Dear Mark: Power Yoga, Pelvic Floor, Keto Reset and Osteoporosis

For today’s edition of Dear Mark, I’m answering three questions. First, is power yoga—a more “intense” version of yoga that includes strength exercises—a suitable alternative to strength training for aging women? Probably not, but that doesn’t make it bad or wrong to do. Second, what’s the deal with pelvic floor dysfunction after menopause? What’s the best way to improve that situation? And third, is the Keto Reset right for older women with osteoporosis?

Let’s find out:

Shannon asked:

Would you consider power yoga “lifting heavy things”? I do power yoga 2-3 times a week and it involves a lot of standing strength and arm/hand stands? Thanks and I love everything on Marks Daily Apple!

Not quite. Nothing can really compete with strength training and high-intensity work for building bone resilience and strength. Your bones need impact and intensity, and yoga generally doesn’t supply enough of it.

That’s why hopping in place can help strengthen hip and thigh bones in older folks. The jarring impact of landing—even from a modest height of six or eight inches—triggers bone resorption and remodeling in the legs.

That’s why lifting heavy things makes bones strong. The bone acts (along with the muscle) as a lever during the lift, which places a lot of stress on the bone. To recover from the activity and be ready for the next time it has to fulfill lever duty, the bone remodels itself, gaining density and getting stronger and more durable.

Power yoga is closely related to ashtanga yoga, long considered a more “intense” form of yoga. Yet an 8-month study found that Ashtanga yoga yielded only mild benefits to bone health. As for strength, another 8-month Ashtanga study by the same group found that it improved leg press strength but little else. It’s better than nothing, but it’s probably not enough to stave off the worst effects aging has on muscle and bone.

Still, if yoga is something you love, continue doing it. Yoga will improve your balance, coordination, flexibility, and even strength under certain contexts. Throwing in a single day or two of dedicated strength training on top of the yoga is a great way to have it all. One day a week is “enough,” two days a week is better (a recent study found that while older women training one day a week maintained strength, training twice a week was necessary to gain ever-critical lean muscle mass).

Power yoga varies a lot from place to place, so it really depends on how your instructor chooses to implement it. I just wouldn’t bank on it providing enough stimulus for your muscles and bones.

Michelle Reese wrote:

I’d like to know a little about how to strengthen and support the pelvic floor, which really gets compromised after menopause, making it hard to do the squats. I’ve really noticed the decline in function after menopause, even though I’ve been working out consistently my entire life. Thanks for doing the research and sharing today’s wisdom!

My pleasure. Thanks for reading!

Realize that the pelvic floor is a system of muscles, and muscles need to be used and loaded, lest they degenerate—which only speeds up as we age. The same thing applies to the rest of your muscle. It’s just that actively using the pelvic floor muscles is harder and less intuitive than actively engaging your biceps or hamstrings. They’re also hidden, so it’s easy to forget they even exist and need our attention.

For pelvic floor stuff, go with Katy Bowman. Check out her articles and books on the subject. Her expertise is unmatched.

Vicki M asked:

No doubt this has been discussed before…..however, for a 60 year old post menopause woman with osteoporosis (but still active, going to gym, walking etc), is Keto reset a good option?

The bad news is that this particular diet has never been studied in this particular population.

The good news is that, as a human, your species has been well-represented in the ketogenic diet literature.

In a long-term 5 year study of human adults, ketogenic dieting failed to produce any negative effects on bone health.

In a shorter study, a low-carb, high-fat diet (no word if it was “ketogenic” or not) failed to worsen bone turnover markers.

Some critics claim that ketogenic diets (and pretty much any diet that includes “evil” animal protein) “dissolve” bones by throwing off the acid/base balance, such that the body must break down bone to ameliorate the acid load. It’s not true, but if it were? In a recent study, elite female race-walkers on a ketogenic diet saw no change in their acid/base balance.

There are more wrinkles to the keto/bone health story, which I’ll explore in the near future. Stay tuned for that.

But long story short, keto reset is fine, provided you don’t just go keto and do nothing else. You still have to train (including strength training), get plenty of sleep, get vitamin D, and focus on the micronutrient content (including the bone-relevant potassium, calcium, magnesium) of your diet and not just the macronutrients.

That’s it for today, folks. Thanks for reading, writing, and commenting. Include any further questions or input you have down below and have an incredible day!

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