Urinary Urgency and Incontinence: Why It’s Not Just Age

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

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

What’s the Deal With Urinary Incontinence?

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

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

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

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

What Goes Wrong?

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

What causes pelvic floor dysfunction?

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

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

Who Develops Incontinence?

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

Signs of Poor Pelvic Floor Function

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

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

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

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

What Can You Do?

Work On Your Squat

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

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

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

Squat a Lot

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

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

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

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

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

Take a Walk and Feel Yourself Up

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

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

Do Kegels—Differently

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

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

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

Do More Than Kegels

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

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

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

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

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

Get Strong and Stay Strong

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

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

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

The Bottom Line

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

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

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

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References:

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

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

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

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

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

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Dear Mark: Oxidative Priority Followup

Last week, Craig Emmerich graced us with a great post on the oxidative priority of various dietary fuel sources, namely fats, carbohydrates, and protein.

If you haven’t had the chance to read through Craig’s post, definitely do. The visuals really drive home the point of fuel priority. Visuals appeal to me. They have a way of sticking with you, and there’s a power in recalling them when you’re making daily choices.

Today, I’m going through and answering some of the questions you folks had in the comment board.

I’m actually answering a great series of questions from Gerard.

I’ve seen this analysis before, and always had the question – can we really lump “carbohydrates” together like this?

No, we can’t. Craig gave a great overview, a useful 30,000 foot view that’s sufficient for most people who just want to eat and metabolize their fuel better, but there are differences between different carbohydrates. I know he’d say as much, and he may have time to weigh in here, too. If his schedule allows, I’ll include his response later today. But back to the differences in carbohydrates…. I’ll save fructose versus glucose for my answers to Gerard’s next questions. What about others?

Think of fiber. Fiber the monolith is already different from more digestible carbohydrates like glucose and fructose in that we can’t extract very much (or even any) caloric energy from it. But you can go even further and look at the individual metabolic fates of the different types of fiber.

Fermentable fibers like inulin and resistant starch are fermented into short chain fatty acids like butyrate and propionate. These provide important cell signaling and are worth about 2 calories per gram, give or take. Others forms of fiber are not fermented and provide colonic bulk but not calories.

Certain carbohydrates are treated differently in different people. Lactose tolerance allows people to digest lactose with lactase and use it for fuel. Lactose intolerance prevents people from digesting lactose, instead diverting it to gut bacteria to ferment and cause terrible digestive distress. FODMAP intolerance is similar. Those with FODMAP intolerance ferment carbs like sugar, lactose, and others in the gut, producing gas but not calories; those without it digest the carbs, producing useable energy.

Are fructose and glucose metabolized differently for this purpose?

There are definitely differences. For one, glucose stimulates insulin production, while fructose does not. But the differences may not be as stark as we often think.

When scientists attached isotopes to fructose, had healthy sedentary people eat it, then tracked the metabolic fate of the fructose molecules, they found:

  • 50% ended up as glucose, converted by the liver to be used elsewhere in the body.
  • 25% ended up as lactate, converted by the liver.
  • 17% ended up as liver glycogen.
  • 2-3% was converted to fat in the liver via de novo lipogenesis.
  • The rest was oxidized and expelled as CO2.

According to the study authors, this is quite similar to the metabolic fate of glucose. Even if you’re talking about de novo lipogenesis, often considered the sole province of fructose overfeeding, research shows that overfeeding with glucose also provokes the creation of new fat.

As far as burning/oxidizing of ingested glucose and fructose, there are differences. At rest, people tend to burn fructose faster than glucose. During exercise, people tend to oxidize glucose faster than fructose. However, when you give someone both fructose and glucose together, they burn them faster than either fuel source alone. In one study, subjects were either given 100 grams of fructose, glucose, or fructose+glucose. The fructose group burned through 43.8% of their dose, the glucose group burned through 48.1% of theirs, while the fructose+glucose group burned through 73.6% of their dose.

Is the storage capacity for energy from fructose and glucose equivalent (i.e., liver vs muscle glycogen)?

There’s actually a misconception about fructose and glycogen repletion. Here’s the story you may have heard: Fructose can only contribute to liver glycogen, while glucose only contributes to muscle glycogen.

It’s not quite accurate. I believed it for awhile, too, until I actually checked it out. It turns out that both fructose and glucose are able to contribute toward both liver and muscle glycogen. Fructose is about half as efficient as glucose at replenishing muscle glycogen, as it first must be converted into glucose in the liver before being sent out, but it will eventually get the job done.

One big difference is that there’s a lot more room in your muscles than in your liver. The average person can store about 300 grams of glycogen in their muscles but only 90 grams in their liver. Even if the metabolic fates are ultimately pretty similar in a vacuum, in the real world there’s simply less room for liver glycogen, and, thus, less room for fructose in the diet without overstepping the bounds and incurring metabolic dysfunction.

So, if you’re talking about an overweight, sedentary person walking around with full glycogen stores eating a hypercaloric diet, fructose will behave differently than glucose. In the healthy, lean, eucaloric, and active, whole foods-based fructose isn’t a big deal and may not have a drastically different metabolic effect compared to glucose.

At any rate, discussing isolated fructose and isolated glucose may not even be very relevant to real world results. You’re eating fruit, not quaffing cola. You’re enjoying a sweet potato, not a bag of Skittles smothered in agave nectar. You’re eating both glucose and fructose together in the context of a meal, of a whole food. Don’t get too bogged down in the effects of isolated nutrient-poor sugars unless you’re consuming them that way.

To what extent is fructose metabolized in a manner that is more similar to alcohol than carbohydrate?

Fructose is metabolized in the liver. Alcohol is metabolized in the liver.

Fructose gets taken up by the liver without insulin. Alcohol ends up in the liver without insulin rising.

But after that, according to Richard Feinman, the similarities stop. Alcohol is a toxin with known toxic metabolites. There may be some benefit to low level exposure to alcohol, but it remains a toxin. Fructose can be situationally toxic, as in the obese guy with glycogen-replete fatty liver and full-blown diabetes, but we are physiologically capable of handing normal amounts without producing toxic metabolites. Feinman considers it more of a rhetorical device than a statement of facts.

That’s it for today, folks. Thanks for reading and if you have any further questions on the topic, let me know down below and I’ll do my best to get to them.

Take care!

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References:

Tappy L, Lê KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev. 2010;90(1):23-46.

Sun SZ, Empie MW. Fructose metabolism in humans – what isotopic tracer studies tell us. Nutr Metab (Lond). 2012;9(1):89.

Blom PC, Høstmark AT, Vaage O, Kardel KR, Maehlum S. Effect of different post-exercise sugar diets on the rate of muscle glycogen synthesis. Med Sci Sports Exerc. 1987;19(5):491-6.

Mcdevitt RM, Bott SJ, Harding M, Coward WA, Bluck LJ, Prentice AM. De novo lipogenesis during controlled overfeeding with sucrose or glucose in lean and obese women. Am J Clin Nutr. 2001;74(6):737-46.

Rosset R, Lecoultre V, Egli L, et al. Postexercise repletion of muscle energy stores with fructose or glucose in mixed meals. Am J Clin Nutr. 2017;105(3):609-617.

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Weekly Link Love — Edition 1

Research of the Week

Keto enhances fat loss without compromising performance in powerlifters and Olympic weightlifters.

Space travel compresses the brain, and the effects linger for months after returning planetside.

The shape and size of birth canals differ by population.

Youngsters with type 1 diabetes tend to have gut biomes that are low in the bacteria that produce short chain fatty acids and ferment human milk oligosaccharides.

APOE4 carriers who want to avoid dementia should consider taking a phospholipid form of DHA (or eat fish eggs or fish, which are natural sources).

Pretty much everyone is pooping out microplastics these days.

Aerobic exercise, especially exercise performed while standing, enhances visual working memory.

New Primal Blueprint Podcasts

Episode 285: Andy Hnilo: Host Elle Russ chats with Andy Hnilo about the near death experience that triggered his creation of cutting-edge natural skincare line.

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.

Media, Schmedia

We’ve all got ten minutes.

Reader Question of the Week

‘What is ‘Sundays with Sisson?’” — Dozens of people in the last week or so.

Sundays with Sisson, or SWS, is a new feature of the newsletter that I send out every Sunday. It contains my thoughts that don’t quite belong on the blog or deserve a dedicated post. It’s not going to be as formal or “well-referenced” as my feature posts on the blog, but that means the possibilities are wide open. It’s where I explore new hypotheses, describe new self experiments, and talk about personal things going on in my life that I think people may find interesting or useful. Not everything is health-focused. I also talk about books I’m reading, products I’m loving (or not), movies and TV shows I’m watching. There may be some rants. Perhaps even a rave or two.

To sign up for the newsletter and get SWS every Sunday, scroll down to the bottom, fill in your email address, and hit “JOIN NOW.”

Interesting Blog Posts

Regarding the microdosing of magic mushrooms for creativity.

Strength training to beat depression.

Social Notes

If you’ve ever wanted to see me in normal shoes, check this out.

If you’ve ever wanted to try our Chocolate Hazelnut collagen bars, check this out.

Everything Else

Well, I’ll be: Vaginal jade eggs are not a traditional practice in ancient Chinese medicine?

Rare birds find sanctuary at Polish churches.

Salmon carcasses and guts stimulate tree growth.

A silver bullet for deadly amoebae.

Things I’m Up to and Interested In

In case you needed another reason to avoid grains: Dozens of grain-based foods test positive for Roundup.

Study I found interesting: Nature exposure (even just pictures) linked to reduced impulsivity.

Article I’m pondering: “The Selfish Dataome.”

Concept I support: Muscle mass as vital sign.

News I found interesting: Researcher discovers the oldest spear heads ever found in North America.

Question I’m Asking

Every Monday, I’ll be asking you folks a question.

More than ever, people seem fixated on current events, the 24-hour news cycle, and everything that’s going wrong in the world. How do you stay focused on health, life, love, community and everything else that you can effectively have an impact on?

Answer down below.

Recipe Corner

Time Capsule

One year ago (Oct 21– Oct 27)

Comment of the Week

“I guess I’ll have to put this device down and go outside and enjoy this beautiful day”

– That’s the spirit, Jack Lea Mason.

The post Weekly Link Love — Edition 1 appeared first on Mark's Daily Apple.

Where’s Weekend Link Love?

Hey everybody, I know some of you are stopping in this morning for your Sunday dose of salient news—all the latest on epigenetic findings, human oddities, and other Primal worthy items.

No worries. We’re not abandoning Weekend Link Love, but we are rescheduling it—this time to Mondays—and adding to it for good measure. You’ll find all the things you love—latest research, stuff I’m up to and interested in, quote of the week (and more)—on Monday mornings, right when you’re just about ready for that first morning break and second cup of coffee.

Still looking for some Sunday content? Newsletter subscribers now get a Sunday morning note from yours truly. No ads, no promos, just me talking about the latest fitness routines I’m trying, books I’m reading, studies I’m pondering—a casual weekend check-in from me to you. I’ve gotten great feedback, and I appreciate all the emails from readers the last few weeks about it. So, if you haven’t signed up for the newsletter (there’s a sign-up form just below this post and on the home page), this is a great time to do it. I’d love to have you join us.

In the meantime, have a great weekend.

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Grain-Free Pumpkin Spice Granola

Many of you enjoyed the Low-Carb Pumpkin Bread a few weeks ago, and we thought we’d cook up another pumpkin treat before the season passes. For a special breakfast or an afternoon indulgence, this grain-free granola is full on taste and relatively low in carbs (10 grams per serving).

For those who miss the crunchiness of morning cereal or otherwise crave a lot of texture, this recipe is for you. Nuts and seeds are soaked overnight to reduce anti-nutrients. Coconut flakes add rich flavor (and healthy fats), and dates or golden raisins add just enough sweetness to this fall favorite.

Servings: 12

Time in Kitchen: 30 minutes (plus 45 minutes cook time and 13 hours of overnight soaking)

Ingredients:

  • ½ cup flaxseeds
  • 1 cup pumpkin seeds
  • 1 cup walnuts, chopped
  • 2 cups almonds, chopped
  • 1 cup golden raisins or 1 cup pitted dates
  • ¼ cup coconut oil, melted
  • 1 tablespoon vanilla extract
  • 1 teaspoon ground cinnamon
  • 1 teaspoon ground ginger
  • 1 teaspoon nutmeg
  • ¼ teaspoon allspice
  • ½ teaspoon sea salt
  • 1 cup unsweetened, shredded coconut

(To switch up the flavors, try: citrus zest (lemon or orange), other spices such as cardamom or cloves, pure vanilla extract, or cocoa powder.)

Instructions:

Place nuts and seeds in a large bowl, cover with water, and soak overnight. Place raisins or dates in a separate bowl, cover with 1 cup water, and soak overnight.

(The next day) In a strainer, drain and rinse nuts and seeds and discard soaking water.

Place raisins or dates, along with their soaking water, in a food processor and puree until smooth. Add nuts and seeds to raisin or date puree in food processor and pulse until they resemble the consistency of granola. Briefly pulse in coconut oil, vanilla, spices, and salt to incorporate.

Transfer mixture onto two large baking sheets Bake for 45 minutes in oven at 250°F.

Top with shredded coconut, and mix well to combine. Cool completely then store in airtight container for 7–10 days.

Nutritional Info (per serving):

  • Calories: 382
  • Net Carbs: 12 grams
  • Fat: 32 grams
  • Protein: 10 grams

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Where’s the Recipe???

Hey all, I know some of you are stopping in this morning wondering where the usual recipe is. Where’s the beef marrow? Where’s the sweet meats? Where’s the roasted veggies.

Fear not. The team and I will be bringing you the same Primal fare as always, but we’re in the midst of adjusting our publishing schedule to reach more folks during the week. Look for more robust recipes and food related articles on Thursdays from here on out. We’ve got some great meal prep ideas and warm autumn dinners coming up—along with a truly Grok-size Thanksgiving menu to come.

In the meantime, see what you may have missed in our recipe archive and on Primal Kitchen’s blog. (They’ve got Keto Donuts and Halloween-themed Deviled Eggs over there this week.) Enjoy your weekend, and I’ll see you back here Monday to unveil the new lineup. Take care.

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I’ve Transformed My Body and Mind

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!

Hello Mark and the Primal Blueprint community! I usually don’t do stuff like this, but like many others who have discovered the Primal Blueprint path, it’s changed my life in such a positive way that it’s hard not to share. Growing up I was always athletic – trim, quick, and agile. I excelled in every physical activity I was into, without much effort. Karate, soccer, skateboarding, snowboarding, surfing, even golf came easy for me. Within my group of friends, I was the guy that was better at everything than everyone else (at least in my mind LOL). It seemed like I could maintain this level of health and physical ability forever.

Then of course life happens. In my late 20s I meet the love of my life. We get married and in short order, our first son is born.  As a parent, you know how life-changing that event is, and being still in our 20’s, my wife and I went into daily survival mode and did our best. I never thought much about eating right or exercising, being one of those people who could (and did) eat anything under the sun and come out (seemingly) unscathed. Fast food, chips, pizza, ice-cream, candy, processed food from boxes, you name it. And it wasn’t just what I ate, it was the time in which I ate it. I never gave much thought to pounding huge meals late at night, or right before bed-time. In fact, it was like I had a “second” dinner every night. And of course, this was all the usual SAD stuff; tons of bread and grains, corn, fried foods, processed sugars, the usual suspects. I ate like this through my 30s.

As I reached my 40s, however, I noticed that I was getting fatter and slower, and had developed a severe case of IBS. I was always fatigued, irritable, and always had a constant feeling of dis-ease and malaise. Though I was still physically active playing soccer and bike commuting religiously, it seemed like I was always pulling a muscle, or getting injured. My reflexes seemed slower. I didn’t sleep well and my head was always in a cloud. I experienced my first panic attack and developed severe anxiety. I was always getting sick, and never had any energy to really play with or interact with my son.

When our second son came along, these symptoms became compounded. I was miserable, and felt ground-down by the pressures of life as a husband, father and sole-breadwinner of our family. I thought what I was feeling was just life happening, and that it was just a part of getting older.

Being now in my early 40s, I was feeling like crap, looking like crap, and had no idea what to do about it. One day I looked at myself in the full-length bathroom mirror (with my IBS, the bathroom was my second home), and I realized I was at a crossroads. Like Tracy Chapman sang, “leave tonight or live and die this way,” I decided it was time to leave my current unhealthy state and go on a new journey; one towards teaching myself how to be a Fat Burning Beast. Through Mark and the ever expanding Primal/Paleo community, I’ve reclaimed my health and fitness. I’ve discovered and use Intermittent Fasting as another tool, and read Mark’s Daily Apple daily for knowledge and inspiration (and dark chocolate recipes).

I’m also being mindful of things like chronic cardio, stress management and finding time to “get wild.” I’m constantly trying to figure out how to implement the Primal philosophy into the choices I make, not only with nutrition, but with life in general. My six-year-old son is now one of my Primal coaches (even though he doesn’t know it). He loves his “Primal” wrestling sessions with daddy, and being used as daddy’s weight lifting equipment. He also likes joining daddy and mommy in our family burpee sessions before dinner.

So, in about a year’s time of living the Primal/Keto life, I’ve transformed my body (and my mind). I’ve cured myself of IBS, and feel great overall. My head is clearer, I sleep better, my energy level has increased. Somehow, I feel more optimistic. My anxiety has lessened enough that I can enjoy coffee again (yay!)

What’s also cool is that through my enthusiasm for this path, my wife is also now onboard the Primal/Keto train (it was hard doing it alone, especially since she does all the cooking for the family). After only a few months, she is looking and feeling great herself, and enjoying more energy than she’s ever had. It hasn’t always been easy of course, but overall, being on the Primal path has been an incredible epiphany in my life. I have co-workers, friends, and family wondering what the heck happened and how I did it.

Thanks Mark for all you’ve done and continue to do. How great it must feel to be helping so many people improve their health and well-being. Congrats on being a game-changer and positive force in the world.

 Sukho V

The post I’ve Transformed My Body and Mind appeared first on Mark's Daily Apple.

Oxidative Priority: Dietary Fuels To the Body

Today’s guest post is generously offered up by Craig Emmerich, husband to—and co-author with—the queen of keto herself, Maria Emmerich. Enjoy!

When we consume macro nutrients, our bodies go through a priority for dealing with them. This priority can be very useful in understanding how our bodies work and how to leverage it for losing weight.

The body doesn’t like having an oversaturation of fuel in the blood at any time. It tightly manages the fuels to avoid dangerous situations like hyperglycemia or blood glucose that is too high. But it also manages and controls other fuels like ketones (beta hydroxybutyrate or BHB levels) and fats (free fatty acids or FFA and triglycerides) to keep them under control and not oversaturate the blood with fuel.

It is like the engine of a car. You don’t want to give the engine too much fuel and blow it up. So the body controls the amount of fuels in the blood to ensure you don’t “blow up.” To do this, the body will address the most important (or potentially most dangerous) fuels first. It does this in a very logical way—in reverse order of storage capacity.

Here is a chart showing the breakdown of oxidative priority for dietary fuels.

Modified Source: Keto. By Maria and Craig Emmerich
Original source: Oxidative Priority, Meal Frequency, and the Energy Economy of Food and Activity: Implications for Longevity, Obesity, and Cardiometabolic Disease, Sinclair, Bremer, et al, February 2017.

The #1 oxidative priority is alcohol because there is zero storage capacity for it. It makes sense that the body would address this first, since it can’t store it anywhere and too high blood alcohol means death.

The second oxidative priority is exogenous ketones. These are ketone salts that raise blood BHB levels. There isn’t a storage site for ketones either, so the body must deal with this before addressing other fuels. That is why exogenous ketones aren’t the best option when trying to lose weight. They displace fat oxidation, keeping fat stored while it uses the exogenous ketones as fuel instead.

The third oxidative priority is protein. Protein is a bit different, as there is a limited storage space for protein, but protein is not a good fuel source. It takes 5 ATP to turn protein into a fuel (glucose through gluconeogenesis) and another 2 ATP to burn in the mitochondria. Why would your body expend 7 ATP for something it can do for 2 ATP by just burning glucose or fat from your body? Protein is only really used as a fuel when other fuels (glucose and fat) are not present and it is forced to use protein. Protein gets preferentially used to stimulate muscle protein synthesis. It builds and repairs lean mass.

The next oxidative priority is carbohydrates. It has a moderate amount of storage capacity at 1,200 to 2,000 calories.

The last oxidative priority is fat. This makes sense, as there is a theoretically unlimited storage capacity for fat. There are people with upwards of 400 pounds of stored body fat, which represents 1.6 million calories.

Oxidative priority can help you understand what happens when you put certain fuels into your body. If you are drinking alcohol while eating carbs and fat, the carbs and fat will primarily go into storage while the body deals with the elevated alcohol.

To understand the power of oxidative priority take the case of an alcoholic. Alcoholics will have very low A1c levels (in the 4s) no matter what they eat! If they eat tons of carbohydrates they will still have an A1c in the 4s because the chronically elevated alcohol levels force the body to store all glucose while dealing with alcohol, creating a low A1c. I am not recommending anyone become an alcoholic to lower A1c level—but quite the opposite actually.

So, what does this mean, and how can you leverage your body’s biology to lose weight?

If you avoid alcohol and exogenous ketones, get a just enough protein to support maintenance of lean mass (about 0.8 times your lean mass in pounds for grams of protein a day), limit the carbs and then reduce dietary fat a bit to force the body to use more stored body fat for fuel you will lose body fat. When you restrict carbs for long enough (4-6 weeks for most people) the body gets used to using fat as its primary fuel (keto adapted). This means it can burn body fat or dietary fat equally well. Eliminating other fuels and keeping dietary fat moderate allows the body to focus on body fat for fuel resulting in fat loss.

That is our bodies system for processing fuels coming in through the diet. Leverage it for improved results and body recomposition.

Craig Emmerich graduated in Electrical Engineering and has always had a systems approach to his work. He followed his wife Maria into the nutrition field and has since dedicated his time researching and looking at nutrition and biology from a systems perspective. Over the last 8 years he has worked with hundreds of clients alongside Maria to help them heal their bodies and lose weight leveraging their biology to make it easy.

Thanks to Craig for today’s keto insights, and thanks to everybody here for stopping in.

You can follow Maria and Craig’s work on their website, Maria Mind Body Health, as well as their subscription site, Keto-Adapted, and their new keto courses.

Questions about dietary fuels and oxidative priority—or other points keto? Share them down below, and have a great end to the week. Take care, folks!

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Mid-60s Check-in: 5 Ways My Workout Has Changed

I’m 65, and though I’ve been able to stave off the worst of what normally passes for the “aging process”—as can almost anyone by paying attention to how you eat, sleep, train, move, and live—the fact remains that I’m not training like I used to.

It’s not so much that I’m “losing” a step, although it happens to the best of us. It’s that I’ve totally transcended the need or desire to train hard for the sake of training hard. There are no more competitions. My ego is content on the training front. I’m not wrapped up in pounds lifted or miles run.

I get regular questions about what I do for workouts and how they’ve changed over time. Today I thought I’d answer this.

Miami has a fantastic gym culture with impressive facilities to support it. I almost have to go the gym. It’s something I still enjoy. I just make it count.

I’ve managed to compress my time in the gym with “super-sets” for each exercise.

These aren’t always super-sets where you’re bouncing between the squat rack and the bench press every other set. The kind of super-set I’m talking about is a rest-pause super-set. I try to hit between 12-20 total reps—that’s my goal—in three mini-sets with minimal rest. The super-set is broken up into three subsets with very short rest periods.

An example: Deadlift, 9 reps. Rest 30 seconds. Deadlift, 6 reps. Rest 30 seconds. Deadlift, 4 reps. You’re done. That’s a total of 19 reps. Once I hit 20, I’m adding weight.

Why I like this method:

  • Over fast. I get in, get a great workout, and get out.
  • No meandering and wasting time between sets. There are hard rules (30-second rests) that I must follow.
  • Hard to go heavy enough to hurt yourself. If you’re doing 15-20 reps with little rest, by necessity the weight you use needs to be manageable.
  • But heavy and intense enough to produce benefits. I know, I know, feeling sore the next day isn’t a good barometer of how effective the workout was. That’s what they say, but everyone secretly loves and craves the feeling of DOMS. Really makes you feel like you did something worthwhile.

I’ve fallen in love with the trap bar.

At this point in the game, I don’t need to hit PRs on the straight bar deadlift. Trap bars just feel safer, more natural, more versatile. Some great possibilities (many of which I throw in) include:

  • Trap Bar Deadlift With Squat Bias—Deadlifts with more knee flexion, almost a half squat.
  • Trap Bar Romanian Deadlift—Knees soft but mostly straight, almost a straight leg deadlift with or without touching the floor in between reps.
  • Trap Bar Power Shrug—Deadlift at a pretty good clip, explode upward and shrug the bar. Almost like you’re jumping without leaving the ground.
  • Trap Bar Squat—Squat down, grasp bar, stand up, repeat. Stack some weights and stand on them for added range of motion/squat depth.
  • Trap Bar Split Squat—Stand inside the hexagon, place foot on elevated surface (1.5 ft, about) behind you, perform a split squat, wake up sore.
  • Trap Bar Row—Stand inside the hexagon, bend over at the waist, row that bar up toward your belly.

The average person can get 90-95% of the benefits using a trap bar instead of a straight bar. Maybe higher, even.

I lift for a different purpose now.

As for the weights I use, now that my PR days are behind me, I lift to avoid injury now more than anything. That means knowing what “heavy” really is and backing down a hair. I’ll do one or two upper body days, and one leg day each week. That’s it. Two, maximum three strength sessions.

I base my workouts around standup paddling and Ultimate Frisbee games.

Both of these are stressful enough (in a good way) that I want to be rested for (and from) those activities before I engage in a lifting session. Just to be clear, I play Ultimate all-out for up to two hours, so it’s become my sprint day.

The Miami Ultimate Frisbee scene is very high-level. I’ve fallen in with a regular pickup squad, and the level of competition rivals Malibu’s. So, that aspect of my activity hasn’t changed. I’m still getting my one day of Ultimate a week.

If I’m feeling up to it, Miami beaches are fantastic for sprints. You don’t go as fast because the sand is so powdery, but it makes you work even harder.

Miami has also really changed how I spend time with my favorite activity, standup paddling.

In Malibu, it was a bit wilder. I’d head out past the breakers and paddle in any direction. It was huge, free, open, and infinite.

In Miami, you have the ocean side which is great and much calmer than Malibu, but you also have these inland waterways, like huge canals running through Miami. I’ve been spending a ton of time exploring them, checking out the beautiful homes and boats and even the occasional manatee popping up. And because it’s so calm, I can really go hard without worrying about waves. While paddling is fun, I go pretty hard for at least an hour and up to 90 minutes, so it’s a serious aerobic day for me.

I walk more.

I can walk so much more in Miami. In Malibu, I had to drive somewhere to walk, whether it was a trail head for a hike, down to the beach for a stroll, or to Venice or Santa Monica to just wander. In Miami, Carrie and I can walk out the door and go the market, the water, the book store, the cafe, or just wander. It’s integrated into our day, not something we have to schedule. People don’t really think of Miami as a ‘walking city,” and it’s certainly no New York or San Francisco, but it beats the pants off Southern California.

Trap bar, rest-pause sets, and environment aside, what I train hasn’t changed all that much. I’m still lifting heavy things, running really fast, moving frequently at a slow pace, and doing activities I love. But somehow I’m doing a better job of seamlessly integrating them into my daily existence. I’ve minimized the amount of time I spend lifting without compromising my results. I’m using my compressed training to fuel the activities I love doing, giving me more time that’s also higher quality.

A lot of this could be the simple result of moving somewhere new after living in the same city for twenty years, sort of a honeymoon phase. We’ll see. My workouts here are even more a part of my general lifestyle. They’re, for the most part, parts of my life rather than interruptions to it, which is the ancestral model at its modern best maybe. That’s how I choose to see it.

Thanks for stopping by today, folks. I’d love to read your feedback and questions and hear what new routines you’re trying out. Take care.

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Sheet Pan Dinners: Three Meals In 90 Minutes

Putting dinner on the table just got easier with this meal prep plan that bangs out three dinners at once. All the mix-and-match ingredients you need for three different meals are cooked on single sheet pans, making cleanup easy, too.

The cooked ingredients are simply seasoned with salt and pepper for maximum versatility. Add more varied flavors when you dish up by incorporating the suggested herbs, spices, dressings, and garnishes.

Each meal provides 4 servings. The food can be served at room temperature, reheated in a microwave, or reheated by sautéing the ingredients briefly in a pan with oil.

Primal Sheet Pan Dinners Menu

  • Chicken Fajita Bowl
  • Steak & Broccoli “Stir-fry”
  • Greek Chicken Plate

This menu is only a guide. Feel free to mix and match the ingredients with your tastes in mind.

Primal Sheet Pan Dinners Shopping List

Tools

  • 3 half-size rimmed sheet pans (13”x18”)
  • Parchment paper or foil (for easier cleanup)
  • Spatula, for mixing ingredients while they cook
  • Food storage containers

Make-Ahead Ingredients

  • Avocado oil or extra virgin olive oil
  • Salt and pepper
  • 8 skin-on, bone-in chicken thighs (This equals 1 chicken thigh per person/per meal. Add a few more chicken thighs for bigger appetites)
  • 1 ½ to 2 pounds steak, about 1 inch thick (try flank steak, top sirloin steak, or strip steak)
  • 1 pound small potatoes (about 2 inch-diameter) if desired
  • 2 delicata squash
  • 3 bell peppers
  • 1 red onion
  • 1 large bunch broccoli
  • 8 ounces cherry tomatoes

Fresh Foods, Garnishes & Flavor Enhancers

  • Cumin
  • Chili powder
  • 1 bunch green onion
  • 1 head of garlic
  • 2 inches ginger root
  • 2 avocados
  • 2 5-ounce bags of baby spinach
  • 1 bunch fresh cilantro
  • 2 bunches fresh Greek herbs (choose from dill, parsley, mint, or oregano)
  • 1 lime
  • 1 lemon
  • 1 container salsa
  • Toasted Nori or SeaSnax
  • 1 jar kalamata olives
  • 1 bag frozen cauliflower rice

Optional Enhancements From Our Own Primal Kitchen® Recipes and Products

Primal Sheet Pan Dinner Plan

Time: Approximately 90 minutes

Heat oven to 425 ºF/218 ºC

Cover sheet pans with parchment paper or foil (optional). IMPORTANT NOTE: Parchment paper cannot go under a broiler. Do not use parchment paper under the steak when broiling.

Sheet Pan #1

Cut the small potatoes into ½-inch-thick rounds. Spread the potatoes out on a sheet pan. Lightly coat the potatoes with avocado oil.

Pat chicken thighs dry with paper towels. Arrange chicken thighs, skin side up, on the sheet pan with the potatoes. Set aside.

Sheet Pan #2

Cut the delicata squash in half lengthwise and scoop out the seeds, peel the red onion and cut in half, stem and seed the bell peppers. Cut all vegetables into 1/2-inch slices.

Spread the vegetables out on a sheet pan. Lightly coat with avocado oil. Set aside.

Sheet Pan #3

Cut the broccoli into florets. Spread broccoli florets out across one side of a sheet pan. Spread the cherry tomatoes out on the other side of the pan. Lightly coat everything with avocado oil. Set aside.

And finally…pat the steak dry with paper towels. Season generously with salt. Set aside on a plate.

Cooking Instructions

Season the ingredients on all three of the sheet pans with salt and pepper.

Put all three of the sheet pans in the oven. Set the timer for 20 minutes. Gently mix and toss the vegetables once or twice while they cook.

After 20 minutes, remove the squash, onion, bell peppers, broccoli, and tomatoes from the oven. (If the vegetables aren’t cooked enough for your preference, they can stay in the oven a bit longer.)

Set the timer for 10 minutes, and continue to cook the chicken thighs 10 minutes more until the skin is browned and chicken is cooked through (165 °F).

While the chicken finishes cooking, scrape the vegetables off one of the sheet pans into a food storage container. Set the steak on this sheet pan. (NOTE: Parchment paper cannot go under a broiler. Remove parchment paper before broiling the steak.)

When the timer goes off, remove the chicken from the oven. Turn the broiler on to high.

Place the sheet pan with the steak on the top rack under the broiler. Broil the steak, flipping once, until the meat registers 135°F (medium-rare) and the meat is charred on the edges, about 4 to 5 minutes a side. Let the cooked steak rest outside the oven for 10 minutes before slicing it thinly against the grain.

Set food storage containers out on the counter. Separate the chicken and steak into containers. Store the potatoes in one container. Store the delicata squash, onion, and bell peppers in another container. Store the broccoli in one container and the tomatoes in another. All of these cooked ingredients will stay fresh in the refrigerator for 3 to 5 days.

 

Assembling the Meals

When you’re ready to eat, take out the containers and assemble a meal. You can assemble the ingredients into meals any way you like, but here are three ideas:

Meal #1: Chicken Fajita Bowls

Shredded chicken with roasted delicata squash, red onion, and bell peppers, plus avocado, green onion, salsa, cilantro, and a squeeze of lime

Shred the meat of four chicken thighs. Toss the meat with ¼ teaspoon cumin and chili powder. In each bowl, combine shredded chicken with half of the delicata squash, red onion, and roasted bell peppers.

Add garnishes: sliced avocado, green onion, salsa, cilantro, squeeze of lime

Add extra flavor: Thin Primal Kitchen Chipotle Lime Mayo with a few squeezes of lime juice until it has a slightly thinner consistency. Drizzle mayo on top.

Nutritional Information (per serving):

  • Calories—448
  • Net Carbs—17
  • Fat—26
  • Protein—28

Meal #2: Beef & Broccoli “Stir-fry”

Steak and broccoli over ginger and garlic cauliflower rice, garnished with green onions, toasted nori, and coconut aminos

In a saucepan, sauté a few finely chopped garlic cloves and a 2-inch piece of ginger root (peeled and cut into thin strips) in avocado oil until fragrant and lightly browned, 1 to 2 minutes.

Heat cauliflower rice according to package directions. Mix the garlic and ginger into the cauliflower rice, and portion into bowls. Top the cauliflower rice with sliced steak and broccoli.

Add garnishes: green onion, toasted nori (or Seasnax)

Add extra flavor: Drizzle coconut aminos on top

Nutritional Information:

  • Calories—360
  • Net Carbs—43
  • Fat—8
  • Protein—57

Meal #3 Greek Chicken

Chicken thighs with roasted potatoes, tomatoes, delicata squash, red onion, bell peppers, and sautéed garlic spinach with kalamata olives, fresh herbs, and a squeeze of lemon

On a plate, serve whole chicken thighs with the roasted potatoes, tomatoes, and leftover delicata squash, red onion, and bell peppers. Saute the bags of baby spinach in extra virgin olive oil with several cloves of minced garlic until the spinach wilts. Add spinach to the plates.

Add garnishes: chopped fresh parsley, dill, oregano, and/or mint, Kalamata olives, squeeze of lemon

Add extra flavor: Drizzle Primal Kitchen Greek Vinaigrette on top

Nutritional Information (without dressing):

  • Calories—465
  • Net Carb—34
  • Fat—22
  • Protein—26

The post Sheet Pan Dinners: Three Meals In 90 Minutes appeared first on Mark's Daily Apple.