Dear Mark: Antibiotic Recovery, Sprinting on Keto, Preparing for Bad Sleep

For today’s edition of Dear Mark, I’m answering three questions. First up, what can a person do to help their gut recover its barrier function after too many antibiotics? Are there any foods, supplements, or dietary strategies? Second, what can explain rapid fatigue during sprint sessions on a keto diet? Is this simply part of the deal, or are there modifications you can make? And finally, what do I do when I know I’m going to get a bad night’s sleep?

Let’s go:

Mark – any idea how to cure leaky gut caused by overuse of antibiotics. Tried raw dairy for a month to no avail.

First of all, check out my post on leaky gut. Read through it and follow my suggestions for preventing and treating intestinal permeability. It’s a great place to start.

Then, let’s look at some other interventions that have been shown to improve recovery from antibiotic therapy. While most of the studies referenced don’t explicitly describe antibiotic-induced leaky gut, anything that improves gut function and restores healthy gut bacteria will also normalize leaky gut—since it’s the eradication of native gut bacteria that causes antibiotic-induced leaky gut.

Fermented dairy. You tried raw dairy. What about fermented dairy? While raw dairy has its merits, it’s fermented dairy that just works for recovery from antibiotics. Yogurt is a good option to try, although the evidence is a bit inconsistent. Kefir is probably better; it’s been shown to improve patients’ tolerance to triple antibiotic therapy during treatment for H. pylori infection. This is even worth consuming during antibiotic therapy, as many of the probiotic bacteria found in fermented dairy show resistance to common antibiotics.

Fermented vegetables like sauerkraut are also must-eats. The fermented cabbage contains ample amounts of L. plantarum, a bacteria strain that’s been shown to prevent antibiotic-related diarrhea in piglets (another omnivorous mammal). Good options exist in stores (check the refrigerated section; shelf-stable pickles and kraut aren’t lactofermented), and even more are available in farmer’s markets, but the best way to get the most bacteria-rich vegetable ferments is to make your own.

Supplemental probiotics are fantastic here, too: large doses of the desired microorganisms delivered directly to your gut. Some of the strains used in Primal Probiotics, like B. clausii and S. boulardii, have been shown to be effective against antibiotic-related diarrhea, so that could be a good choice.

Don’t forget the food for your gut bugs: prebiotics. You need to eat fermentable fibers and other prebiotics like resistant starch to support the growth and maintenance of the helpful bacteria that improve gut barrier function. Consider eating cooked and cooled potatoes, unheated potato starch, leeks, garlic, onions, green bananas, apples, pears, berries, and pretty much any fruit or vegetable you can get your hands on. Plenty of them are low-carb enough to work on a keto diet, if that’s your desire. Oh, and dark chocolate is a great source of fiber and polyphenols, which have prebiotic effects in the gut.

Incorporate intermittent fasting. Going without food for a spell gives your gut a break and induces autophagy, which can help with tissue healing.

Get dirty, too, to introduce potentially helpful bacteria. Go out and garden. Go barefoot at the park (do your due/doo diligence, of course) and practice tumbling, or roughhouse with your kids (or friends). Don’t immediately rush to wash your hands all the time (unless you’ve been handling raw meat and/or dog poop).

Whatever you do, don’t stress too much about the antibiotics you had to take. Stress is awful for gut health and you’ve already taken the antibiotics—which were probably necessary—so that ship has sailed.

If probiotics with prebiotics aren’t helping (or making things worse), you might want to try going the opposite direction—removing all plant foods and doing a carnivore diet for a few weeks. While I have doubts about the long term viability and safety of eschewing all plant foods, enough people have written to me about their great experiences resolving gut issues with a bout of carnivory that it’s worth trying.

When on a strict keto plan, why do I become so quickly fatigued while attempting a HIT sprint workout?

The first five seconds of a sprint are primarily powered by phosphocreatine (or creatine phosphate), a “quick burst” energy source that burns hot but disappears quickly. This is the stuff used to perform max effort Olympic lifts, short sprints, and other rapid expressions of maximum power. It doesn’t last very long and takes a couple minutes to replenish itself. A keto diet doesn’t affect our creatine phosphate levels. If anything, it should improve them if we’re eating meat.

After five seconds, anaerobic metabolism of muscle glycogen provides the lion’s share of your energy needs. The longer your sprint, the more glycogen you’ll burn. The less glycogen you carry in your muscles, the shorter your sprint. Because once you run out of creatine phosphate and glycogen, you’re left with aerobic metabolism—great for longer distances, not so great for max effort sprints.

Keto dieters tend to walk around with less glycogen in their muscles. If that’s the case, longer sprints will be harder.

If you want to keep sprinting:

Do shorter sprints. Try a 10-second hill sprint rather than a 20-second one. Really go hard. Heck, you can even do 5-second sprints and derive major benefits; just do more of them and make sure to recover in between. There’s no rule saying you have to sprint for 20-30 seconds.

Take longer rest periods. Give your muscles a chance to replenish more creatine phosphate (and take creatine or eat red meat and fish, which are the best sources of dietary creatine).

Eat 20-30 grams of carbs 30 minutes before a sprint session. See if it helps. Alternatively, you can eat the 20-30 grams of carbs after the sprint session to replenish lost glycogen stores (without really impacting your ketone adaptation, by the way).

Most people figure out their sprinting sweet spot while doing keto. They may have to play around with the dosages, durations, and rest periods, but you can usually make it work. Be open to trying new permutations.

If you knew you were going to have a poor nights sleep, what measures would you take to reduce some of the damage?

I would exercise hard that night. Normally, a bad night’s sleep tanks your insulin sensitivity the next day, giving you the insulin resistance and glucose tolerance of a diabetic. A good hard interval session the night before a bad night’s sleep, however, counters the next-day insulin resistance.

I would make the most of it. Don’t dawdle. Don’t beat yourself up because of the impending sleep deprivation. It’s going to happen. You have to accept it, not let it destroy you.

Enjoy it. A little-known acute treatment for depression is sleep deprivation. That’s right: a single night of sleep deprivation has been shown to ameliorate depression in patients with clinical depression. Sometimes the effect lasts up to several weeks. It’s not a long term or sustainable fix for clinical depression, obviously, and you can’t do it every single night—chronic sleep deprivation is a major risk factor for developing depression—but it can improve your mood if you give in to it.

I would set out a jar of cassia cinnamon. I always add cassia cinnamon to my coffee in the morning after bad sleep; cassia cinnamon the day after a bad night’s sleep attenuates the loss of insulin sensitivity and glucose tolerance.

That’s it for today, folks. Thanks for writing in and reading! If you have any input on today’s round of questions, let me know down below.

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References:

De vrese M, Kristen H, Rautenberg P, Laue C, Schrezenmeir J. Probiotic lactobacilli and bifidobacteria in a fermented milk product with added fruit preparation reduce antibiotic associated diarrhea and Helicobacter pylori activity. J Dairy Res. 2011;78(4):396-403.

Bekar O, Yilmaz Y, Gulten M. Kefir improves the efficacy and tolerability of triple therapy in eradicating Helicobacter pylori. J Med Food. 2011;14(4):344-7.

Erginkaya Z, Turhan EU, Tatl? D. Determination of antibiotic resistance of lactic acid bacteria isolated from traditional Turkish fermented dairy products. Iran J Vet Res. 2018;19(1):53-56.

Yang KM, Jiang ZY, Zheng CT, Wang L, Yang XF. Effect of Lactobacillus plantarum on diarrhea and intestinal barrier function of young piglets challenged with enterotoxigenic Escherichia coli K88. J Anim Sci. 2014;92(4):1496-503.

Jitomir J, Willoughby DS. Cassia cinnamon for the attenuation of glucose intolerance and insulin resistance resulting from sleep loss. J Med Food. 2009;12(3):467-72.

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Dear Mark: Exercise-Induced Asthma, CBD for Diabetes, Warm-ups In the Morning

For today’s edition of Dear Mark, I’m answering three questions from readers. First, what’s the deal with exercise-induced asthma? Is there anything we can do to lessen its impact and incidence? Second, is CBD oil helpful for diabetics? And finally, do bodyweight exercises always require warm-ups? What about workouts in general—do you need to warm-up before every single session?

Let’s find out:

The first question comes from Caue Cavallaro:

since you are the go-to person when it’s about health, for me, do you have any material related to exercise induced asthma? I had it every now and then but since I started training for triathlon it’s happening more often. Thank you!

This is a classic response. When I was doing triathlon (and training others in the sport), exercise-induced asthma was incredibly common. These were some of the fittest people on the planet, and yet they were wheezing and coughing like they were completely out of shape.

The common denominator was inflammation and oxidative stress. Back then, most of us didn’t know anything about either—and we were loading our bodies with tons of both. Anything you can do to reduce excess inflammation and oxidative stress in a healthy, sustainable manner will help.

First and foremost, how are you training? I’d really consider getting your hands on Primal Endurance or reading this post. The quick and dirty version is that to train the aerobic pathway, you have to go easier and slower than you think. Take 180 and subtract your age. That’s your target heart rate. Stay under it to remain aerobic. You’ll go so slow and so easy that it won’t even feel like you’re training. This will increase how fast you can go while remaining in the aerobic fat-burning zone, and it will limit your tendency to overtrain. Overtraining is the primary reason for exercise-induced asthma because when you overtrain, you’re heaping excessive inflammation and oxidative stress on your system. And you’re doing it every single time you train.

This “easier” style of endurance training is totally applicable to triathlon. Spend a good month or so (longer for most, but you’re probably reasonably fit and ahead of the game) focusing on that for the bulk of your training, building that aerobic base. Pepper in some more intense stuff, some “race pace” running/swimming/biking, some strength training and sprints.

How are you eating? Too many seed oils high in omega-6 fats and too many refined carbohydrates (to support the overtraining, of course) will tilt the balance toward inflammation and oxidative stress. Switch over to more saturated and monounsaturated fat sources, like butter, coconut oil, avocado oil, and olive oil. Be sure to eat fatty fish or take fish oil to balance out your omega-3:omega-6 ratio. Eat fewer carbs, and even consider going keto to enhance your fat-adaptation. The low carb approach goes hand in hand with training easier in the aerobic zone, as it demands less carbohydrate.

You’ll want to support your glutathione production with whey protein, raw dairy, and NAC supplements. Glutathione is the body’s premier in-house antioxidant. We most famously use it to detoxify harmful substances like alcohol and reduce oxidative stress, but glutathione also combines with nitric oxide to become a potent bronchodilator called nitrosoglutathione. Bronchodilators open up the airways and facilitate air flow. Having inadequate glutathione can impair your production of nitrosoglutathione and make your asthma worse—or trigger it.

Choline can help. Studies have shown that getting some extra choline reduces the airway inflammation and oxidative stress in people with asthma. You can take a choline supplement or eat a few egg yolks each day.

Good luck!

Regarding CBD/hemp oil, Carmen asked:

Is there oil for diabetics??

They’ve actually looked at CBD for diabetics. In animal studies, it reduces the incidence of diabetes and shows promise against diabetic complications like high glucose-induced endothelial dysfunction.

But the only human study was a bit of a dud. It compared CBD alone, CBD with THC, and THC alone in people with type 2 diabetes. Only the THC alone improved blood sugar, pancreatic beta cell function, and lipid numbers. CBD was ineffective, if harmless.

When you say, as soon as you wake up, do a quick superset of pushups – doesn’t it require a warm-up session beforehand? Can you really do them right away, as soon as you get out of bed? Is a warm-up not always essential?

I mean, you don’t have to do them right away. I can definitely see an argument for brushing the teeth and having some coffee first. For waking up a bit to get the most out of your workout. But if you work out on a regular basis and have a good base level of strength—which our commenter seems to have—you should be able to do basic bodyweight exercises without much of a warm-up.

If pushups are a major effort for a particular person, then a warm-up is a good idea.

As for the essentiality of warm-ups in general? Warm-ups become necessary when we stop moving for most of the day and do a big workout a few times a week. Warm-ups are necessary when we sit for 10 hours a day, using terrible posture the entire time. Warm-ups are important if you’re going really hard, really intense, and really heavy (think a big CrossFit WOD, a set of heavy deadlifts, or something similar). Warm-ups aren’t as essential if you make your entire lifestyle a movement session.

Thanks for reading, everyone. If you have any comments, input, or questions, leave it down below!

Take care.

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References:

Mehta AK, Singh BP, Arora N, Gaur SN. Choline attenuates immune inflammation and suppresses oxidative stress in patients with asthma. Immunobiology. 2010;215(7):527-34.

Weiss L, Zeira M, Reich S, et al. Cannabidiol arrests onset of autoimmune diabetes in NOD mice. Neuropharmacology. 2008;54(1):244-9.

Rajesh M, Mukhopadhyay P, Bátkai S, et al. Cannabidiol attenuates high glucose-induced endothelial cell inflammatory response and barrier disruption. Am J Physiol Heart Circ Physiol. 2007;293(1):H610-9.

Jadoon KA, Ratcliffe SH, Barrett DA, et al. Efficacy and Safety of Cannabidiol and Tetrahydrocannabivarin on Glycemic and Lipid Parameters in Patients With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Pilot Study. Diabetes Care. 2016;39(10):1777-86.

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Dear Mark: Protein Efficiency in Seniors, Earned Carbs, Hardgainer with Limited Time

For this week’s edition of Dear Mark, I’m answering three questions from readers. First, is the reduced protein efficiency in older adults due to inactivity, or is it something inherent to the aging process, or both? Second, how does a person know if they’ve actually “earned” any carbs? Does everyone on a keto diet earn carbs by virtue of exercising, or is there more to it? And finally, how can a hardgainer with a packed schedule all week long and limited gym time maintain what little muscle mass he’s managed to gain?

Let’s find out:

Interesting observation on protein needs and training in Sunday with Sisson – general consensus is that older folks need more protein as they age but maybe that’s because they are less active and not simply a result of aging.

That’s probably part of it, but it’s not all of it.

In studies where they compare resistance training seniors who eat extra protein with resistance training seniors who don’t, only the seniors eating extra protein gain muscle mass.

Now, it may be that a lifetime of inactivity degrades your ability to utilize protein, and if these older adults had always lifted weights they would have retained their protein efficiency. But maybe not. As it stands, all else being equal, an older adult needs more protein to get the same effect, even if he or she is lifting weights.

Enjoyable read. As someone who lives a ketogenic lifestyle, and who is athletically active, I am not sure exactly how to go about consuming the carbs I’ve “earned.” I rarely run into problems with athletic energy, at least not below anaerobic threshold. Not sure that eating more carbs will improve my performance. And, if they would improve my performance, how does one go about calculating earned carb replacement without losing the fat burning benefits of ketosis?

It sounds like you’re in a good place.

When I say “eat the carbs you earn,” I’m talking to the people who do run into problems with athletic energy, poor performance, insomnia, and other symptoms of exercise-induced stress. Typically, the people who “earn their carbs” are doing stuff like CrossFit, high volume moderate-to-high intensity endurance work, martial arts training, and team sports.

I doubt extra carbs will improve your performance if most of your training takes place in the aerobic zone. But if you wanted to experiment, you could try a small sweet potato immediately after a workout where you passed the anaerobic threshold.

That’s the best way to determine if you’ve earned carbs. Eat 20-30 grams after a workout and see if you enjoy performance gains without gaining body fat. There’s no consumer-friendly way to directly calculate carb debt; self-experimentation is it.

I recently took a job that has me out of bed at 4am and not home until 6pm Monday Through Friday. Is there an efficient way I can maintain muscle mass only lifting weights Saturday and Sunday? I’m a hardgainer at 5’10” and only 140lbs. I’m afraid giving up my 5 day split will ruin what muscle I’ve been able to gain.

Any hardgainer has to eat, and eat, and eat. Increase your food intake. Just eat. Stick to healthy Primal fare, but pack in the food. Meat, milk, veggies, potatoes, rice, eggs, avocados, fruit. Throw some liver in, too (old bodybuilder staple). It doesn’t sound like fat gain is an issue for you, so I’d take advantage of that and just consume calories.

As for training, get some exercise snacks in during the week.

As soon as you wake up, do a quick superset of pushups. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. There you go. That shouldn’t take more than 5 minutes in the morning. Can you squeeze that in?

Repeat this every morning with a different exercise. Pullups, bodyweight rows, kettlebell swings, handstand pushups, dips, bodyweight squats, goblet squats, reverse lunges, reverse weighted lunges. Just choose one thing to do every morning, cram as many reps as you can using the same format (max reps, 30 s rest, max reps, 30 s rest, max reps). Buy any equipment you can if you choose to use weights.

When you get home at night, do the same thing with a different exercise. Morning pushups, evening KB swings, etc. That way, you get about 10 minutes per weekday of intense strength training without impacting your sleep or schedule in any real meaningful way.

Make sure your sleep hygiene is rock solid. Dim those lights at night, turn on f.lux or night mode, wear the blue blocking goggles, get to bed (ideally) by 8:30, 9 to give you 7 to 7.5 hours of sleep. Sleep is essential for gaining lean mass (and staying healthy in general).

On the weekend, hit the weights hard on both days, hitting the entire body. Go high volume/reps. If size is your goal, dropping the weight a bit and focusing on range of motion and a high rep count (10-15 per set) is very effective.

Food, sleep, reps. Good luck!

Thanks for stopping in today, everybody. Additional thoughts for these folks—or questions of your own? Share them below.

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References:

Tieland M, Dirks ML, Van der zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713-9.

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My Favorite Way To Play: Ultimate Frisbee Workout (with Video)

I’m a believer in working hard AND playing hard. When we get stuck in patterns of overwork and overstress, we lose the important connection with our creative, intuitive, playful selves. Our work suffers and so does our happiness (which means everything else, like our relationships, will, too). Stuart Brown, one of the world’s leading experts on play, calls play a “profound biologic process.” What we all know (or used to know until modern living helped us forget) is that play is an essential component of our physical development and general well-being. From a personal standpoint, the older I get the more I recognize play as the linchpin for my own sense of vitality. As a result, I prioritize play—even above exercise. Fortunately, however, I’ve grown into a new relationship with fitness as a result of play. I gave up the slog of grueling training regimens decades ago now, but to this day I’m still living more deeply into a play-based fitness vision. Let me show you a bit of what that looks like for me….

You all have heard me talk about Ultimate—probably as long as Mark’s Daily Apple has been around. The fact is, it’s as thrilling for me today as it was twelve years ago. Nothing else quite combines the diversity of essential movement and the heart of play like Ultimate does. In a single hour, I’m getting regular sprinting, lateral movement, agility training, recovery phases, and mind-body coordination to skillfully throw, catch and move on the field. I love the intense challenge and fast pace of the game.

Ultimate plays very similarly to rugby or football. The field has two end zones, and a team scores by catching a pass in the defensive team’s end zone. The defending team performs a “pull” (think “kickoff” in football) to start the match (and after every subsequent point scored). The offense moves the disc by passing to teammates in any direction. Once a player catches the disc, he must come to a stop as quickly as possible. From this position, he can only move his non-pivot foot. A player has ten seconds to throw the disc after catching it.

The disc changes hands either by turnover or after a score. A turnover occurs when a pass is not completed, intercepted, dropped, blocked, held for longer than the allotted ten seconds, or thrown out of bounds. The defending team assumes control of the disc immediately following a turnover, from wherever the disc lands on the field. There is no stoppage of play (unless a foul, injury or bad weather occurs).

From a physical standpoint, you’re out there running, leaping, twisting, grabbing, throwing, and bumping into other players. You use practically every muscle in the body (if you’re not, you’re doing it wrong) and, rather than long protracted runs, you engage in short bursts of speed and activity punctuated by walking and brief jogging (almost like you’re on the hunt). Not only does it take keen, quick thinking, remarkable agility and throwing accuracy, and raw athleticism, but it also promotes good teamwork and sportsmanship. In fact, Ultimate has an official “Spirit of the Game” (SOTG), a sort of mission statement that stresses sportsmanship and honor. Highly competitive play is condoned, but not at the cost of general camaraderie. Everyone is out there to have a good time and get some great exercise.

Check it out.

Want more ideas for active play? Here you go.

And for more on the importance of play for a Primal Blueprint lifestyle, check out these resources.

Now you tell me: what’s your favorite way to play? How do you merge the Primal goals of mobility and fitness with everyday enjoyment? Thanks for stopping in today.

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Glute and Hamstring Workout

Jessica Gouthro from Paleohacks is joining us today to offer tips for strengthening glutes and hamstrings without traditional gym equipment. Enjoy, everyone.

Strong glutes and hamstrings are more than just nice-looking legs and a booty.

The glutes and hamstrings are the strongest muscles in our skeletal muscular system. When we strengthen these muscles, we can prevent strain and injury while also enjoying a greater ability to squat deeper, lunge pain-free, push heavy objects, run faster and jump higher.

To best train those glutes and hamstrings, you’ll want to emphasize both leg curling (knee bending) and hip extension (or straightening) actions for balanced training. One of the best exercises that do this is the glute ham raise, or GHR.

Very few exercises can isolate the hamstrings and glutes without top-loading excess weight on the spine or testing your grip strength with a loaded barbell. Although you may think this exercise looks easy in comparison to a Barbell Romanian Deadlift or Hip Thrust, it is just as challenging (if not even more so) when performed correctly.

What Is a Glute Ham Raise?

A glute ham raise is an eccentric, or muscle lengthening, exercise that involves a fixed location of the feet, ankles, and hips and a hinge only at the knee joint. By securing the foot position and starting with a bent knee, we enable the hamstring to lengthen eccentrically against gravity using only our own body weight.

Rising back up to the starting position is done by a combination of hamstring contraction and assistance from the upper body pushing against the floor.

Typically, this exercise utilizes specialized equipment called a GHR machine (pictured) that can hold your feet and ankles in place and cushions your knees with a curved, shaped knee pad.

Since you may not have access to one of these in your home or gym, we have a great alternative you can do with a partner. All you need is a friend and a rolled-up towel to cushion your knees!

Partner Assisted Glute Ham Raise | 6 reps

Kneel down on a rolled-up towel. Tuck your toes under and straighten your hips. Lift your hands up in front of your shoulders and tighten your core.

Have your partner press down firmly on your ankles to secure your position. Keeping your hips and glutes tight, inhale as you slowly lean forward, hinging only at the knees.

Once you can no longer control the descent, use your hands to catch yourself and lower the rest of the way down. Push into the floor with your hands, and on an exhale, contract your glutes and hamstrings to rise back up to the starting position.

Complete six reps while your partner holds your ankles steady.

Note: This is an advanced exercise. If you find this exercise too challenging and cannot complete six good reps, you can try this next partner-assisted resistance band hamstring curl exercise as an alternative.

Partner-Assisted Kneeling Band Hamstring Curl | 8 reps per leg

Kneel down on a rolled-up towel, tuck your toes under, and get into an all-fours position. Extend one leg straight out behind you.

Have your partner loop a resistance band around your heel, just above your shoe. As your partner holds her end of the resistance band tight, bend your knee to curl your heel towards your butt.

Exhale and hold momentarily at 90 degrees, then slowly straighten to return to the starting position. Continue to bend and straighten your knee while maintaining that lifted leg position. Complete eight reps, then switch sides.

Note: You will feel this in your glutes on both sides as well as in your hamstring.

In case you don’t have a partner available, here are the five best glute and hamstring exercises you can do anywhere, by yourself. You’ll need a yoga mat, a towel, and an exercise band.

To get the most out of your efforts, I recommend performing all of these exercises at least two to three times per week.

Fire Hydrant | 10 per side

Kneel down in an all-fours position with your feet flexed (toes pointing to the floor). Lift one knee up and out to the side to hip height. Exhale at the top as you flex your glute muscles, then lower back down with control. Maintain a steady torso and upper body as you focus on contracting your glutes.


Complete 10 reps on one side, then switch to the other leg.

Note: Work slowly to ensure quality muscle contractions. Pause each time you hit the top and strongly contract your glutes. You’ll feel this on both sides, even though you’re working one side at a time.

Towel Slide Hamstring Curl | 8 reps

Sit at the bottom edge of your mat with the full length of your legs on a smooth surface floor, like hardwood or tile.
Lie down flat on your back and press your palms into the floor by your hips.

Place your heels on a towel and keep your feet flexed. (If you are working on carpet, use a piece of paper or two paper or plastic plates instead of a towel.)

Engage your glutes and lift your hips off the ground. On an exhale, bend your knees to slide the towel towards your butt. Stop when your knees reach a 90-degree bend. Inhale, and reverse by sliding back out to a straight body.

Complete eight reps, keeping your hips elevated the entire time.

Single Leg Toe Touch | 6 reps per side

Stand tall with your core tight and shoulders rolled back and down. Balance on one foot as you float the other just off the ground.

Inhale to hinge at the hips to tilt forward until your torso and top leg are parallel to the ground. Keep a slight bend in your standing leg and reach your fingertips towards your toes. Exhale to lift back up to standing, contracting your muscles.

Complete six reps per side.

Note: Keep your gaze on the ground to help with balance. If balance is still a challenge, you may hold onto a wall or chair with one hand while you do these reps.

Single Leg Balance Hamstring Curl | 6 reps per side

Balance on one leg with your torso and lifted leg parallel to the ground. Keep a small bend in your standing leg, and grab onto your quad for stability. On an exhale, curl your top leg towards your butt, while maintaining your hip and torso position.


Inhale to straighten your leg, reaching it out long behind you.

Continue six reps on one side, then complete six reps on the other side.

Single Leg Resistance Band Ham Curl | 6 reps per side

Slide one end of your loop resistance band underneath your left heel, pressing down with your heel to secure its position.

Lift your right leg. Loop your right heel through the other end of the band, positioning it on the back of your shoe. Place both hands on your left knee and hinge at your hips with your spine straight.

Exhale to bend your right knee to 90 degrees, then inhale as you lower back down with control, maintaining a small amount of tension on the band so it does not come loose. Your range of motion should be about eight to 10 inches.

Complete six reps, then switch sides.

Note: Hold onto a wall or a chair for balance if you need to.

How To Incorporate This Weekly Workout

Here’s a sample workout you can incorporate into your weekly routine.

Warm up with three minutes of light walking or jogging. Follow with three rounds of the circuit of seven exercises, resting for 10-30 seconds between exercises depending on your fitness level.

Note: Beginners can do just one round and work up to three rounds after a few weeks.

  • Partner-Assisted Glute Ham Raise [OR] Partner Assisted Kneeling Band | 6 reps
  • Hamstring Curl | 8 reps per leg
  • Fire Hydrant | 10 per side
  • Towel Slide Hamstring Curl | 8 reps
  • Single Leg Toe Touch | 6 reps per side
  • Single Leg Balance Hamstring Curl | 6 reps per side
  • Single Leg Resistance Band Ham Curl | 6 reps per side

Thanks again to Jessica Gouthro for these tips and to Brad Gouthro for demonstrating them. Be sure to check out Jessica’s other workout lineups on MDA:“Arm Workout Without Weights,” “13 Ways To Move More At Work” and “10 Moves To Help Ease Joint Pain.”

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

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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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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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