7.
Walia V, Garg C, Garg M. Anxiolytic-like effect of pyridoxine in mice by elevated plus maze and light and dark box: Evidence for the involvement of GABAergic and NO-sGC-cGMP pathway. Pharmacol Biochem Behav. 2018;173:96-106.
De souza MC, Walker AF, Robinson PA, Bolland K. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med. 2000;9(2):131-9.
Lu K, Gray MA, Oliver C, et al. The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum Psychopharmacol. 2004;19(7):457-65.
Terburg D, Syal S, Rosenberger LA, et al. Acute effects of Sceletium tortuosum (Zembrin), a dual 5-HT reuptake and PDE4 inhibitor, in the human amygdala and its connection to the hypothalamus. Neuropsychopharmacology. 2013;38(13):2708-16.
Nell H, Siebert M, Chellan P, Gericke N. A randomized, double-blind, parallel-group, placebo-controlled trial of Extract Sceletium tortuosum (Zembrin) in healthy adults. J Altern Complement Med. 2013;19(11):898-904.
Fißler M, Quante A. A case series on the use of lavendula oil capsules in patients suffering from major depressive disorder and symptoms of psychomotor agitation, insomnia and anxiety. Complement Ther Med. 2014;22(1):63-9.
Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94-9.
Shannon S, Opila-lehman J. Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report. Perm J. 2016;20(4):16-005.
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By now, the average person grasps just how important sleep is for our overall health. It seems like every month there’s a new popular science book extolling the virtues of sleep. Parents remember the zombified newborn days and can see (and hear), firsthand, what happens when a toddler doesn’t get enough sleep. And on a visceral level, we feel the need for slumber. Even if we’re unaware of or refuse to accept the health dangers of long-term sleep restriction, there’s no getting around the abject misery of a bad night’s sleep.
We all want better sleep. We all need better sleep. But how?
Sleeping pills are not the answer for most people.
(But please note: Don’t discontinue or alter a prescribed treatment or medication regimen without consulting your doctor…and, likewise, don’t begin a new regimen—like those below—without running it by your physician.)
In one recent “positive” study on the effects of sleeping pills, almost every single subject suffered one or more side effects, ranging from headaches to nausea to irritability to dizziness to dysgeusia (a condition where your sense of taste is altered).
In another, taking Ambien the night before decreased cognitive performance and increased subjective sleepiness the next morning.
Studies aside, there are thousands of horror stories about people ruining their lives (or behaving in a way that had the potential to do so) after taking sleeping pills. Twitter rants that get you fired, sleep driving, tooth grinding, furniture rearranging, sleep eating. And those are just the ones that people live to tell.
That’s not to say sleeping pills are useless. They’re legitimate drugs to be used for specific medical conditions, in specific patient circumstances. They aren’t to be trifled with. But if you’re just trying to “get better sleep,” you’ve got options. And I’m not even mentioning the lifestyle and behavioral modifications you can make to improve your sleep.
Here are my favorite natural sleep aids….
GABA is the inhibitory neurotransmitter. It calms the brain. It soothes the brain. It de-stresses the brain. And it’s a major factor in the creation of melatonin, the hormone our brain uses to trigger sleep onset. Insomniacs have reduced brain GABA levels compared to non-insomniacs; the same goes for people with sleep apnea. Restoring physiological levels of GABA, then, is a first line of defense against poor sleep.
Oral GABA has a blood-brain barrier problem—it doesn’t cross it particularly well. Children have more permissive BBBs, but most of my readers aren’t children. Nitric oxide tends to increase GABA diffusion across the blood brain barrier, and there are a couple of ways to increase nitric oxide in conjunction with taking GABA to make the latter more effective for sleep.
You could sunbathe. That increases nitric oxide release. The only problem is that most sunbathing occurs during the midday hours, not at night. It’s unclear how long the boost from sunlight lasts, though it certainly can’t hurt.
You could take apocynum venetum, an herb used in traditional Chinese medicine that increases nitric oxide release. In fact, one study showed that taking GABA with apcynum ventum improves sleep quality.
Before you start sedating yourself, see if GABA has an effect.
When it’s bedtime for your brain, your pineal gland starts pumping out a hormone called melatonin. This initiates the onset of sleep and triggers subjective feelings of sleepiness; it also sets your circadian rhythm.
Supplemental melatonin crosses the blood brain barrier and acts very similarly to endogenous melatonin.
Don’t use melatonin every night. Not because you’ll get “addicted” (you won’t) or “your natural production will stop” (it won’t), but because you should focus on producing your own. If I get a big dose of late night blue light, I might nibble on a little melatonin. If I have more than a single glass of wine at night, I’ll have some melatonin before bed as alcohol depresses its production. And when I travel, I always take a few milligrams an hour before my desired bedtime in the new time zone.
The main reason you shouldn’t rely on melatonin for everyday use is that supplemental melatonin pharmacology doesn’t quite emulate endogenous melatonin pharmacology. The way most people take it is in a single dose before bed. The way the brain produces it is consistently through the night. If you want to emulate physiological levels of melatonin, you’re better off taking a single dose of instant release melatonin followed by a dose of slow release melatonin, or a supplement that includes both forms. Even then, it’s not the same.
I still remember the first time I drank a big mug of bone broth at night. It was one of the not-as-rare-as-you’d-think cold “winter” nights in Malibu. I was sitting on the couch, reading a book, and got about 3/4 of the way through a mug of chicken foot broth before, apparently, falling asleep right then and there. A bit of research the next day revealed that glycine, the primary amino acid in collagen/gelatin/broth, can have a powerful effect on sleep quality. Not only that, glycine also lowers body temperature (an important part of the sleep process) and improves wakefulness the next day. And if you’ve got REM sleep behavior disorder, glycine may be the solution.
In fact, the glycine-sleep effect was another consideration in creating Collagen Fuel and Peptides. Everyone talks about the benefits to joint health, performance, skin, nails, hair, and general inflammation, but I want folks to also discover the benefit of glycine-enhanced sleep, too.
We talk a lot about “age-related” declines in health, vitality, performance, and basic physiological functions. We also talk about how much of what we call “age-related” isn’t inevitable. It’s not so much that the passage of time degrades our bodies and how they work, but that we become more susceptible to poor lifestyle, dietary, and exercise choices because of compounding negative interest. We’re born with robust health and if we fail to maintain it, our health worsens as time progresses. If we never stop moving, lifting weights, and eating right, aging doesn’t happen to the same degree.
One thing that changes with age is how we sleep. In older people, sleep architecture is different: More time is spent awake and there’s less slow wave sleep. Sleep spindles, those oscillating bursts of brain wave activity, begin disappearing. Sounds inevitable, right? Except that research shows that taking magnesium reverses these age-related changes to sleep architecture.
5. CBD Oil
As I wrote a couple weeks ago, CBD is the non-psychoactive cannabinoid found in cannabis.
And to me, the most interesting aspect of CBD lies in its potential to improve sleep. A 2017 review provides a nice summary of the effects of CBD on sleep:
In insomnia patients, 160 mg/day of CBD increased sleep time and reduced the number of arousals (not that kind) during the night.
Lower doses are linked to increased arousals and greater wakefulness. Higher dose CBD improved sleep.
In preliminary research with Parkinson’s patients, CBD reduced REM-related behavioral disorder—which is when you basically act out your dreams as they’re happening.
More recently, a large case series (big bunch of case studies done at once) was performed giving CBD to anxiety patients who had trouble sleeping. Almost 80% had improvements in anxiety and 66% had improvements in sleep (although the sleep improvements fluctuated over time).
Theanine is a chemical found in tea, especially tea grown in shady conditions. Because it is structurally similar to glutamate and easily passes the blood brain barrier, theanine binds to various glutamate receptors in the brain, inhibiting the action of some and promoting the action of others. It also increases serotonin, GABA, and glycine in the brain—all chemicals that can pave the way for better sleep.
Theanine is another of those sleep aids that isn’t expressly about sleep. It’s about relaxation, about letting you get out of your own way. If in the course of relaxation and stress reduction you end up taking care of the thing that’s messing up your sleep, theanine can be said to be a big sleep aid.
7. Lutein and Zeaxanthin
One of the most powerful sleep aids is wearing a pair of orange safety goggles that blocks blue light after dark. Viewed after dark, blue (and green) light suppresses melatonin secretion, pushes back sleep onset, and throws off your entire circadian rhythm. Blocking the light with goggles allows normal melatonin production to proceed and promotes earlier bedtimes and better, deeper sleeps.
What if you could take a supplement that simulated the blue-blocking effect of a pair of orange safety goggles? Lutein and zeaxanthin are carotenoids, plant-based pigments found in colorful produce and pasture-raised eggs that are actually incorporated into the eye where they offer protection from sunlight and inhibit the melatonin-reducing effect of nighttime light exposure. Human studies show that taking lutein and zeaxanthin on a regular basis improves sleep quality, reduces sleep disturbances, and lowers dependence on supplemental or pharmaceutical sleep aids.
The best natural sleep aids restore the ancestral sleep baseline. At baseline, humans should be walking around with good GABA levels. They should be getting enough magnesium, collagen/glycine, and carotenoids from their diet. It’s normal to produce melatonin after dark. And even though humans haven’t been dosing themselves with CBD or theanine for very long, it also isn’t normal to be inundated with chronic, low level stress and persistent anxiety—the type of stress that ruins our sleep, the type of anxiety that CBD and theanine can regulate.
8. Lemon Balm
Lemon balm is an herb in the mint family. The fragrance is intoxicating (I’ve even used lemon balm in a roasted chicken), but not the effects. It doesn’t directly induce sleep—it’s not a sedative or a hypnotic—but if stress and anxiety are getting in the way of your sleep, lemon balm will help clear them out.
Valerian root has a long history as an anti-insomnia herb. The ancient Greeks used it and traditional Chinese and Ayurvedic medical traditions continue to use to it to treat bad sleep. Valerian contains a compound that slows down the brain’s metabolism of GABA, thereby increasing GABA levels and letting what the brain already produces hang around even longer.
I’ll admit I’m more ambivalent about these last two options. While they’re certainly gentler than pharmaceutical sleep pills, and lemon balm in particular is a legit way to deal with stress and anxiety, their efficacy for sleep is questionable. The evidence just isn’t there, though I grant that many people report good results.
Many of these individual compounds become more powerful and more effective combined with each other. Since these aren’t pharmaceutical drugs with very narrow safety profiles rife with contraindications, taking them together usually isn’t an issue, but check in with your doctor anyway (especially if you’re taking other medications or have known health conditions).
- There’s GABA combined with theanine, shown to improve sleep quality more than either supplement alone.
- There’s magnesium combined with zinc and melatonin, shown to help insomnia patients get more and better sleep.
- There’s my very own Adaptogenic Calm, which I designed to combat the stress of excessive training and blunt the unnecessary fight-or-flight response we so often find ourselves triggering in the modern world.
And today’s list isn’t exhaustive. There are other compounds, herbs, and supplements that can probably help people improve their sleep.
Most of the adaptogens, like ashwagandha or rhodiola rosea, have been shown in one study or another to improve sleep in humans. Anything that helps get you back to baseline, back to homeostasis, back to normal—will restore your sleep if it’s suffering. And if you’re suffering, your sleep is likely suffering because sleep is such a fundamental aspect of the human experience. Anything that improves your health will also probably improve your sleep.
This goes without saying, but don’t limit yourself to natural sleep supplements. Don’t forget about the importance of lifestyle, of exercise, of diet, of morning light exposure and nighttime light avoidance. Supplements can help, but they can’t be the foundation for good sleep hygiene. You’re just asking for trouble—or subpar results.
Thanks for reading, everyone. Now, let’s hear from you. What natural sleep aids have you found most useful? Is there anything I overlooked or forgot? Let me know down below.
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