It’s Friday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these each Friday as long as they keep coming in. Thank you for reading!
This may not look like your typical success story, but it’s still a primal success nonetheless! I have been blessed in that I’ve never had any illnesses or struggles with health. I’ve always been super active and that had helped me maintain a healthy weight, even throughout three pregnancies. My passion for running has always been deep and I completed my first marathon at the age of 31. I was hooked.
But with the growing number of miles, you can imagine how my appetite grew as well. I had the mindset that since I ran ten miles that morning, I could eat as much as I wanted, especially because I was eating “healthy” things like whole grain pasta, wheat bread, oatmeal, protein and snack bars, etc. I noticed that with every marathon training cycle, the scale would go up a little. I kept telling myself, “It’s okay, after my 20 miler this weekend I will drop the extra weight.” Nope. I noticed my clothes were getting uncomfortably tighter and my stomach was so bloated. I was confused because I would eat a big bowl of pasta and be hungry 30 minutes later. By this point, my weight was about ten pounds heavier than my normal, and the highest it had ever been! Most people probably couldn’t even tell, but I KNEW something wasn’t right. I felt horrible in my own skin.
I cannot even describe how good I felt (except for a pretty bad headache on day two!). I followed the guidelines to a tee and saw incredible results. I lost seven very stubborn pounds during the three weeks and that was without doing any running. My exercise during the 21 days consisted of taking the kids and dog for daily walks. I was blown away that I could lose weight without running!
Needless to say, I didn’t stop after the 21 days. I have now been primal for 6 months and have never felt better. I’ve lost over ten pounds without even really trying. I love my eggs, avocados, nuts, berries, veggies, whole-fat Greek yogurt, and meat. My husband was skeptical at first, but saw my success and joined me in this lifestyle. He lost almost 20 pounds that he hadn’t even realized he’d slowly packed on over time.
I am currently training for the Boston Marathon and can easily go through the day after a run without ever feeling ravenous. If I have to wait to eat or skip a meal, it’s no big deal. I also make sure to avoid chronic cardio by keeping my easy days easy, and my hard days hard.
Thanks, Mark! Although I’m not quite ready to give up marathons, I’ll give up grains, sugar, and bad oils any day!
Chicken noodle soup is comfort food that both adults and kids love. When you don’t have the time or the energy to make long simmered, all-day chicken soup, this is the recipe you need. In about an hour you’ll be slurping noodles from a bowl filled with rich, flavorful broth, chicken and yes, you read that right, noodles.
Shirataki noodles, a low-carb noodle alternative, make a tasty stir-fry and are eminently delicious in a bowl of soup. These almost flavorless noodles soak up some of the flavor in the broth, which is made using only dark meat for the richest flavor. The shredded thigh meat mixed in with the noodles makes a filling and satisfying bowl of chicken noodle soup. Low-carb, richly flavorful, and quick and easy means that this is chicken noodle soup everyone can love.
Time in the Kitchen: 1 hour
Servings: 4 to 6
2 1/2 pounds bone-in chicken thighs (about 6 thighs/1.1 kg)
2 tablespoons unsalted butter or avocado oil (30 ml)
2 carrots, peeled and sliced into 1/2-inch rounds
2 celery stalks, cut into ½-inch half-moons
1 onion, chopped (either finely diced or bigger chunks, whichever you prefer)
Fasted workouts are a controversial topic in the fitness world. To some, the idea of working out without “carbing up” or doing the pre-workout protein shake is unthinkable. Won’t my performance suffer? Won’t my muscles shrink?Won’t my body think I’m in the middle of some horrible famine and go into starvation mode?
To others, fasted workouts are sacred tools, the perfect antidote to modern decrepitude. When I train in a fasted state, I can will my adipocytes to release fatty acids and feel the heat as they burn, hear the barely audible *pop* of muscle satellite cells replicating and proliferating, and see visions of my future physique through my gaping third eye.
Where does the truth lie? Let’s look….
To begin with, the evolutionary argument—the Grok logic—for fasted workouts is extremely appealing and intuitive.
Humans did not evolve with access to 24-7 fast food restaurants, grocery stores containing hundreds of millions of calories, and food supplies so ample that we often throw out half of it before we’re able to eat it. If paleolithic humans wanted to eat, they had to hunt or gather something—both of which require the expenditure of caloric energy—often on an empty stomach. In fact, these “workouts” for hunter-gatherers probably occurred more often than not in a fasted state.
This doesn’t mean that fasted workouts are ideal or optimal for health, performance, and fat loss. It does suggest that humans have the capacity for working out in a fasted state without falling apart or losing all the benefits normally associated with exercise. The question is if fasted workouts offer any special advantages.
Today, I’m going to dig into the literature to explore the most frequent questions and claims about fasted workouts and arrive as close to the truth as we can.
Are Fasted Workouts Good or Bad for Muscle Gain?
Let’s take a look.
One common argument is that since you’re not eating, which already “stresses” the muscles and deprives them of structural substrate, stressing the muscle with exercise causes it to “melt away.” This is overly simplistic, if attractive.
For one, that first bit is wrong. Reasonable durations of fasting don’t cause muscle loss. In fact, you can do a few days of fasting without incurring any significant muscle loss. The ketones generated during the fast have protein-sparing effects, and the fasting-induced spike in growth hormone also spares muscle from breakdown. There was even a study where blocking growth hormone with a GH blocker caused fasting people to lose 50% more muscle than fasters who didn’t get the blocker.
For two, strength training itself is a powerful signal to your body that your muscles are essential tissues vital to your survival. Your body generally tries to avoid burning through essential tissues. Lifting also increases growth hormone. Paired with the fasting-induced GH boost, your muscles will be in good standing.
Okay, so fasted workouts don’t appear to be bad for gains. Are they good?
Fasted training augments the anabolic response—the ability of muscles to take up protein and get bigger and stronger. A 2009 study found that, compared to athletes who lifted weights after breakfast, athletes who lifted weights in the morning before eating had an augmented anabolic response to a post-workout protein-and-carb shake.
Are Fasted Workouts Good for Fat Loss?
This one makes sense, doesn’t it? When you don’t have exogenous calories coming in, and you go for a run or walk or bike ride, your body should burn more body fat since it’s the only energy source available. But does it actually happen?
Well, short term studies find that fasted cardio increases fat oxidation in the body. People who go for a run in a fasted state have a lower respiratory quotient, an indication of greater fat burning versus glucose burning. One study found that a morning fasted cardio session increased 24-hour fat oxidation by 50% in young men.
An increase in 24-hour fat oxidation doesn’t say much about long term fat loss, however.
Another study followed a group of healthy women for four weeks, placing them on a morning fasted cardio routine. Three mornings a week, the subjects would perform 50 minutes of treadmill cardio at 70% of their max heart rate in a fasted state. Both the fasted group and the control group (who performed the same cardio, just not fasted) maintained a daily 500 calorie deficit. What happened?
There were no differences in fat loss between groups. Both groups lost weight and lost body fat, but fasted morning cardio did not accelerate the loss. A recent analysis of the available research came to the same conclusion: no difference in fat loss or weight loss between fasted workouts and fed workouts.
I’d like to see a similar four-week study done with men, who in my experience and from reading the fasting literature tend to have a more favorable response to extremes in caloric restriction.
This isn’t a perfect fasted workout study, but it’s better than nothing. A group of triathletes was placed on a “sleep-low” program: instead of eating a ton of carbs after their afternoon workouts, they ate none at all. They depleted their glycogen with the workout, ate a very low-carb dinner, and went to sleep. Then they woke up and did low-intensity cardio in a fasted state, which is the equivalent of a normal person going for a walk. The study was interested in performance, not fat loss, but the group who did their cardio in a glycogen-depleted, fasted state lost more fat than the control group.
An old bodybuilding classic for shedding fat is the fasted morning walk. Wake up, consume no calories, and go for a brisk 20-30 minute walk. In those who are already pretty lean but want to get very lean (like bodybuilders preparing for competition), fasted low-level cardio can be very effective. This is the hardest body comp transition—from lean to very lean. Lean is what the body “wants,” and going lower requires getting over the natural tendency to hold on to diminished body fat stores. A fasted walk, jog, or cycling session performed in the aerobic zone almost forces the body fat to release into circulation. Insulin is low. Sensitivity is high. The stage is perfect, in theory.
Are Fasted Workouts Good for Performance?
Yes and no.
To answer this question, we must note the distinction between training and competing. You might perform worse in a given workout if you’re fasting. You’ll probably perform better if you’ve eaten. But if you’ve consistently trained in a fasted state, the metabolic and muscle adaptations you’ll acquire will boost performance when you compete in a fed state. And that’s everything, isn’t it? While it’s fun to go hard in a workout, test your PR, and treat your training session like the world championship, the real reason we train is to adapt to the training and get better, fitter, and faster—whether for a legit competition or to simply get healthier. A fasted workout trains you to perform under difficult physiological conditions of low fuel availability, and that comes in handy. You probably wouldn’t enter a race or powerlifting match in a fasted state, but the fasted workouts you did in the months leading up to competition make you more likely to win.
The two are complementary. Train fasted, race fed.
Sprinting performance appears to suffer. In one study, sprinting athletes who had fasted had impaired speed and power thanks to less springiness. In another, fasted sprinting led to slower reaction times. Again—the question is, do the training adaptations you get from sprinting in a fasted state make up for the acute losses in performance?
As for strength training, there isn’t much solid scientific evidence that the fasted state improves or harms performance. One thing I’ve noticed—and have also heard from dozens of anecdotal reports—is that fasted workouts fill me with a special sort of energy. For lack of a better term, it feels more “Primal,” like you’re actually on the razor’s edge of desperation and performance, where your entire being is focused on lifting the weight, sprinting the hill, or spearing the deer that represents the difference between food for a week and total starvation. It’s pretty cool.
Some people report the opposite. Some people seriously lag if they haven’t eaten. They need something in their bellies to have a good workout. This is a subjective thing, and you’ll probably find that it changes from workout to workout. For example, strength workouts and low level aerobic activity (hiking, walking, paddling) go well for me on an empty stomach, while I prefer to have something light to eat before really intense Ultimate Frisbee matches. Figure out what works for yourself.
Implications for Certain Populations and Conditions…
Type 2 Diabetes
Fasted training improves several physiological markers that are especially relevant to people with type 2 diabetes. For one, it improves insulin sensitivity. The basic definition of type 2 diabetes is “extreme insulin resistance”; fasted workouts counter that insulin resistance. It also improves fat burning, another deficiency common in type 2 diabetes.
Keto dieters and fat-adapted folks on low-carb, high-fat programs seem to do better in the fasted state. If you’re already adept at burning your own body fat and training in a low-carbohydrate state, training in the lowest-carbohydrate state—a fasted one—isn’t a big leap.
As I’ve written before, women tend to react more poorly to intermittent fasting, especially fasts exceeding 14 hours. They are simply more sensitive to caloric restriction, seeing as how their biological “programming” prefers they have a steady source of calories in place for growing, feeding, and nursing babies. Whether you have kids or not, that’s what a significant portion of your DNA is geared toward.
That’s not to say fasted training doesn’t work for women. It just might not do anything special compared to fed training. For instance, this study found that whether overweight women did high intensity interval training in a fasted or fed state had no effect on the benefits. Both types of training worked equally well, improving body composition and the ability of the muscles to burn fat.
Other research finds that women can benefit from fasted training, though men may derive unique benefits. In another study, men and women performed fed and fasted endurance training. Both men and women saw better VO2max increases when fasted, but fasted men saw bigger boosts to muscle oxidative capacity. Fasting helped both in this case. It just helped men a little more.
How I Use Fasted Training
These days, most of my workouts are performed in the fasted state. Anything resembling lower level “cardio,” like walking, hiking, standup paddling, and bike rides are all done totally fasted.
Before heavy lifting or HIIT sessions, however, I’ll drink 20 grams of collagen peptides with some ketone salts and often creatine monohydrate. This isn’t to “fuel” me. The collagen provides the raw material my connective tissue (tendons, ligaments, cartilage) needs to adapt to the training stress, the creatine provides the substrate for quick ATP generation for short bursts, and—this is speculative, mostly—the ketones provide brain fuel to prevent “bonking” and act as an epigenetic signal for muscle preservation. This drink doesn’t contain many calories, nor does it provoke a huge insulin response. I’m technically breaking the fast, but I’m retaining most of the benefits.
I always continue the fast after my workouts. Going a few more hours without eating enhances the HGH response, which helps spare muscle burning and augments the adaptive responses. The ability to comfortably fast after a training session is a good sign that you’re fat-adapted. If I were trying to maintain some elite athletic schedule, I’d refill my glycogen stores, but I’m not chasing performance anymore. It just doesn’t make sense to burn through them and eat a bunch of carbs only to go do it again.
I don’t train in a fasted state for magical effects. I’m not expecting any miracles and neither should you. But I do think every healthy human should be able to complete a fasted workout without falling apart or losing more than a step.
I can. How about you? Ever try fasted workouts? How do you use fasting to augment your training?
For many women, menopause can introduce new health challenges. In addition to the symptoms that perturb basic quality of life like hot flashes, headaches, night sweats, and irritability, menopause is also associated with higher risk for serious health concerns like osteoporosis, cognitive decline, and metabolic syndrome. This has made the standard treatment for menopause—hormone replacement therapy, or HRT—a multi-billion dollar business.
A few weeks ago, I explored the benefits and risks of HRT. It has its merits certainly, but it’s not for everyone. Today’s post is for those people. Say you’ve waded through the morass of HRT research and would prefer a different route. Or maybe you’ve actually tried conventional or bioidentical HRT and found it just didn’t work for you. Whatever the reason, you’re probably interested in using “natural” products if you can swing it and if it’ll actually help.
Are there herbal alternatives to HRT that actually work?
As a matter of fact, there are.
A medicinal herb native to North America, black cohosh was traditionally used to treat a wide variety of conditions, including rheumatism and other arthritic conditions, colds, fevers, constipation, hives, fatigue, and backache. They used it to help babies get to sleep and soothe kidney troubles. In the mid 20th century, it gained popularity in Europe as a treatment for women’s hormonal issues. Modern clinical research bears out its relevance for menopause:
In its native Peru, maca root was traditionally used as a root vegetable (like a turnip or radish), as well as for its pharmacological properties as an aphrodisiac and subtle stimulant. Incan warriors reportedly used it as a preworkout booster before battles. Today, we know it as an adaptogen—a substance that helps your endocrine system adapt to stress, rather than force it in one direction or another.
A 2011 review of the admittedly limited evidence found that maca shows efficacy against menopause. More recently, maca displayed the ability to lower depression and blood pressure in menopausal women. And earlier, maca helped perimenopausal women resist weight gain and menopausal women regain their sexual function and reduce depression and anxiety.
What’s going on here? According to a 2005 study, maca actually lowers follicle-stimulating hormone and increases luteinizing hormone in postmenopausal women, thereby increasing estrogen and progesterone production.
And then there are those herbs and plants with more limited scopes.
Ginseng has limited application in menopause. It improves sexual function, and Korean red ginseng appears to help libido and reduce the total hot flash score, but neither type of ginseng reduces oxidative stress, improves endometrial thickness, or reduces hot flash frequency.
You might remember St. John’s Wort as an herbal treatment for such conditions as depression and anxiety, but it’s also quite effective against certain symptoms of menopause.
In one study, 3 months of daily St. John’s Wort supplementation helped perimenopausal women go from three hot flashes to one hot flash a day, get better sleep, and have a better quality of life. In another, it took 8 weeks of St. John’s Wort for both perimenopausal and postmenopausal women to reduce the frequency and severity of their hot flashes. Researchers also combined it with black cohosh to successfully treat hot flash-related moodiness.
Before you go fill your Amazon cart with supplements and start chowing down on powders and pills, however, make sure you’re making the right move.
Talk to your doctor about the herbal alternatives mentioned today. Discuss and research potential interactions with medications and even supplements you’re already taking. Be sure to cite the relevant references.
Minimize the variables. Don’t start taking everything from this article. Start with one and evaluate.
Don’t underestimate the power of plants. Just because something is “herbal” or “botanical” doesn’t mean it’s completely benign at all doses.
That’s it for today, folks. Take care, and be sure to write in down below.
Have you ever used any herbs or botanicals to treat menopause symptoms? If so, what worked? What didn’t?
Episode 287: Victoria Field: Host Elle Russ chats with Victoria Field, a world-renowned expert in high-performance and cancer-centered keto nutrition for people and dogs.
Each week, select Mark’s Daily Apple blog posts are prepared as Primal Blueprint Podcasts. Need to catch up on reading, but don’t have the time? Prefer to listen to articles while on the go? Check out the new blog post podcasts below, and subscribe to the Primal Blueprint Podcast here so you never miss an episode.
“Imagine if our ancestors had internet news and smart phones. All day long, they’d be getting alerts. ‘Ging of Siberia was mauled by a polar bear.’ ‘Huge attack by Comanches kills 100s. Slaves captured.’ ‘Viking ruler overthrown by brother. Bloodiest battle in Katagut.’ ‘Child goes missing in the bush. Feared eaten by dingos.’ ‘Mayan leader Xocolatte accused of once throwing a cup of coffee at ex-girlfriend.’ ”
– Becky imagines if our ancestors had access to the global news cycle.
It’s Friday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these each Friday as long as they keep coming in. Thank you for reading!
Mark Sisson encourages you live a really enjoyable life. I did not think it was difficult to stick to the Paleo Diet. I was 50. I found Mark Sisson and Loren Cordain on YouTube. Soon I would be buying cookbooks and enjoying my health. It sounded true to me and I jumped on board.
I had been constipated for 40 years. Both my parents were constipated their whole life. I had believed in All Bran and Raisin Bran and healthy muffins. My mother taught me to bake bread in my teens. What a joy, it could not be wrong. In high school an instructor recommended “Diet for a Small Planet.” A few years later in college I became a vegetarian. Many of my friends were vegetarians. It was obvious that we did not need to kill innocent animals and eat them. I ate beans and rice, tofu and vegetables, peanut butter and beer.
Around five years after college I visited an acupuncturist for muscle pains. He suggested that I eat meat and fish. So, for the next 20 years I would primarily be vegetarian but would eat meat and fish. About this time I would eat a breakfast cereal in the morning, a sandwich and potato chips for lunch, and for dinner it was often pasta followed by Ben and Jerry’s on the couch. Beer and wine were being consumed for fun quite often. I did not think that any of this was bad for my body. I ignored or made up other reasons why I was constipated and having chronic pain.
Chronic pain. I injured my knee skiing in my late 20s. No surgery, only rehab. I thought it would heal. Knee pain lasted for years. Wore a support on it for a long time. Got it needled by acupuncturist. Took pain relief. Other chronic pain areas developed, like both wrists and both elbows. Used supportive strapping aids on these parts for years. It felt like the muscle was pulling away from the bone. I figured it was my active lifestyle and normal. I wasn’t sleeping that well, since I would wake up with pain in the arms. The thought that my pain came from food was never considered. It was misery. It went on.
I was changing my diet before The Paleo Diet. The first change was dairy. I went dairy free to help my sinus issues. Then I tried gluten free to help my sinus issues. Sugar was still off the radar, as I was eating gluten free cookies, breads and pasta. I laughed off my coffee and donut at 10 a.m. and M&Ms at 3 p.m. Years went by. It was in 2013 that I changed.
It was one moment on YouTube. Then another. What do you mean a Paleo diet? Click, Click, Click. I went to thepaleodiet.com and read what to eat on the Paleo diet.
Mark Sisson was thoughtful and understood what was going on. I couldn’t get enough. Primal became my diet. I owned it.
I mainly started eating more vegetables. Breakfast had been cereal and now became eggs, bacon and vegetables. Lunch went from rice and beans to meat and vegetables. Dinner became big chicken salad.
I became regular and have never turned back. I felt great. Chronic pain went away. My biggest worry had become a hip that I thought would need replacement in the future. The inflammation slowly went away. It seems to be fine.
Weeks before going Paleo I was planning on buying spray on salad dressing to lesson the amount of oil. Now at 57, I happily use Primal Kitchen® dressing and pour it on heavily. What a sea change.
I’m thankful that I am not addicted to sugar anymore.
I’m thankful for beautiful movement of Taoist Tai Chi.
I’m thankful for Eckhart Tolle for the awareness of gaps between thought.
I’m thankful to Mark Sisson and the whole Paleo/Primal worldview that changed my life for the better.
Most people chalk urinary incontinence and excessive urgency up to age. We get old, stuff stops working, we wake up to wet sheets. Cue jokes about adult diapers and investing in “Depends” futures. It’s not entirely out of line. Aging matters. There’s just more to it. Like other aspects of “aging,” incontinence and unreasonable urgency don’t just “happen.” Aging may hasten or accompany the decline, but it’s by no means inevitable, unavoidable, or unmitigated.
There are surgical treatments available, many of which involve the implantation of balloons and slings and rings and hammocks. Those are beyond the scope of this post, which will focus on exercises and other less invasive interventions and preventive measures.
What’s the Deal With Urinary Incontinence?
The most well-known type is stress incontinence. When you do anything intense enough to create pressure, such as a sneeze, a particularly boisterous laugh, a trampoline session, a power clean, or a box jump, the pressure escapes through the weakest point of your body—your slack pelvic floor muscles which support and enable bladder function. The result is inadvertent leakage.
The most common type is urgency incontinence. That’s when you can control your bladder well enough, but you feel like you have to go more frequently than you’d like. This can disrupt sleep and place you in uncomfortable situations.
There’s also prostate-related urinary incontinence. If men have incontinence, it’s usually because of prostate issues or prostate surgery altering the normal flow and function of their urinary tract. Today’s post won’t deal with this explicitly, although many of the exercises I’ll discuss that help women treat incontinence can also help men treat prostate-related incontinence. For more info on this, revisit my post on prostate health from a few weeks back.
Both stress incontinence and urgency incontinence usually have the same cause: pelvic floor dysfunction. The pelvic floor acts as a taut, supple sling of muscle and connective tissue running between the pelvis and the sacrum that supports the pelvic apparatus, including organs, joints, sex organs, bladders, bowels, and various sphincters. We use it to control our urination, our bowel movements, even our sexual functions. It’s very important.
What Goes Wrong?
It gets weak and tight and pulls the sacrum inward (the tail gets pulled toward the front of the body), interfering with urination and urinary control.
What causes pelvic floor dysfunction?
Childbirth is one potential cause, but it’s not a foregone conclusion. Women who have vaginal deliveries are more likely to display more pelvic floor dysfunction than women who have cesareans, while a more recent study found that tool-assisted vaginal delivery and episiotomy were the biggest risk factors for vaginal delivery-associated incontinence, not vaginal delivery alone. Allowing passive descent in the second stage of labor, rather than active pushing from the get-go, might also reduce the association.
Muscular atrophy of the pelvic floor muscles. The pelvis is where the magic happens. It’s where we generate power, walk, run, procreate, dance, and move. To keep it happy, healthy, and strong, we have to move. And then keep moving. Through all the various ranges of space and time and possible permutations of limbs and joints. That’s what all our muscles expect from the environment. It’s what they need. When that doesn’t happen, they atrophy—just like the other muscles.
Who Develops Incontinence?
Stress incontinence is more common among women than men. And most women with stress incontinence are older, although childbirth can increase the incidence.
Signs of Poor Pelvic Floor Function
Besides urinary incontinence and urgency incontinence—which are pretty tough to miss—what are some warning signs of poor pelvic floor function?
Low-to-no glute activity when walking. According to expert Katy Bowman, the glutes play a crucial role in pelvic floor function and incontinence prevention.
Lack of lower back curvature. This suggests your pelvis is being pulled inward due to poor glute activity and/or overly tight pelvic floor musculature.
Muscle atrophy elsewhere. If the muscle’s disappearing from your arms and legs, what do you think is happening in other areas?
What Can You Do?
Work On Your Squat
If you can’t sit in a full squat, with shins fairly vertical and heels down on the ground, you need to work on your form.
One thing to emphasize: go as low as you can without reaching “butt wink” threshold. The butt wink is when the pelvis begins rotating backward underneath the body. If you’re butt winking all over the place, you’re shortchanging your glutes and preventing them from balancing out the pelvic floor situation. Stop short of the butt wink.
Squat a Lot
You don’t have to load up the bar, although that’s a great way to build glute strength. In fact, I’d refrain from heavy squatting if you’re currently suffering from urinary incontinence, as the stress placed on that region of the body during a heavy squat can make the problem worse and cause, well, leakage.
I’m mainly talking about everyday squatting: while playing with the kids, picking up dog poop, unloading the dishwasher, brushing your teeth, cleaning the house, gardening. If you can incorporate squatting while using the bathroom, perhaps with a Squatty Potty or similar product, that’s even better. Katy Bowman recommends women squat to pee in the shower as an integral part of her therapy for pelvic floor disorder.
Squat To Use the Toilet (or At Least Get Your Feet Up)
I wrote an entire post almost ten years ago exploring the virtues of squatting to poop. Not only does it improve symptoms in hemorrhoid sufferers, reduce straining, and alleviate constipation, but squatting to poop turns out to relieve a lot of excessive pressure on the pelvic floor musculature.
Not everyone’s going to hoist themselves up over the toilet standing on a stack of thick books, or go all out and build a Southeast Asian-style squat toilet in their bathroom, or even get the Squatty Potty. It’s probably the best way to do it—and it’s certainly the most evolutionarily concordant way to poop—but it’s not totally necessary. What matters most is getting those feet up and those knees above your hips. If you can achieve this by placing your feet on a stool (not that kind of stool) as you sit on the toilet, it should do the trick.
Take a Walk and Feel Yourself Up
Next time you walk, rest your palms on the upper swell of your butt cheeks. Every time you step through, you should feel your glutes contract. If they contract, awesome. You’re unconsciously using your glutes to propel yourself forward. If they don’t, you’ll have to train them to contract when you walk.
Do this by going for a ten minute walk (minimum) every single day while feeling your glutes. Consciously contract them enough and feel yourself up enough and the resultant biofeedback will make glute activation a passive behavior, like breathing. Eventually you’ll start doing it without thinking. That’s the goal.
The classic therapy for pelvic floor disorder is to train the pelvic floor muscles directly using kegels. This is the muscle you contract to stop yourself from peeing midstream. “Doing kegels” means contracting and releasing that muscle for sets and reps. A common recommendation is to hold for ten seconds, release for ten seconds, repeated throughout the day. Waiting in line? Kegels. Eating dinner? Do some kegels. Remember that man at the DMV last week who would randomly tense up and start sweating as you both waited for your number? He was probably doing kegels.
It’s definitely part of the story—studies show kegels work in men, women, and seniors—but it’s not enough.
Consider Katy Bowman’s take on the subject. She thinks kegels by themselves make the problem worse by creating a tight but ultimately weakened pelvic floor muscle that pulls the sacrum further inward. Combine that with weak or underactive glutes that should be balancing the anterior pull on the sacrum but don’t and you end up with rising pelvic floor dysfunction and incontinence. She recommends doing kegels while in the squat position to ensure that the glutes are engaged and all the other contributing muscles are in balance.
Do More Than Kegels
The bad news is that we don’t have controlled trials of Katy Bowman’s protocols with deep squats and frequent daily movement and going barefoot over varied surfaces and squat toilets. We mostly just have basic “pelvic floor exercises,” which usually just mean “kegels.” The good news is that even these suboptimal exercise therapies seem to work on anyone with incontinence, whether they’re just coming off a pregnancy, a 70th birthday, or a prostate procedure. Young, old, middle-aged, male, female—exercise works.
Actually, we do have one small study that suggests kegels will work much better if you balance them out with exercises that target the glutes and hips. In the study, women suffering from urinary incontinence were split into two treatment groups. One group did pelvic floor muscle exercises (kegels). The other group did pelvic floor muscle exercises, plus exercises to strengthen the hip adductors, the glute medius, and glute maximus. Both groups improved symptoms, but the group that did the combo exercises had better results.
For hip adduction, you can use that hip adduction machine where you straddle the chair with legs spread and bring your knees together against resistance. Another option is to use resistance bands. Attach one end of the band to a secure structure and the other to your ankle. Stand with legs spread, then bring the banded leg inward toward the unbanded leg; you should feel it in your inner thigh. Do this for both legs.
For glutes, you have many options. Glute bridges, hip thrusts, squats, deadlifts, lunges, resistance band glute kickbacks.
If you want to get deep into this subject and really learn the optimal exercises for pelvic floor dysfunction, I’d pick up a copy of Katy’s Down There For Women.
Get Strong and Stay Strong
One of the strongest predictors of urinary incontinence is physical frailty. The more frail—weak, fragile, prone to falling, unable to handle stairs, unsteady on one’s feet—the man or woman, the more likely they are to suffer from urinary incontinence. This mostly comes down to muscle atrophy; the frail tend to have low muscle mass all over, including the pelvic floor.
Studies show that strength training improves urinary control in both men coming off prostate procedures and women.
The best option is to never get frail in the first place. If you’re younger and in shape, keep training and moving. Don’t lose it. If you’re younger and trending frail, get training and moving. Don’t squander the time you have. It goes quickly. If you’re older and frail, you have to start today. Fixing this doesn’t happen overnight. Being frail makes it harder to do the things necessary to get strong, but that doesn’t absolve you of the responsibility.
The Bottom Line
None of this stuff is a guarantee against incontinence. Guarantees don’t really exist in life. But I’d definitely argue that anyone who employs all the tips and advice mentioned in today’s post will have a better shot at maintaining bladder control than their doppelganger in some parallel universe who never tries anything—the earlier the better.
If you have any experience with urinary incontinence, let us know in the comments down below. What worked? What didn’t? What worked for a while, then stopped?
Thanks for reading—and sharing here. Happy Halloween, everybody.