Can Keto and Cardio Mix?

We get lots of questions about how a ketogenic diet works in the context of exercise: Is it possible to maintain one’s fitness (strength, endurance, performance) and also drop one’s carb intake to ketogenic levels? Is it advisable? Will it help me lose weight faster?

Mark already addressed some of these topics, but it’s clear that many people still feel uncertain about how to pair a keto diet with their current workout routine.

Rather than write a single behemoth post, I’m going to tackle this in two parts. For today, let me talk keto and cardio, specifically how keto works for the average fitness enthusiast who thinks more in terms of general exercise. In a couple weeks I’ll follow up with a post on keto for runners and other endurance types who tend to focus on training programs and racing.

So, keto and cardio… This is for people who like to attend group fitness classes, or go out for jogs or spins on the bike, or do a mix of low heart rate exercise with occasional bouts of HIIT. (This is a problem with the term “cardio”—it can mean so many things.)

You probably already know Mark’s stance on cardio: avoid chronic cardio exercise patterns. The Primal Blueprint approach to exercise comprises lots of everyday movement, lifting heavy things, and occasionally going all out. If you simply must do cardio, most of these sessions should be conducted at an aerobic heart rate not higher than 180-age, as detailed in the Primal Endurance book. So, with the caveat that cardio exercise in the traditional sense of slogging away on an elliptical machine or treadmill doesn’t jibe with the Primal Blueprint approach, let’s get to some frequently asked questions.

Will My Workouts Suffer When I Go Keto?

This is a common concern because some people do report that they feel sluggish when they first go keto. And yes, you might feel like your performance in the gym (cardio, strength, HIIT—all of it) takes a hit in the first few weeks of keto. Rest assured that this is a temporary dip as your body becomes efficient at using fat and ketones for energy in the absence of incoming carbs (glucose). It’s a learning process for your body, so to speak.

The more glycolytic your workouts, the more you are going to notice this. Prolonged, difficult workouts that fall into the category of chronic cardio or “black hole” sessions are especially likely to suffer.

To help mitigate temporary performance decrements during the transition to keto:

  • Dial back the intensity and/or frequency of your workouts for a few weeks. Trade some of your more intense cardio (and strength) sessions for walks, yoga or Pilates, or other gentle forms of movement.
  • Mind your electrolytes. If you are feeling weak or lightheaded, if you get a headache, or you just feel “off,” this is likely due to electrolyte imbalance. Try adding ¼ – ½ teaspoon of salt to a glass of water with lemon juice and see if that helps. You want to make sure you are getting 4.5 grams of sodium, 300-400 mg of magnesium, and 1-2 grams of potassium each day on top of your normal food.
  • While your body is making the switch, give it plenty of fuel. Consume extra fat and eat plenty of calories. If fat loss is a goal, you can adjust your macros and calories as needed once you are feeling in the groove with keto.
  • Tough it out. Don’t cave and add carbs in the first few weeks (see the next point). Know that this is temporary, and you should be back to normal within three to six weeks.

Do I Need To Add Back Carbs To Fuel My Workouts?

During the first few weeks of starting keto, you should not add back carbs. It is important to create a low-glucose, low-insulin environment to promote ketogenesis and the adaptations that accompany a ketogenic state. If your workouts are too hard right now, the correct answer is to change your workouts, not to increase your carbs.

After you have done a dedicated period of a minimum three weeks of strict keto—six or more is even better—you should be feeling better during your workouts if you are not engaging in prolonged, chronic cardio activities. (It might take longer to adapt to longer endurance training, as we will discuss in the next installment.) At this point you have some options:

One, you can continue in strict ketosis (less than 50 grams of carb per day) as long as you are feeling good.

Two, you can start experimenting with eating carbs strategically before your workouts. This is known as a targeted keto approach. There are various ways of implementing this, but the basic formula is that you would ingest 25-30 grams of glucose or dextrose (not fructose) about half an hour before high-intensity workouts to replenish muscle glycogen.

There are a few caveats here. First, most sources of glucose/dextrose are not Primal (think hard candy, gels). Probably the closest is pure maple syrup, but that also delivers a hit of fructose. If you are a Primal purist, you will have to decide if this is a compromise you want to make. Second, people tend to overestimate the degree to which they are actually low on glycogen and how much it matters. It is a common misconception that once you go keto you have “no glycogen.” While muscle glycogen stores are reduced, your tanks are probably still at least 50% full, and perhaps on par with non-ketogenic folks if you have been keto for a long time. Furthermore, the average low-to-medium intensity cardio session isn’t truly depleting glycogen. Remember, the point of becoming fat- and keto-adapted is that you burn predominantly fat and ketones at these lower intensities, sparing glycogen. You have to go hard and/or long to really burn through your muscle glycogen stores. Thus, you should target pre-workout carbs only before truly high-intensity sessions.

Instead of adding simple carbs before workouts, another option if you feel like you need more carbs is to add back nutrient-dense carbs after workouts, when insulin sensitivity is increased. This might make sense if you feel like your ability to recover between workouts is lagging, or you want to recover quickly because you have back-to-back hard sessions planned. In either case—adding carbs before or after exercise—the amount you add should be proportional to the difficulty (intensity) of the workout. You don’t need to carb up for your yin yoga class, for example.

Lastly, if you are feeling underpowered during exercise, instead of adding back carbs you can experiment with adding more protein and/or fat. Some people report good success with “protein ups” timed around heavier workout days.

Will Adding Keto to My Cardio Routine Help Me Lose Weight?

Maybe. It’s a common refrain that “abs are built in the kitchen,” meaning that your food plays a bigger role in fat loss than does your exercise. This isn’t to say exercise is unimportant; it does matter. A caloric deficit is necessary to lose body fat, and exercise is one way to create a caloric deficit. However, this can also backfire if your exercise routine leaves you hungrier, so you unintentionally overeat calories due to increased hunger and cravings. Ketones have known appetite suppressing effects, so a ketogenic diet might help counteract any increased hunger that comes with exercise.  

That said, I think the root of this question is the fact that ketosis is a fat-burning state, and so the logic goes that if you are metabolizing fat for energy, you will automatically shrink your body fat stores. Moreover, if you add keto and cardio together, especially if you are exercising in the so-called “fat-burning zone,” you will lose more fat than either alone. Right? Not necessarily. The fat you burn can come from your adipose tissue or from your plate. If you are eating an excess of fat calories relative to your daily caloric needs, you still won’t lose body fat.

We know that for body recomposition, the best bang for your buck comes from a combo of resistance training and HIIT. Cardio exercise still has many benefits for physical and mental health, and of course a lot of people simply enjoy their cardio; but you shouldn’t be putting all your eggs in the cardio basket if fat loss is your goal. All else being equal, though, it certainly can’t hurt to upregulate your body’s ability to use fat for energy.

Summary Recommendations:

  • When first starting out with keto, follow the recommendations laid out in The Keto Reset Diet, and be strict for at least three weeks.
  • If you are struggling in your cardio workouts during this period, don’t add back carbs! Dial back your workouts, add calories (via fat or protein), or both.
  • Once you believe you are keto-adapted, then you can start to experiment with targeted carbs and/or carb ups if you so choose.
  • No matter your diet, avoid chronic cardio exercise patterns that increase stress and your body’s demand for glucose.
  • Check out this post for additional tips for exercising while keto.

Thanks, everyone. Questions, comments? Share them below, and have a good week.

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References:

Koeslag T, Noakes T, Sloan A. Post-exercise ketosis. J Physiol 1980;301;79-90.

Malhotra A, Noakes T, Phinney S. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med 2015;49:967-968.

Matoulek M, Svobodova S, Vetrovska R, Stranska Z, Svacina S. Post-exercise changes of beta hydroxybutyrate as a predictor of weight changes. Physiol Res. 2014;63 Suppl 2:S321-5.

Newman JC, Verdin E. ?-hydroxybutyrate: much more than a metabolite. Diabetes Res Clin Pract. 2014;106(2):173-81.

Sleiman SF, Henry J, Al-Haddad R, et al. Exercise promotes the expression of brain derived neurotrophic factor (BDNF) through the action of the ketone body ?-hydroxybutyrate. Elife. 2016;5:e15092.

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Dear Mark: Fasting, Training, and Growth Hormone; Wear and Tear on the Arteries

For today’s edition of Dear Mark, I’m answering a couple of questions from the comment sections of the last couple weeks. First, it’s been established that fasting and exercise both raise growth hormone. What about fasted exercise—does that have an even stronger effect? And what about continuing to fast after your fasted workout? Then, I discuss the inevitability (or not) of wear and tear on the arteries from blood flow-induced shear stress. Is shear stress “bad,” or do certain factors make it worse?

Let’s dig in.

Marge asked:

So fasting raises growth hormone levels? Interesting. So does weight lifting. I’ll bet fasted weight workouts would be pretty powerful.

They do, and they are.

What’s even better is to work out in a fasted state and keep fasting after the workout. This keeps the GH spike going even longer. And in my “just so story” imagination—which is actually quite accurate, judging from real world hunter-gatherers—it mirrors the circumstances of our Paleolithic ancestors. You’d get up early to go hunting without having eaten. You’d expend a lot of energy on the hunt. You’d make the kill, procure the food. And then you’d bring it back to camp to finally eat. Maybe you’d pass the heart and liver around the circle before heading back. And sometimes, you just didn’t make the kill. You didn’t eat at all.

Makes sense, right? Fasting, doing something physical, and continuing to fast shouldn’t be a monumental undertaking. It should be well within the realm of possibility for the average person.

Now, I wouldn’t do this all the time. There is such a thing as too much of a good thing. A hormetic stressor can become a plain old stressor if it’s prolonged for too long. Instead, I would throw post-fasted-workout fasting in on an occasional basis.

Nor would I expect huge “gains” from this. Physiological growth hormone production won’t make you huge or shredded. In fact, workout-related increases in testosterone and growth hormone don’t actually correlate with gains in hypertrophy. Instead, I’d expect more intangible benefits, things you won’t notice right away. It’s important in cognition. It helps maintain bone health, organ reserve, and general cellular regeneration. It’s great for burning fat.

Growth hormone does way more than promote overt muscular growth.

Steve wrote:

In the linked article it says:

“Endothelial cell dysfunction is an initial step in atherosclerotic lesion formation and is more likely to occur at arterial curves and branches that are subjected to low shear stress and disturbed blood flow (atherosclerosis prone areas) (7,8). These mechanical stimuli activate signaling pathways leading to a dysfunctional endothelium lining that is barrier compromised, prothrombotic, and proinflammatory.

So it seems that endothelial disfunction comes first, triggered by blood flow stresses. It’s common wear and tear in exposed areas. The patched knees on jeans. Managing endothelial health and healing may slow or diminish rate of progression or is it mostly too late for that?

I’m not a doctor. This isn’t medical advice. This is just speculation.

I find it rather hard to believe that healthy arteries are inherently fragile and prone to damage and incapable of weathering the “stress” of blood flowing through them, even at the “susceptible” curves. I find it more likely that poor health, poor diets, and poor lifestyles make us more susceptible to otherwise normal stresses.

Do the mechanical stimuli weaken the endothelium in people with healthy levels of nitric oxide production? Or are we talking about people whose poor nitric oxide status is exacerbating the damaging blood flow patterns, leaving their endothelium vulnerable to atherosclerosis?

Think about how much context matters in our response to stimuli. If you’re shy around girls, a school dance will be a traumatic experience. If you’re comfortable around girls, a school dance will be a great experience. If you’re weak, lifting a barbell will be scary, and you may injure yourself. If you’re strong, lifting a barbell will be second nature, and you may get stronger. The baseline context determines the quality of the response.

I’d argue that blood flowing through your arteries should be a commonplace occurrence. It shouldn’t be a traumatic experience. Now, maybe I’m wrong. Maybe it is stressful regardless of the baseline endothelial health and the amount of nitric oxide you produce. Maybe it’s just a matter of time. But:

  • We know that, as you quote, atherosclerosis tends to occur at bends and curves of the arteries—the places most likely to be subject to “disturbed flow” patterns.
  • We know that “laminar flow”—blood flowing smoothly through the artery—is protective of the endothelial wall, promoting anti-inflammatory effects and making the endothelium more resistant to damage.
  • We know that “disturbed flow” has an opposing effect on endothelial health, promoting inflammatory effects and rendering the endothelium more susceptible to damage. This increases atherosclerosis.
  • The question I’m wondering is if “disturbed flow” at the curves and bends of the arteries is inevitable or not. And if disturbed flow is always “bad.”
  • We know that hyperglycemia—high blood sugar—makes disturbed blood flow more damaging to arterial walls. Diabetics have higher rates of atherosclerosis because their elevated blood sugar interacts with disturbed blood flow patterns.
  • We know that nitric oxide increases vasodilation in response to shear stress—widening the arteries to accommodate the increased stress and mitigate the damage done. We know that people with hypertension don’t get the same vasodilatory benefits from nitric oxide.
  • We know that “functional increases” of shear stress attained via exercise increase nitric oxide and oxygen production and induce autophagy (cellular cleanup) in the endothelial walls.

That sounds like there are a lot of factors that increases and mitigate the effects of shear stress on the endothelial wall. It sounds like some factors make shear stress more damaging, and some factors make it less. There may even be factors, like exercise, that make shear stress healthy.

This topic is really pretty interesting to me. It deserves a deeper dive, don’t you think?

What about you, folks? What’s your take on fasted workouts and GH secretion? Ever try one?

And do you think your arteries are doomed to fall apart at the seams?

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References:

Nyberg F, Hallberg M. Growth hormone and cognitive function. Nat Rev Endocrinol. 2013;9(6):357-65.

Park SK, La salle DT, Cerbie J, et al. Elevated arterial shear rate increases indexes of endothelial cell autophagy and nitric oxide synthase activation in humans. Am J Physiol Heart Circ Physiol. 2019;316(1):H106-H112.

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Falling Off the Mountain and Climbing Back Up

It’s Monday, 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 Monday as long as they keep coming in. Thank you for reading!

My primal story all started while hiking one day back in 2009. Hiking has always been more than exercise for me. It has always been a place to clear my thoughts and think of new ideas. On a late summer day when hiking one of my favorite trails, I asked myself the question. “What would I eat if I lived out here?” I took a mental inventory: pine nuts, rabbits, chipmunks, some berries, and a deer if I was lucky. I started thinking that nothing out in the wild really represented anything I would find at my local store. I would have a hard time finding rabbit and chipmunks at the Mega-Mart, if you know what I mean.

This idea sparked my interest so much I went home and started searching everything online I could find on wild human diets etc. and eventually landed on Mark’s Daily Apple. I was hooked from the first words I read. (I eventually read all of Mark’s books too). I was all in from that day forward. I told my wife I finally figured it out, she said “what” I said “everything” and I told everyone. It all became so clear to me. Not just the diet but the lifestyle in general. It seemed the Primal Blueprint answered all of the problems of modern living.

I started cleaning out the pantry, went grocery shopping, and the next day and started my new life. It was really that easy to be honest. I had a bit of a headache and a few cravings here and there, but after that it was smooth sailing.

At the time I weighed 210 lbs on a large 6’1” frame and thought I was in good health. I hit 185 lbs after the first six months of my life altering experience, and maintained 175 to 185 it for 3 years. I was down 25 lbs, and never felt better. I was hiking about 40 miles a week things were great. All my blood markers were good, my blood pressure was low, and resting heart rate was under 50 bpm. I felt on top of the world, I was invincible.

I maintained the Grok lifestyle until 2012, and then things took a turn. I changed jobs, and moved to Hawaii. Don’t get me wrong—Hawaii was great, but the stress of being so far from family, and the hustle and bustle of a million people on one little island started taking its toll. All the great new foods didn’t help either. Who can’t resist a piece of Haupia Pie now and then? I still followed the primal eating principles for the most part probably 75/25. However things were changing for sure. I started drinking more beer and eating less than ideal (this is not the best way to handle stress). I gained most of the weight back and then some over the next three years.

While living in Hawaii we had a few deaths in the family (this was the breaking point really). So my wife and I decided to move back to the Mainland. The job search was on and I ended up taking a position for a company in the same town we lived before. Sounded great, ended up the worst decision I ever made. The job was a terrible fit, high stress, and I never took so many trips to the HR office in my entire life. To compensate for the stress, I started drinking more (if that was even possible), and eating polar opposite of the Primal Diet—SAD. I also quit hiking. Life was going downhill fast.

I finally hit rock bottom (so I thought). It was late 2015. I had fell off the Primal Wagon and bounced three times. I started having issue with heart palpitations to the point where I would almost pass out. I went to the doctor to get things checked out. The diagnosis was not good. I was up to 233 lbs, had too much bad cholesterol, triglycerides sitting at 180, borderline hypertensive, and well on my way to being a type II diabetic. The good thing through all of this, I was never prescribed any medications, and my echocardiogram looked good.

In the spring of 2016 after a year and a half of pure hell, I quit that horrifying job without notice. The good news, the heart palpitations went away almost the next day, and I slept better than I have for a few years. I started hiking again off and on but I would get a lot of pain in my legs and hips. The bad news, I was drinking even more beer.

Unemployment was not treating me well and I was in a really dark place. Death was not out of the question and an option for me. After 6 months of beer drinking and unemployment I blimped out to 245 POUNDS. I was fat, had leg and joint pain and just wasn’t there mentally. I was afraid to go to the doctor and get things checked out. I really thought the end was near. Then the end of 2016 I interviewed for a great job at a good company and got it. The position started in January 2017. I’m just grateful a good company took a chance on a fat unemployed alcoholic.

I have to admit from 2015 through 2016 had a tremendous negative effect on my family. I don’t wish it on anyone. My wife and kids stood by my side however and supported me, I love them. If not for their support, understanding, and love the difficult times would have been unsurmountable.

2017 was a big year of change, I turned 50, and started getting my head back on straight. I fell off the top of the mountain and needed to start climbing back up. I knew that I needed to make some big lifestyle changes to make the summit. I wanted to be there for my wife, kids, myself, and future grandkids well into my 80s. The first thing I did was quit drinking, cold turkey August 1st 2017. After 25 years of drinking this was one of the most difficult things I have ever undertaken. After I went through that, I figure I can make it through anything!!

After I beating the drinking problem, wanted to start back down the Primal Path. It was difficult at first. I attempted and failed a few times through 2018. Slowly but surely I got back on track. January 7th 2019 I was full on following the Primal Blueprint again. I started with The Keto Reset for the first month and it worked great. I now practice intermittent fasting a few times per week as well. I keep my carb intake around 50 grams per day now. I started at 244 lbs and now I’m down to 220 as of February 18th 2019. My target weight is probably 175 to 180 (this is where I feel best). I’m back on track to hardcore hiking too.

My first grandchild will be born this year and I can’t wait to teach him or her how to live like a Grok Child (payback for my daughter’s teen years). I have also enrolled in the Primal Health Coach Institute, I’m just over 30% complete. I plan on coaching, and helping people for the next 25 years or more. I first need to pass the comprehensive and challenging course however. The Primal Blueprint was great for me the first time. The second time is personal, and I never plan on looking back. I am looking forward to living a happy healthy life well into the future.

The readers featured in our success stories share their experiences in their own words. The Primal Blueprint and Keto Reset diets are not intended as medical intervention or diagnosis. Nor are they replacements for working with a qualified healthcare practitioner. It’s important to speak with your doctor before beginning any new dietary or lifestyle program, and please consult your physician before making any changes to medication or treatment protocols. Each individual’s results may vary.

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Tahini Fudge

Fudge…the creamy, rich squares of pure decadence we might associate with the holidays (or with trips to grandmother’s house). A little sure went a long way, but still…. With versions that typically call for everything from three cups of sugar to marshmallow fluff to sweetened condensed milk, fudge isn’t exactly a realistic Primal option. In fact, however much we may have loved it as kids, most of us have tastes too far adapted from this level of sweetness for it to hold the same temptation anymore. (Does anyone’s teeth hurt right about now?)

But that was then. This is now—with a whole different, Primal take on this classic. We happen to think this recipe is what fudge was always meant to be—all the rich texture and creamy feel (from healthy fats)…with a fraction of the carbs. Enjoy!

Ingredients:

  • 1 packet of Primal Kitchen® Collagen Peptides (optional for nutrition benefit)
  • 1/2 c organic tahini
  • 3/4 c organic coconut butter
  • 1/4 c SunButter (no sugar added)
  • 1/2 fresh vanilla bean
  • 3 tbsp maple syrup
  • 1/2 bar of unsweetened chocolate
  • Sea salt flakes to top

Instructions:

Melt and mix everything (except the chocolate and salt) in a double-broiler. Let cool to room temp.

Chop the chocolate into chips and stir into fudge mixture.

Pour into a silicon cube tray, sprinkle with salt flakes and let chill in the fridge until super firm.

*Store covered in the fridge.

Nutritional Information (per serving):

  • Calories—312
  • Carbs—9 grams
  • Fat—27.5 grams
  • Protein—7 grams

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Sex education: Menstrual health to be taught in school by 2020


A tampon and a sanitary padIt will be compulsory to teach about periods at schools in England by 2020, which endometriosis sufferer Alice Smith calls “massive”.

The 23-year-old was diagnosed with the chronic condition at 14 and has been campaigning for menstrual health to be on the school curriculum.

Alice says the new guidelines mean girls will know “from a much younger age what is normal” and what isn’t when it comes to their periods.

Consent is also to be taught at school.

And children will learn about domestic violence, relationships and staying safe online.

“My experience at school would be very different now,” Alice says.

Endometriosis, which affects one in 10 women in the UK, is where tissue similar to the lining of the womb grows elsewhere in a woman’s body.

It causes chronic pain, fatigue, bowel and bladder problems, and can lead to infertility.

However, leading doctors have previously recommended that primary school children are taught about LGBT issues.

Earlier this year, the Royal College of Paediatricians and Child Health (RCPCH) urged minister go further in their guidance on sex and relationship classes, which will become compulsory from 2020.

Draft Government recommendations say schools are free to determine how they address lesbian, gay, bisexual and transgender (LGBT) issues, ensuring teaching is “sensitive and age-appropriate”.

The Royal College said: “There needs to be a clear statement that LGBT people and relationships are part of teaching about healthy relationships in primary school. This can be demonstrated in relation to families – but also it is helpful to children to learn the meaning of terms such as lesbian, gay and bisexual”.

Arm Workout Without Weights

Jessica Gouthro from Paleohacks is joining us today to offer tips for bodyweight-focused arm workouts. Enjoy, everyone.

Do you ever have those days when you want a good arm workout, but you don’t have any workout equipment?

Curls, presses, tricep kickbacks, and rows are all great for your arms if you’re at the gym with plenty of dumbbells, barbells and cable machines. But what about those days that you just can’t make it to the gym—or simply don’t want to?

Luckily, I’m here to prove to you that a good bodyweight workout is just as good as what you can get at the gym. The best part is, you don’t need anything other than yourself and just 15 minutes at a time to sculpt and tone your arms into incredible shape.

The top three muscle groups we want to focus on when working on our arms are:

  • Triceps: Our largest muscle group of the arm, located on the back of the upper arm. Its function is to extend the elbow joint (straighten your arm).
  • Biceps: The muscle in the front of our upper arm that flexes the elbow joint to bring the forearm towards the upper arm (bend your arm).
  • Shoulders: The muscle primarily targeted in shoulder development is the deltoid. This muscle is responsible for both raising and lowering of the arm as well as overhead pressing movements.

This bodyweight workout focuses on these three muscle groups, helping you form a balanced strengthening approach.

The result of this workout is going to be sleek, defined, strong-looking arms, but even better, you will be gaining real, functional strength at the same time.

Here’s how to do this 15-minute arm workout:

  • Spend 1 minute on each of the five exercises, repeating the circuit three times without breaks between rounds.
  • Beginner (30:30): Follow 30 seconds of work with 30 seconds of rest. (If you need even more rest, you can take it. Good form is always more important than sticking to time!)
  • Advanced (45:15): Follow 45 seconds of work with 15 seconds of rest (Just enough time for a few deep breaths and setting yourself up for the next exercise.)

Diamond Push-Up

This triceps move also shapes your chest, shoulders and core for a full-body functional exercise.

In a push-up position, bring your hands to touching, forming a diamond shape with fingers and thumbs.

Tighten your core, and ensure that your body is in a straight line from shoulders to feet.

Bend your elbows to lower your chest towards your hands.

Stop when you are about four inches away from the floor, then press your palms down into the ground to rise back up to the top.

Keep your elbows close to your body as you lower and lift to put the focus on the arms and shoulders.

Tricep Wing-Backs

This exercise is surprisingly challenging when done with focus and intention.

Get into a low squat, with your knees bent and back straight.

Lift your arms up behind you like you’re reaching for the back wall. Spread your fingers and flex your arms all the way straight.

On an inhale, bend your elbows at a 90-degree angle, making sure to keep your arms up high. Focus on flexing your bicep muscles.

Exhale to extend your arms straight again, flexing your triceps.

With each rep, focus on contracting your muscles.

Single Leg Pike Push-Ups

This just might be the hardest shoulder press you’ve ever tried.

Start in downward-facing dog position, on your hands and toes with your hips in the air. Make sure your hands are at least shoulder-width apart.

Lift one leg up high in the air, pointing your toes towards the ceiling.

Inhale to bend your elbows, lowering your forehead towards the ground between your hands.

Exhale to press your palms down into the ground to lift back up to straight arms.

Lower your leg back down and immediately lift your right leg.

Continue to do the same push-up move, alternating lifts of each leg for the allotted work time interval.

NOTE: Single Leg Pike Push-Up is a challenging move that requires upper body strength and balance. If you cannot do it with good form or do not feel comfortable doing it, do push-ups (or modified push-ups on your knees) instead.

Regular Push-Up

Put feet about shoulder width apart with toes touching the ground. Put hands alongside chest and spread your fingers. Begin to push up, keeping elbows close to the body.

Take some of the work off the wrists by making your fingers “grip” the floor as you push up.

Modified Push-Up

A modification of the traditional push-up that lessens the weight on the upper body. Follow the same routine as the traditional push-up, but use your knees as the point of your lower body touching the floor (instead of the toes).

Extend upward just as you do in a traditional push-up.

Superman Lift-Off

This move tones your shoulders and arms while also strengthening your lower back.

Lie belly down on the ground with arms and legs extended long.

Take a big breath in, then on the exhale, lift your arms and legs off the ground like Superman.

Inhale to lower back to the starting point.

Repeat this lifting and lowering, following the pace of your breath.

Downdog Ankle Tap Twists

This shoulder and tricep blaster is also a great spine-lengthening stretch.

Start in a downdog position with hands and feet shoulder-width apart.

Exhale, and reach your right hand towards the outside of your left ankle to tap it.

Inhale to come back to downdog, then alternate and do the same on the other side.

Continue alternating left and right, one move per breath.

Congratulations! In just 15 minutes, and with no equipment, you have worked your arms in the best way possible.

You may feel sore tomorrow, so give those arms a rest and allow at least 24-48 hours recovery before tackling this workout again.

For best results, I recommend incorporating this workout into your routine two to three times per week, spaced apart to allow for recovery.

Thanks again to Jessica Gouthro for today’s tips. Be sure to check out Jessica’s other workout lineups on MDA:“13 Ways To Move More At Work” and “10 Moves To Help Ease Joint Pain.”

Questions or comments about bodyweight exercises or arm strength? Share them below, and thanks for stopping by.

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10 Primal Date Ideas For Every Couple

I know we missed Valentine’s Day, but I’ve always said love cannot be contained. Besides: People are always going on dates. People are always searching for new ways to break out of the regular mold, which is completely understandable. Dates are try-outs. You’re spending time with another person to determine how they fit into your life. Unconventional dates that branch out from “dinner, movie, drinks” into more adventurous, creative realms provide excellent feedback for making that determination.

Dates are also a way for established couples to keep things fresh and exciting, to keep the relationship moving. There’s no better way than to try something new.

As it happens, most work for friends, too.

Now, some of these dates are silly or out-of-left field. Some are more serious. And one is a Primal Costanza date—what not to do. But regardless, they are all worth exploring. And—as always—I’d love to hear what you’d add.

1) Watch a Movie and Fill In the Dialogue

You know that scene in Eternal Sunshine of the Spotless Mind where Jim Carrey and Kate Winslet are watching a drive-in movie without sound and filling in the dialogue themselves? Do the same thing, only make all the dialogue health and fitness-related. For example, The Empire Strikes Back would work great.

Just before Han is frozen in carbonite, Leia speaks. “I love cold therapy, so many benefits. I can send you the PubMed links.” Han replies. “I know.”

Vader gives Luke the bad news. “Luke, I am a vegan.” “Nooooooooo!”

Pick your favorite movie, and try it out yourselves. Drive-ins aren’t necessary (do they even still have those?); you could just put the T.V. on mute.

2) Couples’ Spa Day

A couple hundreds years ago, you didn’t really go to the doctor. You’d go to a spa. Spas were healing centers erected around natural springs of mineral-rich water. People would bathe in it (many were hot springs), drink it, and engage in other healthy pursuits. Many of today’s most popular bottled mineral waters come from springs that doubled as health spas back in earlier days.

The average person may think of a spa as a pleasure center, a superficial luxury. But getting a massage, soaking in hot mineral water, smearing yourself with mud and/or clay, exposing yourself to extreme temperatures in the sauna, steam room, and cold water pool? These are all objectively healthy and pleasurable experiences with measurable benefits.

Go for a hot soak, followed by a cold plunge. Do the mud bath thing. Get a deep tissue massage. Soak in the salty mineral-rich brine. And do it with your date, as your date.

3) Get Physical

No, not like that (necessarily). I’m talking about doing something physically demanding together, like a yoga session, a tough hike, a Tough Mudder, a Krav Maga class, or even a CrossFit workout.

Intense physical exertion—performed together—increases bonding. You’re sweating, you’re touching, you’re working hard toward a goal. You’re a team. Make it a little dangerous and the juices really flow. For the same reason, going to see a scary movie helps couples get closer.

4) Go Dancing or Take Dance Lessons

Dance is the prelude to closer, more intimate physical contact. And it’s incredibly healthy learning to move with cohesion and fluidity and precision through constantly varying ranges of motion. Dancers are some of the most athletic folks around—think b-boys, ballet dancers, practitioners of modern dance. I’m not a follower of the show, but seriously just look at an episode of “So You Think You Can Dance” for plain evidence of their athleticism.

Go dance, or take dance lessons if you can’t dance yet. If the latter, don’t make this a one-off. Keep the lessons going. Build that skill together. Move together.

Dancing together in your living room to music on your smartphone is completely valid, too.

5) Cook the Farmer’s Market

This is a fun little date to try. Carrie and I used to do this at the Malibu farmer’s market every once in awhile.

Go to every stand, ask the farmer what’s best today, and then buy that item. If your market is huge, you don’t need to buy from every single stand. Try to stick to a dozen stands or so just to keep things manageable.

Be reasonable with the quantities. Otherwise it’ll add up fast. If, say, the farmer recommends the leeks, buy a couple leeks. If it’s cauliflower, buy a head. If it’s strawberries, buy a basket.

Go home and create a meal together using only the things you purchased from the market. Use things like oil/cooking fat, salt, pepper, and spices from home (unless you bought them at the market, in which case you get extra points). If your market doesn’t offer any meat, feel free to incorporate store-bought meat. But do your best to use only things from the market.

Prep and cook it together. There you go, that’s your date.

6) Ten-Mile Date

Walk ten miles, at least. It can be through the city, the suburbs, or the forest. You can stop at stores, cafes, museums along the way—it doesn’t have to be ten miles straight without stopping. But get those ten miles in however you can.

7) Roughhouse

Roughhousing is universal. It’s also great fun. You roughhouse. You wrestle, jostle, poke, prod, but you don’t (ever) hurt each other. You keep things light, engaged, dancing on the edge of intensity. I really like Rafe Kelley’s approach. Check out the one where he and his partner act like their wrists are glued together as they move around, roll, push, and pull. Or where they stand on a large log, clasp hands, and try to pull each other off balance. That stuff is really fun. I’d try any of the videos from that link.

Another is one-legged tug of war. You each stand on one leg, clasp the other’s hand, and attempt to pull the other off balance. If there’s a big weight or strength disparity, have the stronger person stay on one foot and the weaker person use both. Put pillows and other soft landing spaces around your perimeter.

If you’re a man and she’s a woman, there will probably be some strength disparities. Use your better judgement. Keep things fair and competitive and fun.

8) Picnic and a Hike

Think back to all the hikes you’ve done, all the wilderness areas you’ve explored. Were there any perfect picnic spots that jumped out at you? Maybe a dry pebbly shore next to a gurgling creek. Maybe a ring of redwoods. Maybe a grassy meadow. Maybe a beach that only locals know about. If nothing comes to mind, Google one.

Then pack a lunch and get moving.

9) Stand-Up Paddling

I’m extremely biased. Stand-up paddling is probably my favorite activity. It’s training, meditation, adventure, and a fantastic core and rear delt/lat workout all in one. I’ve seen dolphins, manatees, whales, and any number of marine life on my board. I’ve hit the flow state on my board. I’ve finally figured out meditation being on my board. I’ve woken up with some of the most intense DOMS after a long day on my board. My transverse abdominals and obliques have never been stronger. It’s an all-around great time—and it makes a great date. We’re no longer youngsters in love, but Carrie and I have had a lot of good times when I can get her out on a board.

Not everyone has access to a paddle-worthy body of water, although more than you’d think—rivers, lakes, and reservoirs all work with a paddle board, not just the ocean. If you can’t paddle, something similar like kayaking or even cross-country skiing will work well.

10) Lecture Your Date At Dinner

Make sure your date knows exactly how unhealthy everything he or she is putting in her mouth.

When he orders pasta, make a face.

When she fails to confirm that the salad dressing was made with extra virgin olive oil, pull the waiter aside and do it for her.

When he orders the fish, let him know the Monterey Bay rating.

If she gets anything deep-fried, tell her all about how restaurants reuse cooking oil, which (by the way) is most likely very high in unstable polyunsaturated fats.

This will ensure a second date.

That’s it for today, folks. If you try any of these date ideas, let me know how it goes. If you have any other ideas, write them in down below!

Take care.

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Taking Dapoxetine and Viagra together: Safe and effective combination therapy

More and more men are experiencing sexual difficulties. Obviously, the most common problems are poor erection quality and premature ejaculation. Fortunately, a man can quite easily treat both conditions with the help of proper medicines. As you know, the most effective drug for the treatment of erectile dysfunction is Viagra. To prolong the pleasure of sex and avoid premature ejaculation, use Dapoxetine.

But what if you are suffering from both erectile dysfunction and premature ejaculation? With a single pill of Viagra, a man can easily achieve a strong erection. However, even with this highly effective means you can come too quickly, not having time to really enjoy the sexual intercourse itself. In this case, you might take Dapoxetine which prolongs the erection and helps to avoid too quick ejaculation.

Is it possible to use both drugs, Viagra and Dapoxetine, together? According to expert opinion of specialists, this method is quite safe and effective. You just need to be sure that you do not have contraindications. Combination therapy using these two drugs has been successfully tested by many doctors and their patients.

Moreover, nowadays you may choose one of the medicines consisting of both Sildenafil (the active substance of Viagra tablets) and Dapoxetine. The dosage of ingredients in these pills is optimal, which means you do not have to adjust the dose and plan a course of treatment yourself.

At the same time, if you wish, you can use Dapoxetine and Viagra separately, combining them depending on the situation and your needs. For example, some men are more likely to suffer from insufficiently good erection than from premature ejaculation. So, they can take Viagra pills regularly and use Dapoxetine from time to time.

Keep in mind that both Sildenafil (Viagra) and Dapoxetine are available under various brand names. Both branded and generic versions of these drugs must contain the same active substances. Thus, the combination therapy of erectile dysfunction and premature ejaculation will be effective enough.

The effectiveness of medications based on Sildenafil and Dapoxetine was confirmed by numerous studies. In particular, a scientific experiment held in 2017 with the participation of hundreds of 18-64-year-old men showed an excellent result just in four weeks after the start of combined Dapoxetine and Viagra treatment.

Dear Mark: How Does LDL Even Penetrate the Arteries, New Zealand Farmed Salmon, Elevated Ferritin

For today’s edition of Dear Mark, I’m answering three questions. First, can LDL actually infiltrate the arteries, or is there more to the story? Malcolm Kendrick says there’s more to the story, so I dig into some literature to see if they corroborate his position. Second, is New Zealand farmed salmon good to eat? And finally, what should you do about elevated ferritin levels—and why else might they be elevated if not because of your iron?

Let’s go:

My reading of this post by Malcolm Kendrick MD is that LDL particles cannot infiltrate the endothelial lining of our arteries:
https://drmalcolmkendrick.org/2018/08/16/what-causes-heart-disease-part-52/

Great read. Malcolm Kendrick is consistently fascinating, insightful, and enlightening.

He’s basically suggesting that LDL particles can’t manhandle their way into the artery wall, which are equipped with tight junctions—the same kind that regulate passage through our gut lining. Something has to “allow” them in. The something he finds most plausible is injury, trauma, or insult to the endothelial lining (artery wall, for lack of a better phrase).

A free public textbook available on PubMed since last month called The Role of Lipids and Lipoproteins in Atherosclerosis tackles the topic head on. In the abstract, they say:

Population studies have demonstrated that elevated levels of LDL cholesterol and apolipoprotein B (apoB) 100 [note: ApoB is a stand-in for LDL particle number, as each LDL-P has an ApoB attached to it], the main structural protein of LDL, are directly associated with risk for atherosclerotic cardiovascular events (ASCVE). Indeed, infiltration and retention of apoB containing lipoproteins in the artery wall is a critical initiating event that sparks an inflammatory response and promotes the development of atherosclerosis.

This seems to posit that infiltration of the LDL particle into the artery wall is a critical initiating event. But is it the critical initiating event? Does something come before it? How does the infiltration happen, exactly? Moving on:

Arterial injury causes endothelial dysfunction promoting modification of apoB containing lipoproteins and infiltration of monocytes into the subendothelial space. Internalization of the apoB containing lipoproteins by macrophages promotes foam cell formation, which is the hallmark of the fatty streak phase of atherosclerosis. Macrophage inflammation results in enhanced oxidative stress and cytokine/chemokine secretion, causing more LDL/remnant oxidation, endothelial cell activation, monocyte recruitment, and foam cell formation.

If I’m reading this correctly, they’re saying that “arterial injury” is another critical initiating event—perhaps the critical initiating event, since the injury causes “endothelial dysfunction,” which in turn modifies (or oxidizes) the LDL particles. But wait: so they’re saying the LDL particles are already there when the arterial injury occurs. They’ve already made it into the endothelial walls, and they’re just…waiting around until the arteries get injured. Okay, okay, but, just like Malcolm Kendrick points out, nowhere in the abstract have the authors actually identified how the LDL particles enter the endothelial lining. Maybe it’s “common knowledge,” but I’d like to see it explained in full.

Moving on:

In atherosclerosis susceptible regions, reduced expression of eNOS and SOD leads to compromised endothelial barrier integrity (), leading to increased accumulation and retention of subendothelial atherogenic apolipoprotein B (apoB)-containing lipoproteins (low-density lipoproteins (LDL)) and remnants of very low-density lipoproteins (VLDL) and chylomicrons)

Ah ha! So, in regions of the arteries that are prone to atherosclerosis, low levels of nitric oxide synthase (eNOS)—the method our bodies use to make nitric oxide, a compound that improves endothelial function and makes our blood flow better—and superoxide dismutase—an important antioxidant our bodies make—compromise the integrity of the arterial lining. The compromised arterial lining allows more LDL particles to gain entry and stick around. So, are low levels of nitric oxide and impaired antioxidant activity the critical initiators? That’s pretty much what Malcolm Kendrick said in his blog post.

Still—high LDL particle numbers are a strong predictor of heart disease risk, at least in the studies we have. They clearly have something to do with the whole process. They’re necessary, but are they sufficient? And how necessary are they? And how might that necessariness (yes, a word) be modified by diet?

I’ll explore this more in the future.

In regards to the oily fish article (and more indirectly given the omega 6 concern- the Israeli Paradox) What do you think of NZ farmed salmon? I’m in Australia, & occasionally like a fresh piece of salmon- there are no wild caught available here sadly, but I am wondering how it measures up as an alternative?

Last year, I explored the health effects of eating farmed salmon and found that it’s actually a pretty decent alternative to wild-caught salmon, at least from a personal health standpoint—the environmental impact may be a different story.

I wasn’t able to pull up any nutrition data for New Zealand farmed salmon, called King or Chinook salmon. Next time you’re at the store, check out the nutritional facts on a NZ farmed salmon product, like smoked salmon. The producer will have actually had to run tests on their products to determine the omega-3 content, so it should be pretty accurate. Fresh is great but won’t have the nutritional facts available. I don’t see why NZ salmon would be any worse than the farmed salmon I discussed last year.

According to the NZ salmon folks, they don’t use any pesticides or antibiotics. That’s fantastic if true.

I used to eat a lot of King salmon over in California, and it’s fantastic stuff. Very fatty, full of omega-3s. If your farmed King salmon comes from similar stock, go for it.

ok can someone tell me how to reduce ferritin? Is is just by giving blood?

Giving blood is a reliable method for reducing ferritin. It’s quick, effective, simple, and you’re helping out another person in need. Multiple wins.

Someone in the comment board recommended avoiding cast iron pans in addition to giving blood. While using cast iron pans can increase iron intake and even change iron status in severe deficiency, most don’t have to go that far. Giving blood will cover you.

Ferritin is also an acute phase reactant, a marker of inflammation—it goes up in response to infections (bacterial or viral) and intense exercise (an Ironman will increase ferritin). In fact, in obese and overweight Pakistani adults, elevated ferritin seems to be a reliable indicator of inflammatory status rather than iron status.

Thanks for reading, everyone. Take care and be well!

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References:

Birgegård G, Hällgren R, Killander A, Strömberg A, Venge P, Wide L. Serum ferritin during infection. A longitudinal study. Scand J Haematol. 1978;21(4):333-40.

Comassi M, Vitolo E, Pratali L, et al. Acute effects of different degrees of ultra-endurance exercise on systemic inflammatory responses. Intern Med J. 2015;45(1):74-9.

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We Want To Share Your Stories (and a Giveaway!)

Success stories will be back in their regular slot next Monday, but for today I want to issue an invitation.

Now that we’ve turned the corner on the first month of the year, I know some of you have already seen big success with Primal or Primal-keto living. And I’d love to share your stories—to help inspire others here and to offer the kind of varied and personal accounts that only reader experiences can. Will you join the hundreds of others who have helped along the way?

Over the years I’ve heard time and again about folks finally taking the plunge because of a story that touched them personally. Maybe they had the information, knew the Primal laws, had read the blog for weeks or months even, but another reader’s account of their journey brought it all home for them. The difficulties that person started with and the amazing transformation that resulted—this was a story they were somehow meant to read. It was what reached them—and put them on their own path to renewed health, more vitality, and a better life.

The fact is, when you share your own story, you never know who you’ll be helping. And that’s an awesome thing.

I’ll add that it doesn’t matter if you’ve reached your ultimate goals yet or are still on your way. If you’re feeling better, eating better, moving better, sleeping better and just living better, that’s what inspires people. I bet there are a whole lot of folks hesitating on the sidelines wondering if they can do this who would love to hear from someone who hasn’t necessarily reached their goal but is on their way—someone who’s a month or two in who can show them that the beginning isn’t as hard as they fear it will be. And that the benefits come sooner than they dare imagine.

Likewise, if you’re someone who went Primal years ago (and even submitted an earlier success story) but continue to live a better life than you dreamed because of the changes you made long ago—we want to hear how you’ve stayed the course, what adjustments you’ve found helpful, what long-term lessons have surfaced over the years. There’s nothing quite like a great update.

So, let me offer an incentive to kick us off…. 

The Giveaway

Anyone who sends me their success story along with photos will be entered to win a $200 gift certificate to Primal Kitchen®. That’s $200 of Primal bucks for all the Avocado Oil, Mayo, Condiments, Dressings, or Collagen you want—your choice.

Want to try our new BBQ or Steak Sauces? Check. How about a full collection of Collagen or Protein Bars? Check. Prefer to stock up on Primal Fuel? Whatever your favorites, you got ’em.

I’ll also choose two additional submissions for a Primal library collection with some of our most popular titles: The Primal Connection, Primal Cravings, Paleo Cooking Bootcamp For Busy People, The Paleo Primer, and Primal Blueprint: Healthy Sauces and Dressings.

Anyone who submits a story will receive a 20% discount they can apply to any purchase from either PrimalKitchen.com or PrimalBlueprint.com.

I’m sure many of you have thought about sending your story in but just haven’t gotten around to it. There is no better time than now.

Write it up and include a few photos—the more the merrier, the bigger the better (since it’s easier to format for the site that way). Including both pre-Primal and post-Primal pics is even better, but isn’t required.

Don’t worry if you’re not a chiseled Adonis. This isn’t a “who’s the most ripped” competition. No matter where you’re at in your transformation,  tell me what going Primal has done for you so far.

How To Do It

I’m looking for interesting and personal tales. Details about your health history, how you found MDA and the Primal Blueprint, what has worked and what hasn’t, what differences you’ve seen in how you look and feel, and anything else you think readers might be able to learn from and you’re open to sharing are welcome. It doesn’t have to be a 3000-word essay, but it’s hopefully more than a few paragraphs. Feel free to be creative with your story format, too. Still, remember, good stories usually have a beginning, a middle, and an end—and honesty is king.

Check out other Success Stories here for ideas on how to write your own story.

Email me your story along with pictures. Please use the subject heading “My Primal Story.” Otherwise, there’s a good chance we might miss your submission.

Eligibility:

Anyone in the world can enter.

Additionally, everyone who has submitted a Success Story to Mark’s Daily Apple in the past is free to submit an updated story and new photos.

The Deadline:

Friday, March 8, 2019, midnight PST

How the Winner Will Be Determined:

My staff and I determine which stories and accompanying photos get published on MDA. The winners of the giveaway will be chosen at random from those that are submitted by the deadline.

Thanks, everybody. I’m excited to read what you send—and to share it with our MDA audience. Have a great weekend.

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