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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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April 27, 2015

Dear Mark: Osteoporosis, Body Fat Gain on Caloric Deficit, and Stalling on Primal

By Mark Sisson
50 Comments

X-ray image of legsFor today’s edition of Dear Mark, we’ve got a three-parter. First, I try to help out Karson, a guy who’s trying to convince his osteoporotic, sun-starved mother to try a few lifestyle interventions that may improve her condition without coming off as smug. Hopefully I’m persuasive enough. Next, is it really possible to gain body fat on a caloric deficit, or is something else going on? And finally, Dawn seems to be doing everything right, but she’s not losing any more weight — weight that she feels should be coming off. What can she try next?

Let’s go:

Dear Mark,

Since you have a persuasive way with words, I was wondering if you have any suggestions for my mother. My tone sometimes comes off as smug and preach-y. She recently turned 60 and her osteoporosis is progressing. Her job requires her to be at the office from 9am to 5pm and she is not able to get outside during the week to soak in the sweet sweet vitamin D. Whether it is diet recommendations or any key habits she can engage in, any help would be more than appreciated.

Thanks for all you do!

Karson

Mom, your bones are not inert slabs of calcium helpless against the ravages of time. Bone is metabolically active tissue. It responds to movement, to nutrition, to loading. They don’t wear down and lose strength due to tick of the clock, but because we stop using them.

By loading, I mean resistance training. It’s really quite effective for strengthening bones, even osteoporotic bones, especially when paired with the drugs she’s likely been placed on. And I’m not just talking about isolated machine exercises. Heavy squats, for example, have been shown to improve bone mass, bone metabolism, and other skeletal properties in women with osteoporosis. I’m assuming she doesn’t know her way around a barbell or weight room. That should change. Hop on Yelp and look for personal training gyms with the best reviews. Schedule a visit and book a few sessions with a trainer to learn the ropes. Make sure he or she has experience training older adults, particularly those with osteoporosis. It’s a common condition and many personal trainers have dealt with it. If she really likes the trainer, she should consider sticking with them. If not, get comfortable with the movements and do them on her own time at a gym or at home.

If you live nearby, meet up on the weekends for hikes. Get her moving. Start small, with gentler, flatter hikes, eventually progressing to longer ones with more elevation. No mom I know will turn down a visit from her son, even if it involves extracurricular movement. Plus, being out in nature can only help.

She’ll have to supplement with vitamin D. Sunlight is ideal, yes, and not just for vitamin D, but what can you do? Without adequate vitamin D, your bone health will suffer. Vitamin D also improves neuromuscular functionality and muscle strength, which in turn reduces the risk of falls and fractures. Aim for 2000-4000 per day and get sunlight on her days off.

Unless she’s eating lots of gouda cheese, natto, and goose liver paté, get her on vitamin K2 supplementation, stat. Vitamin D doesn’t really work optimally without adequate vitamin K2. It’s particularly effective against postmenopausal osteoporosis. Make sure her doctor knows and has ruled out any untoward interactions with medications, just to be safe. If either she or her doctor are ambivalent or skeptical, send links to the following research:

A good low-dose vitamin K2 supplement is this one.

For higher doses, try this or this.

By the way, she’d probably benefit from gouda, natto, and goose liver paté just the same. And those foods are delicious (well, natto takes some getting used to).

How’s her gut health? Is she eating much prebiotic fermentable fiber? Resistant starch? If not, there’s a chance she’s not actually absorbing all the calcium and other bone-relevant nutrients from her food. Many studies have confirmed the beneficial effects of prebiotics on mineral absorption in humans and animals and bone health in animal models. Galactooligosaccharides (a class of prebiotic fiber) increase calcium and magnesium absorption and improve bone mineral density. Both inulin and resistant starch also promote better mineral absorption.

Make sure she’s eating adequate protein. All else being equal, older adults need more protein than younger folks because they’re less efficient at metabolizing it — and not just to maintain muscle mass. Protein plays a huge role in bone mineral density, so she should eat at least 0.6 grams of protein per pound of bodyweight, mostly from animal sources (whey protein, meat, yogurt, cheese). More could help, too.

It’s never too late, and you’re never too old.

Hi Mark,

I’ve talking to some people that are claiming it is impossible to gain body fat while in a caloric deficit. Is this true? I’ve never seen any studies done and would like to know your thoughts.

Thanks,

Darin

Well, maybe, but you’d have to be losing a lot of lean mass at the same time. Theoretically, I suppose you could be losing enough muscle to explain the caloric deficit while still gaining body fat. In reality, people conflate caloric deficit with calorie reduction. If you reduce calories so much that your metabolism tanks, you may actually go into caloric excess.

Remember that calories in affects calories out. Too few calories and your metabolic rate drops to account for the lost calories. So even though you should be in a caloric deficit, your metabolic rate has plummeted far enough to prevent it.

Hi Mark,

First, thanks for all the wonderful info you provide — I’m reading your book now and just bought the 21 day plan book for my daughter. I’ve always been relatively fit and stable weight (<20 pound variance, other than being pregnant).  I’ve been eating Paleo for ~6 months with very few indulgences (not kidding) and can’t lose any more weight (I’ve lost 4 lbs total).  I’m 50, 5’5 1/2″, 138 lbs; need to be ~125.

Typical day for me is 3/8 cup organic heavy cream (total) divided over my 3 cups of coffee (0 carbs), 2 organic eggs, 1 piece bacon, pile of fresh spinach, 25 raw almonds, ~5 oz piece of baked fish and chicken (skin on), 2 tblsp organic coconut oil, 3-4 cups of green/red veggies and some ghee/butter (1-2 tbsp) or olive oil. That’s it. ~4-6 Corona Light beers over the weekend has been my indulgence. No sugar, no fake food, no grains.

I get at least 10,000 steps in per day, do bursts of heavy lifting, and sprints maybe twice a week. I should be making better progress; I’m super frustrated.

My next step is cut out beer and heavy cream entirely… but it doesn’t seem like I should have to?

Thanks for your time,

Dawn

Your diet looks a little light in calories, protein, and (possibly) carbs.

You’re pretty active, and consistently so (lifting, sprints, 10k steps). You’re most likely deeply ketogenic, though that’d have to be confirmed with some urine or blood tests. You’re sitting at about 1300-1400 calories, which, given your activity levels, should be very hypocaloric. By most accounts, you should be losing weight, but you’re not. So: just do what you’re doing even harder and more strictly?

I don’t think so. I think you should consider switching up your program.

You’re dealing with a lot of stressors with very little relief, and those stressors increase cortisol.

Acute spikes in cortisol are adaptive, and “good,” and generally beneficial for body composition. When we exercise hard, cortisol spikes. When we rest, cortisol returns to normal and we recover from the training and come back stronger/fitter/faster.

Chronic elevations of cortisol are maladaptive and “bad” and promote weight retention and fat gain. Any stressor spikes cortisol. Exercise is a stressor. Eating 1200 calories is a stressor. Eating very little protein is a stressor, particularly if you’re sprinting and strength training and running a calorie deficit. Training hard without adequate calories is a stressor. Being really frustrated all the time about your weight and obsessing over the scale is a major chronic stressor. You add all those things up and it’s no surprise that you’re stuck.

Bottom line: your cortisol is probably chronically elevated and women in particular seem more sensitive to the effect chronic cortisol has on body composition.

From your email, I see a lot of myself in you. I was a pretty tightly-wound guy for many years, and it’s what drove me to be so competitive in my endurance pursuits, but it’s also what made me drag my feet when I knew I should call it quits. I’ve never dealt with stress as well as I’d like. My stress levels didn’t manifest as weight gain or stalls. They manifested as muscle pulls and upper respiratory tract infections and gut issues and arthritis. But I had to heavily modify the lifestyle that was destroying me. The product of that was the Primal Blueprint.

Here’s what I do if I were you:

  • Eat about 500 more calories per day. Just get more food in general.
  • Eat more protein. 2 eggs, a piece of bacon, and a 5 ounces of chicken or fish simply isn’t enough. Add another 5 or 6 ounces of chicken or fish and maybe some whey. Get your protein up to a gram per pound of lean mass, preferably. You’re training a lot and the less food you eat, the more protein you need.
  • Drop some of that cream. I like cream, but that’s nearly a half cup each day, which is too much (especially if you’re stalling). Substitute more protein, leafy greens, and (see below) small amounts of carbs.
  • Consider post-workout carbs. You don’t need a lot. You don’t need to carb load or anything. But a few potatoes, sweet potatoes, or a bowl of fruit around your workouts will only help you recover and, most likely, lose a little more fat by reducing cortisol. Increase carbs by 20-30 g until you notice renewed progress. You may find that 150 grams a day is your sweet spot on the carb curve.
  • Take a week off from all activity except for walking. Don’t lift weights, don’t sprint, just walk. Consider it a deload week.
  • Relax. Take a short vacation. Go for hikes in beautiful natural settings. Camp out, even if it’s just in the backyard. Meditate.

Another thing to consider: your body may have reached its happy place. You may simply be in homeostasis. That’s okay, and oftentimes what “we” want is different from what our body wants.

Thanks for reading, everyone! If you’ve got any input for today’s reader questions, throw it down in the comment section!

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50 Comments on "Dear Mark: Osteoporosis, Body Fat Gain on Caloric Deficit, and Stalling on Primal"

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M
M
2 years 4 months ago

“Another thing to consider: your body may have reached its happy place. You may simply be in homeostasis. That’s okay, and oftentimes what “we” want is different from what our body wants.”

I agree with this advice. Look in the mirror. Do you like what you see? If so, throw out the scale.

Colleen
Colleen
2 years 4 months ago

+1 (I assume this is to Dawn). When did you last maintain 125 easily? Your body may not want to go there.

Martha
Martha
2 years 4 months ago

My mantra: The body has its own agenda. Sometimes we can get in trouble trying to impose our will. Sometimes we need to. Figuring out which is which is one reason I visit MDA.

Jenna Felicity
2 years 4 months ago

+1

Beth
Beth
2 years 4 months ago

I have noticed that my body composition can change by what seems like 5-10 lbs, but the scale doesn’t budge. I have realized that my happy place is when my pants don’t feel tight & I don’t feel packed into my dresses like sausage in a casing.
Unless you’re unhappy with your body comp. throw out the scale. Who needs it if the number makes you unhappy?

Carol
Carol
2 years 4 months ago

” . . . like a sausage in a casing” lured me out of long-time lurking and will keep me laughing all day. This is exactly how I feel in my Levis when I’ve been on a crappy-food bender.

Stacie
2 years 4 months ago

+1

I was curious with the way Dawn worded her weight at “138 lbs, *needs to be* 125.”

Needs to be 125 by who’s standards? Maybe you’re carrying extra weight from an increase in muscle mass, since you’re lifting and sprinting. Maybe your body functions well at this weight. This really piqued my interest because I’m going through a similar “maybe I should stop trying so hard” phase–focus on being healthy and let my weight and body comp take care of itself. If I lose weight, great–but if not, I’m trying to come to terms with that being okay too.

Nicky
Nicky
2 years 4 months ago

For a great example of weight and body composition, check out nerd fitness.com and search Stacie (I’m assuming it’s not you?!). Her progression from overweight couch potato to fitness star is very inspiring!

Stacie
2 years 4 months ago

haha definitely not me, but I’m very familiar with the Rebellion and Stacie’s inspiring story! #TeamNerdFitness

Derek
Derek
2 years 4 months ago

+1 team NF

2Rae
2Rae
2 years 4 months ago
Dawn, stress can stall us, even if we are doing all the “right things”. I have to fight the “less is more” advice when I’m stuck. I prefer to just eat less and do more however, that’s not the answer for me (60 year old woman). I’m going through some pretty powerful stress so have been up about 8 to 10 pounds weight wise. Trying not to stress about it but the clothes don’t look too good that snug so it’s not easy in the morning when it’s time to choose something to wear to work. My focus will be… Read more »
Kelda
2 years 4 months ago

2Rae – agreed, stress has taken me up about 10 lbs in the last year or so.

wildgarden
wildgarden
2 years 4 months ago

2Rae, our advice about stress sounds spot on. As for resources, check out Sweat360 (Griffin Oaks Drive). I’ve been with them for ~ a year and a half now–small locally owned gym, excellent group workouts, Paleo-knowledgable, skilled trainers. Good luck!

Joe
Joe
2 years 4 months ago
How would I know that I’m eating too little calories that my metabolism tanks? For the past year or so, I’ve been doing IF, but not exercising a whole lot (15 min of bodyweight every morning, a bit of dumbbell, walk ~3 miles a day). I also eat almost no carbs (mostly just from fruits and veg), and all home cooking from scratch. I didn’t feel like eating a whole lot most of the time, and when I counted calories, I was eating ~1500 (I’m 45 yr old male, 6’1″, 165lbs). I actually felt pretty good, except for a bit… Read more »
Rick
Rick
2 years 4 months ago

You have increased your overall metabolism with the addition of the barbell training. Your appetite rose as a result. Happily (I would hope) your new equilibrium is a leaner one. But, sadly, you now want to eat more. Hopefully you have the income to do so.
: )

Time Traveler
Time Traveler
2 years 4 months ago

“Hopefully you have the income to do so” – a good one (-;

Jaws76
Jaws76
2 years 4 months ago
This lifestyle really is a journey plotted with waypoints of “success” and “failure”.I have gotten leaner than I ever thought possible and yet I still retain body fat in my lower abdomen. I have tried stricter dieting but was not successful, perhaps my body has reached homeostasis. I always forget about cortisol and stress, those two intangible and invisible bastards that tap us all on the shoulder from time to time. Perhaps I need to eat a bit more, I have not had a week respite from exercise in well over a year despite injuries. The concept of “taking my… Read more »
Carbs on Carbs on Carbs
Carbs on Carbs on Carbs
2 years 4 months ago
People need to stop thinking that just cutting out carbohydrates is the key to success…. its just not necessary and in most cases, counterproductive to ones goals. Even Dr. Jaminet of PHD (BTW, Mark wrote the forward for their book quoting him- “paleo perfected”…..) recommends that if one is trying to loose weight, cutting FAT is the safest place to cut to avoid malnourishment. Carbs don’t make people fat just like fat or protein doesn’t and eating carbs even in LARGE amounts say upwards of 400-600 grams a day doesn’t automatically mean you are going to break down and die… Read more »
Jay
Jay
2 years 4 months ago

I don’t know, 600 grams of carbs a day sounds like a pretty “automatic” amount unless your job is to exercise. That’s 2-3 times the bone-headed USDA amounts, and we see how well that works for most people. That also would presume unhealthy deficits of fat and protein at that amount of calories for an average person.

Laura
Laura
2 years 4 months ago

I believe that Carbs on Carbs meant 400 – 600 calories from carbs, not grams. That breaks down to 100-150 grams of carbs a day. PHD recommends 400-600 calories of carbs a day.

Jay
Jay
2 years 4 months ago

Possibly, but then that would be in line with the higher end of Primal regular daily recommendations, which wouldn’t be unusual at all (and would still be “low carb” by SAD diet standards). Obviously just as we’re different sizes, shapes, and colors and live different lives, the sweet spot is going to vary…

kay
kay
2 years 4 months ago

No, I’m pretty sure he meant 400-600 grams (1600-2400cals)! This would not be unusual for someone eating 70% or more from carbs, if their diet is ~2300 – 3500 cals/day.

I agree with him that carbs don’t make you fat.

kay
kay
2 years 4 months ago

Thankyou!!

After years following low carb primal/paleo and being miserable, I’ve finally changed to a high carb diet (70% carbs, 10% fat). I can’t believe I was stupid enough to avoid whole foods like bananas, mangoes, beans, potatoes, rice, polenta etc. just so I could stay under 50g or 100g.

Unlike before, I now have tons of energy to exercise and I’m down to the last 5 lbs left to lose. And I’ve lost it all whie eating 250-300g of carbs!!

Mike
Mike
2 years 4 months ago

I feel better eating low carb until my evening meal and then I either eat rice or potatoes. I believe that listening to your body is the most important thing. If you do well eating lots of carbs eat them, if you feel good eating lots of meat carry on eating meat etc. I think the biggest issue is the amount of processed food in our diets.

His Dudeness
His Dudeness
2 years 4 months ago

For me, personally, I can eat fat and protein all day without gaining a pound. Throw more than 20g of carbs in the mix and I start growing moobs again pretty fast.
Everyone is a little different, and some need more carbs to function than others. I can get by pretty well with nearly zero, and have for several months now.
I’m curious to know what a gluttonous amount of fat is, exactly. Would a well-marbled 25oz beef ribeye with a big pat of butter be gluttonous? Because if it is, I’m a glutton.

bill
bill
2 years 4 months ago

ConConC:

Red herring much?

2Rae
2Rae
2 years 4 months ago

Even small additions over my “low carb” of carbs will pile on pounds for me. The only way I can feel energized is to up the fat and lower the carbs. Plus, no pain in my joints when I ear higer fat and lower carbs. Just has NEVER worked for me to eat low fat/higer carb.

Harry Mossman
2 years 4 months ago
Thanks for stressing K2. When I started Primal, I read about the value of D3 and started taking a lot. My ancestrally oriented doc encouraged me to. She even gave me a prescription for a super high dose. The result was lots of kidney stones. Now I take lots of D3 (1000 IU/day during the winter) and LOTS of K2. No kidney stones. I am not sure that 2000-4000/day for an office worker is enough. There was that little vitamin D calculation boo boo. Ooopsy! Too bad that 10s? 100s? of thousands of people suffered D deficiency problems, even death,… Read more »
Elenor
Elenor
2 years 4 months ago
I’d suggest, too, that for Vit. D that blood testing is important. When I began (oh, 15 years ago?!) to treat my adrenal fatigue and hypothyroid, I got a D blood test (the ‘right’ D test: the D-25-whatever-whatever) and instead of being between 60 and 80 ng/dL) — I was at 27. I followed the recommended 2-3k IU per day for six months, retested my blood — and made it allllll the way up to: 28 (!!) Took Dr. Holick’s (was it?) suggestion to do 10k units per day PLUS 50k once a week (lotta pills!). Six months later my… Read more »
Alicia
Alicia
2 years 4 months ago
I’m seconding M and semi-seconding ConConC. 138 and 5’5.5″ is a nice healthy weight, especially if some of it is muscle. BMI 22.6. Women in most cultures find their weight drifts up some post menopause, and the BMI associated with the best health outcomes drifts up as we age. Why on earth do you think you need a BMI that is appropriate for a 17 year old girl? Endorsing a carb intake of 600 g per day certainly does smack of trolling (although I believe it is attested in healthy populations that preform much more heavy labor than most people… Read more »
Rick
Rick
2 years 4 months ago

Very well said. There’s a reason we still have a 30 foot long digestive tract.

Rick
Rick
2 years 4 months ago

Oops, 20 feet.

SuzU
SuzU
2 years 4 months ago

Very well said! The only thing I’d add is that humans are highly variable in copy numbers of salivary amylase 1 gene, and the individuals with the highest copy numbers fare the best with starch. This makes sense because the number of copies of salivary amylase 1 reflects the amount of amylase produced in the gut. So each individual has a personal happy number – I think Atkins called it the personal carbohydrate number.

Brandon Berg
Brandon Berg
2 years 4 months ago

A good way to start out with natto is to eat it frozen. It actually doesn’t taste bad (except hikiwari natto, the kind that’s broken up into little pieces); the off-putting part is the slimy texture, which isn’t an issue when frozen. You have to let it thaw a little so it’s not rock-hard. Maybe ten minutes out at room temperature, then you’re good to go.

Rick
Rick
2 years 4 months ago

Dawn, if you need to be 125 I would not add exercise (you’re doing enough imo) but cut calories. Beer is very fattening. You could switch to whiskey and probably see a bit of progress towards 125, while still getting some of the essential alcohol food group.

Shary
Shary
2 years 4 months ago

It should be remembered that K2 is a micronutrient, or at least it’s supposed to be. You can easily get in trouble supplementing/oversuppolementing with nutrients that are naturally trace elements in the body. A healthy Paleo-type diet should supply sufficient K2 in most cases, since it’s available in meat, poultry, eggs, butter, and many types of vegetables, as well as natto (if you can stomach the stuff). Unless you know you’re deficient, many nutrients are better derived from food.

Kelda
2 years 4 months ago
Dawn, you are almost exactly my size, and I’d like 10 lbs less as well, and is what I weighed a year ago. Stress for me is the issue for all the items listed by Mark – there are so many stressors we don’t consider. One extra though that he hasn’t mentioned … Menopausal hormones. I’m 48 and know my hormones are shifting and it is definitely making a difference on fat storing, particularly belly fat. I think this phase of life makes the cortisol issue even more relevant because the fluctuating oestrogen levels really do make a significant difference.… Read more »
Myra
Myra
2 years 4 months ago
“. . .especially when paired with the drugs she’s likely been placed on” Karson, I would also suggest that your mom see a functional medicine/ancestral health oriented doctor about this. I’m 56 and over the past year have added 6% bone density without bisphosphonates, but following all of Mark’s recommendations and a small amount of bioidentical hormone replacement therapy prescribed by a functional medicine doctor. If she hasn’t done so already, she needs to have her Vitamin D level checked. According to my doctor, the aim is to get the level to 100. Most labs and traditional doctors will consider… Read more »
Alicia
Alicia
2 years 4 months ago

I’ve heard tell of side effects above 70, and most of the studies show a drop off in additional benefits once you get over 50. That 100 is an outlier, and it’s always good to wander around on line looking at studies and science-based websites before you decide that this is the good kind of outlier, not the bad kind!

Amy
2 years 4 months ago

Dawn: You “*NEED* to be ~125?”

Says who?

Amy
2 years 4 months ago
Seems like women who hang onto more muscle mass fare better as they age. Metabolically, it will keep you more flexible overall (can “tolerate” more carbs and total calories), but perhaps even more important, stronger women might be less likely to break a hip or an arm if they take a fall. Please know that muscle is “metabolic currency,” as Carl Lanore says (from Superhuman Radio). You *want* to have some of that mass on your body. Don’t be afraid of the number on the scale. Focus more on being strong and active, and positioning your body physically and metabolically… Read more »
kem
kem
2 years 4 months ago

Grams per pound. I can’t get over that concept.

Stuart
2 years 4 months ago

Yeah it’s one of those funny ones, like when people try to convert kg to pounds, ah yes she weighs 3.4 pounds… umm… (crickets chirping).

For me at least, the reason I use “grams per pounds” is because its easy to remember and convert.

Sounds so silly writing all this out.

Anyway I’m off to get some 45.72cm tires to fit my 18″ rims…

Shealin
Shealin
2 years 4 months ago
Mark, thank you so much for an in-depth response to Dawn’s questions and for providing a step-by-step of “what to do”. So many times on a journey of health we search for this type of guided advice and unfortunately don’t find the correct route to get the healthiest advice. This is one of the gabillion reasons I always stop by to read the posts and check out the forum when I hit a bump or become bamboozled by the endless amounts of personal advise offered on the web that doesn’t offer a scientific backing for the reader to peruse themselves.… Read more »
Mooncow
Mooncow
2 years 4 months ago

Being lean is great as a byproduct of healthy activities but a subpar goal

betsy
2 years 4 months ago

So much good advice. I don’t want to contradict the expert, but i am a 56 year old, post-menopausal female, and my experience suggests that i handle fat a bit differently from the younger folk. Fat is good but i do better weight wise with less than what is recommended. I’m just saying that’s my experience.

Alma
2 years 4 months ago

About the K2, does anyone know where to find goose liver paté? does the thrive market has plans to sell it? 😉
I really love fois gras but I guess it’s kind of tricky to get it here in the USA.

HxH
HxH
2 years 4 months ago

I’ve read that grass fed butter has K2 and that K2 is not destroyed by heat so pasteurized (easier to find) will work. Kerrygold butter is at every grocery store where I live (including the commissary). I think that is in the MK-4 form but I’ve also read that Gouda has the MK-7 type (even if not grass fed).

susan
susan
2 years 4 months ago

I’m a woodland fire fighter, 5′ 4″ , in the spring, summer and fall when I’m working out 1 + hours a day I weigh around 130 – 135 lbs, in the winter when I cut back on the work outs and I loss muscle mass ill weigh 125 lbs. But my waist line is what I keep track of, as long as I’m under 27″ and feel good, I don’t worry about my weight much. I’ve been eating primal for about 3 years.

Elaine
Elaine
2 years 4 months ago

Dawn — One thing I did that helped me was adding more protein by drinking a Primal Fuel shake, almost daily. It got me off my plateau and I started shrinking again. Good luck!

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