7 Herbal Alternatives to HRT

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.

Black Cohosh

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:

It’s effective against hot flashes, reducing both severity and frequency.

It improves objective markers of sleep quality (the reduction in hot flashes certainly can’t hurt).

It improves insulin sensitivity, which often degrades during menopause.

It improves early post-menopausal symptoms across the board, leading to a 12.9 point reduction in the Green climacteric score (a basic measure of menopause symptom severity).

In one study, black cohosh was comparable to conventional HRT for reducing most menopausal symptoms and better at reducing anxiety, vaginal bleeding, and breast tenderness.

Here’s a great black cohosh product.

Maca

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.

Make sure you buy gelatinized (cooked) maca, as that’s what the studies use.

Red Clover

The red clover blossom is a rich source of isoflavones, estrogen-like compounds that interact with receptors in our bodies and relieve many symptoms of menopause.

Twelve weeks of red clover cuts the Menopause rating score in half (a good thing!).

Twelve weeks greatly reduces the intensity and frequency of hot flashes and night sweats. Including some probiotics has a similar effect.

Red clover also improves vaginal cellular structure and function while (again) improving menopause symptoms and reducing triglycerides.

More exciting, there’s reason to believe that red clover may reduce the risk of breast cancer and improve bone mineral density in menopausal women.

Here’s a potent red clover supplement.

And then there are those herbs and plants with more limited scopes.

Ginseng

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.

Here’s some Korean red ginseng. Here’s some concentrated ginseng.

Evening Primrose

It’s good for hot flashes, and that tends to improve other things like socializing and sex, but that’s about it.

Here’s some cold-pressed primrose oil.

St. John’s Wort

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.

This is a pretty good product.

Wild Yam

The yam has been used for hundreds of years for menopause treatment. These days, we know it contains estrogen mimetics known as phytosterols with clinical efficacy in menopausal women.

Try this one.

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?

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References:

Mehrpooya M, Rabiee S, Larki-harchegani A, et al. A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. J Educ Health Promot. 2018;7:36.

Jiang K, Jin Y, Huang L, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-67.

Mohammad-alizadeh-charandabi S, Shahnazi M, Nahaee J, Bayatipayan S. Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. Chin Med. 2013;8(1):20.

Zheng TP, Sun AJ, Xue W, et al. Efficacy and safety of Cimicifuga foetida extract on menopausal syndrome in Chinese women. Chin Med J. 2013;126(11):2034-8.

Lee HW, Choi J, Lee Y, Kil KJ, Lee MS. Ginseng for managing menopausal woman’s health: A systematic review of double-blind, randomized, placebo-controlled trials. Medicine (Baltimore). 2016;95(38):e4914.

Lee MS, Shin BC, Yang EJ, Lim HJ, Ernst E. Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas. 2011;70(3):227-33.

Stojanovska L, Law C, Lai B, et al. Maca reduces blood pressure and depression, in a pilot study in postmenopausal women. Climacteric. 2015;18(1):69-78.

Brooks NA, Wilcox G, Walker KZ, Ashton JF, Cox MB, Stojanovska L. Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content. Menopause. 2008;15(6):1157-62.

Shakeri F, Taavoni S, Goushegir A, Haghani H. Effectiveness of red clover in alleviating menopausal symptoms: a 12-week randomized, controlled trial. Climacteric. 2015;18(4):568-73.

Lipovac M, Chedraui P, Gruenhut C, et al. The effect of red clover isoflavone supplementation over vasomotor and menopausal symptoms in postmenopausal women. Gynecol Endocrinol. 2012;28(3):203-7.

Hidalgo LA, Chedraui PA, Morocho N, Ross S, San miguel G. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005;21(5):257-64.

Lambert MNT, Thorup AC, Hansen ESS, Jeppesen PB. Combined Red Clover isoflavones and probiotics potently reduce menopausal vasomotor symptoms. PLoS ONE. 2017;12(6):e0176590.

Beck V, Rohr U, Jungbauer A. Phytoestrogens derived from red clover: an alternative to estrogen replacement therapy?. J Steroid Biochem Mol Biol. 2005;94(5):499-518.

Abdali K, Khajehei M, Tabatabaee HR. Effect of St John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause. 2010;17(2):326-31.

Briese V, Stammwitz U, Friede M, Henneicke-von zepelin HH. Black cohosh with or without St. John’s wort for symptom-specific climacteric treatment–results of a large-scale, controlled, observational study. Maturitas. 2007;57(4):405-14.

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Weekly Link Love—Edition 2

Research of the Week

The latest MDMA trial finds it’s 76% effective at treating PTSD. Full FDA approval expected by 2021.

As many as 500,000 years ago, Arabia was green, and hominids were living and traveling through there.

Scare yourself to recalibrate your emotions.

Increased frequency of global travel may actually reduce the danger of global pandemics.

CoQ10 is good for type 2 diabetics.

New Primal Blueprint Podcasts

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.

Media Schmedia

New surgery students haven’t the manual dexterity necessary to succeed.

Reader Question of the Week

Marek asked:

Hi Mark
This article hit home for me as I’m 57 and living with a slightly enlarged prostate. One of my favourite activities is getting out on my road bike for a good 50 to 75 km ride. I’m wondering if you would know if that is aggravating my prostate? I’ve read so many conflicting reports I’m hoping you may have some insight. Thanks !

Great question.

There may be short-term increases in prostate stress. In men 50 or over, a long bike ride (55-160 km) transiently increases PSA levels by an average of 9.5% when measured 5 minutes post-riding. The longer the ride and the older the rider, the larger the increase. In a sample of 129 riders, just two men had elevated PSA levels before the ride. After the ride, six men had elevated PSA levels. All told, it isn’t very significant, and the authors suggest 48 hours is enough for PSA to return to baseline.

But there probably isn’t any chronic effect. A 2015 meta-analysis of the available research suggested “that there is no effect of cycling on PSA.”

Large observational studies have found road cycling to be linked to increased genital numbness, urethral stricture (where the urethra is blocked or obstructed), but not to any actual sexual problems or impaired urinary function. Oddly enough, cycling-related numbness of the butt was linked to worse sexual function. Padded seats, raising the handlebars to be even with the seat, and using padded shorts seem to improve the symptoms.

I wouldn’t worry. Exercise itself is good for prostate health, as I explained in the prostate post a couple weeks ago. So my gut feeling is that cycling is probably a net plus for the prostate.

Interesting Blog Posts

Paleobiologists attempt to debunk the paleo diet, fail miserably.

Ketosis and arthritis (or the lack thereof).

Social Notes

Went to the doctor.

Halloween has passed, but these NomNomPaleo Halloweenies we made are a great way to get kids involved in the cooking (and eating) process.

Brad Kearns’ last couple podcasts have been great. First, his interview with Vinnie Tortorich and then a “breather” episode where Brad chats about Deepak Chopra insights, longevity, and high-jumping.

Everything Else

AI-created painting fetches hefty price.

Why did thousands of usually-solitary deep sea octopuses gather in the waters outside of Monterey?

I’d vote for him based off this alone.

Wristbands to predict and eventually regulate mood.

Things I’m Up to and Interested In

I wouldn’t be surprised if it was causal: More screen time, less psychological well-being (among teens).

You know what they say: “Lie with Neanderthals, wake up with HPV.”

Article I’m loving: “Why Forests Give You Awe.”

Result you might not have expected: Those who are struggling benefit more from giving advice than receiving it.

Miscellaneous topic I enjoyed: The smell artist.

Question I’m Asking

Will AI-created art—paintings, books, music, etc—ever replace or surpass human art? Or will “something” always be missing?

Recipe Corner

Time Capsule

One year ago (Oct 28– Nov 3)

Comment of the Week

“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.

The post Weekly Link Love—Edition 2 appeared first on Mark's Daily Apple.

The Primal Worldview Changed My Life For the Better

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.

[Final photo] Six months later.

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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.

The post Dear Mark: Oxidative Priority Followup appeared first on Mark's Daily Apple.

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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The post Where’s Weekend Link Love? appeared first on Mark's Daily Apple.

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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The post Grain-Free Pumpkin Spice Granola appeared first on Mark's Daily Apple.

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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The post Where’s the Recipe??? appeared first on Mark's Daily Apple.

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

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