blood sugarWhat’s sweet, red, sticky, and deadly?

Blood sugar. (I’m sure there are other things that qualify, but most of them contain sugar of some sort so I’m sticking with it.)

Too little of it, and you go into hypoglycemic shock. That can kill you if left untreated.

Too much of it, and you waste away slowly. Chronic overexposure to sugar will degenerate your tissues and organs.

Yes, getting blood sugar right is extremely important. Vital, even.

Today, I’m going to explain how and why we measure blood sugar, what the numbers mean, why we need to control it, and how to maintain that control.

First, blood sugar is tightly controlled in the body. The average person has between 4-7 grams of sugar circulating throughout their body in a fasted state—that’s around a teaspoon’s worth. How does that work when the average person consumes dozens of teaspoons in a single day?

Again, it’s tightly controlled.

The majority of the sugar “in our system” is quickly whisked away for safekeeping, burning, or conversion. We store as much of it as glycogen in our liver and muscle as we can. We burn some for energy. And, if there’s any left over, we can convert it to fat in the liver.

But sometimes, sugar lingers. In diabetics, for example, blood sugar runs higher than normal. That’s actually how you identify and diagnose a person with diabetes: they have elevated blood sugar.

There are several ways to measure blood sugar.

  • The basic finger prick: Prick your finger, produce a few drops of blood, place blood on test insert, test blood sugar level. It’s the most common method.
  • Fasting blood sugar: Your blood sugar level when fasted. These tests are usually taken first thing in the morning, because that’s the only time most people haven’t eaten in the last few hours. “Normal” is under 100.
  • Postprandial blood sugar: Your blood sugar after eating. These tests measure your blood sugar response to food; they also measure your ability to dispose of blood glucose.
  • HbA1C: Average blood sugar over 2/3 months. HbA1c measures the degree of glycation of your red blood cells’ hemoglobin; this is an indirect measure of how much blood sugar your cells are exposed to over time, since a red blood cell that’s exposed to more sugar in the blood over its life cycle—2-3 months—will have more glycation. Thus, A1c seeks to establish the average level of blood sugar circulating through your body over the red blood cell’s life cycle, rather than track blood sugar numbers that rapidly fluctuate through the day, week, and month. It’s a measurement of chronic blood sugar levels, not acute.
  • The continuous glucose monitor: A wearable device that measures your blood sugar at regular intervals throughout the day and night. This is becoming more common. The beauty of the CGM is that you get a visual display of blood sugar’s rise and fall throughout the day in response to meals, workouts, fasts, stress, etc. Since elevated blood sugar does its damage over the long term, seeing the entire daily trend is more illuminating than taking single snapshots with a finger prick. It’s similar in power to HbA1c, only with greater accuracy.

What’s Normal?

According to the American Diabetes Association, any fasting blood sugar (FBG) under 100 mg/dl is completely normal. It’s safe. It’s fine. Don’t worry, just keep eating your regular diet, and did you get a chance to try the donuts in the waiting room? They only start to worry at 110-125 (pre-diabetic) and above 125 (diabetic).

This may be unwise. Healthy people subjected to continuous glucose monitoring have much lower average blood glucose—89 mg/dl. A 2008 study found that people with a FBG of 95-99—still “normal”—were 2.33 times more likely to develop diabetes in the future than people on the low-normal end of the scale.

As for postprandial blood glucose, the ADA likes anything under 140 mg/dl.

How about HbA1c? A “normal” HbA1c is anything under 5.7. And 6.0 is diabetic. That’s what the reference ranges, which mostly focuses on diabetes. What does the research say? In this study, under 5 was best for heart disease. In this study, anything over 4.6 was associated with an increased risk of heart disease.

That 5.7 HbA1c isn’t looking so great.

What’s “normal” also depends on your baseline state.

Healthy FBG depends on your BMI. At higher FBG levels, higher BMIs are protective. A recent study showed that optimal fasting blood glucose for mortality gradually increased with bodyweight. Low-normal BMIs had the lowest mortality at normal FBG (under 100), moderately overweight BMIs had the lowest mortality at somewhat impaired FBG (100-125), and the highest BMIs had the lowest mortality at diabetic FBG levels (over 125).

If you’re very low-carb, postprandial blood glucose will be elevated after a meal containing carbs. This is because very low-carb, high-fat diets produce physiological insulin resistance to preserve what little glucose you have for the tissues that depend on it, like certain parts of the brain. The more resistant you are to insulin, the higher your blood glucose response to dietary glucose.

HbA1c depends on a static red blood cell lifespan. A1c seeks to establish the average level of blood sugar circulating through your body over the red blood cell’s life cycle, rather than track blood sugar numbers that rapidly fluctuate through the day, week, and month. If we know how long a red blood cell lives, we have an accurate measurement of chronic blood sugar levels. The clinical consensus assumes the lifespan is three months. Is it?

Not always. The life cycle of an actual red blood cell differs between and even within individuals, and it’s enough to throw off the results by as much as 15 mg/dl.

Ironically, people with healthy blood sugar levels might have inflated HbA1c levels. One study found that folks with normal blood sugar had red blood cells that lived up to 146 days, and RBCs in folks with high blood sugar had life cycles as low as 81 days. For every 1% rise in blood sugar, red blood cell lifespan fell by 6.9 days. In those with better blood sugar control, RBCs lived longer and thus had more time to accumulate sugar and give a bad HbA1c reading. In people with poorer blood sugar control, red blood cells live shorter lives and have less time to accumulate sugar, potentially giving them “better” HbA1c numbers.

Anemia can inflate HbA1c. Anemia depresses the production of red blood cells. If you have fewer red blood cells in circulation, the ones you do have accumulate more sugar since there are fewer cells “competing” for it. Anemia isn’t anything to sniff at, but it does throw off HbA1c.

Hyperglycemia and Health

Okay, is hyperglycemia actually a problem? I’ve heard some suggest that hyperglycemia is a marker of poor metabolic health, but it’s not actually causing anything bad itself. I agree with the first part—hyperglycemia indicates poor metabolic health and is a risk factor for things like heart disease and early mortality—but not the last. Indeed, hyperglycemia is both an effect and direct cause of multiple health issues.

Most cell types, when faced with systemic hyperglycemia, have mechanisms in place to regulate the passage of glucose through their membranes. They can avoid hyperglycemic toxicity by keeping excess sugar out. Other cell types, namely pancreatic beta-cells, neurons, and the cells lining the blood and lymphatic vessels, do not have these mechanisms. In the presence of high blood sugar, they’re unable to keep excess sugar out. It’s to these three types of cells that hyperglycemia is especially dangerous.

Unfortunately, these are all pretty important cells.

What happens when too much glucose makes it into one of these cells?

Reactive oxygen species (ROS) generation is a normal byproduct of glucose metabolism by the cell’s mitochondria. If the stream of glucose into the cell is unregulated, bad things begin to happen: excessive ROS, a mediator of increased oxidative stress; depletion of glutathione, the prime antioxidant in our bodies; advanced glycation endproduct (AGE) formation; and activation of protein kinase C, a family of enzymes involved in many diabetes-related complications. It’s messy stuff.

How does this play out in the specific cell types that are susceptible, and what does it mean for you?

Pancreatic beta-cells: These cells are responsible for secreting insulin in response to blood glucose. They essentially are the first line of defense against hyperglycemia. If maintained for too long or too often, hyperglycemia inhibits the ability of pancreatic beta-cells to do their job. For instance, type 2 diabetics have reduced pancreatic beta-cell mass; smaller cells have lower functionality. Mitochondrial ROS (often caused by hyperglycemia) also reduce the insulin secreted by the cells, thereby reducing their ability to deal with the hyperglycemia and compounding the initial problem.

Neurons: The brain’s unique affinity for glucose makes its glucose receptor-laden neuronal cells susceptible to hyperglycemia. It simply soaks up glucose, and if there’s excessive amounts floating around, problems arise. Hyperglycemia is consistently linked to cognitive impairment, causes the shrinking of neurons and the inducement of spatial memory loss, and induces neuronal oxidative stress. It also impairs the production of nitric oxide, which is involved in the hippocampus’ regulation of food intake.

Endothelial cells: Flow mediated dilation (FMD) is the measure of a blood vessels’ ability to dilate in response to increased flow demands. Under normal conditions, the endothelial cells release nitric oxide, a vasodilator, in response to increased shear stress. Under hyperglycemic conditions, nitric oxide release is inhibited and FMD reduced. A decreased FMD means your endothelial function is compromised and strongly predicts cardiovascular events (PDF) and may cause atherosclerosis (PDF).

Electrolyte depletion: Persistent hyperglycemia can cause the body to shed glucose by urinating it out. In doing so, you also end up shedding electrolytes.

Okay, okay. Controlling your blood sugar is important. Avoiding hyperglycemia is one of the most important things you can do for your health and longevity. How do I do it?

How to Improve Blood Sugar

  • Go for a walk. A short walk after eating will reduce blood sugar. Fifteen minutes is probably enough (although more is always better).
  • Eat vinegar before. Eating vinegar before a meal that contains carbohydrates will improve the blood glucose response to that meal.
  • Exercise. Exercise depletes muscle glycogen, which opens up storage depots for incoming glucose. If glucose is converted to glycogen and deposited in your muscles, your blood glucose will normalize. Pretty much any kind of exercise works.
    • Sprint and/or intervals. A review looked at the blood glucose responses of diabetics (type 1 and type 2) to “brief high intensity exercise,” as which sprinting definitely qualifies, finding that although glucose was elevated immediately post workout, blood glucose control is improved for one to three days following a sprint session. Research finds that endurance training works, too, but sprinting may work faster and better.
    • Steady state endurance. Then again, steady state endurance training was just as effective as sprinting at reducing glucose variability and improving glucose spikes in overweight women. There was no difference between the two—both beat doing nothing.
    • Resistance training.
    • All of the above. As different types of training target different tissues, deplete glycogen at different rates, and induce different metabolic effects, doing sprints, weights, and low level aerobic activity is your best bet for improving glucose control.

When I take a bird’s eye view of all this, the best glucose-lowering exercise is the one you’ll do on a regular basis. It’s all good.

  • Avoid unnecessary carbohydrates. Carbs you earn through glycogen-depleting exercise will not contribute to hyperglycemia. Those are “necessary,” or at least “earned.” Carbs you didn’t earn will contribute to hyperglycemia. A surefire way to avoid hyperglycemia is to avoid the foods that induce it—carbs.
  • Eat more protein and fat, fewer carbs. This is a simple one for most of you guys, but many people never consider it. A basic swap of whole eggs (or egg whites) for carbs reduces not just postprandial glycemia but also endothelial dysfunction.
  • Get enough sleep. Sleep deprivation increases blood glucose variability and impairs regulation.
  • Eat fermented dairy. Kefir improves glycemic control in patients with type 2 diabetes. Yogurt does too. Cheese is also associated with better glucose control.
  • Use spices. Spices can have profound anti-hyperglycemic effects.

If you’re low-carb or keto and need to pass a glucose tolerance test, eat 150-250 grams of carbs per day in the week leading up to the test. This will give you a chance to shift back into sugar-burning mode.

Long Term Blood Glucose Control?

Consistency is everything. Consistently doing all the little tips and hacks we just went over that lower blood sugar in the moment will lead to long term blood sugar control. If you take vinegar before and walk after every single meal for the rest of your life, you will control postprandial blood sugar. If you avoid excess carbohydrates, you will exert long-term control over blood sugar levels. If you exercise 3-4 times a week and get plenty of low-level activity, you’ll be much less likely to have hyperglycemia.

Thus concludes the Definitive Guide to Blood Sugar. If you have any questions or comments, drop them in down below. Thanks for reading!


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We didn’t set out with the intention, but somehow it happened. Keto For Life was assigned a release date of New Year’s Eve—tomorrow, in fact. While there’s never a wrong day to go keto, my writing partner, Brad Kearns, and I felt like the stars aligned. Just when countless people are taking stock at the turn of new decade, wondering what might be possible in their lives, this message would be there. And while a lot of books will be there, too, with promises of weight loss and fitness and wellness, I have to say (biased as I may be) that Keto For Life offers something unique and sustainable among the typical cacophony of health tracts.

While I’ve shared its premise and outline on the blog, today I’m taking up some questions readers have shot my way over the last few weeks. What does it cover that other books haven’t? Does it offer a new take on longevity? How do other principles come into play beyond diet? I’m covering all that and more.

How does Keto For Life differ from The Keto Reset Diet?

Since the start of Mark’s Daily Apple, my core purpose has been to present a counter-argument against flawed and dated conventional wisdom. On the blog here and in my books beginning with The Primal Blueprint in 2009, I’ve focused on presenting the scientific rationale and practical steps for how to escape carbohydrate dependency and become fat- and (more recently) keto-adapted. I’ve made the case for rejecting the “struggle and suffer “ethos of chronic cardio in favor of a Primal approach emphasizing comfortable paced movement and aerobic workouts, lifting heavy things, and sprinting once in a while. And, finally, I’ve emphasized the non-negotiable importance of complementary lifestyle behaviors like getting enough sleep, sun, and play.

All of us in the ancestral health space have been heartened to see how far we’ve come in the past decade. Many ancestral health principles have been widely validated by science and accepted into mainstream culture in a relatively short amount of time. Back in 2009, it was hard to find someone who had any awareness of Primal/paleo/low-carb eating (including major New York publishers—that’s why I had to start Primal Blueprint Publishing!). Today, it’s a different ball game. The movement’s growth over the past decade has allowed discussion to refine and advance. Without the need to push just the basic premise, there’s been more momentum around deeper, more productive levels of personal customization. The keto and carnivore diets are examples of these ancestral offshoots.

The Keto Reset Diet was one of the first comprehensive books published on the subject, but it’s primarily a diet book—how to proceed in a comfortable step-by-step manner to embrace the ketogenic diet without the risk of backslide and burnout that comes with an ill-advised approach. It does cover the complementary exercise, sleep, and stress management practices that support your dietary goals, but the central focus is on introducing the ketogenic diet to the masses.

Keto For Life picks up where The Keto Reset Diet left off by having you leverage the metabolic flexibility you attain from keto efforts and applying it to the ultimate goals of living long and living awesome. In particular, it integrates the critical components of mindfulness, social wellness and emotional well-being for enhancing longevity and enjoying a fulfilling life. It moves beyond the core ancestral health message of “mechanics”—mechanics of eating the right foods, of doing the right workouts, of quantifying everything and checking every box…but with that potential big void of “Are we having fun yet?” Keto For Life leads with life. The focus is squarely on the good, long life we all hope to achieve.

What Does Keto For Life have to say about longevity?

We played around with using the term “longevity” in the title, but who cares about longevity by itself? Today, most people can make it to the average U.S. life expectancy of 79, but too many limp to that finish line, having endured decades of pain, suffering and limitation. The United States ranks 26th out of 35 economically advanced nations in life expectancy, a pathetic showing for the richest and most medically advanced nation in the history of humanity. In Keto For Life, we tackle the goal of healthspan, which conveys both living long and living awesome. Healthspan entails not just checking all the boxes of healthy foods, exercise output and sleep hours; it also means having fun and finding fulfillment along the way. With the Four Pillars of Keto Longevity, we incorporate healthy eating, movement and physical fitness with the concepts of Mental Flexibility and the often-overlooked pillar of Rest and Recovery.

How does compressed morbidity fit in here?

Compressed morbidity describes being healthy, strong and cognitively sharp for as long as possible. Then, by the time the natural inevitabilities of chronological aging come into play, the end is quick and peaceful. Brad’s father Dr. Walter Kearns was a stellar example of this concept. He passed in May of 2019 at the age of 97. Ninety-five of his years were characterized by exceptional mental and physical function. A champion golfer for his entire life, Walter shot below his age over 1,2000 times, including shooting an even par 71 at age 87 and a 76 at the age of 92. Walter was a general surgeon who continued to serve as a physician for decades after closing his private practice. He worked for the Indian Health Service into his late 70s, and volunteered at a weekly diabetes clinic until he was 95. In his final two years, Walter’s cognitive and physical performance started to decline. His golf outings went from 18 holes for money to casual 9-hole outings, and eventually to hitting chip shots in the backyard. He started to take longer naps, eat less food, have longer nights of sleep and shorter walks at the park. Soon, the day came for him to pass peacefully at home, with none of the drama, suffering, or family fatigue of someone paying the price for decades of adverse lifestyle practices with chronic disease patterns.

Going for compressed morbidity is about keeping muscle mass on your body (promoting a concept called organ reserve I’ve discussed at length in The Primal Blueprint and on the blog) as well as your brain! In a pattern that appears often in the book, the Four Pillars are complementary here. Eating an ancestral-style diet in general and making a devoted effort to become keto-adapted (even if you don’t stay in strict keto over the long-term) strongly supports cognitive function. You may have heard the disturbing new nickname for the assorted cognitive decline conditions that are growing at epidemic rates: Type 3 Diabetes. This term was coined by noted researcher Dr. Suzanne de la Monte of Brown University, conveying how cognitive decline is marked by dysfunctional glucose metabolism in the brain. As de la Monte explains, cognitive disease “has molecular and biochemical features that overlap with both type 1 and type 2 diabetes.”

We hear sound bites about doing Sudoku to ward off dementia, but I go far deeper in this book. Extensive research shows us how a vibrant social network, a strong sense of purpose, and a positive self-perception about aging drive healthy cognitive function and extended lifespan. One longitudinal study from Yale tracked a group of 50+ people in Ohio for two decades, revealing an amazing result: Those with a positive self-perception about aging lived 7.5 years longer than those with negative self-perceptions about aging! This tidbit earned distinction as the lowest hanging fruit in the entire book to quickly add years to your life. The longevity champs in Okinawa also get recognition here for their emphasis on yuimaru, a deep sense of social obligation to family, friends, and neighbors. One of the most revealing longevity stats you will ever find is that Okinawan’s who leave the island live 20 years less than those who spend their entire lives on the island.

What’s the #1 quick takeaway from the Mental Flexibility pillar?

“Pivot.” Is that quick enough for you? Thanks for asking. Next question.


I can’t think of a more powerful word to convey the secret to experiencing a life filled with happiness, contentment, purpose, and meaning. I credit the ability to pivot as the key to my entrepreneurial success, and also to my ability to sustain a respectable level of work-life balance. As I shared in my introductory post about the book, pivoting describes being able to go with the flow when facing life change. Pivoting is accepting failure and setbacks with grace and resilience instead of allowing bad stuff to bury you. Pivoting is also knowing when to hold ‘em and when to fold ‘em. It’s impossible to be perfect here, but at least you can be honest with yourself. I share my own experiences of failing but embracing of this strategy in the book.

Pivoting into discomfort by being more honest, more vulnerable, less reactive, and less predictable can be the foundation of emotional resilience as well as solid relationships. Gratitude helps a great deal here. If you can start from a place of appreciation for your current circumstances and connections, whatever they are (if you’re reading this it could be worse, right?), you’re ahead of the game.

Whether you’re new to the Primal scene or you have a stack of well-read books on your shelf, I think you’ll find that Keto For Life breaks new ground and offers the most holistic and actionable resource for creating greater vitality and a happier, healthier and more fulfilling life. The official release date is tomorrow, December 31st, and I’m still offering up a preorder incentive of premium bonuses. Learn more and order through your favorite retailer HERE.

Thanks for reading, everyone. I’m thrilled to begin a new decade with you all this week. See you on the other side of it tomorrow.


The post Keto Q&A: Diving Into Keto For Life appeared first on Mark’s Daily Apple.

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Many people get to age 60 or so and, if they haven’t lived a healthy, active life up to that point, assume it’s too late for them. After all, things only get harder the older you get. You’ve got aches and pains. Your doc is always reminding you about your weight. Things creak and crack. You look wistfully at the gym you pass by every day, thinking to yourself, “It would never work.”

At least, that’s how most people deal with getting old: they lament their “inability” to do anything about it as oblivion approaches and overtakes them.

Forget all that. While you can’t turn back the chronological clock, you can “de-age” yourself by engaging in the right diet, exercise, and lifestyle modifications. So—how?

Realize That It’s Never Too Late

The scientific literature is rife with examples of older individuals making changes to their lifestyle, diet, and exercise and seeing great results.

How about 68-year-olds still getting gains from strength training?

Older women switching to high-fatty-meat or high-cheese diets and enjoying better heart health.

Verifiable examples (or “anecdotes”) from people online are also available. Like PD Mangan, who went from this to this. That’s not impossible, or even difficult to achieve. What you need is the will and means and know-how—all freely available.

Know that it’s possible. Know that it’s probable. Know that your efforts will not be in vain.

Realize That It’s Your Fault—And Even If It’s Not, It’s Your Responsibility

I don’t care where you fall on the belief spectrum. It could be that “your body is a temple ordained by God and you’d be remiss to let it fall to ruin and in doing so fail your creator.” It could be that “your body was the work of hundreds of generations of ancestors who fought and suffered and scrounged and died to ensure you’d make it and to fail to maintain your health is a huge insult to their sacrifices.” It could be that “your body is the product of millions and billions of years of evolution through natural selection, a chance byproduct of a process that probability says shouldn’t have even happened, and you’re going to waste it?”

However you approach it, what matters is that you have a remarkable body (and mind) that deserves your attention, care, maintenance and nourishment. Only you can do anything about it. Maybe you were fed bad food as a kid and bad info as an adult (this is most people). Doesn’t matter. You still have to own it and take the steps necessary to improve your condition. Responsibility means ability to respond. Claim it.

Eat More Protein

If you’re over 50, you need more protein than you think.

If you’re over 50, your ability to utilize protein isn’t as good as it used to be.

If you’re over 50, you need more protein to do the same job as a person 25 years younger.

If you’re over 65, the supposed negative relationship between meat and mortality the “experts” are always crowing about reverses, magically becoming a positive relationship.

And if one of your issues is trouble losing body fat, more protein will also help you beat back exaggerated hunger and keep food intake low enough to lose weight. Many people in the ancestral community don’t like acknowledging this, but it’s true for a great many people: protein is the most satiating macronutrient.

Moreover, protein will help you lose body fat and retain (and even gain) the all-important lean muscle mass. Losing muscle when you’re over 50 is harder and harder to recover from.

The only catch is that if one of your “aging-related maladies” is kidney failure, you may have to slow things down and keep your protein intake low to moderate. Emphasis on “may.” Check with your doctor if that’s the case.

Get As Insulin Sensitive As You Can

The relationship between insulin signaling and aging is a bit unclear. What we know is that people with higher insulin sensitivity live longer and healthier lives. We know that insulin resistance is strongly linked to most degenerative diseases, like cancer, diabetes, sarcopenia, and osteoporosis (to name only a few). But researchers are always oscillating between “cause” and “effect.” Is insulin resistance a cause or a sign of aging? Are insulin sensitive people healthier into old age because they’re insulin sensitive, or are they insulin sensitive because they’re healthier?

I’m not sure it really matters. Either way, to become more insulin sensitive you have to do a bunch of things that will also make you healthier and age better like lifting weights, quitting overeating, taking more walks, doing more low level aerobic work, and regulating your carb intake.

I’ve always said that you should burn as little glucose as possible. The more you can rely on stored body fat for energy and daily maintenance, the better. Well, the more insulin sensitive you are, the less insulin you’ll have blunting your ability to liberate stored body fat, the more fat you’ll burn and the better you’ll age.

Walk Every Day

One of my favorite predictors of mortality in older people is walking speed: they ask people to walk at their normal speed and then track how fast they go. The slower the walk, the higher their risk of dying earlier. It’s my favorite because it’s so elegant. And no, actively forcing yourself to walk more briskly when you get tested won’t increase your longevity. But if you get up and walk every single day, walking will be second nature. Your walking speed will increase naturally, and it’s the natural increase in walking speed that presages a longer, healthier life.

Walking will also force you to get out and see and experience the world. It’ll lower your fasting blood glucose and postprandial blood glucose (hint: walk after meals). It will introduce novelty to your life and in doing so extend your time horizon.

Eat Tons Of Collagen

Collagen improves skin health, elasticity, and reduces wrinkling. This might sound superficial, but altering those “surface level” signs of aging indicates that you’re also modifying the internal aging markers.

Another reason to up your collagen intake is to balance out the meat you’re eating. As an older person, you’ll need to eat more meat to counter your suboptimal protein utilization. That means you need to process more methionine, which requires more glycine, which comes from collagen.

The easiest way to get collagen and hit a few birds with one stone is to eat lots of collagenous meats—shanks, skin, knuckles, oxtails, ears, snouts, feet, tendons. That way you get your muscle meat protein and collagen protein. Collagen protein powder is another option.

Lift Heavy Things To Build Your Musculoskeletal System

Exercise isn’t just good for your muscles and your heart. It’s also the only reliable way to build and maintain bone mineral density. But in order for exercise to improve bone mineral density, it must satisfy several requirements. It should be dynamic, not static. It needs to challenge you. It needs to challenge your muscles. In other words, you need to lift (relatively) heavy things. You need to progress in weight, intensity, and duration. It should be “relatively brief but intermittent.” No long drawn-out sessions that do nothing but overwork and overtrain you. Keep it short and intense. Also, the exercise should place an unusual loading pattern on the bones. That could be different movements, or increased resistance, as long as you’re introducing something “new” to the body; don’t just do the same old weights forever. Finally, for exercise to improve bone mineral density it must be supported by sufficient nutrition, especially calcium, vitamin D, sufficient protein, and vitamin K2.

Develop Your Balance Yesterday

The number one cause of death and degeneration after age 70 is falling and breaking something. You step out of the shower, slip, and break a hip, then never recover. You step off a curb and fall on your knee, breaking your femur, and never recover. Avoid this at all costs. Improve your balance as soon as possible.

Get a slackline: Keep it low to the ground, have a partner to help, or use something like a walking stick to support you. Focus on simply balancing rather than trying to walk.

Try standup paddling: Not only is it a great workout and a great time, paddling forces you to balance—constantly. And as long as you can swim, falling is totally safe.

Walk on uneven surfaces (carefully): Go for hikes, walk in the sand or in the grass, walk along cobblestone streets, walk on slopes.

Walk along curbs (very carefully).

Wear footwear that is as minimalist as you can handle (or just go barefoot if you’re up for it): The bottom of the foot is loaded with nerve endings that inform you and guide your balance as you make your way through the world. They help you subconsciously make those micro-adjustments to your posture and body position that make up “good balance.” A big clunky rubber sole blocks that out and cuts you off from your body.

Play Every Day

They say that when you stop moving, you start dying. I say when you stop playing, you start dying. We see this in dogs; once a dog no longer wants to play, chase the ball, roughhouse, or do the things he or she used to love doing, they’re on the way out. I firmly believe the same is true for people—just spread out across a longer timeline.

So have fun. Play sports. Try Ultimate Frisbee (my favorite).

Don’t forget about the mental games. Game nights. Crosswords in the morning (that’s what I do). Play cards. Do a weekly poker night with friends and make it a potluck.

What I’m not saying is that doing the crossword will stave off Alzheimer’s or make you smarter. What it will do is send the message to your brain and body that “this person hasn’t given up.” Ideally, your physical play will train your muscles, bones, and balance—that way you can satisfy all those requirements and have fun doing it.

Don’t Do It Alone

If you’re an older person reading this and actually preparing to make the changes necessary to be healthy and vigorous, you are a rare bird. Most of your peers have given up. Most have resigned themselves to being less healthy and less vigorous with every passing day. Don’t let that happen. Enlist a friend, a loved one, a peer. Not only will it give you another person to play, train, and walk with, but it will help you stay the course and enjoy doing it. It will also save another person—or at least give them the best chance they’ve got.

Those are the big tips. There are others, though. And for anyone interested in better health and longevity and more life in the years you have, Keto for Life, offers more information than I could fit here. All the points I covered today and many more are fleshed out and expanded upon twenty-fold.

But if you just focused on these 10 tips, you’d be pretty far along on your way to health (no matter what age you are).

That’s it for today, folks. Take care, drop your own tips down below, and have a great Thanksgiving!


The post Late To the Healthy Living Game? 10 Essential Tips Making the Transition to Better Health appeared first on Mark’s Daily Apple.

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As we covered in Parts I and II of this series, during perimenopause and menopause women can experience a complex web of physical, psychological, and social symptoms.

The treatment usually prescribed by doctors, hormone therapy (HT), is controversial and not appropriate for some women. I won’t get into the HT debate here—Mark did a great job covering the pros and cons recently. Suffice it to say that HT isn’t the answer for everyone, and it’s not a panacea by any means.

Whether or not they choose to go the HT route, many women desire additional support during perimenopause and beyond. For the sake of keeping this post from becoming a novella, I’m going to focus on mind-body therapies today.

This is not meant to be an exhaustive list of nonhormonal options, nor is it meant to try to dissuade you from trying HT. That’s a decision you have to make for yourself with your doctor. The approaches below can be used alone or in combination with other modalities, including HT.

As with any medical-adjacent tools, if you are considering any of the options here, take the time to educate yourself, talk to your doctor, and find qualified practitioners to help you implement these practices.

A Note Regarding Research Evidence…

Because so many women are interested in complementary or alternative approaches, there’s a fair amount of research into nonhormonal treatments. There are also important limitations.

A lot of the randomized control trials—experiments that are best for establishing causal effects—are small. There is considerable variability in research design, so it’s difficult to generalize across studies.

Participants in these studies tend to be white and well-educated. Since there are cross-cultural differences in the experience of menopause, we shouldn’t assume that the findings apply to all women. Likewise, a lot of the research focuses on women with a history of breast cancer because HT is generally contraindicated in this population. While the results of these studies probably generalize to other women, it would be great to have more data.

Finally, vasomotor symptoms—hot flushes and night sweats—are studied more than other types of symptoms. Though they are the most common complaint, many women do not experience debilitating vasomotor symptoms. They might, however, experience mood fluctuations, depression, sexual issues, memory problems, and more. We know less about how these approaches might help those women.

Nevertheless, I’ll highlight some of the potentially fruitful avenues you might explore. When possible, I’ll focus on systematic reviews and meta-analyses. They pool the results of multiple smaller studies to help a more reliable picture emerge.

Cognitive Behavioral Therapy (CBT)

In CBT, individuals are encouraged to explore how their thoughts (cognitions) affect feelings, behaviors, and physical symptoms. With help, they change their thoughts or beliefs about a situation to help manage their responses and improve coping skills.

Although there isn’t a ton of research on CBT for menopause, available studies are very promising. Whether or not CBT reduces the actual number of hot flushes—and the data here are mixed—CBT should work by changing women’s perceptions of their hot flushes. Multiple studies do find that after CBT women view their hot flushes as interfering less with daily life. As expected, they are also less bothered by them.

Women who see themselves as having less control over their hot flushes also tend to experience more distress. Changing their perceived control could be an effective intervention for improving quality of life. Indeed, in one study, 95 women received either group-based or self-help CBT. After therapy they reported feeling greater control over hot flushes and having better coping skills compared to women in a no-CBT control condition. Further analyses showed that women’s beliefs about control and coping predicted how problematic they found their hot flushes to be. (Having more positive beliefs about how hot flushes affect sleep also helped.)

Women who participated in CBT also experienced fewer sleep issues and insomnia as well as fewer depressive symptoms and sexual concerns.  They also noticed less impairment at work. Positive results were found with in-person therapy, self-help programs, and telephone-based therapy. When studies included a follow-up assessment, the beneficial effects of CBT persisted for at least six months.

Mindfulness, Meditation and Relaxation Training

A cross-sectional study of 1744 women found that women with higher scores on a mindfulness assessment tended to report less severe menopausal symptoms. For women with higher life stress, this association was especially strong. The idea here is that when women are able to be present-focused and observe their symptoms without judgment, they are protected against some of the distress, and possibly the physical symptoms, associated with menopause.

Although some of the women in that survey are probably mindful by nature—lucky them—mindfulness is also a skill that can be learned and cultivated. Among the many reasons to do so, mindfulness and meditation training can apparently lessen menopausal symptoms.

For example, researchers assigned 110 women to either an intensive eight-week mindfulness-based stress reduction program or a control group. The women who received mindfulness training reported having less bothersome hot flushes, better sleep quality, less anxiety and stress, and greater overall quality of life compared to the control group. When the researchers followed participants over the next 11 weeks, these results persisted or became even stronger.

A few other studies found that women who receive mindfulness or meditation training report fewer and less bothersome hot flushes, improved sleep, and better psychological functioning, though the results have not consistently endured over time. However, when looking at more general relaxation training and paced breathing techniques, effects are minimal, at least for hot flushes.


An ethnographic study of nine female yogi masters concluded that they tend to skate fairly easily through menopause. The authors concluded that menopausal women should be encouraged to practice yoga. Of course, in addition to yoga, these yogi masters’ lifestyles included “healthy food habits, adequate sleep, and the use of nature cure techniques (i.e., fasting, detoxification, selection of suitable food products, and living in well-ventilated houses) that facilitated the art of living in tune with nature.” This sounds pretty great, but can we give really yoga all the credit here?

Probably not. However, two recent meta-analyses did conclude that yoga offers small but significant relief from symptoms of all types: vasomotor, psychological (including depression), somatic (including fatigue and sleep disturbances), and urogenital. Women also report better overall well-being and quality of life after receiving yoga training.

In one study, a group of breast cancer survivors received twelve weeks of yoga and meditation instruction, and they were encouraged to practice daily at home. Compared to women in a control group (no instruction), they reported fewer symptoms and improved quality of life at the end of the twelve weeks and again when asked three months later. A later analysis found that many of the effects were mediated by improved self-esteem in the yoga group.

Note that most of the individual studies are small, and they employ different types of yoga practices. This might be considered a strength insofar as different practices have been shown to work, or a weakness in that it’s not clear if one approach is particularly effective.


Cross-cultural surveys find that women who are more active tend to have an easier time with menopause. For example, two large surveys of Swedish women found that women who exercised at least once per week reported less intrusive symptoms than women who never exercised, and women who exercised more than three hours per week were significantly less likely to experience severe symptoms than their less active counterparts. Sedentary women in this Finnish study experienced more vasomotor, psychological, and somatic/pain symptoms than women who were at least somewhat active.

While promising, experimental studies have not yielded such favorable results. When women were assigned to “physical activity” conditions (often walking), some studies report improvements, but others find no improvements or even worsening symptoms (perhaps depending on women’s baseline fitness). Multiple reviews have concluded that there is no systematic effect of exercise, particularly not for vasomotor symptoms.

Does that mean menopausal women shouldn’t exercise? Obviously no. It’s clear that being active—or at least not being sedentary—is important for overall health, and it probably helps menopausal women through the transition. However, there isn’t enough research to know what types of exercise are most effective and when. Do the types of movement you enjoy and that make your body feel good.


A recent review concluded that acupuncture is effective for reducing vasomotor symptoms, both frequency and severity, as well as for improving quality of life. However, the reviewers also found that acupuncture was not reliably better than sham acupuncture where needles are inserted at points other than the prescribed pressure points and at a shallower depth—a placebo condition.


A handful of studies have shown that clinical hypnosis can reduce hot flush frequency and distress among breast cancer patients. Another study of 187 women without breast cancer found that women who received hypnotherapy had fewer, less severe, and less bothersome hot flashes, as well as improved sleep. These results were evident at the end of the five-week treatment protocol, and they remained or got stronger in the six-week follow-up period.

The Experts Weigh In…

In 2015, the North American Menopause Society released a position statement on nonhormonal management of vasomotor symptoms. Of the approaches discussed here, the only ones NAMS recommended based on the strength of the available evidence were CBT and hypnosis. Mindfulness-based stress reduction earned a “recommend with caution,” which means, “We think it might work, but the evidence isn’t conclusive.”

The others—yoga, exercise, relaxation and paced breathing techniques, and acupuncture—were not recommended. This does not mean they are not worth trying! It simply means that based on their standards, the evidence was not strong enough for the committee to conclude that they are likely to be effective treatments for vasomotor symptoms specifically. This says nothing about other types of symptoms, nor about general well-being or quality of life.

Mind-Body Therapy Pros and Cons

So where does this leave us? Each of these therapies shows promise for alleviating at least some symptoms of menopause. Moreover, all these therapies have the potential to improve overall quality of life, sleep, stress, and general health. While reading these studies, I did wonder whether some of the women felt better simply because they were investing time and energy in taking care of themselves. If so, is that a problem? I don’t think so. They are low-risk interventions with a lot of potential upside.

That said, these aren’t quick solutions. The effective mindfulness/mediation trainings included six to eight weeks of classes and multiple hours per week. Women practiced yoga for two to four months during the study periods. Hypnotherapy was five weeks or longer. It’s not clear what the minimum time frame is for each of these therapies to be useful, but they’ll certainly involve a time commitment that might not be practical for all women. However, yoga, mindfulness/meditation, exercise, and even CBT can all be practiced at home once you know the proper technique.

As I said at the beginning, this is not an exhaustive list of nonhormonal therapies. There are also various supplements that might help, as well as lifestyle modifications that most of you Primal-savvy readers are probably already implementing: eating a variety of nutrient-dense foods, getting plenty of sunlight, practicing good sleep hygiene, and nurturing social connections.

Whatever you choose, be patient. Don’t just focus on one symptom; focus on the big picture. Pay attention to how you’re feeling more globally. Consider that while an intervention might not hit its desired mark, it might help you in ways you didn’t expect.

Have you used mind-body techniques (these or others)? What’s been your experience? Share your insights and questions below, and have a great week, everyone.



Atapattu PM. Vasomotor symptoms: What is the impact of physical exercise? J SAFOMS. 2105 Jan-Jun;3(1):15-19.

Goldstein KM, et al. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric. 2017 Apr;20(2):178-182.

McMillan TL, Mark S. Complementary and alternative medicine and physical activity for menopausal symptoms. J Am Med Womens Assoc (1972). 2004 Fall;59(4):270-7.

Molefi-Youri W. Is there a role for mindfulness-based interventions (here defined as MBCT and MBSR) in facilitating optimal psychological adjustment in the menopause? Post Reprod Health. 2019 Sep;25(3):143-149

Moore TR, Franks RB, Fox C. Review of Efficacy of Complementary and Alternative Medicine Treatments for Menopausal Symptoms. J Midwifery Womens Health. 2017 May;62(3):286-297.

Sliwinski JR, Johnson AK, Elkins GR. Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind-Body Medicine to Improve Cognitive Performance. Integr Med Insights. 2014;9:17–23.

van Driel CM, Stuursma A, Schroevers MJ, Mourits MJ, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG. 2019;126(3):330–339.

The post 6 Mind-Body Approaches for Menopause appeared first on Mark’s Daily Apple.

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Today I’m overjoyed to announce the release of my latest, greatest, and certainly broadest attempt at a comprehensive plan to live long and live awesome: Keto For Life. The book’s official on-sale date is December 31, and—as tradition goes on Mark’s Daily Apple—I’m offering an incredible group of free bonus materials as a pre-order gift. Here’s a link where you can access your favorite online retailers to order, but know you can also visit your favorite brick and mortar bookstore to pre-order, too.

Folks, I know many of you have been here with me and the MDA community for enough years to remember how this all began with the Primal Blueprint. It’s been such an awesome journey—and one that keeps evolving in incredible ways. I genuinely feel like it’s all been leading toward this one. I’ve poured my personal experimentation and hard-gained insight into every book I’ve written, but this one feels, well, like a whole new level of inquiry and practice. Keto has kicked off not just a dietary trend the last few years but truly a whole new realm of scientific research. I’ve been knee-deep in it in writing this book, and I’ve not only delved into these revolutionary findings but have also taken the integration of keto science and Primal lifestyle principles to an entire new level. Let me tell you about it….

With ground-breaking connections for how keto and Primal principles can literally reset your biological clock, Keto For Life is a revolutionary gateway into eating and living for increased longevity and resilient vitality. With endless how-tos in every chapter, a 21-Day Biological Reset plan with multiple holistic lifestyle prompts for each and every day, and more than 80 delicious keto recipes, it’s a deeply comprehensive and fully actionable resource for living Keto For Life—and all it’s meant to be.

Longevity is about much more than just healthy eating. However, oftentimes when you’re stuck in the disease state of carbohydrate dependency, you might as well forget about other lifestyle strategies until you can escape that certain destiny of pain, suffering, accelerated aging and disease. If you’re an ancestral health enthusiast, you likely realize the amazing health awakening that comes when you upregulate your fat burning genes and get off the carb dependency train. Favorable blood test values, dropping excess body fat, and escaping the common problems of energy, mood and appetite swings are indications that your metabolic flexibility is robust. While Keto For Life dutifully cleans up some of the misconceptions, hype, and misinformation that have come with the explosive popularity of keto, I’m expanding the entire picture into “Four Pillars of Longevity.”

I’ll give you a little teaser today about each section so you’ll be eager to dive right in when your book arrives! In the Introduction, you’ll learn how hectic, high-tech modern life is becoming more and more at odds with longevity, especially the hidden costs of hyperconnectivity, destruction of meaningful social connections, and forces like consumerism, flawed and manipulative marketing messages relating to diet and medical care, and even the fitness industry’s obsession with struggle and suffer instead of a more sensible approach to exercise. You’ll learn perspective-altering insights about our actual healthspan as well as intriguing multi-plane views of aging that will revamp the way you look at your later decades—and the journey leading to them.

A new perspective shows us that aging as we know it isn’t a normal and inevitable result of chronology but actually what Dr. Art DeVany describes as “the unrepaired accumulation of routine cellular damage… a loss of cell function, loss of cell integrity, loss of the ability of stem cells to renew tissues.” Embracing this truth, you can take tremendous control over the rate at which you experience decline, instead appreciating and optimizing the variety of human “peaks” we can achieve and harness throughout our lifespans. Chronology has far less to say than we’ve given it credit for.

Pillar #1: Metabolic Flexibility

This is the best catch-all term to convey the magnificent journey of escaping carbohydrate dependency and becoming a fat-burning beast. Literally, metabolic flexibility describes the ability to burn a variety of fuel sources—not just external ingested calories, but also internal sources such as stored fat, stored glycogen and ketones manufactured in the liver as a byproduct of fat metabolism—when carb intake is low. At the highest level of sophistication, you become a “closed loop system” that can survive and even thrive without needing the constant intake of external calories and certainly without needing to adhere to any regimented macronutrient eating patterns.

In this pillar, you’ll reacquaint with the importance of a comfortable, minimally stressful step-by-step process to escape carb dependency and progress toward metabolic flexibility. As detailed in the Keto Reset Diet, you’ll execute a 21-Day Metabolism Reset, a fine-tuning period, and a 6-week nutritional ketosis period. We’ll discuss some advanced strategies for fasting and eating in a compressed time window, particularly the importance of limiting your digestive function to 12 hours. You’ll get guidance on integrating the hottest longevity superfoods and supplements, as well as help sorting through the weight loss hype around them and pinpointing the best ways to use these products.

You’ll learn some of the best long-term keto strategies, including living in what I call the “Keto Zone,” where you eat in a general keto-aligned pattern without stressing about macros, as well as incorporating days or periods where carb intake might increase beyond keto limits without you stressing about it. You’ll also learn what NOT to do with various popular keto strategies that are ill advised or overhyped, including (but not limited to) the ridiculousness of dirty keto, obsessive weekend refeeds, and cheat days.

Pillar #2: Movement and Physical Fitness

Movement and physical fitness are two distinct concepts. Together, along with preserving sharp cognition, they represent the essence of aging gracefully. In contrast, when we lose cognition and mobility, our life expectancy and quality of life plummet as we are relegated to wheelchairs, beds, and medications that limit our physical freedoms and compromise our mental well-being.

The desperate obligation to increase all forms of general everyday movement can be best handled by JFW—Just F—ing Walk! Today, many fitness and health experts assert that simply moving around more (especially avoiding the prolonged periods of stillness that are so common in the digital age) has surpassed the importance of following a structured workout routine as the top priority to be fit for life. How can this be? Because moving around all day is one of our fundamental genetic expectations for health. Our genes crave movement and are averse to stillness. In as little as 20 minutes of sitting still, we can experience impaired glucose tolerance and acute insulin resistance, along with diminished cognitive function. When prolonged periods of stillness dominate your daily routine, it can cause chemical changes in the brain that promote further inactivity. This is quantified by a lower measurement of Non-Exercise Activity Thermogenesis (NEAT)—you burn fat less efficiently at rest and consequently crave more carbohydrates for energy.

Now, because modern life is so comfortable, we also have a desperate need for ambitious fitness endeavors like Spinning, CrossFit, or even completing a half-marathon, but these goals must be only contemplated after you have established a foundation of basic everyday movement, which I detail in the book.

Once your movement looks good, you can get into the genetically optimal workout pattern ala Primal Blueprint with a strategic blend of comfortably paced cardio, regular short duration, high intensity resistance workouts (weights, machines, or just bodyweight exercises like pushups), and occasional brief, all-out sprints (the ultimate Primal exercise to delay aging under the “use it or lose it” natural law.) Let’s also add what I call “play” endeavors that can feature each of the aforementioned. As you know from being a Primal enthusiast, there are massive hormonal and physiological benefits to be gained from putting your body under resistance load regularly, and opening up the throttle occasionally with all out efforts.

These activities, which have been almost completely neglected by most modern humans, give us a boost of adaptive, anti-aging hormones like human growth hormone and testosterone. Brief, intense efforts also help preserve muscle mass as you age, improving the critical longevity component of organ reserve. This is the functional capacity of your organs to perform above baseline level, one of the most fundamental ways to assess your state of health and longevity potential. This Primal approach to fitness is simple, time efficient, and within reach of everyone. It also gives you awesome protection against the accelerated demise associated with inactivity.

Unfortunately, many fitness enthusiasts follow an overly stressful approach that leads to breakdown, burnout, illness and injury. Chronic exercise leads to hormonal and immune dysfunction, and compromises metabolic flexibility—instead pushing you back in the direction of carbohydrate dependency. You’ll learn how to schedule and conduct the various workouts correctly, avoid chronic patterns, and apply an intuitive approach instead of a regimented approach to your fitness goals.

Pillar #3: Mental Flexibility

Mental flexibility makes you resilient for life in the same manner that metabolic flexibility makes you resilient enough to skip meals and maintain energy and focus. While looking after the physical vessel is essential, we must acknowledge the strength of the mind/body connection as previously discussed with the insights from Dr. Chopra and Dr. Lipton.

This section details numerous strategies to hone mental flexibility, starting with pivoting: going with the flow when facing life change. Pivoting entails knowing both when to persevere when your peak performance goals are aligned with your deep beliefs and calling to make the world a better place, and also recognizing when it’s time tone down the influence of your ego and quit when things don’t feel right in your gut.

You’ll learn how to avoid the disease state of ruminating, that is, the act of engaging in obsessive or destructive thoughts about the past or the future that cause you feel anxious, depressed, irritable, overwhelmed and downright sad. Instead, we can cultivate the esteemed skill of mindfulness—accessing a state of calm, present awareness through repetition and endurance. 

Next, you’ll learn the importance of journaling, actually taking pen to paper and recording your thoughts, hopes, dreams and worries. Journaling can help you identify and correct self-limiting beliefs and behavior patterns. The specific practice of gratitude journaling, for example, has been scientifically validated to reduce stress levels, dissipate negative emotions, boost levels of the love hormone oxytocin, and activate calming parasympathetic nervous system function.

You’ll also read about learn to nurture meaningful, reciprocative interpersonal relationships—which might very well be the most powerful and important way to improve your longevity prospects in the entire book. Our genes are wired for connection, and the digital connections that are dominating modern life and coming at an extreme cost to our physical and psychological health. You’ll learn to cultivate a thriving social network, a smaller cluster of your closest family and friends, and place particular importance on the make or break health element of a loving partnership.

Pillar #4: Rest and Recovery

Optimizing your sleeping habits and environment will be the prominent focus here, but we must also consider a broad-based approach to chilling out amidst the hectic pace and constant stimulation of modern life. Strategies include disciplining your use of technology, taking frequent breaks from peak cognitive function to refresh depleted brain neurons, conducting recovery-centric workouts designed to promote relaxation and rejuvenation, and becoming competent at napping when cognitive function declines from afternoon blues. You’ll learn to pair mellow evening habits with a high energy morning routine (plenty of ideas included).

You’ll also turn your attention to proper recovery, both from fitness regimen and workplace overstimulation. You’ll learn about specially designed “Rebound Workouts” that can actually speed recovery in comparison to total rest by stimulating parasympathetic activity. And you’ll learn how to get better about focusing and prioritizing during the workday to avoid the dreaded cognitive middle gear, where you’re busy but ineffective. Finally, you’ll learn the importance of disconnecting on multiple levels to deliver profound hormonal and psychological benefits, stuff we have overlooked and disrespected with our warp speed technological progress.

21-Day Biological Clock Reset

After a comprehensive education and practical instruction about the 4 Pillars, it’s time for a transformative challenge: The 21-Day Biological Clock Reset. The reset features daily action items representing each of the Four Pillars. The journey, while short in duration, is designed to be highly focused and demanding. This is the only way to stimulate lasting lifestyle transformation and release you from the powerful pull of decades-old ingrained habits and powerful cultural forces pushing your out of a balance and stuck in carbohydrate dependency.

You’ll be exposed to a variety of strategies and concepts over the 21 days, and the idea is that you will pick and choose your favorites to integrate permanently into your lifestyle. You’ll be challenged to perform breakthrough workouts, increase daily activity, actually sit down and do stuff like a gratitude journal and create dark, mellow evenings instead of maximum screen time. It’s going to be fun, but it’s also going to be intensive, not to mention life-changing. Completing the Biological Clock Reset once a year is an excellent way to fine-tune your longevity muscles and clarify your focus amidst the constant distractions of modern life.


But the food… Folks always want to know about the recipes. The 80+ Keto For Life recipes are a collaborative effort among numerous authors, coaches, chefs and well-known keto experts, including Dr. Cate Shanahan, Keris Marsden and Matt Whitmore of The Paleo Primer series, William Shewfelt of the carnivore diet movement, Dr. Lindsay Taylor and Layla McGowan, my co-authors on the Keto Reset Instant Pot Cookbook, Tania Teschke, author of The Bordeaux Kitchen, and more.

You’ll find everything you need for beginning, recommitting or reinvigorating your keto eating enjoyment with this diverse selection of dishes, from gourmet to quick and easy, from breakfast to beverages, snacks to side dishes and everything in between.

Let me share one today that might appeal….

Sneak Peek Recipe: Keto Cheesecake

Prep Time: 40 minutes (plus refrigeration time)

Cook Time: 60 minutes

Servings: 8



  • 16 ounces (453.59 g) organic cream cheese, at room temperature
  • 2 tablespoons pure vanilla extract
  • 2 teaspoons fresh lemon juice
  • 1 teaspoon sea salt
  • 1 large egg
  • ¼ cup powdered stevia or 1-2 tablespoons honey


  • 1 cup (96 g) almond flour or 1 cup (128 g) coconut flour
  • 4 tablespoons (60 g) butter, at room temperature
  • 1–2 tablespoons powdered stevia
  • 1 tablespoon pure vanilla extract


  • ¼ cup (34 g) macadamia nuts or assorted nuts
  • 1 bar (3.5 ounces/100 g) dark chocolate (85% cacao or greater), broken into pieces
  • 1 tablespoon coconut oil 2–3 tablespoons fine coconut flakes


Make the filling: In a large bowl, combine the cream cheese, vanilla, lemon juice, sea salt, eggs, and sweetener. Mix thoroughly with an electric mixer on low speed.

Choose between the Instant Pot Method and Oven Method and proceed as directed.

Instant Pot Method: Pour the filling into a round glass bowl or springform pan that can fit inside the Instant Pot. Cover the bowl carefully with foil. Pour 2 cups water into the Instant Pot. Place the cheesecake on the handled steam rack (or in a steamer basket accessory if you have one), and lower the cheesecake into the pot. Cook on High pressure for 25 minutes. When the Instant Pot beeps, allow the pressure to release naturally, about 15 minutes, then lift out the cheesecake.

Oven Method: Preheat the oven to 350°F (180°C).

Make the crust: In a bowl, combine the almond flour, butter, stevia, and vanilla until well blended. Press the mixture into the bottom of an 8-inch springform pan or round glass or ceramic baking dish.

Bake until the crust darkens slightly, about 10 minutes. Allow to cool for 10 minutes (leave the oven on). Pour the cheesecake filling mixture into the pan and smooth out the top with your hand (just kidding, use a spatula).
Bake until the middle is almost firm, but not quite, about 50 minutes. Allow to cool for 10 minutes.

While the cheesecake is cooling, make the chocolate crunch topping (use for either version): In a small food processor, blend the macadamia nuts until they resemble a crumbly flour. In a double boiler or a heatproof bowl set over a pan of simmering water, melt the chocolate and coconut oil. Mix the nuts and coconut flakes into the melted chocolate.

Drizzle the topping carefully across the top of the cooked and cooled cheesecake. Refrigerate the cheesecake until the crust feels hard, 30 minutes to 1 hour. Slice and serve.

Macronutrients Per Serving:

Instant Pot Method: 323 calories; 29 grams fat; 8 grams carbohydrate; 7 grams protein

Oven Method: 459 calories; 42 grams fat; 12 grams carbohydrate; 10 grams protein

Final Thoughts

I realize that there is an overwhelming amount of content hitting us today from books, magazine articles, blogs, podcasts, YouTube and streaming media, and it’s easy for a new book to get lost in the shuffle or buried on a “read later” list. That’s why I want to reiterate what a hugely expansive and life-changing this book Keto For Life represents. My longtime writing/publishing partner Brad Kearns and I joke that we always underestimate the difficulty and duration of a book project by half, and this was no exception. Keto For Life represents an intensive project that took an entire year to complete, with devoted efforts from a sizeable team of researchers, editors, agents, publicists and publisher. It’s designed to stand proudly for years to come as an owner’s manual for longevity. I hope it can help you claim your fullest and longest life.

Now For the Keto For Life Pre-Order Bonus Gifts

This is always my favorite part. For those who order the book early, I have a few gifts for you (available right away even though the book itself comes out 12/31/19).

Bonus Audio Summary

Enjoy a detailed overview of every section of the book to get you excited and prepared to begin your Keto For Life journey. My co-author, Brad Kearns, describes the 4 Pillars in detail.

Sneak Peek Excerpt Booklet

Read some choice excerpts to give you a feel for the comprehensive nature of the book, where you obtain a deep education and scientific rationale for the 4 Pillars, as well as get practical, step-by-step guidance to implement, and (finally) enjoy a few of the delicious 80+ recipes from the book.

$10 Discount at Primal Kitchen®

Grab some of your favorite keto-friendly products to add variety and ease to your keto cooking ventures.

That’s what I got today, and I’m thrilled to offer it up to the community where it all began and where it’s still evolving. Folks, I hope you enjoy reading the book and putting it into practice as much as Brad and I enjoyed writing it. Thanks for being here.

Reprinted from KETO FOR LIFE by Mark Sisson with Brad Kearns. Copyright @ 2019 by Mark Sisson. Photos copyright @ 2019 Jennifer May. Published by Harmony Books, an imprint of Penguin Random House.



The post Introducing Keto For Life: Leveraging Metabolic Flexibility To Pursue The Ultimate Goal of Longevity appeared first on Mark’s Daily Apple.

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Inflammation gets a bad rap in the alternative health world: “Inflammation causes heart disease, cancer, and autoimmune disease! It’s at the root of depression.” These are all true—to some extent.

Name a disease, and inflammation is involved.

Crohn’s disease is inflammatory.

Major depression is inflammatory.

Heart disease is inflammatory.

Autoimmune diseases, which involve an inflammatory response directed at your own tissues, are inflammatory.

Arthritis is inflammatory.

Even obesity is inflammatory, with fat cells literally secreting inflammatory cytokines.

Yes, but the story is more complicated than that. Inflammation, after all, is a natural process developed through millions of years of evolution. It can’t be wholly negative. Just like our bodies didn’t evolve to manufacture cholesterol to give us heart disease, inflammation isn’t there to give us degenerative diseases.

So, Why Does Inflammation Happen?

When pain, injury, or illness hit, the first responder is the acute inflammatory response. In other words, it is brief, lasting several days or less. All sorts of things can cause an acute inflammatory response. Here are a few:

  • Trauma (punch, kick, golf ball to the head)
  • Infection by pathogens (bacterial, viral)
  • Burn (sun, fire, seat belt buckle on a summer day)
  • Chemical irritants
  • Frostbite
  • Stabbing/Cut/Laceration
  • Allergic reaction

Things happen pretty fast in an acute inflammatory response and involve several different players, including the vascular system (veins, arteries, capillaries and such), the immune system, and the cells local to the injury.

  1. First, something painful and unpleasant happens; choose one of the above injury options.
  2. Then, pattern recognition receptors (PRR) located at the injury site initiate the release of various inflammatory mediators, which in turn initiate vasodilation (or widening of the blood vessels). This allows increased blood flow to the injury site, which warms the site, turns it the familiar red, and carries plasma and leukocytes to the site of the injured tissue.
  3. The blood vessels become more permeable, thus allowing the plasma and leukocytes to flow through the vessel walls and into the injured tissue to do their work. Emigration of plasma into tissue also means fluid buildup, which means swelling.
  4. At the same time, the body releases an inflammatory mediator called bradykinin, which increases pain sensitivity at the site and discourages usage of the injured area. These sensations—heat, redness, swelling, pain, and a loss of function—are annoying and familiar, but they’re absolutely necessary for proper healing.

Why Is (Acute) Inflammation Essential?

Allow me to explain why the four primary symptoms of acute inflammation are necessary, despite being unpleasant:

  1. Increased blood flow warms the injury and turns it red, which can be irritating and unsightly, but it also carries the guys—leukocytes—that will be cleaning up the injury site, mopping up pathogens, and overseeing the inflammatory process.
  2. Swollen body parts don’t fit into gloves, are really sensitive, and don’t work as well as their slim counterparts, but a swollen finger is a finger that’s full of a plasma and leukocyte slurry and therefore on the road to recovery.
  3. Pain hurts, but if an injury doesn’t hurt and it’s serious, you’ll keep damaging it because you won’t know not to use it.
  4. Loss of function prevents you from using what could be one of your favorite body parts, but you don’t want to make it worse be re-injuring it. Besides, it’s only temporary.

What About Chronic Inflammation?

These symptoms both indicate and enable inflammation (and, thus, healing), but what’s the deal with inflammation being linked with all those chronic illnesses—like obesity, heart disease, and depression? How does something normal and helpful go haywire and become implicated in some of the most crushing, tragic diseases of our time?


The inflammatory response is supposed to be short and to the point. And because a big part of inflammation is breaking the tissue down, targeting damaged tissue and invading pathogens, before building it back up, the inflammatory response has the potential to damage the body. That’s why it’s normally a tightly regulated system: because we don’t want it getting out of hand and targeting healthy tissue. But if it’s on all the time—if chronic inflammation sets in—regulation becomes a lot harder.

Acute vs. Chronic Inflammation

A perfect example of the acute inflammation versus chronic inflammation dichotomy is exercise.

A single hard workout raises inflammation. It’s a stressor, a damaging event imposed upon your body. See for yourself.

A hard run spikes C-reactive protein for up to two days.

During exercise, skeletal muscle releases the inflammatory cytokine IL-6, a marker of damage.

Volleyball practice elicits spikes in IL-6 in both male and female elite volleyball players.

Acute exercise spiked CRP in cardiovascular disease patients (but a four-month exercise program lowered it).



  • In elderly Japanese women, a 12-week resistance training program reduced circulating levels of inflammatory markers compared to baseline; reductions in CRP were associated with increases in muscle thickness.
  • American adults who engaged in frequent physical activity tended to have lower CRPs than adults who were more sedentary.
  • In type 2 diabetics, (key term coming up) long-term high intensity resistance and aerobic training reduced inflammatory markers over the course of a year (independent of changes in body weight, meaning activity was the key factor).
  • Endurance combined with resistance training reduced CRP in young, healthy women better than endurance training alone.
  • In obese, post-menopausal women, a basic moderate cardio program lowered CRP without really affecting body weight either way over the course of a year.


Identifying Chronic Inflammation: Objective Markers

First, we need to be able to identify chronic inflammation. What symptoms and biomarkers can we use to track our inflammation levels?

CRP, or C-Reactive Protein


Highly sensitive to many different kinds of stressors, CRP rises in response to essentially anything that causes inflammation. This makes it valuable for determining that inflammation is occurring, but it makes it difficult to determine why that inflammation is occurring—because it could be almost anything. But if you’re looking for confirmation that you are chronically, systemically inflamed, an elevated CRP (in absence of any acute infections, injuries, burns, or stressors) is a useful barometer.


IL-6, or Interleukin-6

T cells (type of white blood cell that plays a huge role in the immune response) and macrophages (cells that engulf and digest—also known as phagocytosing—stray tissue and pathogens) both secrete IL-6 as part of the inflammatory response, so elevated IL-6 can indicate systemic inflammation.

Tissue Omega-3 Content

This is a direct measurement of the omega-3 content of your bodily tissue. It’s not widely available, but it is very useful. Remember that anti-inflammatory eicosanoids draw upon the omega-3 fats in your tissues and that inflammatory eicosanoids draw upon the omega-6 fats. People having a higher proportion of omega-6 fats will thus produce more inflammatory eicosanoids. Now, we absolutely need both inflammatory and anti-inflammatory eicosanoids for proper inflammatory responses, but people with high omega-6 tissue levels make way too many inflammatory eicosanoids. Studies indicate that people with the highest omega-3 tissue levels suffer fewer inflammatory diseases (like coronary heart disease).

Research (highlighted and explicated here by Chris Kresser) suggests that omega-3 tissue concentrations of around 60% are ideal, which is a level commonly seen in Japan—the seemingly paradoxical land of high blood pressure, heavy smoking, and low coronary heart disease rates.

Omega-3 Index


Anything above 8% corresponds to a “low risk,” but levels of 12-15% are ideal and roughly correspond to the 60% tissue content mentioned by Chris’ article. Four percent and below is higher risk and can be viewed as a proxy for increased inflammation (or at least the risk of harmful systemic inflammation developing from normal inflammation).

Heart Rate Variability

I’ve written extensively on HRV in the past. Long story short, high HRV predicts lower levels of inflammation.

Systemic Inflammatory Response Syndrome Score

There’s the systemic inflammatory response syndrome, which is incredibly serious and has four criteria. If you have two or more of them at once, congratulations: you qualify—and should probably see a health professional immediately. This isn’t relevant for low-grade systemic inflammation, like the kind associated with obesity or autoimmune disease.

  • Body temperature less than 96.8 F (36 C) or greater than 100.4 F (38 C).
  • Heart rate above 90 beats per minute.
  • High respiratory rate, 20 breaths per minute or higher.
  • White blood cell count fewer than 4000 cells/mm³ or greater than 12,000 cells/mm³.

Of these objective markers to test, I’d lean toward CRP, HRV, and one of the omega-3 tests. CRP is pretty comprehensive, HRV is a two-fer (inflammation and general stress/recovery), and, while omega-3 tissue or blood cell content doesn’t necessarily indicate the existence of systemic inflammation in your body, it does indicate the severity of the inflammatory response you can expect your body to have. Taken together, these tests will give you an idea of where you stand.

Identifying Inflammation: Subjective Markers

There are also subjective markers. They may be harmless artifacts, but they may indicate that something systemic is going on.

Flare-up of Autoimmune Conditions You Haven’t Heard From In Ages


Water Retention


Stress Load


Persistent But Unexplained Nasal Congestion



If you fit the bill for the eight signs of overtraining listed in this post, you’re probably inflamed.

Ultimately, though? It comes down to the simple question you must ask yourself: How do you feel?

I mean, this seems like an obvious marker, but a lot of people ignore it in pursuit of numbers. If you feel run down, lethargic, unhappy, your workouts are suffering, you struggle to get out of bed, you’re putting on a little extra weight around the waist, sex isn’t as interesting, etc., etc., etc., you may be suffering from some manner of systemic, low-grade inflammation. Conversely, if you’re full of energy, generally pleased and/or content with life, killing it in the gym, bounding out of bedlean as ever or on your way there, and your sex drive is powerful and age appropriate (or inappropriate), you’re probably not suffering from chronic inflammation.

Causes of Chronic Inflammation

We need to determine why inflammation is “on” all the time—and then take the steps to counter it. I’m going to fire off a few things that both induce inflammation and tend toward prevalence in developed countries. You let me know if anything sounds familiar to you.

  • Toxic dietsHigh-sugarhigh-processed carb, high-industrial fat, high-glutenhigh-CAFO meat, low-nutrient food is a pretty accurate descriptor of the modern Western diet.
  • Excessive omega-6 intake: Omega-6 fats form the precursors for inflammatory eicosanoids, which are an integral part of the inflammatory response. High omega-6 status (especially when combined with poor omega-3 status) means excessive production of inflammatory eicosanoids and a lopsided inflammatory response to normal stimuli. The more omega-6 you eat, the more omega-3 you crowd out for anti-inflammatory eicasonoid formation.
  • Poor recovery: Other people move too much, with too little rest and recovery. When I ran 100+ miles a week, I certainly wasn’t sedentary, but I was chronically inflamed. Overtraining is a form of chronic inflammation.
  • Lack of nature time: We spend too much time contained in cubicles, cars, trains, and cities, away from trees, leaves, and soft earth. In a way, nature is home for us. Going home certainly has its measured benefits.
  • Poor gut health: The gut houses the bulk of the human immune system. When it’s unhealthy, so is your inflammatory regulation. A healthy gut is also selectively permeable, allowing beneficial compounds passage into the body and keeping toxins out. An unhealthy gut often becomes leaky, allowing toxins into the body to stimulate an immune, inflammatory response.

See what I mean? Since we’re set up for acute stressors requiring an acute inflammatory response, all this other low-level, evolutionarily-discordant, superficially mild stuff set against a backdrop of misaligned fatty acid ratios and impaired gut health throws us off and sets us up for a lifetime of chronic inflammation.

Inflammation is a complex physiological process that can go wrong in a lot of ways. But luckily, sticking to the tried and true dietary and lifestyle measures will get you most of the way toward preventing inflammation from becoming chronic and untamed.

If you have any further questions about inflammation, fire away down below! Thanks for reading.



Eliakim A, Portal S, Zadik Z, et al. The effect of a volleyball practice on anabolic hormones and inflammatory markers in elite male and female adolescent players. J Strength Cond Res. 2009;23(5):1553-9.

Lara fernandes J, Serrano CV, Toledo F, et al. Acute and chronic effects of exercise on inflammatory markers and B-type natriuretic peptide in patients with coronary artery disease. Clin Res Cardiol. 2011;100(1):77-84.

Ford ES. Does exercise reduce inflammation? Physical activity and C-reactive protein among U.S. adults. Epidemiology. 2002;13(5):561-8.

Balducci S, Zanuso S, Nicolucci A, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis. 2010;20(8):608-17.

Daray LA, Henagan TM, Zanovec M, et al. Endurance and resistance training lowers C-reactive protein in young, healthy females. Appl Physiol Nutr Metab. 2011;36(5):660-70.

The post The Definitive Guide to Inflammation appeared first on Mark’s Daily Apple.

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Older people (and those headed in that direction, which is everyone else) are really sold a bill of goods when it comes to health and longevity advice. I’m not a young man anymore, and for decades I’ve been hearing all sorts of input about aging that’s proving to be not just misguided, but downright incorrect. Blatant myths about healthy longevity continue to circulate and misinform millions. Older adults at this very moment are enacting routines detrimental to living long that they think are achieving the opposite. A major impetus for creating the Primal Blueprint was to counter these longevity myths. That mission has never felt more personal.

So today, I’m going to explore and refute a few of these top myths, some of which contain kernels of truth that have been overblown and exaggerated. I’ll explain why.

1) “Don’t Lift Heavy: You’ll Throw Out Your Back”

Obviously, a frail grandfather pushing 100 shouldn’t do Starting Strength right off the bat (or maybe ever, depending on how frail he is). That’s not my contention here. My contention:

Lifting as heavy as you can as safely as you can is essential for healthy longevity. That’s why I put it first in the list today. It’s that important.

For one, lean muscle mass is one of the strongest predictors of resistance to mortality. The more muscle a person has (and the stronger they are), the longer they’ll live—all else being equal. That’s true in both men and women.

One reason is that the stronger you are, the more capable you are. You’re better at taking care of yourself, standing up from chairs, ascending stairs, and maintaining basic functionality as you age.

Another reason is that increased lean mass means greater tissue reserve—you have more organ and muscle to lose as you age, so that when aging-related muscle loss sets in, you have longer to go before it gets serious. And that’s not even a guarantee that you’ll lose any. As long as you’re still lifting heavy things, you probably won’t lose much muscle, if any. Remember: the average old person studied in these papers isn’t doing any kind of strength training at all.

It doesn’t have to be barbells and Olympic lifts and CrossFit. It can be machines (see Body By Science, for example) and bodyweight and hikes. What matters is that you lift intensely (and intense is relative) and safely, with good technique and control.

2) “Avoid Animal Protein To Lower IGF-1”

Animal protein has all sorts of evil stuff, they say.

Methionine—linked to reduced longevity in animal models.

Increased IGF-1—a growth promoter that might promote unwanted growth, like cancer.

Yet, a huge study showed that in older people, those 65 or older, increased animal protein intake actually protected against mortality. The older they were and the more protein they ate, the longer they lived.

Meanwhile, low-protein diets have been shown to have all sorts of effects that spell danger for older people hoping to live long and live well:

And about that “excess methionine” and “increased IGF-1”?

You can easily (and should) balance your methionine intake with glycine from collagen, gelatin, or bone broth. In animals, doing so protects against early mortality.

In both human and animal studies, there’s a U-shaped relationship between IGF-1 levels and lifespan. Animal studies show an inverse relationship between IGF-1 and diabetes, heart disease, and heart disease deaths (higher IGF-1, less diabetes/heart disease) and a positive association between IGF-1 and cancer (higher IGF-1, more cancer). A recent review of the animal and human evidence found that while a couple human studies show an inverse relationship between IGF-1 and longevity, several more show a positive relationship—higher IGF-1, longer lifespan—and the majority show no clear relationship at all.

3) “You’re Never Getting Back That Cartilage—Once It’s Gone, It’s Gone”

Almost every doctor says this. It’s become an axiom in the world of orthopedics.

But then we see this study showing that people have the same microRNAs that control tissue and limb regeneration in lizards and amphibians. They’re most strongly expressed in the ankle joints, less so in the knees, and even less so at the hip—but they’re there, and they’re active.

I’ve seen some impressive things, have been able to personally verify some stunning “anecdotes” from friends and colleagues who were able to regrow cartilage or at least regain all their joint function after major damage to it. Most doctors and studies never capture these people. If you look at the average older person showing up with worn-down joints and degraded or damaged cartilage, how active are they? What’s their diet?

They are mostly inactive. They are often obese or overweight.

They generally aren’t making bone broth and drinking collagen powder. They aren’t avoiding grains and exposing their nether regions to daily sun. They aren’t doing 200 knee circles a day, performing single leg deadlifts, and hiking up mountains. These are the things that, if anything can, will retain and regrow cartilage. Activity. Letting your body know that you still have need of your ankles, knees, and hips. That you’re still an engaged, active human interacting with the physical world.

4) “Retire Early”

This isn’t always bad advice, but retiring and then ceasing all engagement with the outside world will reduce longevity, not increase it. Having a life purpose is essential for living long and living well; not having one is actually an established risk factor for early mortality. And at least when you’re getting up in the morning to go to work, you have a built-in purpose. That purpose may not fulfill your heart and spirit, but it’s a purpose just the same: a reason to get up and keep moving.

Retiring can work. Don’t get me wrong. But the people who retire early and make it work for their health and longevity are staying active. They’re pursuing side projects or even big visions. They have hobbies, friends, and loved ones who they hang out with all the time.

The ones who don’t? Well, they are at at increased risk of dying early.

You don’t have to keep working a job you hate, or even a job you enjoy. You can retire. Just maintain your mission.

5) “Take It Easy As You Get Older”

As older people, we’re told that sex might be “too strenuous for the heart” (Truth: It’s good for it). We’re told to “take the elevator to save our knees.” They tell us “Oh, don’t get up, I’ll get it for you.”

They don’t tell me that because, well, I’m already up and doing the thing. I’m active and obviously so. I don’t take it easy.

Stay vigorous, friends. Stay vivacious. Don’t be foolhardy, mind you. Be engaged.

“Take it easy” quickly becomes “sit in the easy chair all day long watching the news.” Don’t let it happen.

That’s not to say you shouldn’t rest. Rest is everything. Sleep is important. But you must earn your rest, and when you have the energy, take advantage of it. Don’t rest on your laurels.

As you can see, there are tiny kernels of truth in many of these myths. We should all be careful lifting heavy things and pay close attention to technique and form. Everyone should care for their cartilage and avoid damage to it. No one should continue working a job that sucks their soul and depletes their will to live if they can move on from it. And so on.

What we all need to avoid is sending the message to our brain, body, and cells that we’re done. That we’ve given up and our active, engaged life is effectively over. Because when that happens, it truly is over.

Someone asked me when aging begins. How old is “old”?

I think I know now. Aging begins when you start listening to conventional longevity advice. As I said on Twitter earlier today, healthy aging begins when you do the opposite.

Want more on building a life that will allow you to live well into later decades? I definitely have more on that coming up. A perceptive reader shared the news in one of the Facebook groups already, so let me mention it here. My new book, Keto For Life: Reset Your Biological Clock In 21 Days and Optimize Your Diet For Longevity, is coming out December 31, 2019. I’ll have more info, including a special bonus package for those who preorder, in just a few weeks. In the meantime, you can read more about it here on our publisher’s page.

That’s it for today, friends. Chime in down below about longevity or any other health topics you’re thinking about these days. What are the most egregious aging myths you’ve heard? What do you do instead? Take care.



Karlsen T, Nauman J, Dalen H, Langhammer A, Wisløff U. The Combined Association of Skeletal Muscle Strength and Physical Activity on Mortality in Older Women: The HUNT2 Study. Mayo Clin Proc. 2017;92(5):710-718.

Malta A, De oliveira JC, Ribeiro TA, et al. Low-protein diet in adult male rats has long-term effects on metabolism. J Endocrinol. 2014;221(2):285-95.

Carrillo E, Jimenez MA, Sanchez C, et al. Protein malnutrition impairs the immune response and influences the severity of infection in a hamster model of chronic visceral leishmaniasis. PLoS ONE. 2014;9(2):e89412.

Castaneda C, Charnley JM, Evans WJ, Crim MC. Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response. Am J Clin Nutr. 1995;62(1):30-9.

Gaine PC, Pikosky MA, Martin WF, Bolster DR, Maresh CM, Rodriguez NR. Level of dietary protein impacts whole body protein turnover in trained males at rest. Metab Clin Exp. 2006;55(4):501-7.

Wu C, Odden MC, Fisher GG, Stawski RS. Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA. J Epidemiol Community Health. 2016;70(9):917-23.

The post 5 Biggest Longevity Myths appeared first on Mark’s Daily Apple.

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Hypertension is a problem. It raises the risk of heart disease; it’s one of the most consistent risk factors for that condition, as well as others like kidney disease. But before you start freaking out about your high blood pressure, make sure you actually have it. A single elevated reading does not a hypertension diagnosis make. Readings are snapshots in time. They can be a part of a trend, or they can be an isolated case. Don’t assume based on one bad reading.

I can remember going to the doctor about ten years ago for a routine checkup, showing 140/100, and almost getting a prescription based on that. It was absurd, so absurd that I took matters into my own hands and got a fancy blood pressure device to measure my own over the next couple weeks. The result?

There was almost no pattern. Maybe it was a lot lower after dinner, due to relaxation, but other than that there weren’t any trends. Sometimes it was high, mostly it was low-normal. It all depends on stress

Okay, say that’s not you. Say you have a legitimate problem with protracted and consistently high blood pressure. What can you do in addition to (or besides, if your doctor says it’s safe to wait) opt for the prescription?

1) Eat More Potassium

A common cause of salt-related blood pressure increases is inadequate potassium intake. Very few of us eat as much potassium as we evolved eating.

The pre-agricultural environment was potassium-rich and sodium-poor. That’s why we have a physiological taste for salt, and why salted food tastes so good: we had to seek it out. That’s why we don’t have a physiological taste for potassium: it was everywhere. Loren Cordain estimates some hunter-gatherer groups got upwards of 10-12 grams of potassium a day, whereas the average American gets about 2.5 grams.

Studies show that both sodium-sensitive and potassium-deficient subjects with high blood pressure see the biggest improvements with increased potassium intake.

I love sodium, and it’s actually beneficial for endothelial health when consumed with enough potassium, but you have to eat potassium too.

2) Improve Your Insulin Sensitivity

Ever since earlier studies established that hypertensive patients tend to exhibit abnormally high insulin responses to standard glucose loads, researchers have wondered about a connection between insulin and blood pressure.  It turns out there is a powerful connection.

  • In non-diabetic people with normal blood pressure, insulin levels and shifts in blood pressure are related—higher insulin, higher blood pressure; lower, lower.
  • In both diabetic and non-diabetic subjects, lower insulin sensitivity predicts elevated blood pressure.
  • Insulin increases sodium retention in the blood, which increases blood volume and pressure. The less insulin sensitive you are, the more insulin you’ll release in response to a given stimulus, and the more sodium you’ll shuttle into the blood.
  • Both insulin resistance and the compensatory hyperinsulinemia (elevated insulin levels) that results have distinct pro-hypertensive effects.

Luckily, there are dozens upon dozens of ways to improve your insulin sensitivity. Choose a few, or all of them (a better proposal, actually), to not only improve your blood pressure but also your health and life in general.

3) Earn Your Carbs With Physical Activity

The ones you earn through physical activity, that is. Let’s look at two scenarios.

First: You eat way more carbs than you actually earn through training. You haven’t trained, so you’re more insulin-resistant than the You from the alternative universe who did train. This means any carbs you eat will cause a greater spike in insulin, which has been shown to increase blood pressure.

Second: You only eat the carbs you’ve earned through training. Since you’re training, your insulin sensitivity is high, and you don’t actually secrete all that much insulin in response to the carbs. Training also upregulates non-insulin dependent glycogen repletion, meaning you can shove glycogen into muscles post-workout without even using insulin.

Once or twice, this isn’t an issue. But if you’re consistently eating more carbs than you need, the resultant elevation in insulin will raise blood pressure. At the very least, it won’t help.

Not only that, but regular training improves endothelial function and reduces the risk of high blood pressure on its own.

4) Eat Fermented Dairy

Milk fermented with the L. helveticus bacteria has been shown to lower blood pressure in people with hypertension in a number of studies.

In one, they drank the fermented milk for 21 weeks.

In another, they drank the milk for 10 weeks.

Look for products that include Lactobacillus helveticus, such as kefir, aged cheese (Swiss, emmental, pecorino romano, cheddar, parmigiano reggiano),

5) Get Your Zinc (Red Meat and Oysters)

Zinc is an essential nutrient for regulating the nitric oxide synthase system in the body. Without adequate zinc, your ability to produce nitric oxide—which increases blood vessel dilation and thus regulates blood pressure—is hampered.

6) Get Sunlight

There are consistent relationships between adequate vitamin D levels and normal blood pressure, though it’s unclear whether this is causal. Studies haven’t found a consistent blood pressure effect of actually supplementing with vitamin D. What might be going on is that vitamin D is acting as a marker for sun exposure, because we know that sunlight increases the production of nitric oxide, a compound that improves the function of your blood vessels.

Sure enough, human studies show that sun exposure causes the conversion of nitrogen oxide in the skin to nitric oxide, lowering blood pressure and improving endothelial function.

7) Address Your Stress

Stress might be the biggest trigger for hypertension, especially since most of us live lives laden with hidden, inevitable stressors—commutes, jobs we don’t like, bills, and the like. It’s everywhere, we can’t really escape it entirely, so we have to figure out how to deal with it.

I know how I do it (paddling, Ultimate, walks, quality time with family, smart supplementation). There are other ways, like adaptogens, or this, or this. You can rethink stress entirely. You can meditate, or try alternatives that achieve similar things. What are you going to do?

If your blood pressure is resistant to dietary, exercise, or lifestyle changes, make sure you manage it with your doctor.

8) Take ACE Inhibitors or AR Blockers If Warranted

The body uses a hormone called angiotensin to raise blood pressure in a couple ways.  First, by directly constricting blood vessels and increasing flow pressure. Second, by promoting the release of aldosterone, a hormone that shuttles sodium to the blood to increase blood volume. ACE inhibitors inhibit angiotensin secretion and AR blockers block angiotensin receptor sites. While I know we’re usually suspicious of drugs that block or inhibit the secretion or action of hormones, ACE inhibitors and AR blockers appear to be quite safe and effective. And there’s even evidence that normotensive subjects who take them live longer than normotensive subjects who don’t.

They do tend to lower zinc status, though, so keep up with your zinc intake.

That’s it for today, folks. The good news is that high blood pressure is manageable with diet and lifestyle changes, and even if that doesn’t work, the available medications seem better than most.

How do you manage your blood pressure? What’s worked? What hasn’t?



Sebastian A, Cordain L, Frassetto L, Banerjee T, Morris RC. Postulating the major environmental condition resulting in the expression of essential hypertension and its associated cardiovascular diseases: Dietary imprudence in daily selection of foods in respect of their potassium and sodium content resulting in oxidative stress-induced dysfunction of the vascular endothelium, vascular smooth muscle, and perivascular tissues. Med Hypotheses. 2018;119:110-119.

Filippini T, Violi F, D’amico R, Vinceti M. The effect of potassium supplementation on blood pressure in hypertensive subjects: A systematic review and meta-analysis. Int J Cardiol. 2017;230:127-135.

Takano T. Anti-hypertensive activity of fermented dairy products containing biogenic peptides. Antonie Van Leeuwenhoek. 2002;82(1-4):333-40.

Seppo L, Jauhiainen T, Poussa T, Korpela R. A fermented milk high in bioactive peptides has a blood pressure-lowering effect in hypertensive subjects. Am J Clin Nutr. 2003;77(2):326-30.

Jauhiainen T, Vapaatalo H, Poussa T, Kyrönpalo S, Rasmussen M, Korpela R. Lactobacillus helveticus fermented milk lowers blood pressure in hypertensive subjects in 24-h ambulatory blood pressure measurement. Am J Hypertens. 2005;18(12 Pt 1):1600-5.

The post A Primal Guide to Blood Pressure: 8 Common (and Not So Common) Interventions appeared first on Mark’s Daily Apple.

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I’ve been around the block. I’ve spent thousands upon thousands of hours in the gym, on the track, on the bike, in the water. I’ve tasted glory and defeat. I’ve been sidelined with injuries, I’ve gone stretches where I felt invincible. I’ve trained with, and trained, some of the best to ever do it. And along the way, I learned a lot: what to do, what not to do, what matters, what doesn’t.

Last week a comment from a reader gave me a great idea for a post: Give fitness advice to younger Groks. Help them avoid the mistakes I made and capitalize on the wins.

Let’s get right to it.

“Gain As Much Muscle As You Can Through Natural Means.”

Lean mass, which primarily includes muscle mass but also connective tissue and organ reserve, is in my opinion the single most important variable for overall health, wellness, physical capacity, and performance. The more muscle you have, the better you’ll age. The younger people will assume you are. The more capable you’ll be. The less frail. The harder to kill. The better to conceive children, give birth, and be an active parent (and eventually grandparent). You’ll have more energy. Basically, more muscle allows you to resist gravity, and gravity is what slows you down, breaks you down, and makes you feel old.

The more muscle you have when you’re younger, the more muscle you’ll retain as you grow older. Because when you’re older, you can still gain muscle, but not as easily. You’ll need more stimulus and more protein to get the same effect.  And entropy is working against you.

And by “natural means,” I mean don’t take anabolics unnecessarily (unless you have low/lower testosterone and a doctor helps you gain physiological levels via TRT). Don’t spend three hours a day in the gym. Don’t let strength training take over your life.

“Listen To Your Gut. If Something Feels Wrong, or Even Not Right, Back Off.”

I realized that every single time I hurt myself, I knew it was coming on some level. I had a premonition that I shouldn’t train or perform that day. Sometimes that message would come hours before the injury. Sometimes it would come moments before. It was usually non-specific, often nothing more than a vague sense of disquiet. But there was always something.

That time I strained my bicep tendon maxing out on bench, I remember waking up in the morning feeling like I probably shouldn’t go for the PR. Still I went for it and paid the price.

And last year during a set of pull-ups, I’d noticed I was leading with my chin—something I’m usually good about avoiding—and told myself to stop. But I thought I had another rep in me and, sure enough, as I was trying to finish the next pull-up, I felt something to the left of my ear and down around my trap give. I actually did keep the chin neutral but still got hurt. Leading with my chin was my body’s way of indicating that I was reaching the limit. I ignored that indicator and regretted it.

It’s not always a physical sensation or “pain” at all. Sometimes it’s just a weird feeling in my gut that says “this isn’t right.” Listen to that feeling. One day it won’t just be a tweaked shoulder or tendon. It might be downright catastrophic.

“Pull More Than You Push.”

Your phone. Your desk job. Look around at the average person walking around—their shoulders are rolled inward, internally rotated. Are yours? Society pulls our shoulders inward at every turn, and then you go to the gym and do a bunch of push-ups, bench presses, and dips, followed by a few sets of rows. That’s not enough. To maintain shoulder health (and build a strong, stable back from which to exert great shoulder force), you should train with a 2:1 pull:push ratio. That means for every 10 reps of presses (dips, pushups, bench, overhead press, etc) you do 20 reps of pulls (rows, pullups, face pulls, etc). If you already have problems with your shoulder or posture, bump that up to a 3:1 ratio.

“Focus On Compound Movements, But Include Some Isolation/Bodybuilding Movements As Well.”

While compound, multi-joint movements are the best way to build total body strength and athleticism, it turns out that training the “beach muscles” is important too. For instance, an exercise like curls can go a long way toward building up your bicep tendons and ligaments, preparing you for placing more stress on the muscles themselves and helping you avoid injuries down the line.

Plus, they make you look good—which is its own benefit but also motivates you to keep going.

“Compete With Yourself.”

Competition is good. Competition compels us to be greater, to improve ourselves. Just be wary about whom you’re competing with. These days, you have billions of potential competitors. You can hop on social media and find hundreds of people with better bodies, stronger lifts, faster times, and more perfect technique than you. It’s fine to use these people as motivation to improve yourself, but don’t beat yourself up—or, worse, get yourself injured—trying to beat them. Not everyone can do everything. We have different skills, different capacities, different priorities.

What you can and should do is compare your current self to your past self. Are you getting stronger than that person? Faster? Fitter? Leaner? Great. That’s how you do it. That’s what matters most.

“Walk Every Day.”

You won’t get the physiological/fitness effects right away, but they build up over time. Walking every day for the rest of your life is all about accruing compound interest.


From being in nature to improving blood glucose control to better cognitive function to improved insulin sensitivity to fat loss to joint mobility, walking is legitimate exercise.

“Get a Tribe.”

There’s research showing the physiological benefits of training in a group setting, but that’s tangential to my main point: having a fitness tribe—a group of friends, a sport, a training school—creates accountability, which promotes consistency. When someone’s counting on you, expecting you, you’re more likely to stick with the training. When you train with your friends or tribe toward a common goal, it becomes a joyous occasion. And even when it’s downright difficult and miserable, you can endure by drawing on the energy of the others.

“Have Fun.”

If you can figure out a way to train in a way that you love and truly enjoy on an intrinsic level, you’ll never be out of shape.

For some people, that means CrossFit. Or powerlifting. Or bodybuilding. Or running, martial arts, wrestling, parkour, or rock climbing. Dancing, mountain biking, surfing. There are many ways to skin the cat, but what really matters is that you enjoy the act of training for its own sake.

For me, I trained in the opposite manner. I loved the feeling of finishing a race. I liked the accolades and pride I felt and received when I won. But the act of racing? The moment to moment experience of training all those days? Miserable. That should have been an indication that I shouldn’t be doing it. I ignored it, though, and paid a price.

“Train To Support Your Goals.”

These days, as I’m fond of saying, I train to play. I train to support my Ultimate Frisbee match every weekend. I train so that I can get out on the paddle board twice a week. I train so I can try all the fun new fitness gadgets. If I were to do heavy squats and deadlifts 3 times a week, I wouldn’t be able to play Ultimate very well or go paddling whenever I wanted. I’d be recovering. Since my goal is to play, my training has to support that.

Search within your soul and figure out what your goals are, then hew your training to them. Are you trying to get as strong as possible? As fast? To build up your VO2max? To look good naked? Then align your training with your goals.

“Don’t Think You Have To Squat and Deadlift and Press With a Barbell.”

Those lifts are fantastic for building strength and developing athleticism, but they aren’t the only paths. Lunges, single leg deadlifts, kettlebell swings, trap bar deadlifts, and dumbbell presses are excellent alternatives that work many of the same muscles and can even be gentler on the body than the Big Three lifts.

There’s probably way more that can be said on this subject, but that’s where you come in. Down below, let me know what you’d say to your younger self who came to you asking about fitness tips. What would you do differently? What would you keep the same?


The post Fitness Advice From A Primal Elder to Younger Groks: What To Focus On and What To Let Go Of appeared first on Mark’s Daily Apple.

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